Pathways to Culturally Safe Dementia Care (CSDC): A Concept Analysis and Transformational Model for Practitioners and Organizations.

This study aims to conduct a concept analysis on cultural competence in community healthcare. Clarification of the concept of cultural competence is needed to enable clarity in the definition and operation, research and theory development to assist healthcare providers to better understand this evolving concept. Rodgers' evolutionary concept analysis method was used to clarify the concept's context, surrogate terms, antecedents, attributes and consequences and to determine implications for further research. Articles from 2004 to 2015 were sought from Medline, PubMed, CINAHL and Scopus using the terms "cultural competency" AND "health," "cultural competence" OR "cultural safety" OR "cultural knowledge" OR "cultural awareness" OR cultural sensitivity OR "cultural skill" AND "Health." Articles with antecedents, attributes and consequences of cultural competence in community health were included. The 26 articles selected included nursing (n=8), health (n=8), psychology (n=2), social work (n=1), mental health (n=3), medicine (n=3) and occupational therapy (n=1). Findings identify cultural openness, awareness, desire, knowledge and sensitivity and encounter as antecedents of cultural competence. Defining attributes are respecting and tailoring care aligned with clients' values, needs, practices and expectations, providing equitable and ethical care, and understanding. Consequences of cultural competence are satisfaction with care, the perception of quality healthcare, better adherence to treatments, effective interaction and improved health outcomes. An interesting finding is that the antecedents and attributes of cultural competence appear to represent a superficial level of understanding, sometimes only manifested through the need for social desirability. What is reported as critical in sustaining competence is the carers' capacity for a higher level of moral reasoning attainable through formal education in cultural and ethics knowledge. Our conceptual analysis incorporates moral reasoning in the definition of cultural competence. Further research to underpin moral reasoning with antecedents, attributes and consequences could enhance its clarity and promote a sustainable enactment of cultural competence.

The socio-cultural diversity within our society poses challenges for the healthcare professional to ensure the quality of health care services. Addressing the cultural competencies of the health care professional is the strategic approach to improve the quality and effectiveness of the health care services for socially and culturally diverse groups. Cultural competence is the ability of the professional to recognize, appreciate, and respect the values, preferences, and expressed needs of patients seeking health care services under their care. In Rural health care settings, the ethnics and cultural differences based on caste, class and gender create severe challenges for the health care professional to address the expectation and needs of the patients which leads to miscommunication and dissatisfaction among the patients which even challenges the ethical values of the health care professionals. Therefore cultural competence has to be integrated into health care practices very effectively. Evidence from various studies showcases that cultural competence training of the health care professional is quite effective in promoting the knowledge, attitudes, skills of the profession on cultural sensitiveness and practices which can be effective in fulfilling the goal of health for all. Therefore this study emphasized understanding the issues associated with the cultural competence of the healthcare professional in rural healthcare settings by outlining the concept of the cultural competence from rural healthcare settings and by exploring the existing consequence of deficiencies in cultural aspects in health care. It is evident from the study that many staff engaged in the rural health care setting recognise the importance of the issues and opinion that the issues must be addressed so that the health practices can be enhanced. Based on the opinion of the respondents finally through the study effort has been made to propose the possible social work intervention to address the issues and promote cultural competencies among the health care professionals. The social work intervention focused on intensive training on cultural competence and cross-cultural issues for health professionals and ensuring multidomain teams work so that the cultural barrier can be overcome effectively.

Changing language, changes lives: Learning the lexicon of LGBTQ+ health equity.

Sensitivity to cultural differences is generally agreed to be a highly desirable characteristic of sound practice in all human services. The terms "cultural competence," "cultural sensitivity," "cultural responsiveness," and "cultural appropriateness" are frequently seen in contemporary literatures (see Gollnick & Chinn, 2002; Lee, 2003; Shealey & Callins, 2007; Sleeter, 1999). Definitions of these terms are often not what behaviorists would consider operational. For example, Shealey and Callins (2007) state that "culturally responsive teaching refers to the extent to which educators use students' cultural contributions in transforming their lives and the lives of their families and communities by making education relevant and meaningful" (p. 195). They go on to say that demonstration of cultural sensitivity requires teachers to "learn about the cultures represented in their classrooms and translate this knowledge into instructional practice" (p. 196) and state that culturally mediated instruction is "characterized by the use of culturally mediated cognition, culturally appropriate social situations for learning, and culturally valued knowledge in curriculum content" (p. 196). As good as these ideas are, educators guided by them may be unable to identify a practice that is multicultural or culturally responsive or a practice that it is not. Teachers may also be unable to discriminate cultural sensitivity from cultural insensitivity. Our purpose, therefore, was to seek evidence of responsiveness to behavioral interventions related to cultural identity. Thus, we reviewed behavioral literature related to three cultural markers--ethnicity, gender, and religion--to see whether we could find data supporting differences in behavioral interventions depending on cultural distinctiveness. Some writers have suggested that behavioral interventions in education are inappropriate in or insensitive to some cultures. These writers find that the very characteristics that make behavioral interventions a practical tool for working in the scientific tradition may make them unacceptable for use with those who do not share the viewpoint of behavioral scientists. That is, they promote "culturally sensitive" practices that have little or no empirical support or urge teachers not to be "culturally insensitive" by using practices that do have considerable empirical support. For example, in his website on behavior management, McIntyre (2007) stated: Behaviorist interventions are often inappropriate for, and sometimes even discriminatory against large numbers of culturally different youngsters with learning and behavioral disorders. Readers are asked to ponder whether behaviorism's practices, despite the empirical research demonstrating their effectiveness, should be implemented with youngsters who do not adhere to a Western European life view and orientation. The same essay concluded: Behaviorists' research may be able to "prove" that behavioral change occurs, but at what cost? Is a method, despite its empirical validation, appropriate for everyone? Is it morally right to change culturally different behavior in culturally insensitive ways? One need only ask former students made to attend Bureau of Indian Affairs schools in decades past, or those youngsters who are willing to comply and love to learn, but refuse to do so in ways that they perceive to be "acting white" (identifying with a group they believe to be oppressors). While behaviorist practices may be "effective", we must question if the means, or even the ends, are appropriate in all cases. If data showing that effectiveness (regardless of how it is defined) is achieved with given methods, yet those methods are proscribed as culturally inappropriate, then we have no way to judge the effectiveness of interventions. Data showing better outcomes, even if desired by an individual, could be judged convincing only if the methods used to obtain them are judged culturally appropriate. …

Background: People with moderate to advanced dementia living in residential care are at risk of occupational deprivation. Person-centered care has been adopted as a guiding principle in the provision of residential care for older adults with dementia. In this context, there has been shift in occupational therapy practice from addressing occupational performance towards focusing on meaningful engagement. While both meaningful engagement and person-centered care have been well researched the relationship between the two concepts is poorly understood.Aim: A critical interpretative synthesis was conducted to determine how principles of person-centered care inform occupational therapy practice in relation to promotion of meaningful engagement among residents with moderate to advanced dementia.Methods: A systematic search of research addressing meaningful engagement of people with moderate to advanced dementia identified 26 papers.Results: Papers were classified as theoretical papers and empirical research. Two overarching constructs emerged, namely promoting a culture of collaborative care and understanding the resident as a person with a past, present and future.Conclusions: Occupational deprivation prevails and person-centered care is not fully addressed if opportunities for growth and engagement for residents with moderate to advanced dementia is not extended beyond their life history.Significance: Creating continued opportunities for building agency of residents with dementia could promote occupational justice in residential care.

Large language models (LLMs) are increasingly used in nursing education, yet their conceptual foundations remain abstract and underexplored. This concept analysis addresses the need for clarity by examining the relevance, meaning, contextual applications, and defining attributes of LLMs in nursing education, using Rodgers' evolutionary method. This paper aims to explore the evolutionary concept of LLMs in nursing education by providing a concept analysis through a comprehensive review of the existing published literature. Rodgers' evolutionary concept analysis method was used. PubMed, CINAHL, PsycINFO, Scopus, and Google Scholar were used to search for relevant publications. A total of 41 papers were included based on inclusion criteria that focused on studies published in English within the last 5 years to ensure relevance to the current use of LLMs exclusively in nursing education. Studies were excluded if they focused on clinical nursing applications, were not available in English, lacked full-text accessibility, or examined other artificial intelligence (AI) technologies unrelated to LLMs (eg, robotics). As a result of this analysis, a proposed definition of LLMs in nursing education has been developed, describing them as accessible, personalized, innovative, and interactive tools that create revolutionary learning experiences, often leading to enhanced cognitive and skill development and improvement in learning and teaching quality. This concept analysis highlights LLMs' transformative potential to enhance access to resources, support individualized learning, and augment nursing education. While promising, careful attention must be given to their limitations and ethical implications, ensuring their integration aligns with the values and goals of nursing education, particularly in specialized areas such as graduate nursing programs.

Purpose: This study aimed to define coaching in nursing clearly and elucidate its essential role within the context of contemporary nursing education in clinical settings.Methods: A concept analysis was conducted using Rodgers’ evolutionary method. Literature was extracted from databases such as Web of Science, Medline (PubMed) and CINAHL.Results: Results of analysis led to the development of an operational definition of coaching in nursing characterized as an educational approach focusing on nursing tasks. Coaching in nursing is a systematic and formalized process that can enhance the learning experience through interactive engagement rather than direct instruction. The analysis identified five core attributes of coaching in nursing: nursing task-focused, educational, facilitative, processive, and interactive.Conclusion: The purpose of this concept analysis was to propose a comprehensive definition of coaching in nursing that could align with its theoretical foundation within modern nursing practice. Using Rodgers' evolutionary concept analysis method, related terms, attributes, antecedents, and outcomes were identified, culminating in a detailed definition. This concept analysis provides a contemporary definition of coaching in nursing, clarifying its meaning, ensuring applicability, and offering guidance for future research, education, and clinical practice.

Cultural competence, which encompasses cultural awareness, cultural skills, cultural desire, cultural encounters and self-efficacy, is essential for delivering effective, equitable, person-centred care and improving health outcomes in a diverse population. This 'How to' article details ways in which nurses can promote cultural competence in nursing practice, by taking practical steps to ensure they and the organisations they work for are providing accessible and culturally relevant care and services that meet the needs of local populations. • Nurses should critically reflect on their cultural background and consider how it may influence their practice and interactions with patients from backgrounds different to their own. • Reviewing, evaluating and updating local resources related to cultural competence can help to ensure these are current and fit for purpose. • Interacting with diverse cultural groups, for example through local community events, can enhance cultural awareness and connection between healthcare providers and patients from diverse backgrounds. • Requesting and sharing constructive feedback on interactions with and care approaches to patients from diverse cultural backgrounds can help nurses to identify cultural competence development needs. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when delivering care to individuals from cultural groups different from your own. • How you could use this information to educate nursing students or enable colleagues to practise and promote cultural competence.

To clarify the concept of anticipated stigma and examine its relevance to cannabis use disclosure in nursing using an evolutionary concept analysis approach. Concept analysis guided by Rodgers and Knafl's evolutionary method. An interdisciplinary purposive literature review was conducted using empirical and theoretical sources drawn from nursing, public health, psychology and sociology. Literature published between 1963 and 2024 was included, with specific emphasis on health-related stigma, disclosure and cannabis use. Rodgers and Knafl's evolutionary method was used to identify the defining attributes, antecedents, consequences, related concepts and contextual variations of anticipated stigma. Empirical and conceptual literature were synthesised to reflect cross-disciplinary themes. A model case was constructed to illustrate the concept's application in a nursing context, followed by a critical synthesis of implications for nursing theory, research and practice. Anticipated stigma is a future-oriented expectation of devaluation or discrimination associated with disclosing a stigmatised identity or behaviour. Five core attributes were identified. Antecedents include individual identity salience, sociocultural norms and structural factors. Consequences include psychological distress, concealment and reduced healthcare engagement. Anticipated stigma is a dynamic and under-theorised concept that hinders therapeutic communication and person-centred care in nursing settings. This analysis offers conceptual clarity and supports stigma-informed approaches to assessment and communication in nursing education and practice, especially when addressing cannabis use and other stigmatised health behaviours. No patient or public contribution.

Development of cultural competency and cultural sensitivity through collaborative online international learning among advanced practice nursing students: A quasi-experimental pilot study.

Value co-creation supports the delivery of optimal person-centred care in an efficient way Primary health care is the backbone of a high performing and efficient health system and is most people's first contact with the health care system.1, 2 The supplement accompanying this issue of the MJA reports on initiatives and approaches that strive to build high performing person-centred primary health care that is critical to achieving the Quadruple Aim, a well regarded framework for optimising the health care system by simultaneously focusing on improving patient experience, improving population health, reducing costs, and improving the health care team experience.3 These themes are intertwined across seven articles, to provide perspectives, lessons and examples of how they might be translated into practice and policy. The common thread is value-based care — a health system delivering optimal person-centred outcomes in an efficient way.5, 6 The numerator in the value-based care equation is outcomes and experiences of care that matter to patients, including quality and safety of care — as such, person-centred care is a central tenet. In the supplement, Dawda and colleagues7 define person-centred care as individualised, enabling, coordinated care that is respectful and compassionate, and they identify the gaps and opportunities to enhance person-centred care.8 Janamian and colleagues9 focus on the enabling dimension and describe patient activation (a behavioural concept) defined as an individual's knowledge, skill and confidence for managing their health.10 The authors argue that the role of patient activation requires further serious consideration if we are to improve the long term health and wellbeing of all Australians. Armed with the patient's activation level from the Patient Activation Measure survey, the provider can tailor their care and help the patient achieve better self-care, which can improve outcomes of care and reduce unnecessary health care utilisation.11 Effectively implementing person-centred models of care requires workforce and organisational capability building. Janamian and colleagues12 describe how value co-creation4 and user-centred design13 can be used to co-design education and training programs that build workforce capacity to help implement integrated health care initiatives. They describe the process using two case studies. The authors argue that as we strive to strengthen the role of consumers as active partners in care and improve service delivery, patient outcomes and experience in Australia, the use of value co-creation and user-centred design at all levels of the system becomes more important in jointly creating better value for all stakeholders. In another article, Janamian and colleagues14 explore how, by co-designing resources that are culturally safe, flexible and responsive to a diverse and far-reaching audience, the Gwandalan National Palliative Care Project is co-creating value for all frontline workers delivering palliative and end-of-life care (and others working with Aboriginal and Torres Strait Islander peoples in a range of settings). The goal is that as relationships are strengthened and capacity is continually built, Indigenous palliative care patients and their families and communities, as well as frontline staff and their own networks, will gain greater knowledge, experience, benefits and co-created outcomes as part of the process, and that these will be further spread across their respective networks and communities. True and colleagues15 outline lessons from the Health Care Homes trial, which tested a new model of person-centred care for people with chronic and complex health conditions. This value-based primary health care initiative bundled elements of person-centred care, organisational development and funding reform for a risk-stratified population. Despite limitations, the Health Care Homes model demonstrated that change can be achieved with dedicated transformational support, and highlighted the importance of the enablers and reforms embedded in the Primary Care Reform Steering Group16 report underpinning Australia's Primary Health Care 10 Year Plan.17 As we move towards person-centred models of care and a value-based health system, keeping the Quadruple Aim in focus, we must understand what value means to those in the transformation process. McColl-Kennedy and colleagues18 strengthen the co-creation perspective, suggesting that value is a multidimensional construct that requires a better understanding of what patients, their family and carers, practitioners, practice managers, nurses, allied health workers, receptionists and owners value, and how different actors in the ecosystem can co-create value. The authors argue that all actors are responsible for co-creating value, not just with patients but with everyone in the primary care clinic's service ecosystem. They also underscore the need to promote interaction among actor groups to enhance experiences and outcomes for all. Finally, Dawda and colleagues19 bring it all together by focusing on the value-based health care concept, which is not new but has had limited implementation, particularly in primary care.5 The authors identify a lack of published Australian literature on value-based health care and describe its four domains:6 enabling context, policies and institutions; measuring outcomes and costs; integrated and patient-focused care; and outcome-based payment approaches. The authors map existing initiatives to these domains and note that Australia's Primary Health Care 10 Year Plan contains elements of value-based health care. Australia's National Health Reform agenda20 explicitly states the need for a stronger primary care system. Accompanying this is the Primary Health Care 10 Year Plan, which is a strong foundation and framework for strategic reform over the next decade. The medical profession21 and consumer bodies22 collectively support a vision for a stronger primary health care system. There is broad stakeholder alignment for a stronger primary health care system striving towards the Quadruple Aim and a person-centred care system. Achieving this requires an equal contribution from all stakeholders and aligned resources to co-create a future delivering value-based health care. No relevant disclosures. Commissioned; not externally peer reviewed.

Background and Purpose. Effective health care requires cultural and cultural competency, which are vital aspects of a health professional's background. The purpose of this study was to investigate if a difference occurs in cultural pre- and post-international clinical placement. Participants. Seventeen final-year health professions students were recruited from Curtin University of Technology for this study. Methods. Participants attended a 4-week placement in China or India. Social demographic information included previous intercultural experience, prior language study, and intercultural friendship. The Intercultural Development Inventory (IDI) measured cultural pre-and post-placement and was analysed using the paired sample t test. Experiences and reflections of participants were obtained using a guided learning journal; qualitative data were analysed using a phenomenological approach. Results. Overall IDI developmental scores (mean -4.31, 95% CI -9.55 to 0.93) and individual scale scores increased but did not reach statistical significance except for the Acceptance/Adaptation scale (mean -0.34, 95% CI -0.63 to -0.04). Five themes emerged from qualitative analysis suggesting development of cultural sensitivity: increased vigilance and adaptation to environment, uncertainty and anticipation, grappling with supremacy, recognizing and appreciating differences, and cultural immersion and development. Discussion and Conclusion. International placements increase the cultural and competency of health professions students. Future studies should explore variables that will further enhance these cultural attributes in health professionals. Key Words: International Education, Clinical Education, Cultural Competence. BACKGROUND AND PURPOSE Cross-cultural interactions are an inevitable and integral part of clinical practice in a globalised health care environment.1 Government policies including A First Class Service: Quality in the NHS2 in the United Kingdom and National Action Agenda3 in the United States have been implemented to ensure provision of high-quality service by the health care sector to all patients. The Australian Department of Health and Ageing also has in its vision better health for all Australians, with priorities including a move towards health equality in indigenous and non-indigenous populations.4 The resulting focus on the ability of health care professionals to care for a culturally diverse patient population1,5 is driving the assessment of professional competency to encompass not only discipline-specific skills, but also generic cultural competency. This challenges health care professionals, as the diverse groups possess unique notions of illness and health beliefs that influence the delivery and receptivity of care.6 Cultural biases also exist in interpreting communication cues such as body language, facial expression, and tone of voice.7 Therefore, a lack of cultural understanding can compromise the quality of health care services.8,9 To provide effective health care, cultural and cultural competency are vital aspects of a health professionals background.6,10,11 Despite widespread usage and acceptance of the phrases, these concepts are not definitive. Bhawuk and Brislin12 defined cultural as sensitivity to cultural differences and to the points of view of people in other cultures.(p414) This develops as one begins to appreciate, respect and value diversity13 and is essential to facilitate cross-cultural interactions.6,10 Burchum13 identifies cultural as an integral component of cultural competency, which is a broader concept encompassing 6 attributes: cultural awareness, knowledge, understanding, sensitivity, skill, and interaction. Cultural competency is a dynamic process built on the ongoing development of these component attributes.14,15 Previous studies have revealed that students are less competent in handling cross-cultural encounters in the absence of appropriate teaching. …

Introduction: Biology education is essential in enhancing students' cultural awareness by integrating local wisdom. However, does the reality align with these expectations? Therefore, this bibliometric analysis is conducted as an initial step to address the following questions: 1) Mapping the trends in cultural awareness studies within biology education. 2) Identifying research gaps in cultural awareness studies within biology education. 3) Proposing alternative solutions to bridge these gaps.Methods: This study employs a bibliometric approach. Data were obtained from the Scopus database using the following keywords: TITLE-ABS-KEY ("cultural sensitivity" OR "cultural awareness" OR "cultural competence" OR "intercultural understanding" OR "cultural intelligence" OR "cultural appreciation" OR "cross-cultural knowledge" OR "intercultural awareness" OR "global awareness" OR "diversity awareness") AND TITLE-ABS-KEY (biology) AND TITLE-ABS-KEY (education OR learning). Data analysis was conducted using VOSviewer and Microsoft Excel.Results: A total of 32 scientific publications were recorded from 2003 to March 2025, with an average of two publications per year. The most frequently occurring keyword is evolution, appearing seven times, while the strongest linked keyword is cultural competence, with a total link strength of 192. Conclusions: The trends in cultural awareness studies within biology education remains very low and stagnant. There is a notable gap in ethnobiology education, which should play a crucial role in promoting students' cultural awareness but is rarely studied. The proposed solution is to expand the ethnobiology education approach beyond an intradisciplinary ecological perspective to include an interdisciplinary social approach, thereby enhancing students' cultural awareness.

To describe the proposed Culturally Competent Community Care (CCCC) model, and the process of development and testing of the model. Community health nurses are challenged to provide culturally competent care in all types of communities. However, existing models have not provided community nurses with specific guidelines, and none attempt to explain the effects of culturally competent care on populations in community settings. Therefore, it is necessary to develop a model that is comprehensive in its description of the dimensions of culturally competent care in community-based settings and that also requires a focus on ethnic populations. The model is essential for reducing racial and ethnic health disparities. Based on literature review and concept analysis, three constructs of the Culturally Competent Community Care Model were developed. Two of the constructs, the health care system and health outcomes, were developed based on a literature review. The main construct of the model, cultural competence, was developed after a concept analysis, following the development and testing of the Cultural Competence Scale (CCS). Interviews with eight community health nurses and a survey by five community nurse experts were conducted in order to refine and confirm the dimensions of cultural competence and its impact on health outcomes. The proposed dimensions of culturally competent care are caring, cultural sensitivity, cultural knowledge, and cultural skills. This model focuses on the relationship between cultural competence and health outcomes for culturally diverse populations. The framework provides specific guidelines for community nurses in developing and assessing cultural competence and meeting the health needs of diverse communities.

Using keywords, we searched the online databases MEDLINE, CINAHL, ScienceDirect, and PubMed from January of 1990 through to December of 2016. Some 1543 articles were retrieved, and inclusion and exclusion criteria were applied. A total of 38 papers were included in the concept analysis. The data were analyzed using Coad's (2002) adapted framework based on Rodgers's (1989) evolutionary concept analysis, focusing on the attributes, antecedents, consequences, and related terms in relation to culturally competent care. A model case of culturally competent care was also constructed. The literature provides evidence that the concept of culturally competent care is a complex one, which is often expressed ambiguously. In addition, there is a paucity of research that involves service users as experts in defining their own needs and assessing their experiences related to cultural care. Cultural care should be integral to holistic patient care, irrespective of a person's race or ethnicity. There is an urgent need to involve young BAME patients with palliative care needs and their families in the development of a robust tool to assess cultural competency in clinical practice.