Printer Friendly

Provision of culturally competent health care: an interim status review and report.

Introduction

The American Academy of Nursing (AAN), an organizational unit established in 1973 under the aegis of the American Nurses Association (ANA), has a public mission to:

(1) advance health policy and practice;

(2) anticipate national and international trends in health care; and

(3) address resulting issues of health care knowledge and policy

(AAN, 2012; Giger et al., 2007).

Within its infrastructure, the AAN has a number of standing committees and expert panels, including the Expert Panel on Cultural Competence, whose charge is to ensure that measurable outcomes be achieved that "reduce or eliminate health disparities commonly found among racial, ethnic, uninsured, underserved, and underrepresented populations residing throughout the United States" (Giger et al., 2007, p. 96).

The U.S. Department of Health and Human Services Office of Minority Health, established in 1986, has a public mission to improve the health of racial and ethnic minority populations through the development of health policies and programs that help to eliminate health disparities. In releasing its Culturally and Linguistically Appropriate Service (CLAS) standards, the Office of Minority Health has required health care providers to offer health care services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients (U.S. Department of Health & Human Services Office of Minority Health, 2005).

The 1994 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) supports the provision of care, treatment, and services in a manner that is conducive to the cultural, language, spiritual and religious needs of individuals. As the premier national accrediting body for hospitals, the JCAHO was seated on the committee that helped to develop the CLAS standards and has integrated cultural competency mandates within its own JCAHO standards (Underserved Quality Improvement Organization Support Center [UQIOSC], 2007).

Currently, 14 states have Medicaid and Medicare contracts with cultural competency requirements. As a major purchaser of health care services for Medicare/Medicaid, the federal government is requiring their contractors to be culturally diverse and to deliver culturally competent service and care (UC Davis Health System, Human Resources, 2012).

The 2004 U.S. Census Bureau reported that in the year 2000, White Americans accounted for 69.4% of the total population, Blacks 12.7%, Hispanics 12.6% and Asians 3.8%. The 2010 U.S. Census Bureau reported that U.S. minorities will be in the majority by 2042, increasing from 34% in 2008 to 54% in 2042. Currently, minorities outnumber non-Hispanic Whites in Hawaii, New Mexico, California, Texas, and the District of Columbia (U.S. Census Bureau, 2010). With demographic shifts in the nation, the United States health care industry has been making its way toward "cultural competency" for more than fifty years, and the talk around cultural diversity and cultural competence has seemingly become a mantra (Leininger, 2007; Liu, Mao, & Barnes-Willis, 2008; Mixer, 2008; Sanner, Baldwin, Cannella, Charles, & Parker, 2010). Nevertheless, as the United States health care system and industry moves along the continuum toward cultural competency and proficiency, we should ask: are we there yet? Are we making appropriate and exemplary progress toward the provision of culturally competent health care?

Research purposes

The purposes of this nursing literature review are to examine the (1) concepts of culture, cultural competence, culture care, culturally competent care, and cultural diversity (2) middle range nursing theories and nursing conceptual models of cultural care and diversity; and (3) currently reported levels of cultural competence of nurse educators, nursing students, and nursing practitioners.

Review of the literature

The nursing literature reveals an assortment of definitions for the concepts culture, cultural competence, culture care, culturally competent care and cultural diversity. While a full concept analysis of these terms is beyond the scope of this review, the nursing literature has been examined to offer an analysis of these concepts as they relate to nurses and nursing practice. The author notes and concurs with findings in the literature that differences in definitions and foci have led to delayed advancements toward the provision of exemplary culturally competent nursing care in the United States (Schim, Doorenbos, Benkert, & Miller, 2007).

Culture defined

Culture has been defined in anthropological terms as "that complex whole which includes knowledge, belief, arts, morals, law, custom, and many other capabilities and habits acquired by man as a member of society" (Tylor, 1958, p. 1). This definition recognizes the attributes one acquires by growing up or living in a particular society, rather than through biological inheritance (Schim, Doorenbos, Benkert, & Miller, 2007). Leininger (2001) defines culture as the "learned, shared, and transmitted values, beliefs, norms, and lifeways of a specific individual or group that guide their thinking, decisions, actions, and patterned ways of living" (as cited in Sitzman & Eichelberger, 2004, p. 95). This definition similarly recognizes the attributes one acquires and expresses by living with a particular group.

The U.S. Department of Health and Human Services Office of Minority Health (2005) defines culture as the "thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups" (para. 1).

The term culture encompasses a broad range of concepts.

It is an individual concept, a group phenomenon, and an organizational reality. The construct of culture also implies a dynamic, nested, systems perspective that goes beyond discussions of race and ethnicity to include diverse subcultures. Such subcultures include communities of interest and communities with common needs. (Schim, Doorenbos, Benkert, & Miller, 2007, p. 104)

Culture pervades all aspects of life, as it pervades all aspects of health care. Culture defines how health care information is received, how rights and protections are exercised, what is considered to be a health problem, how symptoms and concerns about the problem are expressed, who should provide treatment for the problem, and what type of treatment should be given (U.S. Department of Health & Human Services Office of Minority Health, 2005). Understanding the complexities of culture becomes imperative to respond to the global health needs of people, communities, and nations (Mixer, 2008; Schim, Doorenbos, Benkert, & Miller, 2007).

Cultural competence defined

As a simplistic definition, cultural competence is "the ability to care for patients with diverse values, beliefs and behaviors, including tailoring health care to meet the patient's social, cultural, and linguistic needs" (Wood & Atkins, 2006, p. 50).

Cultural competence is also defined as "a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations" (U.S. Department of Health & Human Services Office of Minority Health, 2005, p. 2).

Purnell and Palunka (2003) define cultural competence as those actions that a health care professional takes to develop and raise his/her awareness of his/her existence, sensations, thoughts, and environment without letting these factors have an undue influence on those for whom care is provided, and those steps that the health care professional takes to adapt his/her care in a manner that is congruent with the patient's culture.

McFarland and Eipperle (2008) offers a definition of a culturally competent practitioner as one who is "knowledgeable and respectful of diverse cultural beliefs and practices, and partners with the client to develop a care regimen that produces the desired health outcomes within the context of the client's cultural values" (p. 51).

Cultural diversity is a concept that goes beyond the constructs of ethnicity and race.

Liu, Mao and Barnes-Willis (2008) opine that cultural competence should be considered as a process rather than an end-point. "It is more than the achievement of skills to work with people of different ethnic groups, including understanding their traditions, beliefs, customs, and values, but also including to work with the cultural context of the individual, family, or community" (p. 101; St. Clair & McKenry, 1999).

Culture care defined

Leininger asserts culture care is a synthesized, integrated and interdependent construct, not two separate concepts. She also asserts that the concept of care alone is "too fuzzy; care cannot be measured and known. Furthermore, nurses have [in the past] had no time to learn about care and culture, as they [had to] keep to medical tasks" (Fawcett, 2002, p. 133).

In developing her theory of transcultural nursing, Leininger has offered nurses' ways of thinking that are different from the medical model and traditional nursing knowledge, practice and constructs.

From an anthropological and an historical perspective, one can see that after World War II the medical treatment emphasis came strongly into focus and took over nursing. Nurses got so caught up in following and pleasing physicians in order to get approval. They were shaped by medicine in a rapid enculturation process (Fawcett, 2002, p. 133).

In an effort to refocus nurses and the nursing profession to reflect on cultural factors that influence care, Leininger (2002a) defines culture care as "those assistive, supportive, enabling, and facilitative culturally-based ways to help people in a compassionate, respectful, and appropriate way to improve a human condition or lifeway" (p.12). Culture care has symbolic meaning and includes concepts such as "care as protection, care as respect, and care as presence" (McFarland & Eipperle, 2008, p. 49).

Culturally competent care defined

Germain (2004) defines culturally competent care as regimens of care that are rooted in a respectful and informed knowledge based on the cultural beliefs and practices of the patient and includes the patient as a partner in the development of the care plan and the desired health outcomes (p. 435).

Leininger (2006) defines culturally competent care as care that is provided when culture care values, beliefs, expressions, and patterns are explicitly known and used appropriately, sensitively, and meaningfully with people of diverse or similar cultures (p. 19).

Waite and Calmaro (2010) defines culturally competent care as those sets of "skills and behaviors that enable the nurse to work effectively within the cultural context of a client (i.e., individual, family, or community)" (p. 74).

Cultural diversity defined

Cultural diversity is a construct that is variable in quantity and quality, across place and time. In any given environment, there are varying degrees of diversity that are represented. Some communities have relatively homogeneous populations, others have a great variety of groups represented. Some healthcare organizations serve communities with little variations in socioeconomics or lifestyles, ethnicity, race or interests, while others serve communities with wide disparities and interests (Schim, Doorenbos, Benkert, & Miller, 2007). Cultural diversity is a concept that goes beyond the constructs of ethnicity and race. It includes other aspects of diversity, such as class, gender, sexual orientation, physical abilities/disabilities, and care beyond multiculturalism (Papadopoulos & Omeri, 2008). Cultural diversity is a fact of life in America.

What was once conceptualized as the American 'melting pot' changed to being described as a 'salad' or 'stew,' in which the ingredients work together while retaining the special flavors of distinct origins and cultures. Public debate has expanded over time to include different voices that were once silent and marginalized. People of color, women, and people who are gay/lesbian/bisexual/ transgendered are speaking up, achieving representation, and demanding open acknowledgement and full participation in society to a larger degree than ever before (Schim, Doorenbos, Benkert, & Miller, 2007, p. 105).

Middle range nursing theory of culture care and diversity

Madeline Leininger conceptualized her Theory of Culture Care Diversity and Universality in the late 1950s for use in the early 1960's. The theory is unique in that: (1) it is the only nursing theory focused explicitly on culture care as the dominant theme of nursing inquiry; (2) it is a holistic, culturally based care theory "that incorporates broad humanistic dimensions about people in their cultural life context;" and (3) it incorporates "social structure factors, such as religion, politics, economics, cultural history, life span values, kinship, philosophy of living" and "geo-environmental factors" as potential influences of culture care phenomena (Leininger, 2007, p. 9). The purpose of her theory is to discover culturally-based care that "fits" or is congruent, meaningful, and relevant, to cultural groups and in ways in which culture influences the "lifeways" of people (Leininger, 2007, p. 9).

The Theory of Culture Care Diversity and Universality supports the field of transcultural nursing and requires nurses to discover "dominant care constructs" and perform in-depth studies of cultures to identify the close relationship of care to culture and ways that culture care contributes to health and well-being. The theory also replaces the once-prevailing medical and nursing ideology of focusing on diseases, symptoms, pathological conditions, and medical curing practices with "caring" as its dominant focus (Leininger, 2007, p. 9).

A unique feature of the theory is that it focuses on emic and etic care knowledge. Emic knowledge "comes directly from cultural informants as they know and practice care with their values and beliefs in their [own] unique cultural contexts" (Leininger, 2007, p. 10). These are the natural, local, indigenous root care values. Etic knowledge is derived from "outsider views of non-local or non-indigenous care values and beliefs such as those of professional nurses" (Leininger, 2007, p. 10). Both emic and etic care data are crucial factors in formulating therapeutic, culturally congruent health care plans.

Another unique feature of the theory is that it is conceptualized upon three modes of nursing actions: (1) culture care preservation/maintenance ("those assistive, supportive, facilitative, or enabling professional acts or decisions that help cultures retain, preserve or maintain beneficial care beliefs and values"); (2) culture care accommodation ("those assistive, supportive, facilitative, or enabling professional acts or decisions that help cultures adapt to or negotiate with others for culturally congruent, safe and effective care"); and (3) culture care re-patterning/restructuring ("those assistive, supportive, facilitative, or enabling professional acts or decisions that help people reorder, change, modify, or restructure their lifeways and institutions for better healthcare patterns, practices or outcomes") (McFarland & Eipperle, 2008, p. 49, Leininger, 2006, p. 15). These three modes guide nursing practitioners, students, and educators to use culturally-based specific-care values, beliefs, and practices to assure and maximize wellness, prevent illness, alleviate cultural stresses, and help to sustain the quality of cultural life. "Most importantly, the three modalities would guide practitioners away from using largely inappropriate, routine, unsafe, traditional, or destructive actions that failed to fit or to be acceptable to cultures" (Leininger, 2007, p. 11). Inappropriate cultural care often leads to cultural conflicts, clashes, and imposition of non-therapeutic practices that would be rejected by the patient (Fawcet, 2002, p. 135).

Fawcett, Newman and McAllister (2004) have added dimensions to Leininger's Theory of Culture Care Diversity and Universality by establishing six criteria for theory application in advance practice nursing. The six criteria are that the application of the theory should: (1) be inclusive, rather than exclusive; (2) foster a focus on the whole person rather than the disease or illness; (3) consider the patient's/ family's/significant other's perception of the situation; (4) be holistic in nature; (5) facilitate autonomous nursing practice; and (6) encourage diverse ways of knowing, including empirics, ethics, aesthetics, personal knowing, and sociopolitical knowing (p. 136).

Conceptual model of cultural competency

Campinha-Bacote (1998) developed a model of cultural competency by establishing essential components of cultural competence in the domains of cultural (1) awareness; (2) knowledge; (3) skill; (4) encounters; and (5) desire.

Cultural awareness involves a self-examination and self-assessment of one's own culture and its potential influence on his/her ways of thinking and behaving. This process is essential if the provider wishes to avoid imposing their own values upon their patient's (Campinha-Bacote, 1998; Sealey, Burnett, & Johnson, 2006).

Cultural knowledge involves obtaining information about the worldviews of different cultural groups, including knowledge about how its members (1) interpret illnesses; and (2) what causes the group attributes to illness. Cultural knowledge also involves obtaining information about the degree of acculturation of the individual in order to assess whether the patient is fully immersed in his/her own cultural values as opposed to having been acculturated and consciously rejecting his/her group's cultural practices (Campinha-Bacote, 1998; Sealey, Burnett, & Johnson, 2006).

Cultural skill involves the ability to collect relevant data that reflects the patient's health history and presenting problem, as well as accurately and appropriately perform a physical examination that is congruent with and respects the beliefs, practices, and values of the cultural group (Campinha-Bacote, 1998; Sealey, Burnett, & Johnson, 2006).

Cultural encounters involve the process of engaging in direct encounters with patients from diverse cultural backgrounds in order to increase the practitioners repertoire of responses and communications, both verbal and non-verbal. These encounters also serve to validate, clarify, modify, and sometimes negate pre-conceived notions about other cultures (Campinha-Bacote, 1998; Sealey, Burnett, & Johnson, 2006).

Cultural desire involves the motivation of the practitioner to want to engage in cultural encounters and advance along the continuum of cultural competency in the provision of culturally competent health care (Campinha-Bacote, 1998; Sealey, Burnett, & Johnson, 2006).

Levels of cultural competence within the nursing community

The importance of considering patients' culture as an integral part of assessing health needs, planning, and implementing culturally appropriate nursing care has been endorsed by many nursing and government organizations, including the Transcultural Nursing Society, the American Nurses Association Council on Diversity in Nursing Practice, the American Academy of Nursing Expert Panel on Cultural Diversity, the American Academy of Nursing, the U. S. Department of Health and Human Services Office of Minority Health, the Centers for Medicare Services, and the Joint Commission on Accreditation of Healthcare Organizations (Sealey, Burnett, & Johnson, 2006).

Acquiring cultural competence requires health care practitioners to see themselves as becoming culturally competent as opposed to merely mirroring or mimicking behavior in a culturally characteristic manner. Cultural competence, therefore, requires more than just an understanding of race and ethnicity; it requires a higher level of knowledge and understanding gained from conceptual and theoretical perspectives. Skills, attitudes, and personal beliefs must be linked to care designed to meet the needs of marginalized groups, individuals, or communities of people who have similar or distinct characteristics that might also differentiate those people from the mainstream (Giger et al., 2007).

Although we have made great advances in the development of ethnonursing research methods and transcultural nursing theories and concepts, Barbee and Gibson (2001) have articulated that:

We need to recognize that despite the number of 'dog and pony shows' and books that purport to deal with 'cultural diversity', talking and writing about cultural diversity without consciously and forthrightly dealing with [it] in nursing education [and practice] are essentially empty exercises that will continue to perpetuate the status quo (as cited in Waite & Calamaro, 2010, p. 74).

The question, therefore, has become: have we, albeit unintentionally, essentially perpetuated the status quo?

Review of the nursing literature has revealed that the majority of nurses continue to believe they are less confident and inadequately prepared to provide sustained, culturally competent care to patients from diverse cultures, often regardless of their educational experiences or personal experiences (Fawcett, 2002; Giger, et al., 2007; Leininger, 2007; Leininger, 2002b; Levine & Perpetua, 2006; Luna & Miller, 2008; McFarland & Eipperle, 2008; Mixer, 2008; Papadopoulos & Omeri, 2008; Waite & Calmaro, 2010).

Tools that assess and measure cultural competence

Testing the effectiveness of transcultural theories and models requires the application of both qualitative and quantitative methods. Several quantitative scales have been developed to assess and measure cultural competence in nursing. One such scale is the Cultural Diversity Questionnaire for Nurse Educators, which is based on Campinha-Bacote's (1998) model of cultural competence. The instrument includes items which measure cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desire and contains 55 statements that the respondents are asked to express their level of agreement with on a five-point Likert-type scale. Content validity of the scale was reported in the research of Sealey, Burnett, and Johnson (2006). This study, domiciled in Louisiana, revealed that very few of the responding nurse educators had formal preparation to teach transcultural nursing and generally felt uncomfortable doing so (Sealey, Burnett, & Johnson, 2006, p. 138). The researchers suggested that "perhaps the existing low levels of cultural competence among generic students, masters students, and practicing nurses is the result of erroneous approaches to teaching cultural competence" (Sealey, Burnett, & Johnson, 2006, p. 139; Bond, Kardong-Edgren & Jones, 2001).

Another quantitative scale measuring cultural self-efficacy is the Cultural Self Efficacy Scale (CSES), a 26 item, 5-point Likert scale, which is designed to measure the perceived sense of self-efficacy of nurses in caring for culturally diverse patients. The CSES is the "most frequently used tool for measuring cultural competency" (Kardong-Edgren & Campinha-Bacote, 2008, p. 39). This scale was used by Liu, Mao, and Barnes-Willis (2008) in their study of community health nurses who were in their last semester of a California state-funded university nursing program. This instrument contains items that are grouped into three subscales and measure knowledge of: (1) cultural concepts; (2) cultural patterns of specific ethnic group; and (3) skills in performing cultural care. Participants in this study were asked to rate their perceptions of confidence about their cultural knowledge, patterns, and skills in caring for three ethnic groups of patients: Blacks, Latino-Hispanics, and Southeast Asians. Content validity of the scale was reported and Cronbach's alpha coefficients of the instrument ranged from 0.86 0.98. Results of the study revealed the students' self-efficacy ratings for all items fell between the "neutral" or "non-committal" rating of confidence (Liu, Mao, & Barnes-Willis, 2008, p. 103). Kardong-Edgren and Campinha-Bacote (2008) have advised against using the Cultural Self Efficacy Scale with student nurses because "most cultural competency tools have been normed on practicing nurses" and student nurses are often not aware of what it is that they do not know (p. 39, as cited in Coffman, Shellman & Bernal, 2004).

A third quantitative scale measuring the process of cultural competence over time is the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals. The instrument was developed by Campinha-Bacote (1998) and is a 20 item, 4-point Likert scale tool that measures the constructs of cultural (1) awareness; (2) knowledge; (3) skill; and (4) encounters. Internal consistency of the instrument was determined to be high (alpha =0.81-0.86). This instrument was used as a pre-test and post-test by Wilson, Sanner and McAllister (2010) in their study of 28 Health Science faculty teaching nursing and other allied health students (p. 71). The instrument was used before a continuing education cultural awareness program, was provided to the faculty, was also used immediately after the workshop, and was repeated at three months, six months, and again twelve months following the program. Results of the study revealed that the faculty scores improved in cultural (1) awareness; (2) knowledge; (3) skill; and (4) encounters immediately following the program; however, there was a decrease in the mean score of four items over time "indicating that some faculty were still uneasy about personal cultural competence concepts, such as still having frustration when their values and beliefs clash with others, their knowledge about world views, personal stereotyping and the inability to recognize personal limitations when working with persons of other cultures" (Wilson, Sanner, & McAlister, 2010, p. 71).

The Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised[C] was used as a post-test in Kardong-Edgren and Campinha-Bacote's (2008) study on graduating students from four schools of nursing. The study evaluated the effectiveness of four different nursing program curricula in producing culturally competent nursing graduates. One program integrated Madeline Leininger's theory of transcultural nursing into its program, one program integrated Campinha-Bacote's model of transcultural nursing into its program, one program used a mixed integrated approach, and one program utilized a free-standing two credit culture course within its curriculum. The instrument used was a 25-item scale that measured the five cultural constructs of cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desire, with five items addressing each construct. The instrument reportedly had a reliability coefficient Cronbach's alpha of 0.83 (Kardong-Edgren & Campinha-Bacote, 2008, p. 39). Results of the study revealed, even without the benefit of a pre-test, that regardless of the approach used, the students scored only in the culturally aware range. "Programs with the most diverse student bodies, most international students, oldest and youngest student bodies, also did not faire better than any other program" (Kardong-Edgren & Campinha-Bacote, 2008, p. 40).

The Openness to Diversity and Challenge Scale (ODCS) was used in Sanner, Cannella, Charles, and Parker's (2010) study to determine the effectiveness of a cultural diversity forum on nursing students' cultural sensitivity as measured by their openness to diversity. The instrument used was an eight-item Likert scale that measured the students' openness to diversity and challenge. The scale reportedly had a reliability score of Cronbach's alpha of 0.83 (Sanner, Cannella, Charles, & Parker, 2010, p. 59). Forty-seven out of 125 students who registered and attended a Diversity Forum agreed to participate and complete both the ODCS pre-test and posttest. The results of the study suggested that diversity forums were more effective with older, minority women (Sanner, Cannella, Charles, & Parker, 2010, p. 60).

Recent qualitative studies addressing nursing students perceptions of their level of cultural awareness following culturally specific curricula enhancements include Wood and Atkins (2006) (studies of communities in Choluteca, Honduras); Levine and Perpetua (2006) (studies of communities in Honduras, Mexico, Nepal, the Phillipines, Russia, and Slovenia); and Ndiwane, et al., (2004) (studies of underserved immigrant communities in Worchester, Massachusetts). In all three studies, the overarching goal was to increase the student's capacity to value diversity, acquire cultural knowledge, and provide appropriate, culturally-sensitive care. Although all students self-reported an increase in cultural knowledge and awareness following their experiences, there were reported limitations related to the practitioners abilities to maintain sustainable changes in practices (Levine & Perpetua, 2006).

Implications for organizations

As much as we would like to think that the current status of transcultural nursing and education translates into effective education programs and exemplary provisions of culturally competent care, the literature may be indicating otherwise. We are still only beginning to understand how the nursing profession can provide critical learning environments and workplaces for students, faculty and practitioners to grasp the concepts of transcultural nursing that go beyond the constructs of race and ethnicity and include such subcultures as gay/lesbian/bisexual/transgendered, blind, deaf, and the mentally challenged communities and then evaluate the effectiveness of our actions and implementations. "With more than 4,000 distinct cultures in the world, there are more culture care constructs to be discovered in the future" (Leininger, 2007, p. 11).

Nevertheless, this interim status report provides us with opportunities to be creative in designing cultural immersion experiences, faculty workshops, educational programs, certification programs, and quantitative and qualitative evaluation tools to measure the effectiveness of our cultural competence programs and experiences (Luna & Miller, 2008, p. 2). We are also provided with further opportunities to disseminate important concepts, information and findings through research, conferences, scholarly journals, nursing publications, staff development and continuing education programs.

CE Activity: Provision of Culturally Competent Health Care: An Interim Status Review and Report

Thank you for your participation in Provision of Culturally Competent Health Care: An Interim Status Review and Report, a new 1.4-hour CE activity offered by NYSNA. NYSNA members and non-members are invited to take part in this activity, and you do not need to be a resident of New York State.

INSTRUCTIONS:

In order to receive contact hours for this educational activity, participants are to read the article presented in this issue of the Journal, complete and return the post-test, evaluation form, and earn 80% or better on the post-test.

This activity is free to NYSNA members and $10 for non-members. Participants can pay by check (made out to NYSNA & please include CE code 11WHD8 on your check) or credit card. The completed answer sheet and evaluation form may be mailed or faxed back to NYSNA; see the answer sheet for more information.

The New York State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

NYSNA wishes to disclose that no commercial support was received for this educational activity.

All planners/authors involved with the development of this independent study have declared that they have no vested interest.

GOAL:

To examine the current status of the nursing professions' initiative to integrate multicultural, diversity training into its educational programs and on the degree to which nurses' report on their preparedness to provide exemplary, culturally competent care following their educational training.

OBJECTIVES:

By completion of the article, the reader should be able to:

1. Define culture, cultural competence, culture care, culturally competent care, and cultural diversity.

2. Identify one theory and one conceptual model of cultural care.

3. Discuss nurses' currently reported levels of cultural competence as measured by tools that assess and measure cultural competence.

Please answer the questions below. Remember to complete the answer sheet by putting the letter of your corresponding answer next to the question number. Each question has only one correct answer.

The 1.4 contact hours for this program will be offered until July 12, 2016.

1. The Expert Panel on Cultural Competence is charged with ensuring that measurable outcomes be achieved that reduce or eliminate health disparities found in all of the following populations, except:

a) The uninsured.

b) The underserved.

c) The underrepresented.

d) The racial minority living abroad.

2. The Office of Minority Health has required health care providers to offer health care services that are respectful of and responsive to all of the following, except:

a) Health beliefs of diverse patients.

b) Cultural practices of diverse patients.

c) Musical practices of diverse patients.

d) Spiritual needs of diverse patients.

e) Linguistic needs of diverse patients.

3. Differences in definitions and foci have led to delayed advancements toward the provision of exemplary culturally competent nursing care in the United States.

a) True

b) False

4. The definition of "culture" includes all of the following except:

a) Morals

b) Biological inheritance

c) Custom

d) Beliefs

5. The definition of "culture care" includes all of the following, except:

a) Those assistive, supportive, enabling, and facilitative culturally-based ways to help people in a compassionate, respectful, and appropriate way to improve a human condition.

b) The concept of care as a regimen.

c) The concept of care as protection.

d) The concept of care as respect.

6. The definition of "cultural diversity" includes all of the following, except:

a) It is a concept that serves communities with little variations in socioeconomics or race.

b) It is a construct that is variable in quantity and quality, across place and time.

c) It is a concept that goes beyond the constructs of ethnicity and race.

d) It is a concept that includes class, gender, sexual orientation, and physical abilities/ disabilities.

7. Madeline Leininger's Theory of Culture Care Diversity and Universality is unique in that:

a) It is the only nursing theory focused explicitly on "culture care" as the dominant theme of nursing inquiry.

b) It is a holistic, culturally-based care theory that incorporates broad humanistic dimensions about people in their cultural life context.

c) It incorporates social structure factors, such as religion, politics, economics, cultural history, and philosophy of living.

d) All of the above.

8. All of the following are true about Madeline Leininger's Theory of Culture Care Diversity and Universality except:

a) It requires nurses to discover dominant care constructs and perform in-depth studies of cultures to identify the close relationship of care to culture.

b) It is a theory that reinforces the medical and nursing ideology of focusing on diseases, symptoms, and pathological conditions.

c) It is a theory that incorporates "caring" as its dominant focus.

d) It is a theory that focuses on "emic" and "etic" care knowledge.

9. Fawcett, Newman and McAllister have added all of the following dimensions to Leininger's Theory of Culture Care Diversity and Universality for theory application in advance practice nursing, except:

a) The theory should foster a focus on the illness.

b) The theory should consider the patient's significant other's perception of the situation.

c) The theory should facilitate autonomous nursing practice.

d) The theory should encourage diverse ways of sociopolitical knowing.

10. Which of the following statements is not true of Campinha-Bacote's conceptual model of cultural competency:

a) Cultural awareness involves a self-examination and self-assessment of one's own culture and its potential influence on one's way of thinking and behavior.

b) Cultural knowledge involves obtaining information about the worldviews of different cultural groups, including how its members interpret illnesses.

c) Cultural skill involves the ability to perform a physical examination that is measured by the prevailing standards of practice.

d) Cultural encounters involve the process of engaging in direct encounters with patients from diverse cultural backgrounds in order to increase verbal and non-verbal communication skills.

11. The Cultural Diversity Questionnaire for Nurse Educators measures all of the following, except:

a) Cultural awareness

b) Cultural skills

c) Cultural desire

d) Cultural assessments

12. The Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals measures all of the following except:

a) Cultural awareness

b) Cultural skills

c) Cultural desire

d) Cultural encounters

13. The Openness to Diversity and Challenge Scale is most appropriate for use with:

a) Nursing educators

b) Minority nurses

c) Practicing nurses

d) Student nurses

14. Nursing practitioners report limitations related to their ability to maintain sustainable changes in practices following culturally specific curricula enhancements.

a) True

b) False

15. Transcultural nursing goes beyond the constructs of race and ethnicity and includes such subcultures as:

a) Gay/Lesbian/Bisexual/Transgendered

b) Blind/Deaf

c) Mentally challenged

d) All of the above

[ILLUSTRATION OMITTED]

[ILLUSTRATION OMITTED]

REFERENCES

American Academy of Nursing. (2012). Retrieved from http://www.aannet.org/aboutthe-academy.

Barbee, E. L., & Gibson, S. E. (2001). Our dismal progress: the recruitment of non-whites into nursing. Journal of Nursing Education, 40(6), 243-244.

Bond, M. Kardong-Edgren, S. & Jones, M. (2001). Assessment of professional knowledge and attitudes about patients of diverse cultures. Journal of Professional Nursing, 17(6), 305-312.

Campinha-Bacote, J. (1998). The process of cultural competence in the delivery of healthcare services: A culturally competent model of care (3rd ed.). Cincinnati, Ohio: Transcultural C.A.R.E Associates.

Coffman, M., Shellman, J., & Bernal, H. (2004). An integrative review of American nurses' perceived cultural self-efficacy. Journal of Nursing Scholarship, 36, 180-185.

Fawcett, J. (2002). The nurse theorists: 21st century updates--Madeleine M. Leininger. Nursing Science Quarterly, 15(2), 131-136.

Fawcett, J., Newman, D. M. L., & McAllister, D. (2004). Advanced practice nursing and conceptual models of nursing. Nursing Science Quarterly, 1 7, 135-138.

Germain, M. (2004). A cultural variable in practice. In Joel, L. A. (Ed.). Advanced nursing practice: Essentials of role development (p. 435). Philadelphia, PA: FA Davis & Company.

Giger, J., Davidhizar, R. E., Purnell, L., Taylor Harden, J., Phillips, J., & Strickland, O. (2007). American Academy of Nursing Expert Panel report: Developing cultural competence to eliminate health disparities in ethnic minorities and other vulnerable populations. Journal of Transcultural Nursing, 18(2), 95-102.

Kardong-Edgren, S. & Campinha-Bacote, J. (2008). Cultural competency of graduating US Bachelor of Science nursing students. Contemporary Nurse, 28, 37-44.

Leininger, M. (2001). Culture care diversity and universality: A theory of nursing. Sundbury, MA: Jones and Bartlett Publishers.

Leininger, M. (2002a). Transcultural nursing and globalization of healthcare: Importance, focus, and historical aspects. In Leininger M. and McFarland, M.R. (Eds.). Transcultural nursing: Concepts, theories, research and practice (3rd ed., p. 12). New York, NY: McGraw-Hill.

Leininger, M. (2002b). Culture care theory: A major contribution to advanced transcultural nursing knowledge and practices. Journal of Transcultural Nursing, 13(3), 189-192.

Leininger, M. (2006). Culture care diversity and universality theory and evolution of the ethnonursing method. In Leininger M. M. and McFarland M. R. (Eds.). Culture care diversity and universality: A worldwide theory of nursing (2nd ed., p.15). Sudbury, MA: Jones and Bartlett Publishers.

Leininger, M. (2007). Theoretical questions and concerns: Response from the theory of culture care diversity and universality perspective. Nursing Science Quarterly 20(1), 9-15.

Levine, M. A., & Perpetua, E. M. (2006). International immersion programs in baccalaureate nursing education: Professor and student perspectives. Journal of Cultural Diversity, 13(1), 20-26.

Liu, L., Mao, C. L., & Barnes-Willis, L. E. A. (2008). Cultural self-efficacy of graduating baccalaureate nursing students in a state funded university in the Silicon Valley. Journal of Cultural Diversity, 15(3), 100-107.

Luna, L. J., & Miller, J. (2008). The state of transcultural nursing global leadership and education. Contemporary Nurse, 28(1-2), 1-2.

McFarland, M. M., & Eipperle, M. K. (2008). Culture care theory: A proposed practice theory guide for nurse practitioners in primary care settings. Contemporary Nurse, 28(1-2), 48-63.

Mixer, S. J. (2008). Use of the culture care theory and ethnonursing method to discover how nursing faculty teach culture care. Contemporary Nurse 28(1-2), 23-36.

Ndiwane, A., Miller, K. H., Bonner, A., Imperio, K., Matzo, M., McNeal, G., Amertil, N., & Feldman, Z. (2004). Enhancing cultural competencies of advanced practice nurses: Health care challenges in the twenty-first century. Journal of Cultural Diversity, 11(3), 118-121.

Papadopoulos, I., & Omeri, A. (2008). Transcultural nursing theory and models: The challenges of application. Contemporary Nurse, 28(1-2), 45-47.

Purnell, L., & Palunka, B. (Eds.). (2003). Transcultural health care. Philadelphia, PA: F. A. Davis.

Sanner, S., Baldwin, D., Cannella, K. A. S., Charles, J., & Parker, L. (2010). The impact of cultural diversity forum on students' openness to diversity. Journal of Cultural Diversity, 17(2), 56-61.

Schim, S. M., Doorenbos, A., Benkert, R., & Miller, J. (2007). Culturally congruent care: Putting the puzzle together. Journal of Transcultural Nursing, 18(2), 103-110.

Sealey, L. J., Burnett, M., & Johnson, G. (2006). Cultural competence of baccalaureate nursing faculty: are we up to the task? Journal of Cultural Diversity, 13(3), 13 1-140.

Sitzman, K., & Eichelberger, L. W. (2004). Understanding the work of nurse theorists: A creative beginning. Sundbury, MA: Jones and Bartlett Publishers.

St. Clair, A., & McKenry, L. (1999). Preparing culturally competent practitioners. Journal of Nursing Education, 38(5), 228-234.

Tylor, E. B. (1958). Primitive culture. New York, NY: Torchbooks.

Underserved Quality Improvement Organization Support Center (UQIOSC). (2007). A cultural competency standards crosswalk. A tool to examine the relationship between the OMH CLAS standards and JCAHO/URAC/NCQA accreditation standards. Retrieved from https://www.urac.org/savedfiles/CLAS_Standards_Crosswalk_V2.pdf

UC Davis Health System, Human Resources. (2012). Cross cultural competency program. Retrieved from http://www.ucdmc.ucdavis.edu/hr/hrdepts/eod/cross_cultural_ competency.html

U.S. Census Bureau. (2004). Projected population of the United States, by race and Hispanic origin: 2000 to 2050. Retrieved from http://www.census.gov/population/ www/projections/usinterimproj/natprojtab01a.pdf

U.S. Census Bureau. (2010). The next four decades. The older population in the United States: 2010-2050. Population estimates and projections. Retrieved from http://www. census.gov/prod/2010pubs/p25-1138.pdf

U.S. Department of Health & Human Services Offices of Minority Health. (2005). What is cultural competency? Retrieved from http://minorityhealth.hhs.gov/templates/ browse.aspx?lvl=2&lvlID=11

Waite R., & Calmaro, C. J. (2010). Cultural competence: a systemic challenge to nursing education, knowledge, exchange, and the knowledge development process. Perspectives in Psychiatric Care, 46(1), 74-80.

Wilson, A. H., Sanner, S., & McAllister, L. E. (2010). A longitudinal study of cultural competence among health science faculty. Journal of Cultural Diversity, 17(2), 68-72.

Wood, M. J., & Atkins, M. (2006). Immersion in another culture: One strategy for increasing cultural competency. Journal of Cultural Diversity, 13(1), 50-54.

Carol Lynn Esposito is the Labor Education Specialist, Strategic Research, Policy, and Labor Education, New York State Nurses Association in New York, N.Y
Table 1. Scales Measuring Cultural Competence

Scale                Measures                  Reliable Uses

Cultural Diversity   * Cultural Awareness      55 item, five-point
Questionnaire for    * Cultural Knowledge      Likert scale for use
Nurse Educators      * Cultural Skills         with nursing educators
                     * Cultural Encounters
                     * Cultural Desire

Cultural Self        * Cultural Concepts       26 item, five-point
  Efficacy Scale     * Cultural Patterns       Likert scale for use
                     of Ethnic Groups          with practicing nurses
                     * Skills in Performing
                     Cultural Care

Inventory for        * Cultural Awareness      20 item, four-point
  Assessing the      * Cultural Knowledge      Likert scale for use
  Process of         * Cultural Skills         with nursing faculty,
  Cultural           * Cultural Encounters     practicing nurses, and
  Competence                                   nursing students
  Among Healthcare
  Professionals

Inventory for        * Cultural Awareness      25 item, five-point
  Assessing the      * Cultural Knowledge      Likert scale for use
  Process of         * Cultural Skills         with practicing nurses
  Cultural           * Cultural Encounters     and nursing students
  Competence         * Cultural Desire
  Among Healthcare
  Professionals
  Revised

Openness to          * Openness to Diversity   8 item, five-point
  Diversity and      * Openness to Challenge   Likert scale for use
  Challenge Scale                              with older, minority
                                               nurses
COPYRIGHT 2012 New York State Nurses Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2012 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Author:Esposito, Carol Lynn
Publication:Journal of the New York State Nurses Association
Article Type:Report
Geographic Code:1USA
Date:Sep 22, 2012
Words:6679
Previous Article:Editorial: a continuing commitment to excellence.
Next Article:Education to increase women's knowledge of female myocardial infarction symptoms.
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters