Process Of Cultural Competence Research Articles

Improving cultural competency in advanced practice providers at an academic medical center

Racial health disparities and healthcare provider bias are concerning problems. Cultural competency training (CCT) is effective to address this bias, resulting in improved patient outcomes. This project aimed to increase cultural competency among advanced practice providers (APPs) who completed CCT. The Process of Cultural Competence in the Delivery of Healthcare Services model and its primary constructs of cultural awareness, skill, knowledge, encounters, and desire guided this work, along with other evidence. Eighteen APPs completed the training and tests, demonstrating statistically significant score increases in overall cultural competency (p < .001), cultural awareness (p = .030), cultural skill (p = .017), cultural knowledge (p = .002), and cultural encounter (p < .001). An increased cultural desire was not statistically significant (p = .120). Evidence reviewed demonstrates how this work can guide future quality improvement efforts to implement evidence-based CCT professional development for all healthcare workers.

Testing the Assumptions in the Process of Cultural Competence in the Delivery of Healthcare Services Using Empirical Data, Focusing on Cultural Awareness.

Encounters with children of foreign origin call for school nurses' cultural competence during the health visits. This study aimed to investigate the statistical associations between the cultural constructs described by the Process of Cultural Competence in the Delivery of Healthcare Services (PCCDHS) model and whether school nurses' cultural encounters, cultural knowledge, and cultural skill could statistically predict their cultural awareness. Spearman correlation and hierarchical regression analyses were conducted using cross-sectional secondary data from 816 Swedish school nurses. The cultural constructs in the theoretical description of the PCCDHS model guided the selection and sorting of the items on cultural competence. The constructs of cultural knowledge, cultural skill, cultural encounters, and cultural awareness were positively correlated with each other. However, becoming culturally aware was not statistically predicted by included cultural constructs (R2 = 13.4, p = .06). Despite the interrelations between the investigated cultural constructs of the PCCDHS model, understanding cultural awareness development requires further empirical testing.

Converging Cultures: Partnering in Affirmative and Inclusive Health Care for Members of the Lesbian, Gay, Bisexual, and Transgender Community.

BACKGROUND: Members of the lesbian, gay, bisexual, and transgender (LGBT) community suffer from disproportionate rates of physical and mental illness. This population experiences enhanced vulnerability to illness as a result of societal marginalization, known as minority stress, which is compounded by insufficient LGBT education for health care professionals and stigmatizing experiences within medical institutions. AIMS: The aims of this study were to review the literature on LGBT cultural competence interventions; evaluate the effect of a 4-hour pilot workshop, "Converging Cultures," on the development of cultural competence; and make recommendations for best practices in developing LGBT cultural competence among health care providers. METHOD: The study used a repeated-measures pre-/posttest design among a sample of 130 hospital employees and undergraduate nursing students. The GAP (Gay Affirmative Practice scale) scale, a measure of LGBT-affirmative practice beliefs, and an objective Knowledge Quiz were administered before and directly following the training. The posttest included three open-ended questions to elicit self-reflection and capture the development of cultural competence according to Campinha-Bacote's theory, the process of cultural competence in the delivery of healthcare services. RESULTS: Paired sample t tests revealed significant improvement on the GAP and Knowledge Quiz. Open-ended responses reflected the five constructs of Campinha-Bacote's theory. CONCLUSIONS: Self-reflection is an essential component of LGBT cultural competence education to uncover personal biases that affect clinical behavior. Future educational efforts for sexual and gender minorities should strive to avoid inadvertent marginalization of LGBT people through integration of concepts with existing curricula and workplace training.

LGBT inclusivity in health assessment textbooks.

Lesbian, gay, bisexual, and transgender (LGBT) people make up 4% of the adult population in the United States; however, it is unclear if there is sufficient material in nursing textbooks for students to learn how to provide care for sexual minority populations. A content analysis of two commonly used health assessment textbooks was completed to identify material that prepared nurses for LGBT patient interactions. Topics such as gender neutrality, same-sex partners, and other terms referring to LGBT persons were considered LGBT content. Campinha-Bacote's The Process of Cultural Competence in the Delivery of Healthcare was used as the theoretical framework to assess the textbooks' content on five constructs: awareness, knowledge, skill, encounters, and desire to learn. Eleven pages in one text and 14 in the other had at least one line that addressed LGBT health assessment. Investigators found content related to the constructs of awareness, knowledge, and skill in both textbooks. In all cases, the content was limited in depth; both textbooks lacked exemplars and application of LGBT-specific health content. Inclusion of this information in textbooks or other learning resources is needed to enhance nurses' cultural knowledge and skill to improve health care outcomes within this vulnerable population.

Truth Telling as an Element of Culturally Competent Care at End of Life.

Nondisclosure of terminal prognosis in the context of intercultural interactions can cause moral distress among health care providers guided exclusively by informed consent. However, cultural humility can show that revealing and withholding prognostic information are two equally valid paths to the goal of protecting the patient from harm. Assumptions and history giving rise to the preference for truth telling in the United States(US) are examined. Principles of biomedical ethics are described within the context of US, Chinese, and Latin American cultures. The process of cultural competence in the delivery of health care services is explained and introduces the concept of cultural humility. By focusing more on biases and assumptions brought forth from the dominant culture, health care providers may experience less moral distress and convey increased caring in the context of intercultural interactions and nondisclosure of prognosis of a terminal illness.

Cultural Respect Encompassing Simulation Training: Being Heard About Health Through Broadband.

BackgroundCultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity – defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire – of the streamed simulations.Design and MethodsIn this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted.ResultsForty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST.ConclusionsCultural sensitivity education using live video-streaming and simulation can contribute to health professionals’ learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training.Significance for public healthThere are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals' learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings.

Australian nursing and midwifery educators delivering evidence-based education in Tanzania: A qualitative study

Since 2011, Western Australian nursing and midwifery educators have been providing evidence-based continuing education to Tanzanian health professionals. Despite thorough preparation before departure, differences in local resource levels and available facilities have necessitated impromptu adaptation of curriculum content and delivery methods to ensure an effective program was delivered.This study explored the personal, cultural and teaching strategies utilised by Western Australian nursing and midwifery educators in Tanzania and examined if the transferability of education packages was influenced by the educators' cultural competence. Using a qualitative exploratory approach, data was collected from 15 Western Australian nursing and midwifery educators using a demographic survey and in-depth individual semi-structured interviews. The core themes identified from the analysis were Determination to learn, Assessing needs, Communication skills and Greater understanding. These findings are described using the conceptual framework of Campinha–Bacote's The Process of Cultural Competence in the Delivery of Healthcare Services.With appropriate levels of cultural competence, international health professionals can be effective at providing ongoing professional development to colleagues in developing country contexts, which may help address difficulties with retention and motivation of staff. It is essential that prior to departure cultural competence training is provided to educators to enhance their teaching capacity and effectiveness in international settings.

Curricular Integration and Measurement of Cultural Competency Development in a Group of Physical Therapy Students

Abstract&#x0D; &#x0D; Introduction and Background&#x0D; &#x0D; The link between cultural competence and effective physical therapy encounters is established. Physical therapist educational programs face the challenge of fostering the cultural competence of students in effective and meaningful ways within the curriculum. They also face the challenge of measuring the development of cultural competency to establish efficacy in the curriculum. One program measured the development of cultural competency in its students using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version (IAPCC-SV) before and after the program’s various educational opportunities immersed throughout the curriculum that could serve to increase cultural competency. In the three-year curriculum, the students participated in both mandatory and voluntary experiential learning opportunities. Required didactic presentations and activities were integrated throughout the curriculum and designed to enhance cultural competency. Voluntary experiences included providing service and/or leadership to a student-run pro bono clinic. The program was interested in whether cultural competency increased after these experiences and whether leadership opportunities or additional hours of voluntary service beyond the class median caused increases that exceeded the minimal detectable change (MDC) reported in the literature.&#x0D; &#x0D; Methods &#x0D; &#x0D; All students completed the IAPCC-SV at the beginning of their Doctor of Physical Therapy education and again at the end of their final year of didactic curriculum. &#x0D; &#x0D; Results&#x0D; &#x0D; For the class of 2011, a Wilcoxon signed ranks test noted a significant increase in IAPCC-SV scores from pre-test (56.51 +/- 4.82) to post-test (64.16 +/- 6.19) in the Class of 2011, p  .001. For the class of 2012, a Wilcoxon signed ranks test noted a significant increase in IAPCC-SV scores from pre-test (58.87 +/- 5.67) to post-test (64.13 +/- 5.47) in the Class of 2012, p  .001. Sixteen students from the class of 2011 and 13 from the class of 2012 exceeded the 8.57-point MDC of the IAPCC-SV. &#x0D; &#x0D; Discussion and Conclusion &#x0D; &#x0D; Exposure to a variety of cross-cultural encounters throughout a physical therapy curriculum significantly increases self-rating of cultural competency in these graduate students. Students who take advantage of volunteer leadership roles in extensive cross-cultural encounters may be more likely to achieve an increase that exceeds the MDC on the IAPCC-SV. These results are particularly interesting given that the students themselves were ethnically homogeneous and did not experience cultural diversity within the constituents that made up their class or faculty.

Nursing students′ cultural ability of two vocational colleges in Shanghai

Objective To investigate nursing students′ cultural ability of two Shanghai vocational colleges in order to provide the scientific basis of teaching methods and clinical practice for improving nursing students′ cultural ability. Methods By adopting inventory for assessing the process of cultural competence among health care professionals revised(IAPCC-R), 529 nursing students in two vocational colleges were investigated. Results The average score of nursing students′ cultural competence was (65.53±6.50), 91.1% of the students were in general level; 8.1% of the students were in high level, 0.8% nursing students were without cultural competence, no one was found as a proficient person in this area. There was significant difference between students in different colleges (t=3.714, P<0.001); There was no significant difference among students in different grades (F=3.714, P=0.452). Conclusions Generally nursing students′ cultural ability in Shanghai was not high, so efforts are needed to increase the humanities curriculums in colleges and teaching staffs′ culture ability as well as the examinations of cultural ability, which are very important for nursing students to provide professional humanistic care services for patients after they work in hospital as nurses. Key words: Students, nursing; Vocational nursing college; Cultural competence

The Challenge of Cultural Competency in the Multicultural 21st Century: A Conceptual Model to Guide Occupational Therapy Practice

Background: Occupational therapists increasingly encounter clients from diverse cultural backgrounds and need to meet their professional obligation of delivering culturally competent practice. Yet the process of cultural competency is poorly understood in occupational therapy practice. There is a need for a clear understanding of the meaning and process of cultural competency as it is enacted in practice with a wide range of individuals from culturally diverse backgrounds.Aim: To investigate the process, stages, characteristics, and requirements of cultural competency as practiced by experienced occupational therapists.Method: Semi-structured interviews were carried out with 13 community occupational therapists experienced in delivering occupational therapy services in clients’ homes in a culturally diverse area in London, England.Findings: Interview data were analyzed and ordered into the format of a conceptual process model where cultural competency formed the core concept. The model of cultural competency that emerged from this study comprised six stages: cultural awareness, cultural preparedness, a cultural picture of the person, cultural responsiveness, cultural readiness, and cultural competence.Conclusion: Cultural competency is a complex process that needs to be based on underpinning occupational theory and actualized at the level of practice. Further research is needed to test out the model and illuminate the process of cultural competency in different areas of occupational therapy practice. (Less)

Providing Culturally Competent Care in Home Infusion Nursing

All health care providers, and particularly nurses who are on the front lines of patient care, must be skilled in providing culturally appropriate and competent care. Cultural competence needs to be guided by a philosophical framework. This article was written to describe cultural care in the context of home infusion nursing using the Process of Cultural Competence in the Delivery of Healthcare Services model. The model is used to provide structural reference in order to offer nursing care to members of diverse cultures. The 5-part model gives an overarching conceptual orientation to assist the nurse in providing quality care that is culturally sensitive.

Review of Self-Administered Instruments to Measure Cultural Competence of Nurses - Focused on IAPCC &amp; CCA

Purpose: As Korean society has rapidly become multicultural in the last few decades, it is essential for nurses to become culturally competent to provi de effective care for ethnically and culturally diverse populations. Considering the advantages of standardized instrument, there is a need to evaluate current cultural competence instruments to assess adaptability to Korean nurses. Methods: Using Macdowell’s instrument evaluation guideline, a review and evaluati on was done of the Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals (IAPCC) and Cultural Competence Assessment (CCA), which were both developed based on cultural competence theoretical models and have been commonly used in nursing research. Two other Korean instruments were also evaluated. Results: The instruments reviewed have limitations in reliability and validity, as well as cultural background and development process, for measurement of cultural competence in Korean nurses. Conclusion: The results of this study indicate that it is necessary to discuss and agree on a definition of what cultural competence is and to develop instruments to measure cultural competence in Korean nurses.

Development of a Multidisciplinary Course in Cultural Competence for Nursing and Human Service Professions

A multidisciplinary teaching model was used to develop a pilot course for students in the human service professions of nursing, education, and social work to gain additional knowledge and skills in providing diverse clients with culturally appropriate services during field and clinical experiences. This article focuses on the process of developing a multidisciplinary course in cultural competence that is consistent with a university mission to prepare students for leadership and service in an increasingly diverse society. Using the theoretical framework of Campinha-Bacote's process of cultural competence and the six developmental stages of intercultural competence in Bennett's developmental model of intercultural sensitivity, the course content covered the five components of cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desire. Students' written reflections indicated growth in acquisition of cultural knowledge, skills, and desire. Faculty collaboration across disciplines included the benefits of an enriched knowledge base and shared scholarship.

Addressing Cultural Heterogeneity Among Hispanic Subgroups by Using Campinha-Bacote's Model of Cultural Competency

Campinha-Bacote's model "The Process of Cultural Competence in Delivery of Health Care Services" is used to describe Hispanic cultural heterogeneity and to guide nurses in providing culturally competent and sensitive holistic care to individuals from different Hispanic subgroups. But for nurses to do so, healthcare organizations also must make the appropriate resources and structural supports available to them.

Enabling nursing students to become culturally competent – a documentary analysis of curricula in all Swedish nursing programs

Research has shown that majority of nurses feel that they lack relevant knowledge about immigrant's cultural backgrounds, and therefore, feel incompetent in providing these patients with good care. Last year alone, 4520 nursing students graduated from nursing schools throughout Sweden. Later on, they will meet and treat people from diverse cultural backgrounds and consequently, it is crucial that their educational training prepares them for their future work in a multiethnic society. The aim of this study was to investigate whether the nursing curricula in Sweden's nursing schools provide students with the necessary tools for becoming culturally competent. The present study was based on two main questions: (i) Do the present educational plans and courses provide nursing students with the opportunity to become culturally competent? (ii) How do the contents of the educational plans match the contents of the course plans? The study was conducted using a quantitative documentary analysis, where the authors analysed the curricula of 26 nursing schools in Sweden and then compared them to the theoretical frame of reference 'The Process of Cultural Competence in the Delivery of Healthcare Services', a model written by Campinha-Bacote. The results showed that 69% (18/26) had included the concept of culture in their educational plans, whereas 77% (20/26) had included this in their courses. In all, 15% (78) from a total of 504 curricula had included the concept of culture in some way or another. However, the analysis found that only three schools provided students with specific training on the topic. Conclusively, the results showed that nursing students were not prepared for their work in a multiethnic society and nursing education in Sweden has failed to implement existing research into the nursing curricula.

Cultural Competence of North Carolina Nurses

This study reports the survey findings of self-reported cultural competence of a convenience sample of 66 registered nurses of varying ages, gender, ethnicity, educational backgrounds, and experience in North Carolina. Campinha-Bacote's model of cultural competence and Benner's model of clinical skills acquisition serve as the conceptual frameworks. The process of cultural competence among health care professionals, developed by Campinha-Bacote, is used to measure cultural competence in participants. In addition to descriptive statistics, bivariate analysis of variance was conducted to compare means of cultural competence scores of different groups. Findings indicate that level of education, nursing experience, and continuing education are factors that promote cultural competence, whereas gender and race/ethnicity have no bearing. In addition, qualitative data generated four themes: language or verbal communication barrier, religious beliefs, different health beliefs and behaviors, and culturally inappropriate nonverbal communication. Implications of these findings for nursing education, practice, and future research are elaborated.

Cultural Aspects of Bipolar Disorder: Interpersonal Meaning for Clients and Psychiatric Nurses

Bipolar disorder is a complicated mental illness to diagnose and treat. The symptoms of the disorder cause a multitude of fluctuations in mood and behavior, affecting the way individuals function and interact with others on a daily basis. Individuals diagnosed with bipolar disorder experience symptoms within a framework that is grounded in their cultural beliefs, values, and norms. Culture is a complex and personal biopsychosocial phenomenon that provides meaning within life for an individual, a group, or a community. It is essential that psychiatric-mental health (PMH) nurses understand the role of culture and integrate this knowledge into the biopsychosocial care of clients. The development and maintenance of the interpersonal therapeutic relationship between PMH nurses and their clients requires the use of a cultural framework, which refers to the connection of culture and cultural competence. The purposes of this article are to define culture and the process of cultural competence, provide a brief overview of bipolar disorder, propose the use of a cultural framework for bipolar disorder, and discuss the implications for PMH nurses who care for culturally and ethnically diverse clients.

Reliability and validity of three cultural competency measures

Context and setting Since the Liaison Committee on Medical Education has required that all medical schools in the USA offer cultural competency training, several surveys have been developed to measure cultural competency. However, these cultural competency measurements have neither been compared nor applied to a non-Englishspeaking setting. This report presents the psychometrics of 3 instruments tested in a Taiwanese medical school, where a cultural competency curriculum was recently introduced. Why the idea was necessary Due to globalisation, the ethnic make-up of Taiwan’s population is becoming increasingly diverse. There is an urgent need for cultural competency training in Taiwan, and reliable and valid assessment tools are essential to evaluate its effectiveness. What was done In May 2006 we recruited 90% (237 ⁄262) of our Year 3 and 4 medical students to fill out a survey containing the Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals-Revised (IAPCC-R), which has 5 subscales (cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire), the California Brief Multicultural Competence Scale (CBMCS), which has 4 subscales (multicultural knowledge, awareness of cultural barriers, sensitivity to consumers, sociocultural diversities), and an instrument designed to measure the preparedness of US residents to deliver cross-cultural care (CCC), which has 2 subscales (self-reported preparedness and self-reported skill levels). Within 3 weeks, 78 students volunteered to take the retests. These instruments were chosen because they are reported to have good psychometric properties with large testing sample sizes. We analysed the data with SAS 9.1. Evaluation of results and impact The values of Cronbach’s a for internal consistency coefficient ranged from 0.06 to 0.57 in the IAPCC-R subscales, from 0.76 to 0.92 in the CBMCS subscales, and were 0.95 and 0.96 in the CCC instrument’s subscales. These results indicate that the IAPCC-R does not have good reliability for internal consistency, whereas the CBMCS and the CCC instrument do. Regarding the results of the paired t-tests and the test-retest correlation coefficients, the IAPCC-R and the CBMCS scales do not have good test-retest reliability, whereas the CCC instrument does. The Kaiser)Meyer)Olkin measure of sampling adequacy was computed to examine construct validity and the results indicated that factor analysis was appropriate for all 3 scales. We used parallel analysis to determine the number of factors. Exploratory factor analysis with iterated principal factor extraction and Promax oblique rotation showed that the IAPCC-R does not have an identifiable factor structure. The 2 factors of the CBMCS (correlation coefficient 0.66) were not fully correspondent to the hypothetical 4-factor structure. The results of the CCC instrument revealed that the factor structure was consistent with the hypothetical factor structure (correlation coefficient 0.79). In summary, our results indicate that the CCC instrument has good internal consistency, good test-retest reliability, and good construct validity. The CCC instrument is useful for assessing cultural competency skills, but it does not measure awareness and knowledge. The instruments we tested which contained awareness and knowledge constructs showed problematic reliability and validity, indicating the need to develop better instruments to measure cultural competency in settings like Taiwan.

Many Faces: Addressing Diversity in Health Care

Diversity. The changing demographics and economics of our growing multicultural world, and the long-standing disparities in the health status of people from culturally diverse backgrounds has challenged health care providers and organizations to consider cultural diversity as a priority. The purpose of this article is to present a model that will be helpful in providing culturally competent care. The concept of cultural competence is discussed, The Process of Cultural Competence in the Delivery of Healthcare Services Model is described, and a mnemonic to guide in providing culturally competent care is presented.

The Process of Cultural Competence in the Delivery of Healthcare Services: a model of care.

Several models of service care delivery have emerged to meet the challenges of providing health care to our growing multi-ethnic world. This article will present Campinha-Bacote's model of cultural competence in health care delivery: The Process of Cultural Competence in the Delivery of Healthcare Services. This model views cultural competence as the ongoing process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community). This ongoing process involves the integration of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.