Cultural Competence In Care Research Articles

Experiences with and perceptions of the child welfare system during the perinatal period of mothers with intellectual and developmental disabilities

ABSTRACT This qualitative study explored the perceptions and experiences of 16 mothers with intellectual and developmental disabilities (IDD) regarding their interactions with the child welfare system during the perinatal period. Adverse themes included fear of child removal, wariness of the healthcare system, insufficient assistance, and trauma and stress. Positive themes included support from others and believing in one’s self. Findings underscore the need for disability cultural competence, non-discrimination, family preservation, enhanced support, self-advocacy, and family-centered care across perinatal and child welfare systems to improve equity for mothers with IDD and their children. Further research is warranted.

Lived Experiences of Cervical Cancer Patients Receiving Chemotherapy at Cancer Diseases Hospital in Lusaka, Zambia

Background: Cervical Cancer poses a significant global health challenge, especially in lowresource settings. It is a significant health problem worldwide, with over half a million new cases diagnosed each year, accounting for approximately 6.6% of all gynecological Cancer cases and over 300,000 deaths each year. In Zambia, it is the leading cause of mortality and morbidity among women. The number of cases has increased by approximately 40%. This study explored the lived experiences of Cervical Cancer patients undergoing chemotherapy at the Cancer Diseases Hospital in Lusaka, Zambia, focusing on their subjective experiences. By examining their journeys through chemotherapy, the study aimed to highlight the subtle complexities in which treatment impacts patients’ lives and well-being. Methods and procedures: Employing a qualitative descriptive phenomenological study design, in-depth interviews were conducted with 10 participants with diverse demographics. The sample size was determined by data saturation and saturation was reached at 10. Ethical protocols were ensured, and Study approval was obtained from UNZABREC and the National Health Research Authority. Thematic analysis was conducted on audio-recorded interviews with cervical cancer patients, ensuring confidentiality and accuracy while discerning significant patterns and themes in their narratives. Results/findings: Emotional experiences ranged from anxiety to gratitude. Psychological challenges encompassed coping mechanisms, stress management, emotional adjustments, and treatment-related fears. Socially, community support, workplace accommodations, and healthcare provider roles were key. Physical experiences revealed side effects managed through coping strategies. Financial challenges significantly impacted individuals and families. Conclusions and recommendations: The study revealed that cervical cancer patients undergoing chemotherapy face complex challenges spanning emotional, psychological, social, physical, and financial domains, underscoring the imperative for comprehensive patient-centered care. Recommendations suggest focusing on financial aid for cancer patients and tackling treatment expenses and insurance issues. The Cancer Diseases Hospital should establish multidisciplinary teams for holistic care, and enhance patient education efforts. Nurses should adopt strategies integrating cultural competence and patient-centered care to address diverse challenges during chemotherapy. These aim to enhance the well-being and care quality of Cervical Cancer patients.

Culture, Cultural Competence, and Clinical Care.

Culture competence is a concept that can be traced back to health care considerations in the 1960s and 1970s, and in particular to nursing education. Critics of the concept have argued that this was not simple a listing of cultural facts, behaviors, and practices, but instead follow a more ethnographic understanding of culture. In this article, I recognize that culture is not simply about the other, but something we all possess, and is also always changing throughout our lives. Understanding and respecting diversity and culture is key to improving services, including lactation support.

Into the looking glass on cultural and religious competent care: optimizing healthcare for Haredi individuals with mental illness

Previous research has shown that minority groups tend to underuse healthcare services. One community whose experiences remain particularly under-researched in the Western world is Haredi Jews- a diverse group of individuals committed to traditional Talmudic and Halakhah teachings and observances. This presentation aims to enhance participants' understanding of mental health-seeking behaviours and challenges faced by Haredi individuals. We conducted a qualitative study that involved in-depth interviews with 24 adults who identified as Haredi and used mental health services, as well as informal consultations with local rabbis and community leaders. Interviews were transcribed and analyzed using thematic analysis techniques. Analysis revealed several important themes, including: (1) Strength of religious practices, community, and relationship with God as a factor determining mental well-being. (2) Implications of devotion to religion within the patient-physician encounter. (3) Stigma and acknowledged lack of awareness surrounding mental health in Haredi communities. These themes will be explored in the presentation, which will aim to bring light to participants’ lived experiences. We hope to address the proverbial "elephant in the room" often ignored or overlooked, as encountered by Haredi community members and their interactions with the healthcare system. We will present the unique strengths and challenges related to mental health encountered by Haredi Jews in our study, while discussing potential measures that can produce better health outcomes and culturally sensitive care for Haredi individuals.

Barriers to delivery of culturally competent care among nurses: A multi-center cross-sectional study in a resource-limited setting

BackgroundIn a growing multicultural society like Ghana, the cultural competence (CC) of nurses is imperative. Despite the importance of CC within the healthcare environment, factors that hinder nurses’ ability to render culturally competent care (CCC) to patients in the clinical unit have not been adequately explored. PurposeTo examine the barriers nurses encounter in the delivery of CCC across two regions of Ghana. MethodsFrom October to December 2022, an institutional-based cross-sectional study in eight hospitals involving nurses was conducted in the Western and Ashanti regions. A probability sampling method was employed to select 759 participants. Data was entered into a spreadsheet and exported to S.P.S.S version 23. Binary and multivariable logistic regressions were used to establish the associations between dependent and independent variables. The odds ratio with a 95 % confidence interval was computed. Outcome variables with a P-value < 0.05 were deemed statistically significant. ResultsThe majority of the respondents were females (61.4 %; n = 466). The three-factor structure of the instrument was validated using an exploratory factor analysis. The study revealed that barriers that hindered nurses were the lack of CCC policies (β = 0.150, 95 % CI = 0.120, 0.180), nurse staffing-related factors (β = 0.120, 95 %; CI = 0.090, 0.150), and the lack of training related factors (β = 0.084, 95 % CI = 0.054, 0.114). Nurses’ age, marital status, and experience were significant at a p-value of < 0.05. ConclusionThe lack of culturally appropriate policies, lack of training-related factors, and nurse staffing-related challenges hindered respondents’ efforts to render CCC. Interventions aimed at improving CCC should target these barriers.

Exploring the education in cultural competence and transcultural care in Spanish for nurses and future nurses: a scoping review and gap analysis

BackgroundGlobalization and population migration have led to increasingly culturally diverse societies, which has made nursing education in cultural competence and transcultural care a priority. This includes the ability to provide person-centered and culturally congruent care, even within one's own culture. However, this sort of training has been developed and implemented in practice comparatively more by English-speaking societies. Therefore, the aim of this study was to identify the existing educational initiatives for nurses and future ones in cultural competence and transcultural care in Spanish and explore their didactic characteristics in terms of teaching and learning formats, contents, skills, and evaluation methods at different academic levels.MethodsA scoping review was carried out by following the specific PRISMA recommendations and those of the Joanna Briggs Institute guidance throughout PudMed, Web of Science, Embase, Google Scholar, and Cinahl databases and also gray literature in the form of official documentation that later was complemented with a gap analysis including training programs published by Spanish and Latin-American educational institutions and the approaches of key academic informants.ResultsThe published evidence on nursing training in cultural competence or related topics in Spanish-speaking higher education for nurses is limited. Specific nursing programs in Spanish-speaking universities are primarily found in Spain, with fewer options available in Latin America. These contents are offered either as optional subjects or immersed in other courses and mainly taught in theoretical sessions. Practice in real contexts is supposed to be evaluated transversally under the cultural scope according to national educational recommendations though barely visible in students’ evaluation reports. Even though postgraduate training dedicated to these issues exists, it is still limited, mixed with other contents, and generally depends on a few researchers investigating and publishing on the topic from very specific universities.ConclusionsIt is essential to establish a common global strategy including Spanish-speaking countries in nurses’ higher education and professional training on topics focused on cultural competence as well as the provision of nurses’ social and cultural sensitivity towards their own culture and to define whether those that currently exist are effective. It is also crucial that this training was evaluated in practice in order to achieve enough impact on students, health organizations, and population health.

Aotearoa New Zealand emergency ambulance services and the provision of end-of-life care: a short survey.

To characterise emergency ambulance service (EAS) clinical roles and experiences (including cultural competency and pastoral care) in the delivery of end-of-life (EOL) and palliative care in Aotearoa New Zealand. A nine question online survey was distributed to St John and Wellington Free Ambulance clinicians. Four questions enabled voluntary free-text comments to be submitted for thematic analysis. A further opportunity for free-text comments was available at the end of the survey. There were 444 participants, which is 14% of the paid ambulance workforce. 63% reported that they frequently transported EOL care patients to hospital when they could be better managed at home. EAS clinicians depend heavily on informal collegial support for pastoral care as formal debriefs are rarely offered. There were 671 free-text comments. Dominant themes included the importance of seniority, the need for further education, the importance of documented care plans and the need for better integration with community services, including hospice. More can and should be done to ensure EAS clinicians are supported to deliver quality EOL care for patients alongside other community providers.

Clinical Applications of the History of Medicine in Muslim-Majority Nations.

Since the early twentieth century, a number of physicians and professional historians have argued for the integration of the history of medicine into both medical education and clinical practice. After the supplanting of the humoral model of medicine in favor of the germ theory of disease in the late nineteenth century, medical school administrators have repeatedly asked medical historians for their rationale for studying "outdated science" in medical training programs beyond antiquarianism and knowledge for knowledge's sake. However, a number of arguments can be adduced for the use and relevance of the history of medicine, including the observations that history: 1) provides examples of inspiring or highly ethical individuals who can serve as role models in practitioner identity formation; 2) helps to develop critical analytical skills and other modes of humanistic thought and behavior directly relevant to patient care (e.g., empathy); 3) promotes culturally-competent care, since history informs culture; 4) encourages inquiry into the sociocultural factors that affect the development of modern medical ecosystems; 5) provides a philosophical tradition for critiquing ethics in the medical profession. This contribution specifically traces the potential uses of Islamic medical history in the clinic and medical schools in Muslim-majority countries, primarily in the Middle East.

Cultural differences in caring for people with dementia: a pilot study of concern about losing face and loneliness in Chinese American and European American caregivers

ABSTRACT Objectives Heavy demands upon dementia caregivers can lead to a number of poor health outcomes including declines in physical, mental, and brain health. Although dementia affects people from all backgrounds, research in the US has largely focused on European American caregivers. This has made providing culturally-competent care more difficult. This study begins to address this issue by empirically examining how culturally-shaped beliefs can influence loneliness in family caregivers of people with dementia. Methods We conducted a preliminary questionnaire study with Chinese American and European American family caregivers of people with dementia (N = 72). Results Chinese American caregivers were more concerned than European American caregivers about losing face, which in turn, was associated with greater loneliness. This pattern remained when accounting for caregiver gender, age, and relationship to the person with dementia. Conclusions These preliminary findings highlight the role that cultural beliefs can play in adverse caregiver outcomes, and suggest that addressing concerns about losing face may be an important way for healthcare providers to help reduce loneliness among Chinese American caregivers. Clinical Implications Understanding how cultural beliefs influence caregiver outcomes is critical as healthcare professionals work to provide culturally-competent care and design culturally-sensitive interventions.

Beliefs and Intentions of Anesthesia Physicians Toward Providing Culturally Competent Care to Transgender Patients.

Anesthesiologists have limited relationships with their patients before delivering care and have little time for patient interactions. Yet, they should possess the knowledge and skills to treat all patients in an equitable, culturally competent manner, including transgender patients. The study's purpose was to determine behavioral factors influencing culturally competent care by anesthesia physicians with transgender patients. A two-phase design was utilized in 2020 to examine the attitudes, subjective norms, and perceived behavioral control of anesthesia physicians, both in training and practicing independently. Phase 1 allowed exploration of themes related to facilitators and barriers of the provision of culturally competent care to transgender patients. Phase 2 involved the creation and deployment of a 51-question survey informed by phase 1 to 100 anesthesia physicians at a single academic medical center in the southeastern United States. Thematic analysis was performed on results from the phase 1 elicitation survey, which informed the creation of the survey for phase 2. One hundred phase 2 surveys were distributed, with a 70% response rate. Analyses were conducted to determine the largest influence of intent to interact with transgender patients in a culturally competent manner, as well as to establish the reliability of the tool. Attitude followed by subjective norms were positive influencers of intent, while lack of knowledge was a negative influencer. Strengthening attitudes and subjective norms, while implementing programs to increase knowledge, competence, and humility, would be goals for future studies and actions toward improving healthcare of transgender individuals.

Addressing Cultural Competency and Primary Palliative Care Needs in Community Health Nursing Education.

To meet the primary palliative care needs of older adults, especially the underserved and those of color, a qualitative descriptive study was conducted among nursing students (n = 34) in community health nursing whose clinical rotations included independent living facilities for low-income populations. Two themes were identified that influence student nurse confidence and self-efficacy in initiating conversations with seriously ill clients and assessing their primary palliative care needs: (1) emotional assessment skills and cultural competency and (2) an assessment guide to primary palliative care needs that provides structure and guidance to conduct such conversations. Two major categories were identified that influence student nurse confidence and self-efficacy in initiating conversations with seriously ill clients: (1) educational needs and desired experience and (2) cultural impact. Two major categories were identified that facilitated the assessment of primary palliative care needs: (1) a guide that provided structure and guidance in initiating and conducting conversations about serious illness and (2) insight into the primary palliative care needs of clients in the community.

Culturally Aligned Health Care: Implications for Patient Care and the Nursing Profession.

Professional nurses utilize person-centered/patient-centered models of care to provide meaningful and effective healing or promotion of wellness. Using their skills, knowledge, and expertise, nurses are poised to lead quality improvement efforts that enhance patient outcomes, reduce inequities among populations, and contain costs. Culturally aligned organizational models are built on key concepts of cultural competency, patient- and family-centered care, and diversity, equity, inclusion, and belonging concepts. Nurses are poised to lead cultural alignment innovations across health-care professional teams, using their foundational skills to enhance quality and safety across the health-care spectrum.

214 CARE OF THE LGBT OLDER ADULT: A NARRATIVE REVIEW

Abstract Background The number of older Irish adults who identify as Lesbian Gay Bisexual or Transgender (LGBT) is growing. Various barriers exist which can deter LGBT older adults from effectively engaging with healthcare services. These include, and are perpetuated by, heteronormative (and cis-normative) culture within the healthcare setting, and inadequate physician knowledge of LGBT healthcare needs. Methods The aim of this research is to enhance our awareness and understanding of the challenges experienced by LGBT adults in later life. Key electronic databases were interrogated using a considered search strategy and selected based on specific inclusion criteria. Results Key themes which emerged were; health disparities of LGBT older adults compared with the wider non-LGBT population; the impact of minority stress on the burden of chronic disease; the role of marginalisation/discrimination as a barrier to engagement with health services; institutional erasure of sexuality, particularly in the setting of long term care; the importance of non-biological chosen family, particularly in the context of advance care planning and preparation for end of life; heteronormativity, cis-normativity and physician bias in the healthcare setting. Conclusion It is imperative for physicians and allied health professionals to familiarise themselves with the many barriers faced by LGBT older adults when interacting with healthcare services, as well as their unique concerns in later life. In doing so, we can ensure the provision of inclusive and culturally-competent care for all LGBT older adults in Ireland, enabling them to age well in a health system that is sensitive to their needs.

Bridging The Gap: Demanding 1-1 Representation of Dark-Light Skin Tones Within Medical Lectures/Resources

Being a good physician means having the ability to recognize diseases in all kinds of individuals. This is especially true for skin lesions (e.g., acne, cancer), which present differently based on skin color and tone. Developing skin-tone-dependent diagnosing skills depends on the medical education (e.g., lectures, medical textbooks, and online board certification prep resources) and hands-on clinical experiences doctors receive. We find it alarming that medical students' gold standard resources overrepresent light skin and underrepresent dark skin to the point where many medical students can recognize a lesion on white skin but fail to recognize a similar lesion on dark skin. This lack of representation perpetuates race as a social determinant of health, leading to missed diagnoses and diagnosis at a later/worse stage in people of color. To combat this underrepresentation within medical education, we propose the Liaison Committee on Medical Education (LCME) amend Accreditation Standard 7: Curricular Content, Subsection 7.6: Cultural Competence and Health Care Disparities. The amendment is to include 1 of the 2 following policy changes, with preference for the top-down mandate: 1) Top-down Mandate: An objective measure and subsequent goal (1:1 representation) for the representation of skin of color within a school's medical lectures, which is evaluated by an LCME-approved curriculum committee and mandated for schools wishing to continue to be LCME accredited. 2) Bottom-up Individualized Institutional Goals: A requirement for schools to choose their own goal, create their committee, and evaluate their progress. These progress reports will be submitted to the LCME annually.

Home Health Nurses’ Journey Toward Culture-Sensitive/Patient-Centered Skills: A Grounded Theory Study

Introduction. Home health patients, who are members of minority and vulnerable groups, suffer disparate outcomes. Patient-centered care (PCC) and culturally-competent care (CCC) aim to facilitate high-quality, equitable care. How home health nurses incorporate PCC and CCC principles into their assessment and care-planning practices has not been -investigated. This study answers the question, “ What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?” Methods. Home health nurses (n= 20) were recruited into this grounded theory study from agencies around the United States via flyers, websites, and contacts. We conducted in-depth recorded interviews using a semi-structured interview guide to ask questions about nurses’ assessment and care-planning practices, their understanding of CCC and PCC principles, and facilitators/barriers to CCC and PCC practice. Results. Participants primarily gained their CCC and PCC assessment and care-planning skills through a “seat of your pants,” trial-and-error process, with little educational or agency assistance. They combined caring, diverse patient experiences, and critical, creative self-reflection on their experiences to gradually learn helpful, though not optimal, CCC and PCC strategies. However, they reported numerous barriers that discouraged or distressed them in their quest to deliver culturally-competent and patient-centered care. Only a few nurses demonstrated the resilience to overcome these challenges creatively and happily. Conclusion. If we accept that patient-centered care and culturally competent care are key elements of high-quality, equitable care, this grounded theory may help home healthcare clinicians, administrators, educators, and policy-makers identify impact points for enhancing CS/PC practices.

The Use of Simulation to Enhance LGBTQ+ Care Competencies of Nursing Students

Current literature demonstrates that a lack of education in nursing programs regarding culturally-competent care for lesbian, gay, bisexual, transgender, queer, and other sexual identities outside of the heterosexual norm (LGBTQ+), results in health disparities. A simulation experience using a narrative script and a high-fidelity manikin was incorporated into an undergraduate nursing course (N = 91). A simulation scenario designed to facilitate the delivery of healthcare to a transgender identifying patient was piloted within the undergraduate curriculum. A pre-simulation and post-simulation survey served as the evaluation for this pilot program. Paired sample t-tests compared participants’ (n = 77) attitudes, beliefs, comfort, and competency regarding providing care for LGBTQ+ individuals. There was a significant difference in pre- and post-simulation scores. Results demonstrate that simulation can be an effective educational intervention for promoting knowledge related to culturally-sensitive LGBTQ+ healthcare.

Ntersectionality: The Role of the Athletic Trainer in Providing Culturally Competent Patient-Centered Care

ntersectionality: The Role of the Athletic Trainer in Providing Culturally Competent Patient-Centered Care

840 Reducing healthcare disparities using enhanced recovery after surgery for cesarean delivery

Enhanced recovery after surgery programs aim to achieve impartial surgical healthcare through the utilization of standardized protocols. Our objective was to compare disparities in hospital length of stay (LOS) by race-ethnicity before and after the implementation of an enhanced recovery after surgery for cesarean delivery (ERAS-CD) program. An ERAS-CD program was implemented at our institution in October 2018. Using a healthcare analytics platform, we compared disparities in LOS after delivery (calculated from time of delivery to discharge) and 30-day readmission rates (defined as any inpatient hospitalization within 30 days of delivery) based on race-ethnicity before (October 2017 – September 2018) and after (November 2018 – October 2019) ERAS-CD implementation. We excluded any outliers, defined as a LOS >25 days using the Academic Medical Center model, and any patients without reported race-ethnicity. Student’s T test and Chi square were used for comparison with p<0.05 considered statistically significant. Continuous data are expressed as mean +/- standard deviation. After applying exclusion criteria, 1520 patients underwent cesarean delivery in the pre-ERAS-CD group and 1522 in the post-ERAS-CD group. Before ERAS-CD implementation, Asian, Black, Hispanic and patients of other race-ethnicity all had a significantly longer mean LOS after cesarean delivery as compared to White patients. After ERAS-CD implementation, this disparity was no longer seen (Table 1). 30-day readmission rates were similar pre- and post-ERAS-CD in patients of all race-ethnicities. After the implementation of an ERAS-CD program, we saw a reduction in healthcare disparity as it relates to hospital LOS, without an increase in readmission rates. We believe that consistent patient education and multidisciplinary standardized guidelines contributed to this effect. Although our findings show promise in addressing known healthcare disparities, one must equally practice cultural competency and patient-centered care to achieve truly impartial surgical healthcare.

Strengthening Child-centred Health Systems response: what happens with migrant children?

Abstract Migrant children are especially vulnerable to the challenges experienced during the migratory process and its integration in the host country, even more, if they are unaccompanied. Child-centred Health Systems responses are needed, for that reason, the Erasmsus+ project EUVETCARE aims to strengthen the capacity of the professionals and systems to meet the specific needs of this population. A qualitative study allowed a needs assessment of the health and social care professionals in 5 EU countries (Cyprus, Germany, Greece, Italy and Spain). A total of 15 focus groups were carried out (99 participants). Focus groups discussions were transcribed verbatim in local languages and transcripts were analyzed using thematic analysis. Moreover, a literature review informed about the current learning opportunities for professionals in the European context regarding migrant children. Focus groups discussions highlighted some general needs for all professionals such as communicative skills with migrant children and their families as well as cultural competence to deal with these cases. Moreover, participants stressed the need to deal with this population with low levels of health literacy too. Finally, strategies to provide integrated care and meet the major needs of these children were needed. Unaccompanied minors were highlighted as a vulnerable group by participants. In addition, the literature review revealed some gaps in the learning guidelines offer across Europe. Future training for professionals should stress the specific gaps in order to don't replicate existing materials. Furthermore, professionals' voices should be taken into account in the design of these new training to directly answer to their professional needs. Additionally, the needs of migrant children have to be differentiated and appropriated culturally-competent care delivered in order to minimize health inequalities for this group. Key messages Training of healthcare professionals should target culturally-competent case management strategies for minor migrants. The delivery of health care for minor migrants requires major intensity from the health care services.

620: Enhanced recovery after surgery for cesarean delivery: Reducing healthcare disparity

Enhanced recovery after surgery (ERAS) programs aim to achieve impartial surgical healthcare through the utilization of standardized protocols. Our objective was to compare disparities in hospital length of stay (LOS) by insurance payer status before and after the implementation of an ERAS protocol for cesarean delivery (CD). An ERAS-CD program was implemented at our institution in October 2018. Using a healthcare analytics platform, we compared disparities in LOS after delivery (calculated from time of delivery to discharge) based on insurance payer status before (January-June 2018) and after (January-June 2019) ERAS implementation. Student’s T test and Chi square were used for statistical comparison with p< 0.05 considered statistically significant. Continuous data are expressed as mean +/- standard deviation. 883 patients underwent CD in the pre-ERAS group, 763 (86.4%) of whom had private insurance and 120 (13.6%) of whom had Medicaid. In the post-ERAS group, 892 patients had a CD; 783 (87.8%) were privately insured and 109 (12.2%) had Medicaid. Pre-ERAS, patients with Medicaid had a significantly longer mean LOS after CD than those with private insurance (3.33 +/- 1.15 days vs 3.15 +/- 0.90 days, p=0.05). After ERAS implementation, this disparity was no longer seen (2.87 +/- 1.09 days vs 2.69 +/- 0.87 days, p=0.18). Re-admission rates were similar pre- and post-ERAS; 10.8% vs 9.2%, p=0.69 for patients with Medicaid and 3.0% vs 4.0%, p=0.29 for privately insured patients. After the implementation of an ERAS-CD program, we saw a reduction in healthcare disparity as it relates to hospital LOS among patients with Medicaid vs private insurance. We believe that patient education and multidisciplinary, standardized guidelines contributed to this effect. Although our findings show promise in addressing known healthcare disparities, one must equally practice cultural competency and patient-centered care so as to achieve truly impartial surgical healthcare.