Cultural Competence In Health Care Research Articles

Assessing Cultural Competence at a Local Hospital System in the United States

Cultural competence in health care has come to the forefront with the changing demographics in the United States. Standards have been created by the Office of Minority Health for culturally appropriate health care. This article presents the findings of one hospital system's cultural competency assessment. Employee surveys and patient and physician focus groups were conducted to gain insight into cultural differences and challenges encountered in this system. Statistically significant effects of ethnicity and gender on language skills and awareness, as well as differences in awareness and knowledge by the respondent's employment position, were found. Patient concerns included access to care and respect from staff. The need for cross-cultural education and training for all health care delivery personnel was reinforced. Cultural competency will not be achieved if education, attention to diversity, trained interpreters, and the understanding that social factors have a profound influence on health and health outcomes are not considered.

Cultural Competency in Health Care and Its Implications for Pharmacy

As the United States becomes more diverse, a patient's cultural influences on health outcomes and health care decision‐making and delivery need to be considered. Cultural influences affect a patient's decision to take drug therapy and concomitant alternative therapies. Seven components have been identified to improve culturally competent care in a variety of practice sites. The first component to developing culturally competent practices involves the analysis of self and system attitudes and practices toward various cultures. In the second component, health care providers should increase their knowledge about the cultures they serve through different patient assessment techniques, readings, and community activities. The third component involves improving cross‐cultural communication by being aware of differences in social norms, assessing health literacy, using interpreters, knowing another language, and using bilingual patient education materials. In the fourth component, pharmaceutical care plans should accommodate cultural preferences such as the use of herbs, spiritual healers, and additional family decision‐makers. Therapeutic plans should be negotiated between patient and provider to optimize outcomes. The fifth component discusses health care provider and system involvement in the community through health fairs, ethnic festival participation, and communication with cultural decision‐makers to help provide culturally competent care by fostering communication ties. In the sixth component, knowing and following regulations such as the federal Culturally and Linguistically Appropriate Services and the Joint Commission standards for organizational cultural competency can help enhance care for patients from various cultures. In the last component, quality assurance assessments of procedures to improve care for various diverse cultures should be conducted, with findings (in terms of strengths and areas of improvements) shared with other providers and systems. Pharmacists and pharmacy technicians in a variety of systems and practices can improve care to patients with differing cultures by using these seven components to enhance culturally competent care.

Diversity in Genetic Counseling: Strategies from the LEND Network

To the Editor: We appreciate the article published 17 June 2008, “Diversity in Genetic Counseling: Past, Present and Future,” and its illumination of the issue concerning a lack of ethnic and racial diversity in genetic counseling. The lessons learned regarding the experiences of other health professions offer a solid basis for developing similar initiatives in the field of genetic counseling. Experiences within the network of Leadership Education in Neurodevelopmental Disabilities (LEND) Programs offer additional strategies to address diversity. LEND programs are federally funded, advanced level interdisciplinary training programs committed to training leaders in the field of neurodevelopmental and related disabilities. There are currently 38 programs in the U.S. In 2005, the Association of University Centers on Disabilities (AUCD) announced a grant opportunity within the LEND network to increase leadership training in genetic counseling programs, to increase the genetic content in LEND curricula and to develop innovative means to increase the number and diversity of genetic counselors serving children with special health care needs and their families. Three 3-year projects were funded. They included the LEND programs at Albert Einstein College of Medicine, University of Wisconsin, and Virginia Commonwealth University. Funding was provided through the Health Resources and Services Administration’s Maternal and Child Health Bureau.

Cultural Competence in Health Care: A Guide for Professionals

Cultural Competence in Health Care: A Guide for Professionals

Cultural competency in healthcare: Learning across boundaries

During 2006-2007, 1 was fortunate to study and work as a Fulbright Scholar at the Institute for Professionalism and Ethical Practice, Children's Hospital, Boston. As part of my Fulbright experience in the United States, 1 collaboratively developed a cross-cultural educational experience between the faculty of the Institute of Professionalism and Ethical Practice and of the Chair of Medical Psychology, San Paolo Hospital, Milan to explore how patient-centered care is interpreted and enacted across cultures. Both groups wrote a patient-centered dialogue based on the same clinical scenario. Dialogues were exchanged and each group commented on the other's dialogue during a videoconference. Both groups identified responding to the patient's illness experience and emotions as central to patient-centeredness, while patient autonomy was understood differently. Constructing an ideal patient-centered dialogue and the discussion with a group of another culture enabled participants to become more aware of their implicit assumptions about patient-centeredness. This experience helped both groups to better understand our 'blind spots' and enhance our cultural humility. It was thanks to the 'other' that we ultimately learned more about ourselves.

Clinical Cultural Competence and the Threat of Ethical Relativism

Taking seriously the value of cultural competence in healthcare requires at least three general commitments. First, it involves accepting the view that patients' health beliefs and behaviors are influenced to a significant degree by their own social and cultural practices. Second, it requires careful attention to how health professionals typically respond to patients' different social and cultural standards at various levels of the healthcare delivery system. And third, it calls for developing interventions that are sensitive to these first two issues to assure the delivery of quality healthcare for culturally diverse patients. This much is plain, insofar as we are talking about the broadest of commitments necessary to support the value of cultural competence in healthcare. But what other, more specific commitments are implied in accepting the value of cultural competence?I thank the guest editors of this issue, John R. Stone and Erika Blacksher, for their helpful suggestions on an earlier draft of this paper.

Cultural Competence in Health Care and Its Implications for Pharmacy

Pharmacists are caring for more individuals of diverse age, gender, race, ethnicity, socioeconomic status, religion, sexual orientation, and health beliefs than in previous decades. Not all residents of the United States equally experience long life spans and good health. Health disparities in various cultures have been documented. One critical aspect of reducing health disparities is moving health care providers, staff, administrators, and practices toward increased cultural competence and proficiency. Effective delivery of culturally and linguistically appropriate service in cross‐cultural settings is identified as cultural competence. Culture is a dynamic process, with people moving in and out of various cultures throughout their lives. The failure to understand and respect individuals and their cultures could impede pharmaceutical care. Incongruent beliefs and expectations between the patient and pharmacist could lead to misunderstandings, confusion, and ultimately to drug misadventures. Models and frameworks have been developed that provide descriptions of the process by which individuals, practice settings, and organizations can become culturally competent and proficient. This article, the first in a five‐part series, presents an overview of issues related to cultural competence in health care with an emphasis on the pharmacy profession. Also provided are definitions for cultural competence and related terms, a brief overview of health disparities and challenges to the common morality, and a discussion of models and frameworks that describe pathways to cultural competence and proficiency.

Teaching Cultural Competence to Reduce Health Disparities

As part of the Genesee County, Michigan, REACH 2010 initiative, a new course, Cultural Competence in Health Care, was developed at the University of Michigan-Flint. The objective of this course is to improve the cultural competence of future health and human service providers and to reduce persistent racial and ethnic health disparities. This article describes the course and the important role that REACH 2010 partners played in its development and implementation. Course materials, methods, and student feedback are summarized, along with lessons learned.

The internationalisation of the nursing curriculum

This paper explores the complexities of the internationalisation of the nursing curriculum. It discusses one aspect of the international activity within a British University, a short student exchange programme and how this facilitates personal and professional learning. The paper focuses on the educational, professional, geo-political and philosophical ideas that influenced the development of these exchanges. The process of facilitating cultural and professional learning following Campinha-Bacote's model (1999) [Campinha-Bacote, J., 1999. A model and instrument for addressing cultural competence in health care. Journal of Nurse Education 38 (5) 203-7] for developing cultural competence is applied and discussed.

Addressing Barriers to Cultural Competence

Although the need for cultural competence in healthcare is well established, the integration of cultural competence approaches in most healthcare settings is not yet a reality. A review of the literature reveals several factors in clinical settings that pose barriers for health providers. The purpose of this article is to explore the barriers to cultural competence faced by nurses and to examine the role of staff development in addressing these barriers.

Cultural considerations in interprofessional education and practice

Promoting cultural competency in health care was examined from the Canadian perspective, and explored practice environments and educational programs for future health professionals that foster cultural awareness and support culturally sensitive care. Many of the issues raised are generic and likely to occur whenever patients' health practices and beliefs differ from conventional Western care. The main theme that emerged with respect to the practice environment was the use of a participatory action approach to foster collaboration with patients, traditional healers and the community. Successful collaboration is likely to result in a blend of ideas and perspectives from traditional health practices and conventional Western health care. With respect to education, programs need to focus on providing opportunities both in the classroom and in the clinical arena for students to work in interprofessional teams. These teams should not only comprise partners from medicine, nursing, physical therapy and other health professions but also include aboriginal paraprofessionals. Pedagogical initiatives also need to incorporate case-based formats and interactive sessions with patients and families. The principles underlying this approach: openness, mutual respect, inclusiveness, responsiveness and understanding one's roles should be fundamental to the delivery of culturally competent health care to all ethnic communities.

Cultural competence: A call to action

C e US SURGEON GENERAL Richard Carmona, RN, MD, MPH, FACS, had a chance encounter that changed his whole life. At the time, Carmona was a 17-year-old high school dropout in New York City. He encountered a man, Sal, who was dressed in a uniform and green beret. During that chance conversation, Sal told Carmona that he needed to do something with his life and encouraged him to join the army. Carmona went on to join the army, obtain his GED, and become a combat medic with the Special Forces in Vietnam.

Perspectives of cultural competence in health care

The aim of this study was to explore the views of one group of healthcare professionals on the importance of cultural awareness in healthcare practice. A qualitative approach was used. Ten nurses of varying age from two counties in Scotland who worked across a range of clinical practice areas were interviewed. The interviews were largely unstructured but included an opening question and prompts for the interviewer A lack of knowledge and understanding was demonstrated by the participants in relation to the diverse cultural groups who constitute the population of this country, and a gap in nurse education and training provision across a range of healthcare areas. Nursing curricula need to include more knowledge and learning about cultural awareness, and nurses need more practical experience of caring for patients from different cultures. The findings assisted in the development of a framework for nurse education that embraces the concept of cultural competency.

Perspectives of cultural competence in health care

Perspectives of cultural competence in health care

The Black–White Perception Gap and Health Disparities Research

Reducing and eliminating racial and ethnic health disparities has become a national research priority. This research agenda requires new research frameworks that encompass the social determinants of health and the translation pathways of these social contexts into physiological morbidity. Within these sociobiological research frameworks, identity and emotions are seen as crucial links in the causal pathways from stressors to biological responses. In this country, the lived social reality of African American individuals is experienced through the color of their skin. Their identity is bound with the racial inequities of our society. It has been suggested that the emotions of anger and frustration resulting from this institutionalized racial discrimination are an emotional causative pathway to the pathophysiology contributing to the health disparities experienced by African Americans. However, as much as we espouse the concept of cultural competency in health care, until recently, there has been very little honest dialogue about how race and racism influences health. This article will explore the Black-White cultural perception gap and attempt to provide insight on the relationship to African American health and implications for health disparities research.

CULTURAL CONSIDERATIONS IN End-of-Life Care

“Cultural competence” has gained a certain cachet in health care, so much so that an Internet search of the phrase brings up more than 40,000 results. Yet racial and cultural disparities in health and health care persist, perhaps no more heartrendingly so than in end-of-life care. A recent study of the experience of dying in nursing homes noted that “lack of attention to cultural needs,” when it occurred, was a “predominant factor” in a person’s experience of dying.1 How can this be when there’s so much talk of cultural competence in health care?

Australian women and heart disease: Trends, epidemiological perspectives and the need for a culturally competent research agenda

Heart disease commonly manifests as acute coronary syndromes (unstable angina pectoris, or myocardial infarction) and heart failure (HF). These conditions are major causes of morbidity and mortality in Australia and internationally. Australian faces particular challenges in health care delivery given the cultural and ethnic diversity of society and unique issues related to rurality. These factors have significant implications for health care delivery. Following an acute cardiac event women have poorer outcomes: higher mortality rates, higher incidence of complications and greater psychological morbidity compared with men. Language barriers, socioeconomic factors, psychological trauma related to migration and alternate health seeking behaviors and varying perceptions of risk are likely to impact adversely on health outcomes. Selfmanagement in chronic cardiovascular disease underscores the importance of models of care that incorporate aspects related to self-care and promotion of adherence to primary and secondary prevention initiatives. Implicit in this statement is the inclusion of the individual in negotiating and developing their care plan. Therefore health professionals need to be aware of the patient’s needs, values, beliefs and health seeking behaviours. These factors are strongly influenced by culture and ethnicity. The cultural diversity of Australian society mandates cultural competence in health care. This paper presents an overview of nursing science related to women and heart disease in Australia and suggests directions for culturally-competent research and development and evaluation of models of care to improve health outcomes for all Australians.

Cultural Competence in Health Care

Consequently, speech-language pathologists and audiologists working in the health care setting must be prepared to provided services that are respectful of and responsive to cultural and linguistic needs of a diverse patient population. For instance, health care disparities in racial and ethnic minorities in the United States can no longer be discounted or ignored. The Institute of Medicine (IOM) Report, Unequal Treatment, summarized a growing body of literature documenting racial or ethnic differences in health care outcomes for many different diagnoses including coronary artery disease, diabetes, cancer, and HIV. Health care providers have to overcome cultural and communication barriers that may negatively influence appropriate diagnosis and treatment, provide culturally competent health care, and create health care systems that provide equitable access to all clients/patients.

Performance measures and their benchmarks for assessing organizational cultural competency in behavioral health care service delivery.

A project is described in which performance measures of cultural competency in behavioral health care were selected and benchmarked. Input from an Expert Panel representing the four major ethnic and racial groups in the U.S. and persons with extensive experience in implementing cultural competency in health care, along with survey data from 21 sites were used in the process. Measures and benchmarks are made specific to organizations that administrate care networks, and to service entities that deliver care. Measures were selected to parallel an implementation process, and benchmarks were set at "gold standard" levels.

Cultural Competence in Health Care: A Practical Guide

A manual written for health care professionals who care for patients from diverse religious and cultural backgrounds. First developed by doctors and nurses at Children's Hospital in Boston, it contains detailed, practical information for working with dozens of religious and cultural groups and is designed to help providers best meet needs of their ethnically diverse patients while satisfying stringent new regulatory standards for culturally sensitive care.