Connecting and becoming culturally competent: a Lakota example

Evaluation of a Cultural Competence Course

This study addressed the perceived lack of an integrated course with theoretical and experiential knowledge related to cultural competence for public health nurses (PHNs) and the importance of providing culturally competent services to clients. Mixed methods were used to examine the effectiveness of a course to increase 76 PHNs’ level of cultural competence. A one-group repeated measures design was used to ascertain the pattern of change in participants over time. The qualitative results complemented the quantitative findings, which were significant in relating to the five dimensions of Campinha-Bacote’s model of cultural competence.

The Use of Talking Circles to Describe a Native American Transcultural Caring Immersion Experience

BACKGROUND

The Christine E. Lynn College of Nursing at the Florida Atlantic University is grounded in the Nursing as Caring theory. A transcultural caring immersion experience for nursing students is provided within the tribal community of the United Keetoowah Band of Cherokees.

AIMS

The purpose of this study was to ascertain descriptions of nursing students' transcultural immersion experience.

DESIGN

A qualitative descriptive approach was used via the Talking Circle method. The consensual qualitative research analytical approach was used to categorize participant responses.

FINDINGS

Six themes emerged that are consistent with the Nursing as Caring theoretical key concepts: (1) persons are caring as diverse human beings, (2) persons care from a unique cultural perspective moment to moment, (3) persons are whole and complete in the moment when engaging with diverse others, (4) personhood is a process of living with meaningful purpose by diverse persons, (5) personhood evolves while caring for diverse others in nurturing relationships, and (6) connecting nursing as both a profession and a discipline occurs among unique and diverse persons.

CONCLUSIONS

The findings from this study reveal the value of providing a transcultural caring immersion experience to students from a Nursing as Caring theoretical perspective.

Socialization of Culture and Coping with Discrimination Among American Indian Families: Examining Cultural Correlates of Youth Outcomes

OBJECTIVE

The current study examines the interrelations between observed parental cultural socialization and socialization of coping with discrimination, and youth outcomes among a sample of 92 American Indian adolescents and their parents in a rural reservation.

METHOD

Path analysis is used to examine the relationships among observed parental socialization (cultural socialization and socialization of coping with discrimination), and youth-reported perceived discrimination, ethnic identity and depression.

RESULTS

Findings reveal that higher levels of observed parental cultural socialization and socialization of coping with discrimination predict lower levels of depression as reported by youth 1 year later. Path analyses also show that observed parental cultural socialization and socialization of coping with discrimination are positively associated with youth ethnic identity.

CONCLUSIONS

These findings point to the importance of integrating familial socialization of culture and coping with discrimination in fostering resilience among American Indian youth.

Alcohol Screening and Brief Intervention as Standard Practice: Working with the American Indian/Native Alaskan Populations

Alcohol use and the resulting problems associated with high-risk drinking in the American Indian/Native Alaskan (AI/NA) population are well-documented, as alcohol misuse has taken an incredible toll on many AI/NA communities. Presently, both overall health issues and alcohol use occur disproportionately within this population. This article provides an updated overview of the impact of alcohol use in the United States and within AI/NA communities specifically. It also provides recommendations for an alcohol-related screening and brief intervention instrument that social workers can begin using in their practice and can be utilized within the AI/NA community.

Of goldfish tanks and moonlight tricks: can cultural competency ameliorate health disparities?

Within nursing, cultural competency is seen as an important mechanism for reducing racial and ethnic health disparities; however, after years of attempted implementation of "cultural competence," minimal evidence exists demonstrating a relationship between culturally competent interventions and improved health outcomes or reduced disparities. We examine how cultural competency as an intervention for tackling health disparities is undertheorized and misguided, and deflects attention and efforts needed to address broader social determinants of health. We provide a historical overview of cultural competency, critiques of the concept, and recommendations for moving beyond cultural competency as a means of diminishing health disparities.

Cultural competence of nurse practitioner students: a consortium's experience

Professional standards require culturally competent care, but competencies are rarely assessed. An instrument adapted from the work of cultural competence experts was used to assess the cultural competence of nurse practitioner students (n = 122). The 30-item instrument indicated adequate reliability scores (.78 to .87). Students reported high levels of comfort with people who are different from themselves and felt that cultural knowledge was important. Students scored fairly low on engaging in community-related culturally relevant behaviors. Predictors of culturally competent behaviors in clinical practice and the community were: comfort with others who are different from themselves, the degree of importance attached to cultural knowledge, and likelihood of future practice in rural areas. Nurse practitioner programs need to concentrate on increasing students' comfort with culturally diverse client groups and stressing a deeper cultural knowledge in clinical practice.

Balancing empiricism and local cultural knowledge in the design of prevention research

Prevention research aims to address health and social problems via systematic strategies for affecting and documenting change. To produce meaningful and lasting results at the level of the community, prevention research frequently requires investigators to reevaluate the boundaries that have traditionally separated them from the subjects of their investigations. New tools and techniques are required to facilitate collaboration between researchers and communities while maintaining scientific rigor. This article describes the tribal participatory research approach, which was developed to facilitate culturally centered prevention research in American Indian and Alaska Native communities. This approach is discussed within the broader context of community-based participatory research, an increasingly prevalent paradigm in the prevention field. Strengths and limitations of the approach used in the study are presented.

Development of a Cultural Competence Assessment Instrument

This article describes initial testing of an instrument designed to provide evidence of cultural competence among health care providers and staff. The Cultural Competence Assessment (CCA) instrument was based on a model describing cultural competence components (fact, knowledge, attitude, and behavior). Content and face validity were confirmed through expert panel review, subject feedback, and field-testing. The CCA was administered to an interdisciplinary health care team in a community hospice setting. Preliminary findings suggest that the CCA performed well. Internal consistency reliability for the scale was 0.92. Construct validity by factor analysis demonstrated that 25 items had loadings above 0.42. Construct validity was supported with a significant correlation to the widely used Inventory for Assessing the Process of Cultural Competence among Health care Professionals (IAPCC). Validity also was supported by significant differences between individuals with different educational levels and prior diversity training. The CCA is a promising tool to measure cultural competence in populations with a wide range of educational levels and backgrounds.

Nursing in a diverse community: a narrative review

Almost 6% of Britain's population are of black or minority ethnic origin. There is increasing recognition that the health needs of such groups are not adequately met within the current health care system. One factor in reducing health inequalities is for health professionals to become culturally aware in order to serve these communities effectively. This literature review focuses on pre-registration nursing programmes that address cultural sensitivity as part of basic training. The studies were selected by a computerized search of a number of databases and a hand search of selected nursing journals. The papers were reviewed under the following headings: setting, programme design, conceptual framework, curricula content, student assessment, and course evaluation. The programmes presented were undertaken predominantly in the USA. Either few programmes exist in the UK, or the programme details have not been published. Although, in the UK, cultural sensitivity training appears in its infancy, there are positive signs of change.

Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model

This article develops a conceptual model of cultural competency's potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly.

A review of the concept of culture in holistic nursing literature

Core Value IV of the American Holistic Nurses' Association includes valuing the client's cultural background. The authors reviewed all article abstracts from two major holistic nursing journals for a 3-year period (N = 198). References to concepts of culture or ethnicity were found in only 9.6% of abstracts. Many theorists and researchers did not discuss how the theory or research findings varied between culturally or ethnically diverse samples. When culture is a core value, practitioners and researchers cannot assume that culture has been considered without stating what was the interaction of culture with the phenomenon of concern. The authors recommend that nurses develop cultural competence in caring for clients from differing cultural orientations by (a) committing to improve their knowledge of multiple cultures; (b) exploring their own cultural background; (c) seeking exposure to cultures other than their own; and (d) regularly discussing culture and ethnicity in nursing theory, research, and practice.

Increasing students' cultural sensitivity. A step toward greater diversity in nursing

Increasing minority representation in nursing is essential to assure culturally competent care in the next century. Academic institutions need to recruit, encourage, and retain minority students and faculty. Students need minority mentors in their academic and clinical environments. Euro-American faculties teaching in predominantly white institutions need to explore effective ways to facilitate aggregate understanding and appreciation of cultural diversity within the profession. The author explains a teaching strategy to increase awareness and sensitivity of graduate nursing students to the role of minority nurses within the culture of nursing. Becoming culturally sensitive is a prerequisite to increasing diversity and culturally competent care.

Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model

This article develops a conceptual model of cultural competency's potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly.