American Academy of Nursing Expert Panel report: developing cultural competence to eliminate health disparities in ethnic minorities and other vulnerable populations

Nursing students' internationalization: Virtual exchange and clinical simulation impact cultural intelligence

BACKGROUND

There is a need for globally competent nurses; however, some cannot train abroad. Internationalization at home strategies seek to teach intercultural and international competencies to all students, regardless of location.

PURPOSE

This study evaluated the impact of a virtual exchange and clinical simulation program on nursing students' cultural intelligence.

METHODS

The Global Nursing Care (GNC) program was designed to improve nursing students' global competencies, particularly cultural intelligence. It was implemented in two universities in Spain and the USA. A quasi-experimental, analytic, and longitudinal study involved 261 nursing students, 57 from the GNC program and 204 in the control group. Sociodemographic data were collected, and the Cultural Intelligence Scale was used to measure cultural intelligence.

DISCUSSION

All cultural intelligence dimensions were augmented following program participation. Moreover, students who participated in the program presented higher cultural intelligence than the control group.

CONCLUSION

The results suggest that program participation was associated with a statistically significant gain in nursing students' cultural intelligence.

Cultural competence and associated factors among nurses working in public health institutions in the Assosa zone, Benishangul Gumuz regional state, Ethiopia, 2022

BACKGROUND

Cultural competence is one of the principal foundations of clinical nursing. In Ethiopia, nurses in nursing care still focus more on physical needs, the healing process, and treatment and less on the cultural aspects of the patient.

OBJECTIVE

This study aims to assess the cultural competence and associated factors among nurses working in public health institutions found in the Assosa Zone, West Ethiopia, in 2022.

METHODS

An institution-based cross-sectional study design was conducted on 362 nurses who were selected by simple random sampling. Data was collected using a structured, self-administered English version of the Nurse Cultural Competence Scale Questionnaire for Nurses. The data were entered into Epi Data version 3.1 and exported to SPSS version 25. Linear regression analysis was used to identify factors statistically significantly associated with the cultural competence of nurses at a p-value < 0.05.

RESULT

Overall The mean score of cultural competence of participants was 113 (CI, 111.7-115.7), with a mean item score of 3.2 (CI, 3.15-3.26). Nurse-to-patient ratio (B;.93, CI;.59_1.3), experience with previously working in a primary hospital than the current health institution (B; -11.1, CI; -18_-4.2), and experience with previously working in a health center than the current health institution (B; -11.5, C;-18.5_-4.8), being diploma education level (B; -23.2, CL;-32_-14.8), being BSC education level (B;-20.3, CI;-28_-12.3), and the presence of a feedback system in a health facility (B; 13.5, CI; 9.5_17.5) were identified as predicted factors of cultural competences.

CONCLUSION

The overall mean score of the cultural competencies of the participants was moderate. To improve the cultural competence of nurses, it is typically necessary to provide educational opportunities to raise their educational level and establish a feedback system in all health institutions across the nation.

A concept analysis of cultural competence in nursing: A hybrid model approach

BACKGROUND

Cultural competence is considered one of the criteria for high-quality nursing care.

AIM

This study aimed to analyse cultural competence in nursing.

METHODS

This study was performed using the hybrid concept analysis approach in three phases. In the theoretical phase, literature was reviewed by searching Persian and English language databases, and 94 articles were included. In the second or fieldwork phase, 11 semi-structured interviews were conducted with purposefully selected nurses. The results of both theoretical and fieldwork phases were analysed using conventional content analysis, and in the final analysis phase, the results of the previous phases were triangulated.

RESULTS

The attributes of cultural competence were obtained in the theoretical phase in six and the fieldwork phase in three categories. In the final phase, the categories obtained in both previous phases were triangulated: cultural competence in nursing is a continuous, developmental, flexible, extensive and complex process that is patient- and justice-oriented and emerges through learning and skills acquisition, including cultural knowledge, attitudes and practices.

CONCLUSION

Managers and planners of nursing education can use the results of this study to educate nursing students and nurses and evaluate outcomes as one of the criteria for quality care.

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

BACKGROUND

Globalization 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.

METHODS

A 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.

RESULTS

The 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.

CONCLUSIONS

It 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.

The cultural meaning of Sámi language, costume, and food to the Sámi, from the perspective of well-being

The Sámi people, a northern indigenous people, have a statutory right to receive social and health services, which should take cultural characteristics into consideration. Cultural sensitivity is integral to the ethical principles of social and health care; however, based on previous research, the Sámi’s cultural rights have not been recognised. To reinforce their language rights and develop culturally sensitive health care, research is needed to determine what Sámi cultural characteristics mean to Sámi people’s well-being. The aim of this study was to describe and understand the meaning of cultural characteristics to the well-being of different generations of Sámi. In this research two Sámi experts described what the Sámi language, costume and food meant to them from a well-being perspective. Data-driven content analysis was applied to their responses. During everyday life, to the Sámi their cultural characteristics represent safety, awareness of one’s roots, inner strength, the ability to be oneself, continuity, and communality. These meanings are interconnected with changing environment for the different generations and reflect Sámi people’s lived experiences. Consideration of their cultural characteristics in the provision of social and health care will support the Sámi peoples´ integrity and cultural uniqueness, empowering both individual Sámi and their society.

Structural equation modeling of the association between professional and cultural competencies of nurses in Saudi Arabia

AIM

To determine the influence of Saudi nurses' professional competencies on their cultural competency using the structural equation model (SEM).

BACKGROUND

Nurses are an essential component of the health care delivery system; it is crucial to understand their professional and cultural competencies. However, these concepts remain underreported from a middle eastern perspective.

DESIGN

A correlational, cross-sectional design.

METHODS

Data were collected using two self-report instruments from 587 nurses employed in three government-run tertiary hospitals in Saudi Arabia. Spearman rho and SEM were performed to analyze the relationships of the studied variables.

RESULTS

The emerging model showed acceptable model fit indices. Among the six dimensions of professional competency, only three significantly influence cultural competency. Specifically, both care pedagogics and medical and technical care had a moderate, positive influence on cultural competency. Contrastingly, value-based nursing care had a moderate but negative influence on cultural competency.

CONCLUSIONS

Cultural competency is a complex and underused nursing concept influenced by nurses' professional competencies. The knowledge acquired from the presented model can be used by nurse leaders, administrators and educators in developing appropriate policies, programs and strategies.

Cultural Diversity Training: The Necessity of Cultural Competence for Health Care Providers and in Nursing Practice

The purpose of this article is to discuss the need to provide culturally sensitive care to the growing number of diverse health care consumers. A literature review of national standards and research on cultural competency was conducted and specifically focused on the field of nursing. This study supports the theory that cultural competence is learned over time and is a process of inner reflection and awareness. The domains of awareness, skill, and knowledge are essential competencies that must be gained by health care providers and especially for nurses. Although barriers to providing culturally sensitive care exist, gaining a better understanding of cultural competence is essential to developing realistic education and training techniques, which will lead to quality professional nursing practice for increasingly diverse populations.

The evolution of cultural competence theories in American (United States) nursing curricula: An integrative review

INTRODUCTION

Baccalaureate nursing students develop cultural competence through curricula of theories and frameworks which evolve to reflect new knowledge, but their synthesis and impact upon health quality outcomes is not known.

METHODS

A cross-platform literature review was conducted to identify innovation and use of cultural competency theories and frameworks in nursing. Optimal literature included a formal theory, pedagogy, measures, and outcomes, which were then classified and evaluated. Additional perspectives and interventions were reviewed for potential influence on curricula and impact through the lens of integrative review.

RESULTS

A shift in theory from essentialism to constructivism has occurred in undergraduate curricula. Challenges to measuring outcomes have been noted. All studies reported positive outcomes but suffer from self-selection, unvalidated instruments, and little to no longitudinal data.

CONCLUSIONS

Nursing students are exposed to culturally competent care via several validated and canonical frameworks, but self-efficacy and long-term impact have not been assessed.

Cultural competence of nurses in Pudong New Area, Shanghai: a mixed-method study

Objective

Cultural competence has gradually attracted attention from many countries, including China. This study was undertaken to determine the cultural competence of registered nurses in Shanghai, China, and to identify the cultural competence among registered nurses in Pudong New Area, Shanghai.

Methods

Qualitative interviews were conducted in combination with a quantitative survey. Fifteen clinical nurses were interviewed, and 1088 clinical nurses were recruited for the survey with cultural competence scale for registered nurses, based on the results of the qualitative and quantitative studies.

Results

The overall level of cultural competence among registered nurses in Shanghai's Pudong New Area was moderate. Among the seven dimensions, cultural encounter had the highest score, followed by cultural practice, cultural awareness, cultural desire, cultural skill, cultural experience, and cultural knowledge. Age, level of hospital care, mastery of secondary level, and studying overseas were the influencing factors.

Conclusions

Hospitals and universities should be aware of the importance of studying cultural competence. Cultural competence-related courses should be increased, and various forms of training should be undertaken to enhance the interest of nurses.

Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review

Background

In 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes.

Objectives

Our objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies.

Review methods

An information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence.

Results

We identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated.

Limitations

Our review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women.

Conclusions

Available evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this.

Future work

Studies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource.

Study registration

This study is registered as PROSPERO CRD42015023605.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.

Using a Low-Fidelity Simulation to Enhance Cultural Awareness and Emotional Intelligence in Nursing Students

Undergraduate didactic nursing leadership courses lack experiential opportunities to address working with culturally diverse populations. The authors used Bafa Bafa©, a cross-cultural low-fidelity simulation, to further develop critical thinking and emotional intelligence skills in prelicensure nursing students. This article describes the authors' experiences of integrating this innovative teaching strategy in the classroom to increase cultural awareness. The students' discovery of unexpected feelings, thoughts, and perceptions has the potential to extend beyond the simulated experience when coupled with faculty reinforcement of engaging in self-reflective practice as a professional nurse.

Nurses’ Barriers to Care of Ethnic Minorities: A Qualitative Systematic Review

Several studies have reported nurses’ challenges when caring for ethnic minority patients from diverse cultures and who have language differences. This qualitative systematic review aims to identify and describe barriers to nursing practices and to understand the common perceptions that nurses in Western countries have when providing culturally competent care to ethnic minority patients. In this review, eight qualitative, peer-reviewed studies published from 2010 to 2018 are synthesized to identify barriers to nurses’ practice with ethnic minority patients. Qualitative systematic review protocols with thematic synthesis as a methodology were employed, and five common themes were identified: communication issues; unclear, missing, or culturally inappropriate care information and resources; insufficient cultural training and education; challenging therapeutic relationships with patients; and concern about quality of care. These results suggest that future studies should explore the cost-effectiveness of cultural competency training.

Developing and validating the Nursing Cultural Competence Scale in Taiwan

Background

Culture influences personal health habits and behavior, and healthcare personnel possess different views of cultural perspectives. Currently, an appropriate instrument to assess cultural competence in clinical practice is limited. The present study aimed to develop and examine the psychometric properties of the Nursing Cultural Competence Scale (NCCS) for clinical nurses.

Methods

Developing and assessing the scale was carried out in two phases: Phase I involved a qualitative research to explore the themes of nurses’ cultural competence and instrument development; Phase II established construct validity of the scale using a sample of 246 nurses in Taiwan. Data from the questionnaire were analyzed using exploratory factor analysis, confirmatory factor analysis, internal consistency and test-retest reliability. Analysis results were used to determine the reliability and validity of the developed scale.

Results

The results showed four factors including cultural awareness ability, cultural action ability, cultural resources application ability, and self-learning cultural ability were generated by exploratory factor analysis, and these factors explained 62.0% of total variance. Cronbach’s α of the Nursing Cultural Competence Scale was .88, and test-retest reliability correlation was .70.

Conclusions

The establishment of the tool will facilitate accurate monitoring of the cultural competence among nurses and nursing managers, which can inform the construction of nursing policies aimed at pledge cultural competence expansion.

Physician Assistant Students' Perceptions of Cultural Competence in Providing Care to Diverse Populations

PURPOSE

To determine physician assistant (PA) students' perceived levels of preparedness to treat patients from culturally diverse backgrounds.

METHODS

An online survey with quantitative and qualitative components was distributed to students at 8 PA programs in different geographic locations of the United States. The survey used a modified version of the previously validated Self-Assessment of Perceived Level of Cultural Competence Questionnaire and evaluated PA students' knowledge, skills, encounters, attitudes, awareness, and abilities regarding cultural competence, as well as students' evaluation of these components of their education. Descriptive statistics were generated using SPSS software, and qualitative findings were analyzed for common themes.

RESULTS

PA students rated their attitudes, awareness, and abilities about cultural competence as significantly greater than their cultural knowledge, skills, and encounters. Second-year students and racial minority students reported higher personal ratings for levels of cultural competence. Most PA students reported being well prepared (39%) or moderately prepared (46%), compared to those who did not feel at all prepared (15%). Students indicated that specific classes focusing on cultural topics, discussions about cultural issues, and clinical experiences were the most useful for promoting cross-cultural education.

CONCLUSION

While PA students perceive cultural competence to be important, they appear to be deficient in the areas of cultural knowledge, skills, and encounters. Integrating cultural competence courses, cultural discussions, and clinical rotations involving diverse patient populations should be encouraged throughout PA training as they may strengthen students' preparedness to provide cross-cultural care.

Use and Misuse of Opioid Pain Medications by Pregnant and Nonpregnant Women

BACKGROUND

The use and misuse of opioid pain medication is a public health problem that has extended to pregnant women. Assessing both the use and misuse of opioid pain medication had been limited.

AIMS

The aim of the present study was to disseminate data from a national sample of pregnant and nonpregnant women, tracking the rate and predictors of opioid use and misuse.

METHODS

In 2015 the National Survey on Drug Use and Health expanded the assessment of opioid pain reliever use and misuse. Here, a secondary analysis of 2 years of National Survey on Drug Use and Health expanded data assesses the use and misuse of opioids in pregnant and nonpregnant women ranging in age from 18 to 44 years (N = 46,229).

RESULTS

Opioid medication use was reported by 31.89% of pregnant women and 38.87% of nonpregnant women. Race and pregnancy status were associated with risk, with pregnancy being protective and White women having significantly higher risk.

CONCLUSIONS

The high rates of use and misuse of opioids in pregnant women underscores a critical need for screening for opioid use and misuse, particularly among White women. Pregnancy provides a unique window of opportunity to educate, screen, and provide treatment.

HIV pre-exposure prophylaxis uptake by advanced practice nurses: Interplay of agency, community and attitudinal factors

AIMS

To identify associations among agency, community, personal and attitudinal factors that affect advanced practice nurses' uptake of HIV pre-exposure prophylaxis, an intervention consists of emtricitabine/tenofovir once-daily pill, along with sexual risk reduction education.

DESIGN

Cross-sectional.

METHODS

During March-May 2017, randomly selected Indiana advanced practice nurses were invited to complete an online survey, consisted of several validated self-rating measures (N = 1,358; response = 32.3%). Final sample (N = 369) was predominantly White, non-Hispanic, female advanced practice nurses in urban practices (mean age = 46). Conceptual model for structural equation model included 29 original/composite variables and five latent factors.

RESULTS

Final model consisted of 11 variables and four factors: agency, community, HIV prevention practices (including screening) and motivation to adopt evidence-based practices overall. Community had direct effects on HIV prevention practices (estimate = 0.28) and agency (estimate = 0.29). Agency had direct effects on HIV prevention practices (estimate = 0.74) and motivation to adopt evidence-based practices (estimate = 0.24). Community had indirect effects, through agency, on the two remaining factors.

CONCLUSION

Barriers exist against pre-exposure prophylaxis implementation, although practice guidelines are available. HIV prevention practices must be integrated across organizational structures, especially in high-risk communities, whereas practice change is more effective when focused on changing providers' attitudes towards intervention. When planning a pre-exposure prophylaxis intervention, advancing inputs from healthcare professionals, organizational leadership and community members, is crucial to success.

IMPACT

In settings where advanced practice nurses are primary contact points for health care, they may be best positioned to have an impact on implementation of HIV risk reduction strategies. Further research is needed to optimize their contributions to pre-exposure prophylaxis implementation.

Strategies for recruiting a sample of adults with type 2 diabetes from primary care clinics in rural Appalachia: Incorporating cultural competence

BACKGROUND

Recruiting research participants from primary care in rural Appalachia is a major challenge and can be influenced by cultural characteristics, making it critically important to incorporate strategies of cultural competence in the overall design of clinical research.

OBJECTIVES

The purpose of this paper is to describe culturally competent strategies used for recruitment and data collection with a sample of adults with type 2 diabetes from primary care settings in Appalachia.

DESIGN

The Purnell model of cultural competence and relevant literature served as a framework for study design. Four overarching approaches informed the organization of recruitment strategies and development of the data collection plan.

PROCEDURES

The approaches included selection of research sites, establishing collaborations, sustaining collaborative relationships, and enhancing understanding of benefits of participation. Four recruitment sites were selected based on potential to enhance diversification of participants; multiple steps were included in each of the three remaining approaches to build relationships and gain participation. A study log was maintained to provide evaluation data.

RESULTS

Recruitment took 14 months and a sample of 102 subjects provided consent with 101 participants providing complete data. Demographics were representative of the region except that African American participation was higher (6.9%) compared to current north central Appalachia (3%). Over 72% of participants indicated they would be interested in participating in future studies.

CONCLUSIONS

These findings emphasize the importance of employing strategies for cultural competence in study design. Use of concepts from the Purnell model led to enhanced representativeness and potential for subsequent generalizability.

Free Clinics and the Need for Nursing Action in Uncertain Political Times

Free clinics have been a source of health care for uninsured and low-income Americans for half a century and serve some of the nation's most vulnerable within their home community. Despite parallels to nursing's significant involvement in the formation of free public clinics and commitment to care for all, there is paucity of nursing literature about free clinics. This article details the history of U.S. free clinics and the intersections among free clinics and value-based care, health reform, and tax reform, including the Patient Protection and Affordable Care Act of 2010 and the Tax Cuts and Jobs Act of 2017. Challenges impacting free clinics are detailed, as well as strategies nurses may employ to support survival of free clinics and enhance service to their target populations. Roles for nurses in free clinic governance, management, and practice are described as well as suggestions for research, education, and public policy.

Increasing undergraduate nursing students' cultural competence: an evaluation study

BACKGROUND

Cultural competence has become increasingly important for Chinese health professionals because of internationalization and the opening up of China to overseas visitors and business as well as a growing awareness of the needs of minority groups within China. This study aimed to evaluate a workshop designed to improve cultural competence among Chinese undergraduate nursing students.

METHODS

A one-group pretest and posttest design was applied. The intervention was a one-day workshop based on transformative learning theory using a variety of teaching strategies. Forty undergraduate nursing students from a university in Wuhan, China selected by convenient sampling received the intervention. Data were collected before the intervention (T1), immediately after the intervention (T2), and 1 month (T3) and 3 months (T4) following the intervention through the Chinese version of Cultural Competence Inventory for Nurses (CCIN). A researcher-designed evaluation form including open-ended questions was also used.

RESULTS

Participants' scores by CCIN increased significantly in the total score (p < .001) as well as the components of cultural awareness (p = .003), cultural knowledge (p < .001), cultural understanding (p = .007) and cultural skills (p < .001), but not in cultural respect. This improvement maintained at T3 and T4. Overall, participants were satisfied with the workshop, and the qualitative results supported the effects of this intervention.

CONCLUSIONS

The one-day workshop was effective in improving nursing students' cultural competence. Replication or further refinement of this workshop is recommended for future research among additional nursing students with diverse backgrounds.

Implementing a cultural competence training as a psychopolitical empowerment process

The cultural competence training (CCT) of health care professionals represents a useful resource to face the challenges involved in health care assistance for multicultural populations. However, the traditional perspective has shown limited results, as it does not consider professionals in their contexts and avoids continuous assessment processes. In response to these limitations, we describe a model of CCT implemented by two professors of the Faculty of Nursing at the University of Seville in Spain as a psychopolitical empowerment process, and exemplified by the experience of the emergency nurses at the Virgen Macarena Hospital. This process adds the notion of power to traditional CCT and uses dialogic learning to: (a) state a mission and develop critical thinking; (b) take stock of the actions for change and increase the capacity of nurses to respond; and (c) motivate nurses to plan the future and take action. As a result, professionals become a learning community, able to develop a new professional identity and role, and can also implement actions for the transformation of health care settings.

Factors affecting the cultural competence of visiting nurses for rural multicultural family support in South Korea

Background

With the recent growth of multicultural families in the Korean society, the importance of the role of qualified visiting nurses in the delivery of culturally sensitive health care has grown dramatically. As the primary health care provider for multicultural families enrolled in public community-based health care centers, the cultural competence of visiting nurses is an essential qualification for the provision of quality health care for multicultural families, especially in rural areas. Cultural competence of visiting nurses is based on their cultural awareness and empathetic attitude toward multicultural families. This study aimed to examine the levels of cultural competence, empowerment, and empathy in visiting nurses, and to verify the factors that affect the cultural competence of visiting nurses working with rural multicultural families in South Korea.

Methods

Employing a cross-sectional descriptive study design, data from 143 visiting nurses working in rural areas were obtained. Data collection took place between November 2011 and August 2012. The measurement tools included the modified Korean version of the Cultural Awareness Scale, the Text of Items Measuring Empowerment, and the Interpersonal Reactivity Index to measure the level of empathy of visiting nurses. Analyses included descriptive statistics, a t-test, an ANOVA, a Pearson correlation coefficient analysis, and a multiple linear regression analysis.

Results

The cultural competence score of the visiting nurses was 3.07 on a 5-point Likert scale (SD = 0.30). The multiple regression analysis revealed that the cultural competence of visiting nurses was significantly influenced by experience of cultural education, empathy, and scores on the meaning subscale of the empowerment tool (R² = 10.2%).

Conclusions

Institutional support to enhance visiting nurses' empowerment by assuring the significance of their job and specific strategies to enhance their empathy would be helpful to improve the cultural competence of visiting nurses. Additionally, regular systematic education on culturally sensitive care would be helpful to enable visiting nurses to provide culturally sensitive care for multicultural families.

Older Adult Caregiving in an Amish Community

Amish older adults represent a growing and understudied population whose current health practices, interactions with health care systems outside of their community, and care needs are unknown. Limited research exists on why, when, and how Amish older adults and their caregivers experience health care services outside of their family and community. The purpose of the current study was to describe and explore the perspectives of Amish caregivers caring for older adults and their experiences with health care services outside of their community. A qualitative phenomenological research design was used in combination with a community-based participatory framework with caregivers in a small, rural Amish settlement. Amish caregiving of older adults is a complex phenomenon that is influenced by cultural characteristics. Caregivers place significant cultural value on home caregiving, emphasize the experience as a blessing, and relate misunderstandings between themselves and outside health care providers as significant concerns. [Res Gerontol Nurs. 2018; 11(1):29-38.].

Healthcare Factors for Obtaining a Mammogram in Latinas With a Variable Mammography History

PURPOSE/OBJECTIVES

To understand the relationship between mammography history and current thoughts about obtaining a mammogram among Latinas and examine the mediation effects of several healthcare factors.
.

DESIGN

Cross-sectional survey.
.

SETTING

Federally qualified health centers (Sea Mar Community Health Centers) in western Washington.
.

SAMPLE

641 Latinas nonadherent and adherent with screening mammography.
.

METHODS

Baseline survey data from Latinas with a mammography history of never, not recent (more than two years), or recent (less than two years) were analyzed. Preacher and Hayes methods were used to estimate the mediation effect of healthcare factors.
.

MAIN RESEARCH VARIABLES

The survey assessed mammography history, sociodemographic and healthcare factors, and current thoughts about obtaining a mammogram.
.

FINDINGS

Latinas' thoughts about obtaining a mammogram were associated with mammography history. Having had a clinical breast examination mediated 70% of differences between Latinas with a never and recent mammography history. Receipt of a provider recommendation mediated 54% of differences between Latinas with and without a recent mammography history.
.

CONCLUSIONS

These findings emphasize the importance of the patient-provider relationship during a clinic visit and help inform how nurses may be incorporated into subsequent screening mammography interventions tailored to Latinas.
.

IMPLICATIONS FOR NURSING

As providers, health educators, and researchers, nurses have critical roles in encouraging adherence to screening mammography guidelines among Latinas.

Perceived Transcultural Self-Efficacy of Nurses in General Hospitals in Guangzhou, China

Background

Conflicts arising from cultural diversity among patients and hospital staff in China have become intense. Hospitals have an urgent need to improve transcultural self-efficacy of nurses for providing effective transcultural nursing.

Objective

The purpose of the research was to (a) evaluate the current status of perceived transcultural self-efficacy of nurses in general hospitals in Guangzhou, China; (b) explore associations between demographic characteristics of nurses and their perceived transcultural self-efficacy; and (c) assess the reliability and validity of scores on the Chinese version of the Transcultural Self-Efficacy Tool (TSET).

Methods

A cross-sectional survey of registered nurses from three general hospitals was conducted. Quota and convenience sampling were used. Participants provided demographic information and answered questions on the TSET.

Results

A total of 1,156 registered nurses took part. Most nurses had a moderate level of self-efficacy on the Cognitive (87.9%), Practical (87%), and Affective (89.2%) TSET subscales. Nurses who were older; who had more years of work experience, higher professional titles, higher incomes, and a minority background; and who were officially employed (not temporary positions) had higher perceived transcultural self-efficacy. Reliability estimated using Cronbach’s alpha was .99 for the total TSET score; reliability for the three subscales ranged from .97 to .98. Confirmatory factor analysis of TSET scores showed good fit with a three-factor model.

Conclusion

The results of this study can provide insights and guidelines for hospital nursing management to facilitate design of in-service education systems to improve transcultural self-efficacy of nurses.

Transcultural care and individuals with an intellectual disability

Healthcare delivery today reflects a history of change, which has responded to lifestyle changes, cultural diversity, population needs and expectations. In today's health-care environment it is crucial for health-care professionals to be mindful of cultural factors that affect health. These factors include the intricate interdependent biological, intellectual, psychological, social and spiritual needs of the individuals they work with. However, challenges exists for those who provide healthcare to people with intellectual disability. This article presents the transcultural care challenges for people with intellectual disability, through highlighting the biomedical/sociocultural perspectives of healthcare, communication and inequality experienced by those with intellectual disability. As a population group, people with intellectual disability can often be considered part of a larger culture rather than a culture within itself, and this article endeavours to emphasize that intellectual disability is in itself a coterminous culture. By highlighting intellectual disability as a cultural community within a larger community, requiring a transcultural response to care on several levels health-care professionals can provide culturally compatible care to those with intellectual disability within a transcultural framework to augment a person-centred approach to care.

The lived experiences of acute-care bedside registered nurses caring for patients and their families with limited English proficiency: A silent shift

AIMS AND OBJECTIVES

To explore the lived experiences of acute-care bedside nurses caring for patients and their families with limited English proficiency.

BACKGROUND

Approximately 8.6% of the total US population is considered limited English proficient. In the hospital setting, registered nurses provide the most direct contact with patients and their families. Effective communication between patients and healthcare professionals is essential when providing quality health care. There are only few published studies about registered nurses' experiences caring for patients with language barriers, but studies among nurses' experiences on patients with limited English proficiency and their families in an acute-care setting have not been explored.

DESIGN

A qualitative exploratory study was performed.

METHODS

The phenomenology research approach provides the most meaningful ways to describe and understand the entirety of the bedside nurses' experiences. A convenience, purposive sample of 40 registered nurses who work in bedside care in a 380-bed hospital in the western USA were interviewed. Each nurse had a minimum of three years of acute-care experience. The sample size was determined by data saturation.

RESULTS

Four themes emerged from the data of this research including: Desire to Communicate; Desire to Connect; Desire to Provide Care; and Desire to Provide Cultural Respect and Understanding.

CONCLUSIONS

Care of patients with limited English proficiency is a challenge to many nurses and other healthcare providers. This study reinforces the need to give acute-care nurses a voice to share their experiences and ideas for solutions to the challenges they face in the care they provide. Findings from this study have the potential to identify clinically relevant concerns, barriers to communication, resources for effective communication, and needs or concerns of the bedside nurses when providing care.

RELEVANCE TO CLINICAL PRACTICE

A look at the process and organisational system may suggest opportunities for improvement in support of the nurses' expressed desires to provide the care needed for patients with limited English proficiency.

Interpretation time in an ethnically diverse pediatric orthopedic clinic

Purpose - The purpose of this paper is to determine whether there were differences in clinical encounter time between patients who speak English and those who require an interpretation service in an ethnically diverse pediatric clinic. Design/methodology/approach - Encounter time with patients requiring interpretation was compared to encounter time with patients who spoke English. The sample consisted of 310 encounters at a pediatric orthopedic clinic where patients spoke over 18 primary languages. Data were analyzed using ANOVA to compare four types of encounters. Findings - Approximately 12 percent (n=38) required interpretation and encounters requiring interpretation took 30 percent (nine minutes) longer than those that did not, p < 0.01(25 vs 16 minutes). Furthermore, this difference was mainly among new patients: Approximately, 53 percent increase in time for new patient encounters requiring interpretation (36 vs 23 minutes) while only 25 percent increase in encounter time for established patients (20 vs 16 minutes) was detected. Research limitations/implications - Preventing problems due to language barriers requires time for interpretation which places demands on staff resources and presents clinical challenges. However, long-term benefits of quality health care outweigh the costs associated with interpretation service. Originality/value - To the knowledge, this is the first study to investigate actual encounter time differences in a pediatric clinical setting. The authors found that clinical encounters requiring interpretation took approximately nine minutes longer in general and four minutes longer for established patients. These findings could give much needed information for hospital administrators to allocate appropriate amounts of time and resources to care for those who need interpretation services. However, they also indicate a broader concern of the reduction of clinical encounter time for overall health care system in the country that might need further investigation.

Effectiveness of an Evidence-Based Quality Improvement Approach to Cultural Competence Training: The Veterans Affairs' "Caring for Women Veterans" Program

INTRODUCTION

Although providing culturally sensitive health care is vitally important, there is little consensus regarding the most effective strategy for implementing cultural competence trainings in the health care setting. Evidence-based quality improvement (EBQI), which involves adapting evidence-based practices to meet local needs, may improve uptake and effectiveness of a variety of health care innovations. Yet, to our knowledge, EBQI has not yet been applied to cultural competence training. To evaluate whether EBQI could enhance the impact of an evidence-based training intended to improve veterans affairs health care staff gender sensitivity and knowledge (Caring for Women Veterans; CWV), we compared the reach and effectiveness of EBQI delivery versus standard web-based implementation strategies of CWV and assessed barriers and facilitators to EBQI implementation.

METHODS

Workgroups at four diverse veterans affairs health care sites were randomized to either an EBQI or standard web-based implementation condition (SI). All EBQI sites selected a group-based implementation strategy. Employees (N = 84) completed pretraining and posttraining assessments of gender sensitivity and knowledge, and focus groups/interviews were conducted with leadership and staff before and after implementation.

RESULTS

Reach of CWV was greater in the EBQI condition versus the SI condition. Whereas both gender sensitivity and knowledge improved in the EBQI condition, only gender sensitivity improved in the SI condition. Qualitative analyses revealed that the EBQI approach was well received, although a number of barriers were identified.

DISCUSSION

Findings suggest that EBQI can enhance the uptake and effectiveness of employee trainings. However, the decision to pursue EBQI must be informed by a consideration of available resources.

Ethics and Defining Cultural Competence

Global ethics calls upon the discipline of nursing to critically evaluate personal and culture-based beliefs to nurture professionalism in relationships and improve health disparities. What does it potentially mean to provide nurse services based on culture and cultural competence? This article begins a discussion of potential ethical questions that surround the concept of culture and potential implications for education and practice from a nursing theoretical perspective.

Advancing Organizational Cultural Competency With Dissemination and Implementation Frameworks: Towards Translating Standards into Clinical Practice

Substantial public health efforts have been activated to reduce health disparities and ensure health equity for patients through the provision of culturally and linguistically appropriate services; yet associated policies and standards are sluggishly translating into practice. Little attention and resources have been dedicated to translation of public health policies into practice settings. Dissemination and implementation is presented as an active, strategic approach to enhance uptake of public health standards; reviews dissemination and implementation concepts; poses a systematic model to adoption, implementation, and dissemination; and concludes with recommendations for hospital-based implementation teams and complementary interprofessional collaboration.

Development and psychometric assessment of the healthcare provider cultural competence instrument

This study presents the measurement properties of 5 scales used in the Healthcare Provider Cultural Competence Instrument (HPCCI). The HPCCI measures a health care provider's cultural competence along 5 primary dimensions: (1) awareness/sensitivity, (2) behaviors, (3) patient-centered communication, (4) practice orientation, and (5) self-assessment. Exploratory factor analysis demonstrated that the 5 scales were distinct, and within each scale items loaded as expected. Reliability statistics indicated a high level of internal consistency within each scale. The results indicate that the HPCCI effectively measures the cultural competence of health care providers and can provide useful professional feedback for practitioners and organizations seeking to increase a practitioner's cultural competence.

Cultural competency training for public health students: integrating self, social, and global awareness into a master of public health curriculum

Cultural competency training in public health, medicine, social work, nursing, dental medicine, and other health professions has been a topic of increasing interest and significance. Despite the now burgeoning literature that describes specific knowledge, attitudes, and skills that promote cultural "competence," fully defining this complex, multidimensional term and implementing activities to enhance it remain a challenge. We describe our experiences in introducing a mandatory, full-day workshop to incoming Master of Public Health students, called "Self, Social, and Global Awareness: Personal Capacity Building for Professional Education and Practice." The purpose of the program is to provide a meaningful, structured environment to explore issues of culture, power, privilege, and social justice, emphasizing the centrality of these issues in effective public health education and practice.

Applying best practices to designing patient education for patients with end-stage renal disease pursuing kidney transplant

Despite the known benefits of kidney transplant, less than 30% of the 615 000 patients living with end-stage renal disease (ESRD) in the United States have received a transplant. More than 100 000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients' lack of comprehensive education about transplant. The purpose of this article is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant.

Enhancing Nurses’ Ability to Care Within the Culture of Incarceration

Incarcerated women are a highly vulnerable population, most of whom have had extremely adverse life experiences. Nurses who work in corrections have significant challenges as they attempt to care in a setting that is focused on punishment. This article focuses on the unique culture of incarceration as it applies to women, along with the common challenges nurses face when caring for these women. Leininger’s Theory of Culture Care and the Sunrise Enabler are discussed as useful tools to assist nurses in providing culture care within the confines of the prison, as well as a means of understanding these women as cultural beings apart from the prison setting. Despite the many security restrictions that exist within the correctional environment, “care” can be provided regardless of the setting. A model case has been developed to show the enormous impact that culture care can have on the lives of many women who face incarceration.

Cultural considerations at the end of life

It is important for nurse practitioners to understand their patients' cultural backgrounds to provide competent care at the end of life. Understanding the concepts of various cultures can keep the lines of communication open and help providers elicit the necessary information to make the end-of-life experience as comfortable as possible.

Cultural Competence Models and Cultural Competence Assessment Instruments in Nursing

The author reviewed cultural competence models and cultural competence assessment instruments developed and published by nurse researchers since 1982. Both models and instruments were examined in terms of their components, theoretical backgrounds, empirical validation, and psychometric evaluation. Most models were not empirically tested; only a few models developed model-based instruments. About half of the instruments were tested with varying levels of psychometric properties. Other related issues were discussed, including the definition of cultural competence and its significance in model and instrument development, limitations of existing models and instruments, impact of cultural competence on health disparities, and further work in cultural competence research and practice.

The other mother: a narrative analysis of the postpartum experiences of nonbirth lesbian mothers

The purpose of this study was to develop a metastory of nonbiological lesbian mothers' postpartum experiences utilizing Riessman's structural approach to thematic analysis. Ten nonbirth lesbian mothers were interviewed. Each shared a unique story of her first year of motherhood. Themes were individually analyzed within each story. The metastory of the postpartum experiences of nonbirth lesbian mothers revealed 6 themes including the following: At the mercy of health care providers, Nursing is the major difference between us, Defined by who I am not, Fighting for every piece of motherhood: The world can take them away, What's in a name?, and Epilogue: The new normal.