Nursing in a diverse community: a narrative review

‘Work in progress’: nurse educators' views on preparing pre-registration nursing students in Wales for practice in multi-ethnic environments

Nurses need to be adequately prepared to practise competently in increasingly ethnically diverse communities. This study explored nurse educators' views regarding the extent and nature of pre-registration nursing education intended to prepare students for multi-ethnic practice in Wales. A qualitative approach was taken with a purposive sample of programme directors ( n = 6), branch leaders and lecturers ( n = 25) and practice mentors ( n = 35). Data were collected through focus groups, interviews, questionnaire and documentary review. Qualitative data were analysed using thematic analysis and three themes were identified: curriculum design and content, a theory–practice gap and personnel and material resources. Findings indicated that knowledge of the most effective way to prepare pre-registration nursing students for practice in multi-ethnic communities is ‘work in progress’ in Wales. Our findings raise questions about the extent to which the curriculum prepares students to engage with the Welsh social justice agenda. Improved clarity regarding what constitutes an adequate curriculum and improved preparation of nurse educators and mentors to competently and confidently prepare students for working within ethnically diverse communities is required.

Minority ethnic users experiences and expectations of nursing care

Abstract:

During the last two decades, there has been a growing emphasis on the delivery of health care to meet the needs of minority ethnic patients, but there is less emphasis on the views of the patients themselves. This paper aimed to give minority ethnic groups the opportunity to voice their opinions on nursing care and to inform future nurse education. Focus groups were used to collect data. Six community groups, some of mixed ethnicity and some of specific ethnic identity, were included in the study. Data were analysed using a thematic approach and three themes were identified as representing the views of the participants. Participants identified that knowledge of cultural and religious practices were essential for nurses in order for them to understand the basis of their beliefs and practices. They also highlighted how the actions and behaviour of nurses either confirmed or ignored their specific requirements. They also recognised the inherent communication problems for those who had difficulty in communicating in English. Overall, they reiterated their need to be treated with dignity and respect. For nurse educators, the challenge is to develop not only the knowledge base of student nurses but also to help them translate that into practice that demonstrates cultural understanding and sensitivity.

Muslims in Australian hospitals: The clash of cultures

The objective of this paper is to review the multicultural nature of Australian society, with a specific focus on the Islamic culture. Islamic principles will be presented and the impact this has on the health-care provision of Muslim people will be explored. This paper highlights issues that Muslim patients face when hospitalized in Australia. Australia has seen a major shift in its society, from English-speaking European to one that boasts enormous cultural diversity. However, this cultural diversity poses a number of challenges for a Western-based health-care service based on differing needs and expectations. This challenge is perhaps most evident during times of illness, when the Muslim patient must attempt to adhere to the principles of their faith in the non-Islamic environment of the Australian hospital. The differences discussed in this paper serve to highlight the importance of having strategies that identify the needs and expectations of culturally diverse consumers of the hospital system.

Measures of cultural competence: examining hidden assumptions

PURPOSE

The authors critically examined the quantitative measures of cultural competence most commonly used in medicine and in the health professions, to identify underlying assumptions about what constitutes competent practice across social and cultural diversity.

METHOD

A systematic review of approximately 20 years of literature listed in PubMed, the Cumulative Index of Nursing and Allied Health Literature, Social Services Abstracts, and the Educational Resources Information Center identified the most frequently used cultural competence measures, which were then thematically analyzed following a structured analytic guide.

RESULTS

Fifty-four instruments were identified; the 10 most widely used were analyzed closely, identifying six prominent assumptions embedded in the measures. In general, these instruments equate culture with ethnicity and race and conceptualize culture as an attribute possessed by the ethnic or racialized Other. Cultural incompetence is presumed to arise from a lack of exposure to and knowledge of the Other, and also from individual biases, prejudices, and acts of discrimination. Many instruments assume that practitioners are white and Western and that greater confidence and comfort among practitioners signify increased cultural competence.

CONCLUSIONS

Existing measures embed highly problematic assumptions about what constitutes cultural competence. They ignore the power relations of social inequality and assume that individual knowledge and self-confidence are sufficient for change. Developing measures that assess cultural humility and/or assess actual practice are needed if educators in the health professions and health professionals are to move forward in efforts to understand, teach, practice, and evaluate cultural competence.

The (un)-certainties of district nurses in the context of cultural diversity

AIM

This paper is a report of part of a study exploring district nurses' understanding and practices in relation to discrimination and inequalities issues.

BACKGROUND

Clients from minority ethnic groups continue to experience inequalities in health status and care provision. District nurses work with a wide range of clients, yet research has demonstrated inequities in service provision to clients from minority ethnic groups due to organizational, professional and personal constraints.

METHODS

A qualitative methodology was used to explore district nurses' understanding of discrimination and equalities issues in the context of their work. Semi-structured interviews were undertaken during 2003 with 18 district nurses employed in two primary care organizations in England providing healthcare services to a large and culturally diverse population.

FINDINGS

District nurses' accounts were marked by uncertainty, suggesting that many lacked confidence when discussing issues of ethnicity and cultural difference. There were marked differences in the extent to which they appeared to recognize or engage with clients' experiences of discrimination or inequalities, or to recognize inequitable service provision to clients from minority ethnic groups. Key issues were a lack of provision of district nursing services to some clients, and failures to meet clients' language and communication needs, and although reflecting organizational constraints, such continuing inequities were largely unquestioned.

CONCLUSION

There is a need for further educational and practice developments to enable district nurses to provide more equitable care to clients from culturally diverse communities, ensuring that the key professional discourse of individual care and advocacy are fully realized in their work with all clients.

Toward a model of psychological health empowerment: implications for health care in multicultural communities

This article presents a model of health empowerment from an individual psychological perspective. Building on Menon's (2001) model of psychological empowerment in organizations, psychological health empowerment is developed as a construct to capture the individual community member's feelings of empowerment with regard to health and health care. The context for health empowerment is first conceptualized as an interactive system of three elements, namely, the individual community member, health service providers, and the regulatory environment consisting of health policy and systems. The individual manages his or her own health on a daily basis, interacts with health service providers when in need of specialized medical assistance, and is affected by the 'health policy and systems' element. Perceived control, perceived competence, and goal internalization, the three facets of Menon's empowerment model, are then adapted to the health context. A scale for measuring psychological health empowerment is also proposed. The implications of this approach for health care in multicultural communities are then explored.