Congruent Care Research Articles

Health Beliefs, Health Practices, and Health-Seeking Behaviors among Swartzentruber Amish in Clark County, Wisconsin

Although the literature contains valuable information about Amish culture, few qualitative studies have been conducted on the health beliefs, health practices, and health-seeking behaviors of the Swartzentruber Amish, the most conservative group of Old Order Amish. The purpose of this study was to describe these dynamics for the Swartzentruber Amish of Clark County, Wisconsin. Utilizing the grounded theory approach, 25 participants were interviewed and seven themes were identified: shared decision-making is common in families; causes of illness are believed to be etiological or the will of God; home remedies are the first choice; preventive medicine is an unfamiliar concept; health information is sought from within their settlement; and professional medical care is a last resort in treatment. These Amish identified several obstacles to seeking or using professional medical care: unfamiliarity with the English medical system; communication barriers; lack of trust in medical professionals; the high cost of medical care; belief of diminished or no say in a child’s healthcare; and concern about prescription drugs. An understanding of the Swartzentruber Amish is important if healthcare professionals are to provide them with culturally congruent care. Numerous recommendations based on the findings are included for healthcare providers. [Abstract by author.]

Interrelações das Epistemologias do Sul e o cuidado transcultural nas práticas em saúde e Enfermagem

Abstract Objective to reflect on the interrelationships of transcultural care and the Epistemologies of the South of health and Nursing practices. Method this is a reflective study, based on a narrative review of the literature, highlighting the concepts of abyssal line, ecology of knowledge, and decolonization of knowledge from the framework of the Epistemologies of the South. Results after the reflective analysis of the material, three reflexive axes emerged, namely: Populations south of the abyssal line; Ecology of knowledge and interculturality; and Decolonization of knowledge in health and nursing practices: culturally congruent care. Final considerations and implications for practice the appreciation of the self-care culture of vulnerable population groups south of the abyssal line is essential to create opportunities for visibility and voice removed by the colonization process in the health field, as a result of the overvaluation of biomedical knowledge. There is a need for dialogue between knowledge to build an environment of mutual learning, characterized as the ecology of knowledge. For this, the decolonization process is needed from the perspective of post-abyssal thinking, with the appreciation of popular knowledge, in favor of culturally congruent care. Finally, in nursing, the framework of the Theory of Universality and Diversity of Cultural Care equips nurses to plan and implement sensitive transcultural care.

A concept analysis of cultural competence within a diverse midwifery context in South Africa

BackgroundSouth Africa is known for its cultural diversity. Within this context, midwives are challenged to provide culturally congruent care to women receiving maternal care who are from diverse cultural backgrounds. When researchers identified lack of consensus on what cultural competence in midwifery means, a concept analysis was activated. The study aimed to define cultural competence within the midwifery context in South Africa. ObjectiveTo define the concept ‘cultural competency’ within the midwifery context. MethodA concept analysis approach following the eight steps of Walker and Avant (2014) was used. This approach followed a qualitative descriptive design, whereby literature obtained from multiple data sources between 2008 and 2018 were included. Only literature that met inclusion criteria was used. The concept selected to be analysed was cultural competence. ResultsIn addition to the theoretical definition, the concept analysis process identified cultural diversity and ongoing learning as the antecedents of cultural competence. Cultural awareness, cultural knowledge, cultural encounters, cultural skills, and cultural desire were identified as attributes. The consequences of cultural competence were identified as being a culturally competent practitioner, improved quality of care, and improved health outcomes. ConclusionFrom a theoretical definition, midwives in culturally diverse settings can facilitate cultural competency, which can improve maternal outcomes for patients from diverse backgrounds. ContributionThis study led to developing a theoretical definition for cultural competence in the South African context.

Geospatial analysis of patients' social determinants of health for health systems science and disparity research.

Geospatial analysis of patients' social determinants of health for health systems science and disparity research.

Experiences of midwives regarding provision of culturally competent care to women receiving maternal care in South Africa

Due to the cultural diversity in South Africa, midwives are challenged to provide culturally competent, congruent, and sensitive maternal care. Using a qualitative descriptive design, this study aimed to explore and describe the experiences of midwives providing culturally competent care to women receiving maternal care within overburdened public hospitals. Purposive sampling of thirty-four (n = 34) midwives employed to provide maternal care (antenatal, intrapartum, and postpartum) at five public hospitals in the North West Province of South Africa was done. Semi-structured interviews were conducted in English and transcribed verbatim. Data was analysed thematically with the assistance of an independent co-coder. Data revealed that midwives viewed communication as a key component of cultural competence. Midwives do not necessarily understand the concept “cultural competence.” It is recommended that a policy of culturally competent maternal care be developed and implemented by midwives in practice.

Cultural competence in medical and health education: an approach to the topic

Cultural competence is essential to ensure safe, high-quality healthcare; and adequate preparation is necessary to provide culturally congruent care. A literature review was conducted to examine the theoretical foundations of cultural competence and its application to medical and health education. The search for information in databases was carried out using the terms “cultural competence”, “health education”, “medical education”, “cultural sensitivity” and “cultural humility”. Cultural competence is the ability of a student or healthcare professional to provide culturally appropriate and specifically tailored care to patient populations with diverse values, beliefs, and behaviors. The development of cultural competency in medical education has occurred surprisingly rapidly in response to gaps in student training and skills identified by educators, clinicians, and care provider and accrediting bodies. The acquisition of cultural competencies by health professionals’ addresses: the interest in learning about other cultures, learning about another culture, interactions with people from different cultures and the set of capabilities to respond to people's health needs. from another culture. Competition consistently directs attention to political and social circumstances as well as individual considerations that can alleviate suffering and promote health and well-being

International Portuguese Nurse Leaders' Insights for Multicultural Nursing.

Cultural diversity among patients and healthcare workers in the Portuguese healthcare organizations will increasingly challenge nurse managers to develop favorable nursing work environments and to improve culturally congruent care. Aim: This study aimed to identify nurse managers’ interventions that improve favorable nursing work environments in multicultural nursing teams and culturally congruent care for patients, based on Portuguese nurse leaders’ experience in international settings. Methods: A qualitative and exploratory study was conducted as the first stage of a sequential exploratory mixed study design. A convenience sample of Portuguese nurses with leadership experience of multicultural teams was recruited to participate in one focus group. Qualitative data were recorded and transcribed for content analysis. Text segments were organized into themes and categories with the support of the qualitative software IRaMuTeQ. Results: Nurse managers’ interventions, such as adapting the leadership style, thanking nurses for their work, adjusting the unit to attend to patients’ worship practices, and supporting foreign nurses in learning the local language, were categorized into three main themes and five categories—transcultural nursing leadership assumptions, capitalizing nurses, improving culturally congruent care, team problems and strategies, and improving effective communication. Conclusions: These findings corroborate international studies, advocate for capable nurse managers to lead in a globalized world, and are suitable to develop a transcultural nursing leadership questionnaire.

The School of Nursing has a problem with diversity, equity and inclusion. Can curriculum revision address it? An educational case study

Introduction: This article describes an educational case study based in a School of Nursing at a private university in the Southeastern United States which is called by students to address structural racism and a lack of diversity, equity and inclusion in the program. In the case study, a decision is made to review and revise the curriculum. A variety of stakeholders are included, and they have a variety of motivations and levels of commitment to the work.Methodology and results: The case was created by nurse educators, and based on a fictitious school with invented characters. Teaching notes are provided for the facilitator, and discussion questions and activities for the learners.Discussion: Current and future nursing faculty may use this case study to learn about curricular revision to support equitable educational practices. Instilling diversity, equity and inclusion in the nursing curriculum equips future nursing professionals to provide culturally congruent health care.

Explaining the educational challenges in the path of cultural competence: The experiences of Iranian nursing students.

Cultural care is necessary for healthcare settings due to the presence of culturally diverse clients. Nursing students face different challenges in the path of cultural competence. This study aimed to characterize nursing students' educational challenges in achieving cultural competence. Data were collected through interviews with 14 nursing students, 2 faculty members, and 2 nurses working in educational and clinical centers affiliated to Kerman University of Medical Sciences in southeastern Iran. The Graneheim and Lundman approach was used to conduct purposeful sampling and analyze data. Data analysis revealed the theme of nurses' educational challenges with cultural competence with four major categories: the neglect of cultural competence in educational approaches, the lack of importance of culturally congruent care in clinical settings, poor intercultural communication, and insufficient skill in cultural humility. The present study shows numerous barriers to nursing students' cultural competence, which impair their learning and care for culturally diverse patients.

Timorese women’s experiences and expectations of skilled birth attendance in Timor-Leste: A qualitative inquiry

ObjectiveThe study explores women’s experiences and expectations of maternity care in Timor-Leste. MethodQualitative, descriptive research using focused ethnography. Thirty women and seventeen health professionals from three districts in Timor-Leste were interviewed and/or participated in focus groups. ResultsWomen’s expectations of care include the provision of information, advice and clinical assessment from midwives who have the capacity to provide emergency obstetric care if required. Midwives’ access to technology (for example: the fetal doppler), increased the women’s confidence in services. The women also identified poor experiences, including angry, busy midwives, poor communication, and lack of privacy in antenatal and birthing services. The lack of privacy inhibits women’s communication with health professionals. An absence of covers and multiple staff present during labour and birth embarrass the women and their families. Many Timorese women live in poverty and have poor literacy skills. These women want knowledgeable, approachable, and clinically competent midwives who can support them through their pregnancies and childbirth. Poor communication, angry, busy midwives and lack of privacy cause discomfort and embarrassment and may discourage the women and their family’s uptake of skilled birth attendant (SBA) services. ConclusionMidwives have a critical primary role in the provision of advice, information and care of Timorese women during the childbirth continuum. Continuing education of midwives with an emphasis on communication and culturally congruent care will improve women’s satisfaction and childbirth outcomes. Impoverished women are particularly vulnerable when birthing in health care services. Attention to the women’s privacy and her additional needs can include a focus on the birthing space and the number of staff who have access to it.

How Mexicans' Emotional Responses to Non-Alcoholic Fatty Liver Disease Can Help Inform Culturally Congruent Health Care.

This article aims to increase understanding of how Mexican immigrants respond to learning about non-alcoholic fatty liver disease (NAFLD), a spectrum disease with a heavy burden among Mexican-origin people. This article presents findings from qualitative interviews (n = 26) that formed part of a mixed-methods study of foreign-born Mexican immigrants carried out in 2019 to 2020 in southern Arizona to assess NAFLD awareness. We documented common experiences of surprise, fear, and hope during study participation, all of which motivated research participants to reduce their NAFLD risk by seeking additional information, sharing it with others, and making lifestyle changes. Understanding how these emotional experiences are tied to cultural and historical factors-including Mexico's high rates of liver disease, participant's limited access to health care, and the ability to address the NAFLD risk with lifestyle changes-may promote the development of more effective and culturally congruent care in this population.

Lived Experiences of Mongolian Immigrant Women Seeking Perinatal Care in the United States.

There is inadequate information available about many of the smaller minority groups living in the United States. Mongolian culture has unique traditions that warrant understanding to provide culturally congruent care. The purpose of this study was to explore the lived experiences of Mongolian immigrants seeking perinatal care in the United States. Using a phenomenological approach, 12 Mongolian women were interviewed using semi-structured interviews. The study follows the "consolidated criteria for reporting qualitative studies" guidelines for qualitative studies. Results focus on successes and failures of the health care system in meeting the needs of these women. Cultural communication barriers, disparate health practice beliefs, and limited cultural awareness among providers reduce quality of care. Study findings support practice interventions that enhance provider sensitivity for immigrant women. Improved cultural awareness of Asian cultures increases sensitivity to the needs of Mongolian women and can help providers deliver high-quality care.

Qualified Nurses' Perceptions of Cultural Competence and Experiences of Caring for Culturally Diverse Patients: A Qualitative Study in Four European Countries.

Background: European nurses are expected to provide appropriate care for patients from diverse cultural backgrounds. However, there is limited knowledge and understanding of this process. The aim of this study was to analyse the perceptions of culture and experiences of caring for patients from diverse cultural backgrounds of a purposive sample of qualified nurses from four European countries, namely Belgium, Portugal, Spain and Turkey. Methods: A qualitative phenomenological approach was selected in order to understand complex phenomena through the participants’ lived experiences, meanings and perspectives. Individual interviews and focus groups took place with 28 staff nurses and 11 nurse managers from four European countries. The sociodemographic and cultural characteristics of the sample were described and analysed using descriptive statistics. Qualitative data were transcribed verbatim, translated into English and analysed following Braun and Clark’s phases for thematic analysis. Results: Five themes and twelve subthemes emerged from thematic analysis of the transcripts. The themes included: (1) relevance of culture for nursing; (2) culture in the healthcare service; (3) qualities of the healthcare professionals; (4) challenges to culturally competent care; (5) becoming a culturally competent nurse. Conclusions: There are challenges to the delivery of culturally congruent care, namely language and communication difficulties, prejudices and stereotyping in the health service, a tendency for ethnocentrism, a lack of education and training in cultural competence and a lack of support from the health service to facilitate new ways of acting.

Looking through racism in the nurse-patient relationship from the lens of culturally congruent care: A scoping review.

AimThis review aimed to identify the nature of racism in the nurse–patient relationship and summarize international research findings about it.DesignA scoping review of the international literature.Data sourcesThe search process encompassed three main online databases of PubMed (including MEDLINE), Scopus and Embase, from 2009 until 2021.Review methodsThe scoping review was informed by the Levac et al.’s framework to map the research phenomenon and summarize current empirical research findings. Also, the review findings were reflected in the three‐dimensional puzzle model of culturally congruent care in the discussion section.ResultsThe search process led to retrieving 149 articles, of which 10 studies were entered into data analysis and reporting results. They had variations in the research methodology and the context of the nurse–patient relationship. The thematical analysis of the studies' findings led to the development of three categories as follows: bilateral ignition of racism, hidden and manifest consequences of racism and encountering strategies.ConclusionRacism threatens patients' and nurses' dignity in the healthcare system. There is a need to develop a framework of action based on the principles of culturally congruent care to eradicate racism from the nurse–patient relationship in the globalized context of healthcare.ImpactRacism in the nurse–patient relationship has remained a relatively unexplored area of the nursing literature. It hinders efforts to meet patients' and families' needs and increases their dissatisfaction with nursing care. Also, racism from patients towards nurses causes emotional trauma and enhances job‐related stress among nurses. Further research should be conducted on this culturally variant phenomenon. Also, the participation of patients and nurses should be sought to prohibit racism in healthcare settings.

Nurse Educators' Perceptions of Teaching Patient-Centered LGBTQ+ Gender-Affirming Care to Undergraduate Students.

Nurse educators are uniquely positioned to equip students with the knowledge, skills, and attitudes to provide LGBTQ+ persons with culturally congruent inclusive care. Using Quality and Safety Education for Nurses' patient-centered care competency as a framework, this study used a qualitative exploratory-descriptive design to investigate nine undergraduate nurse educators' perceptions of teaching LGBTQ+ gender-affirming care. Three themes emerged from the interviews denoting challenges: importance of patient-centered care, limited knowledge, and barriers to curricular integration. Incorporating LGBTQ+ topics across the undergraduate nursing curriculum is necessary to support the delivery of person-centered care.

Wy'east: An Innovative, Culturally Responsive Postbaccalaureate Pathway for American Indians and Alaska Natives.

American Indians and Alaska Natives (AIANs) face significant health disparities that are exacerbated by limited access to high-quality, culturally congruent health care providers. There are no premedical postbaccalaureate programs focused on AIAN students. The Northwest Native American Center of Excellence designed the Wy'east Pathway in 2018 to increase the number of AIANs matriculating to U.S. medical schools by supporting those on the cusp of matriculation. Wy'east scholars undertake 10 months of structured programming to augment their academic preparation, improve their Medical College Admission Test (MCAT) scores, and enhance their confidence and cultural identity. Cultural events and mentorship opportunities with AIAN faculty, staff, and cultural liaisons are threaded throughout the pathway curriculum to foster cultural resilience, mentorship, and community. Scholars earn conditional acceptance to Oregon Health and Science University (OHSU) School of Medicine if they complete Wy'east and meet the following criteria: pass all examinations in the primary curricular threads, obtain a qualifying MCAT score, and meet professionalism standards. All 14 scholars who successfully completed Wy'east and met criteria in the first 2 cohorts (academic years 2018-2019 and 2019-2020) earned conditional acceptance to OHSU School of Medicine. Ten of the 14 scholars (71.4%) matriculated to OHSU School of Medicine, 2 (14.3%) matriculated to other medical schools, and 2 (14.3%) chose to pursue other health care fields. Wy'east scholars rated the foundational science of medicine and population health and epidemiology threads higher in terms of making them feel better prepared for medical school (mean = 4.71 and 4.83, respectively) than the academic skills and wellness thread (mean = 3.43). Over the next 5 years, Wy'east will grow incrementally to offer a total of 18 conditional acceptance spots per cohort across 3 medical schools. Longitudinal tracking of Wy'east scholars' medical training and career outcomes will be conducted.

Understanding Medication Adherence in Bhutanese Refugees With Diabetes in a Midwestern City.

Bhutanese refugees have a higher prevalence of type 2 diabetes but are less likely to achieve medication adherence and glycemic control. The purpose of this project was to understand factors affecting diabetes medication adherence in this population. This was a qualitative project using focus groups of adult Bhutanese refugees with type 2 diabetes ≥18 years old and hemoglobin A1C ≥8% and their caregivers from a family medicine clinic at the University of Kansas. Data were analyzed using content analysis. A total of 23 individuals participated. Three themes emerged from data analysis: desire to engage in care but face multiple barriers, family and community support invaluable for health, and considerations for culturally contextual person-centered care. Participants provided specific recommendations to address the barriers, with emphasis on improving health literacy. Integrating the identified factors can foster person-centered, culturally congruent care to improve diabetes medication adherence in Bhutanese refugees.

Nutrition and Congruent Care Improve Wellbeing of Residents With Dementia in Slovenian Care Homes.

IntroductionCurrent nutritional strategies for people with dementia focus on nutritional diets and regimens, although in recent years congruent care for people with dementia has been increasingly recognized to improve their wellbeing. This includes consistency of care, respecting the variability of psycho-sociological factors, emphasizing the importance of participation in activities, and congruence with the individual's needs and capabilities. When applied to the nutritional aspects of care, it aims to empower people with dementia to have an active role in their care and during meals. Congruent care has previously shown promising results in improving the quality of life of residents, reducing the incidence of negative social interactions and daily intake of medicines.MethodsA mixed methods qualitative-quantitative study was carried out. Out of 102 residential care homes for the elderly in Slovenia, a non-random sample of homes was selected. Seven homes that have implemented congruent care and five who have not implemented it agreed to participate. Content analysis of the transcripts of focus group interviews was carried out, to establish how the congruent care model was included into their everyday practice of care for people with dementia. Qualitative comparative analysis was used to describe the differences in the practice of care between the two groups of homes, in the fields of nutritional and general care. Frequencies and assigned importance of statements relating to different aspects of nutritional care were statistically compared.ResultsThe introduction of congruent care improved the wellbeing of the people with dementia, as observed by caregivers. The homes that had implemented congruent care gave more attention to the food choice aspects of nutritional care (p = 0.0474, 95%CICongruent = 50.77–72.35%, 95%CINon−congruent = 27.65–49.23%), while the homes that had not were more attentive to the dietary intake aspects (p = 0.0067, 95%CICongruent = 22.79–44.74%, 95%CINon−congruent = 55.26–77.21%). In the homes for the elderly that had implemented congruent care, both caregivers and management reported that the frequency of use of pro re nata medication decreased, which is supported by the results of the linear regression ( =78.4, p = 0.005), although the data available is limited.ConclusionFirst, the people with dementia in the care homes that had implemented congruent care were observed to have improved in mood, attitudes toward eating and wellbeing, as reported by caregivers. Second, the implementation of congruent care was well received by the management and caregivers of the care homes. A model of implementation of congruent nutritional care for people with dementia is presented.

Culturally competent care in the neonatal intensive care unit, strategies to address outcome disparities

In the past two years, we have witnessed social unrest, the unequal effects of a pandemic across our society, and a focus on how systems in the United States produce unequal outcomes along racial and cultural divides. With increased national awareness, there has also been a call for change in healthcare, specifically racial inequities in Neonatal Intensive Care Unit (NICU) outcomes (1). While race may be a data point used to classify outcomes, it has no basis in biology, and merely identifying it does not make it simple to address. To address these inequities we need to look past the social construct of race and to the social aspects of our care in the NICU. Focusing on small and large changes that we can make as individuals, units, and as a specialty that can improve the care and outcomes of this at-risk patient population. This perspective focuses on culturally congruent care, trauma-informed care, and other approaches to reduce disparities in neonatal outcomes.

Family Planning Research in African Immigrant and Refugee Women: A Scoping Review.

African immigrants are a vulnerable population who are seldom seen in the literature, however, the scant research available reports that they experience increased challenges when making family planning decisions. A robust understanding of their specific family planning practices is imperative to providing appropriate, culturally congruent care. Considering this disparity, a scoping review was conducted to synthesize empirical knowledge and identify gaps in the literature around family planning in African immigrant populations in the United States. Guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) framework, EMBASE, Global Health Database, PsycINFO, CINAHL, and PubMed were searched for literature regarding family planning topics such as decision-making and health care access among African immigrant women in the United States in June 2020. The small number of retrieved studies for the literature review clearly highlights a dearth of research. Available evidence indicates stark disparities in health care access, unmet individual needs, and unacknowledged preferences. Ignoring cultural considerations for the growing African immigrant population perpetuates the divide in family planning practices.