Competent Healthcare Providers Research Articles

Integration of Cultural Competence in Physical Therapist Education

Background and Purpose. The purpose of this study is to describe the integration of cultural competence in physical therapist education program. Case Description. The sample population was obtained using snowball sampling to identify physical therapist educational programs in which the faculty has significantly integrated cultural competence into their curricula. This paper outlines the process of integration of cultural competence of one program. The study involved an ethnographic, qualitative design. Data collection included document analysis, program site visit, class observations, and interviews. Data were analyzed using an inductive constant comparative analysis. Themes were generated as they emerged from the data. Outcomes. The physical therapist education program studied integrated cultural competence in its curriculum by (1) developing strategic plan where faculty were committed to diversity, (2) immersing faculty and students in diverse environments, (3) using artifacts, language, and teaching methods to raise diversity to conscious level, and (4) incorporating reflection and discussion that allowed individuals to discover their own cultural values and beliefs, as well as those of others. Discussion and Conclusion. Faculty members embraced diversity and applied theory to practice, resulting in an educational model for developing culturally competent practitioners. Key Words: Culture, Cultural competence, Physical therapist education. BACKGROUND AND PURPOSE Twenty-first century health care providers are challenged to meet the needs of population differing in age, gender, race, ethnicity, disability status, sexual orientation, and religious affiliation, as well as sociocultural and socieconomic status.1,5 Physical therapists are called to recognize and respond to these changes and the accompanying needs of their patients/clients and the population around them. The physical therapy profession, through its Core Values, advocates that physical therapist professionals be prepared to provide physical therapy to all populations who can benefit from our services. Physical therapist educators are encouraged to educate graduates for professional (entry-level) practice who can identify, respect, and act with consideration for patients'/clients' differences, values, preferences, and expressed needs in all professional activities. 6(p12) Yet, how does one educate culturally competent practitioners for 2 1st century diverse society? The purpose of this study was to describe the integration of cultural competence in physical therapist education program. Leavitt2 defines cultural competence as a set of behaviors, attitudes, and policies that come together in continuum to enable health care system, agency or individual practitioner to function effectively in transcultural interaction. (p26) Numerous authors suggest that an individual starts with an understanding of one's own culture, as well as consciously acknowledging and considering one's values and beliefs about those different from oneself.5,7-13 The culturally aware person is conscious of many of the cultural assumptions he or she has internalized unconsciously.14 In one approach, an inwardoutward approach, the individual starts by assessing values, beliefs, and biases about his or her own culture and then seeks to become informed about other cultures, taking on more global perspective, while understanding that each of us is product of the decades in which we were born and raised.5,15 Physical therapist educators choosing this approach can encourage their students to reflect on their pasts to understand how the values and beliefs they developed throughout their lives have shaped their thought processes about themselves and others. Rorie and Paine16 state that becoming culturally competent health care provider requires an accurate knowledge of one's own cultural roots, beliefs, and behaviors. …

The Content and Process of Mother--Adolescent Communication about Sex in Latino Families

Research has shown that Latino parents discuss sexual topics with their children less often than do parents from other ethnic groups; however, communication about sex in Latino families is not well understood. The present study explored the content and process of mother-adolescent communication about sex to better understand how to facilitate communication in urban Latino families. Focus-group interviews were conducted with 63 Latino mother-adolescent pairs in New York City. Latina mothers were able to discuss certain sex-related topics, such as the consequences of sexual activity, but not others, including sexual intercourse and birth control. Adolescents wanted to discuss sexual topics with their mothers, yet most did not because of fears their mothers would assume they were sexually active and would punish them. Our findings suggest that Latino culture and the urban environment play a large role in mother-adolescent conversations about sex. Latina mothers were raised in a culture not supportive of open discussions about sex in the home, yet they recognize the risks their adolescents experience in an urban U.S. environment. The present study provides information on the nature of communication about sex in Latino families and can help tailor interventions aimed at reducing adolescent sexual risk behavior. KEY WORDS: adolescent sexual behavior; Latino families; mother-adolescent communication ********** Adolescents continue to be at risk of the negative outcomes associated with sexual risk behavior. Approximately 840,000 adolescents 15 to 19 years of age become pregnant each year (Centers for Disease Control and Prevention [CDC], 2000a), and each year teenagers account for one-quarter of new cases of sexually transmitted diseases (STDs) in the United States (CDC, 2000b). Between 2000 and 2003, 13% of HIV cases in 32 states were diagnosed in young people 13 to 24 years old (CDC, 2004). Latino youths may be particularly at risk of these outcomes. Although Latinos represent 13% of the U.S. population, they accounted for 20% of new AIDS cases reported in 2003 (CDC, 2004). Latinos are also less likely to receive preventive care than non-Latinos (Carrillo, Trevino, Betancourt, & Coustasse, 2001; Carter-Pokras & Zambrana, 2001) and have less access to health education, health care, or culturally and linguistically competent health care providers than do white or African Americans (Carrillo et al.; Carter-Pokras & Zambrana). Earlier research has explored parental influences on adolescents' sexual risk behavior, often with a focus on parent--adolescent communication about sex. Although findings have been mixed (for a review of this literature, see Jaccard & Dittus, 1993; Miller, Benson, & Galbraith, 2001), more recent research with improved methodology has found negative associations between parental communication and sexual initiation (East, 1996; Jaccard, Dittus, & Gordon, 1996; Pick & Palos, 1995; Ward & Wyatt, 1994) and number of sexual partners (Holtzman & Robinson, 1995) and positive associations between parental communication and contraceptive and condom use (Whitaker, Miller, May, & Levin, 1999) and communication with sexual partners about condoms (Hutchinson & Cooney, 1998; Shoop & Davidson, 1994; Whitaker et al.). In all of these studies, greater frequency and higher quality of parent-adolescent communication about sex were associated with reduced sexual risk among adolescents. Research on the influence of parent--adolescent communication about sex within Latino families has also yielded inconsistent results. Studies focusing on Latino families have generally depicted less parent-adolescent communication, of both a general and a sex-specific nature, than in families from other ethnic groups (CDC, 1991; Hovell et al., 1994; Hutchinson, 2002; O'Sullivan, Meyer-Bahlburg, & Watkins, 2001). In a study of Latinos between the ages of 18 and 49, nearly half of the respondents reported never talking to their parents about sex (VanOss Marin & Gomez, 1997). …

Pilot project for education of patients with type 2 diabetes by pharmacists

The objective was to adapt and test an educational programme for type 2 diabetes patients. The sample consisted of 24 individuals with type 2 diabetes between 31 and 75 years of age that did not require insulin, without severe complications of diabetes. A patient satisfaction questionnaire was applied in the beginning and at the end of the survey. A five-month education was conducted on: hypo- and hyperglycaemia, nourishing and physical activity, feet care, eye care and possible adverse drug reaction. The costs of the education and the pharmacological treatment were calculated. Improvement was observed in patients' diabetes knowledge and there was a decrease in the frequency of hypo- and hyperglycaemic incidents (about 60% less). At the end of the programme no incidents were matched, saving Euro 10/patient. The benefit to cost ratio is about 1:1 (Euro 140:Euro 142.80). The patients' quality of life improved by about 5% according to the Diabetes Questionnaire (IMG). The educational approach has the potential to decrease diabetes complications and therefore the economic cost of type 2 diabetes. Introduction of the programme will benefit diabetes patients, promote pharmacies as a source of independent drug information and recognise pharmacists as competent healthcare providers.

A Qualitative Study of How Experienced Certified Holistic Nurses Learn to Become Competent Practitioners

Artistry of holistic nursing requires practitioners to be equipped with the ability to integrate and assimilate knowledge and experience. This integrated wisdom is woven into proficiency and expertise, thus allowing for the transition to an experienced competent health care provider who can meet the complex mélange of practice. This qualitative naturalistic study was designed to explore how 10 experienced certified holistic nurses (HNCs) learned to become competent holistic nurses. In-depth interviews of 10 HNCs, critical incident reports, and a summative focus group. (a) Disjuncture existed between the structure of traditional nursing and the need of nurses for continued personal and professional growth and development; (b) need for credibility was key to nurses becoming competent holistic nurses; (c) use of informal learning strategies to help them achieve competency; and (d) overcoming challenges emanating from the traditional system as they transitioned to becoming holistic nurses.

REACH-Meharry Community-Campus Partnership: Developing Culturally Competent Health Care Providers

An important national health care effort is elimination of racial and ethnic disparities in six specific conditions: infant mortality, cancer screening and management, cardiovascular disease, diabetes, human immunodeficiency virus infection, and child and adult immunizations. To address this concern, several health entities in Nashville, Tennessee responded to a grant initiative from the Centers for Disease Control and Prevention to develop a Racial and Ethnic Approaches to Community Health (REACH) demonstration project. The resulting award is the Nashville REACH 2010 Project, charged to develop sustainable methods to reduce and, in time, eliminate racial and ethnic disparities in cardiovascular disease and diabetes in the North Nashville community, where mortality rates of these diseases are substantially higher than in other parts of the county. As one of its many interests, the project included potential health care providers to receive and disseminate messages about disease prevention and health education. The present paper describes the community-campus partnership between the Nashville REACH 2010 project and the post-baccalaureate program of Meharry Medical College, a partnership that enfolded Meharry's pre-professional health care students into the community-based participatory service research project to increase the awareness and sensitivity of future minority health care providers to issues in minority and poor, underserved populations and to increase potential providers' familiarity with the processes involved in community-based participatory research.

REACH-Meharry Community-Campus Partnership: Developing Culturally Competent Health Care Providers

An important national health care effort is elimination of racial and ethnic disparities in six specific conditions: infant mortality, cancer screening and management, cardiovascular disease, diabetes, human immunodeficiency virus infection, and child and adult immunizations. To address this concern, several health entities in Nashville, Tennessee responded to a grant initiative from the Centers for Disease Control and Prevention to develop a Racial and Ethnic Approaches to Community Health (REACH) demonstration project. The resulting award is the Nashville REACH 2010 Project, charged to develop sustainable methods to reduce and, in time, eliminate racial and ethnic disparities in cardiovascular disease and diabetes in the North Nashville community, where mortality rates of these diseases are substantially higher than in other parts of the county. As one of its many interests, the project included potential health care providers to receive and disseminate messages about disease prevention and health education. The present paper describes the community-campus partnership between the Nashville REACH 2010 project and the post-baccalaureate program of Meharry Medical College, a partnership that enfolded Meharry's pre-professional health care students into the community-based participatory service research project to increase the awareness and sensitivity of future minority health care providers to issues in minority and poor, underserved populations and to increase potential providers' familiarity with the processes involved in community-based participatory research.

Pediatric Obesity Epidemic: Treatment Options

The increasing prevalence of overweight youth in the United States and the associated increase in medical comorbidities has created a growing need for effective weight-management interventions. The recommended treatment for an overweight child to achieve a more healthful weight uses four primary behavioral strategies: (a) reduce energy intake while maintaining optimal nutrient intake to protect growth and development, (b) increase energy expenditure by promoting more physical movement and less sedentary activity, (c) actively engage parents and primary caretakers as agents of change, and (d) facilitate a supportive family environment. Although this approach has the most empirical support, the impact on the pediatric obesity epidemic has been limited, particularly for adolescents with more severe obesity and for African-American, Native-American, and Hispanic children. This has prompted efforts to adapt strategies that have been effective in adult weight management for use in pediatric behavioral intervention programs. These include using motivational interviewing to increase readiness for health behavior changes, modifying the carbohydrate content of children’s diets, using culturally appropriate messages and materials, improving cultural competency of health care providers, and using computer-based strategies. Randomized, controlled clinical trials are needed to test the safety and efficacy of these approaches before they can be recommended for clinical practice. Pharmacotherapy and bariatric surgery are more aggressive and historically adult interventions with greater risk that are being considered for severely obese adolescents who have serious obesity-related medical complications and who have failed other more conventional methods.

Health Seeking Behaviors of African Americans: Implications for Health Administration

Disparities in health care and good health between African Americans and other populations while established in the literature are traditionally based on socioeconomic measures of race, income, age, and education (Bailey, 2000; Lillie-Blanton, Brodie, Rowland, Altman and McIntosh, 2000; Ren and Amick, 1996; Watson, 2001; Weinick, Zuvekas, and Cohen, 2000). This study broadens the scope by exploring how sociocultural (poverty, racism, prejudice, and discrimination) and psychosocial factors (perceived health status, the lack of personal efficacy in contributing to decisions about health care, feelings of helplessness, and the lack of trust in the health care providers) relate to health-seeking behaviors of African Americans (Bailey, 1991; Ren and Amick, 1996, Watson, 2001). Interviews were conducted with 111 African American adult patients at a community health center, focusing on health-seeking behaviors, and sociocultural and psychosocial factors. Results suggest that when these negative factors are removed, the health seeking behaviors of African Americans closely mirror the behaviors of the majority population. Subjects did not view themselves in poorer health, fail to seek medical attention when needed, or distrust their primary health care providers. In general, fears associated with health care were attributed to illness rather than health care providers, although a weak linkage was found between patient self-esteem and fear or dislike of future treatment by physicians (adj R2 = .362, S.E. = 15, F=21, sig. <.001). The study highlights the need for further study in two areas: cultural competency of health care providers, especially those from Asia and Africa who are often assigned to community health centers, and the impact of an accessible community health center on the health seeking behaviors and health status of predominately African American communities.

Changing healthcare professionals' behaviors to eliminate disparities in healthcare: What do we know? How might we proceed?

The patient-healthcare provider communication process--particularly the provider's cultural competency--is increasingly recognized as a key to reducing racial/ethnic disparities in health and healthcare utilization. A working group was formed by the Office of Minority Health, Department of Health and Human Services to identify strategies for improving healthcare providers' cultural competency. This expert panel, one of several working groups called together to explore methods of reducing healthcare disparities, was comprised of individuals from academic medical centers and health professional organizations who were nationally recognized as having expertise in healthcare communication as it relates to diverse populations. During the 2-day conference, the panel identified, from personal experience and knowledge of the literature, key points of intervention and interventions most likely to improve the cross-cultural competency of healthcare providers. Proposed interventions included introduction of cultural competence education before, during, and after clinical training; implementation of certification and accreditation requirements in cross-cultural competence for practicing healthcare providers; use of culturally diverse governing boards for clinical practices; and active promotion of workforce cross-cultural diversity by healthcare organization administrators. For each intervention, methods for implementation were specified. On-going monitoring and evaluation of processes of care using race/ethnicity data were recommended to ensure the programs were functioning.

Attitudes of registered nurses toward nurse practitioners.

Registered nurses (RNs) work closely with nurse practitioners (NPs) in all facets of patient care and often have a direct influence on the patient's perception of the professional who is directing the care, and a patient's perceptions may affect clinical outcomes. However, few studies have been conducted to measure RN acceptance of the NP. The authors surveyed RNs in southern Illinois to assess their attitudes concerning the level of care provided by NPs. Southern Illinois was chosen because of the limited number of NPs in the area and because of concerns that limited exposure might negatively influence RN attitudes about the NP role. A 26-item research questionnaire, previously used with school nurses, was modified to reflect RNs in general. Seven items related to demographic information, and 19 items created a five-response Likert-formatted scale (r = .93). The questionnaire was mailed to 500 randomly selected RNs from the 11 southernmost counties of Illinois. The results showed support of the NP role. RNs believed that NPs were knowledgeable, competent health care providers. RNs were also comfortable working with NPs and often consulted them for advice and information. They saw the role of the NP as a positive addition to the health care team. One identified concern was that scores indicated RNs felt that they received limited respect from NPs. Although the scores were high in this category, some RNs had concerns that NPs might not respect or understand the difficulty of the RN role in providing patient care. NPs need to recognize their collegial and professional ties to RNs and should take time to provide positive feedback to RNs as they collaborate to provide health care. Such behavior would only solidify the health team approach.

Improving Primary Care for Persons with Disabilities: The nature of expertise

It has been well documented that persons with disabilities (PWDs) have a more vulnerable health status than persons without disabilities; yet, they often receive inadequate primary care within the US health care system. This study explores how PWDs think about the health care they receive, particularly how primary care providers facilitate or hinder quality care for PWDs. The findings from this study expand the concept of expertise in health care, suggesting it goes well beyond technical competence of health care providers. For PWDs, expertise is multi-dimensional, not solely the domain of providers and includes having knowledge and using that knowledge within the context of the provider-patient relationship. PWDs identified three distinct areas of expertise: medical/technical, medical/biographical, and systems. Expertise can be brought to health care encounters by both PWDs and providers, and it can be developed through collaboration during interactions between providers and PWDs.

Race Consciousness and the Health of African Americans

The historical experience of African Americans in our country has been shaped by the institution of slavery, dehumanization of blacks, segregation, pursuit of civil rights, and racism in contemporary American society. Disparities in health care provide compelling evidence that issues of race or skin color for the descendants of slaves and other ethnic minorities persist in the 21st century. Nurses providing care for African Americans must bridge the racial divide and incorporate culturally relevant content in the health history. As an integral aspect of their professional growth as culturally competent health care providers, they must incorporate the idea of race consciousness which is described as an awareness of the historical journey of the group, knowledge of disparities in health care for the people, and a self appraisal of one’s attitudes and biases toward the group.

Stotland Discusses Postpartum Depression With Congress’s Black Caucus

Stotland Discusses Postpartum Depression With Congress’s Black Caucus

Assuring Continued Competence - Policy Questions and Approaches: How Should the Profession Respond?

This article reviews approaches to assure the continuing competence of health care providers, beyond the competency of initial licensure, by nursing organizations, private sector groups and state and federal governmental approaches. Specific methods to assure continuing competence are discussed including the American Nurses Associations' proposed Continuing Professional Nursing Competence Process; the many nursing policy questions this issue raises are presented.

Continuing competence in the health professions.

The health professions are confronted with external pressures to assure the public of the continuing competence of health care providers and internal pressures for self-regulation. This article describes the forces driving continuing competence, the difficulty defining the scope of professional competencies for experienced practitioners, the difficulty creating valid measures to evaluate continuing competence, and the need for shared responsibility and collaboration among regulatory boards, professional associations, and specialty certification programs. The article presents findings from the Study of Professions, which was based on literature review, document review, and telephone interviews with key informants from 13 regulated health professions.

Cultural Themes in Health, Illness, and Rehabilitation for Native Hawaiians

Increasing the cultural competency of health care providers requires an understanding of the cultural group being served. For Native Hawaiians, however, little is known about their participation in and views of rehabilitation. In this study, focus groups were conducted in which Native Hawaiian and non-Hawaiian rehabilitation professionals were asked to interpret utilization data and offer their perceptions of the rehabilitation experience of Native Hawaiians. Consistently noted were cultural values and traditions reflecting the importance of `aina (environment), `ohana (family), kuleana (specific responsibilities of family members), and kokua (mutual support and interdependence). Findings demonstrate the link between cultural values and health behaviors and provide guidelines that inform practice, policy, and research.

The healing process for the multidisciplinary team: recovering post-inpatient suicide.

1. With an inpatient suicide, the staff may experience grief for a variety of reasons. The staff member's perception of self as a competent mental health care provider may be destroyed. The caregiver may grieve the loss of an ideal. Some inpatient staff members mistakenly believe that suicide can always be prevented and that the multidisciplinary team can accurately assess all patients. 2. To successfully mourn a loss, Worden (1982) identified four tasks of grieving that must be completed: accept the reality of the loss; experience the pain of grief; adjust to an environment in which the deceased or lost object is missing; and withdraw emotional energy and reinvest it in another relationship. 3. Interventions to promote healing post-inpatient suicide must be aimed at individual caregivers and the multidisciplinary team. Individual caregivers will differ in their responses based on experiences, beliefs, values, and culture.