Education and Training in Culturally Competent Care

Abstract

The International council of Nurses (ICN) acknowledges the requirement for nurses to receive appropriate initial and ongoing education and training as well as life-long learning to practice competently; other major participants in the planning and direction of nursing education, nursing services, regulatory bodies, and other health related activities are included. Governmental agencies, NGOs, and national nursing associations and organizations are responsible for overseeing and regulating the education of nurses. ICN supports the integration of cultural care knowledge and training for cultural competence into all levels of nursing education (Madden-Styles and Affara, ICN on regulation: towards 21st century models. Global health care is core knowledge, Geneva, 1998). In addition, cultural content is required for all nursing programs.

Guideline: Nurses shall be educationally prepared to provide culturally congruent health care. Knowledge and skills necessary for assuring that nursing care is culturally congruent shall be included in global health care agendas that mandate formal education and clinical training, as well as required ongoing continuing education for all practicing nurses.

Douglas et al. (2014: 110)

Appendices

Appendix 1: Recommended Content for Beginning Level Cultural Competency Education

Beginning level includes vocational or practical nursing programs, associate degree and diploma programs, and continuing education and in-service programs. The cultural content can be provided in a separate course as well as integrated into existing clinical curriculum. Modules of key concepts can be developed to provide for the greatest flexibility of presentation of this material. Key concepts that need to be integrated follow.

1.1 Overall Program Objectives Related to Culture

Develop cultural assessment skills of self and others (individuals and families):

• 1. Identify cultural similarities and differences and potential approaches to differences.

• 2. Use culture-related resources available for potential problems.

• 3. Recognize forms of discrimination in nursing care and take action to prevent or address them.

1.2 Content Related to Culture

• 1. Effective communication is essential for healthcare practice at all levels. A sample communication exercise is included (see Appendix 2 Chap. 14).

• 2. Culturally congruent care should be integrated as a component of every clinical course.

• 3. Social and material determinants of health should be included in theory courses and reinforced in clinical courses.

• 4. Cultural patterns and values of select cultural and ethnic or subcultural groups should be included in theory courses and reinforced in clinical courses.

• 5. Common cultural terms should be included in theory courses and reinforced in clinical courses. Some essential terms and concepts are collectivism, individualism, and individuality; cultural awareness, sensitivity, competence, and congruency; cultural imposition, relativism, and imperialism; cultural assimilation and accommodation, ethnocentrism, and stereotyping versus generalizing; individual and organizational cultural competence; interpretation versus translation; and ethnicity and subculture.

• 6. Biocultural variations should be incorporated into anatomy and physiology and pathophysiology and reinforced in clinical courses.

• 7. Genetic and hereditary diseases should be included in pathophysiology courses and reinforced in all clinical courses.

• 8. Common illnesses and diseases in cultural and ethnic groups should be included in pathophysiology and reinforced in clinical courses.

• 9. Dietary practices that include prescriptive, restrictive, and taboo practices of specific cultural and ethnic groups should be included in all clinical courses.

• 10. Health belief systems and complementary and alternative practices can be incorporated in pharmacology and/or assessment and reinforced in all clinical settings.

Appendix 2: Recommended Content for Advanced-Level Cultural Competency Education

Components of culture should be integrated into courses such as health assessment, pharmacology, anatomy and physiology, and all specialty clinical courses. Communication strategies beginning with assessing the client’s preferred language and health literacy along with spatial distancing, eye contact, greetings, temporality, touch, and name format are essential. Interpretation and translation that include sign languages are also essential components of communication (see Chap. 14). In a pharmacology course, the racial/cultural difference in response to drugs should be included. In physiology and pathophysiology courses, the biocultural aspects of diseases should be included as well as the biocultural variations in pain, height, weight, musculoskeletal variations, and physical appearances in general.

The following is a sample stand-alone course recommended for senior healthcare practitioners, nurse practitioners, and masters and doctoral level students. Cultural case studies should be included in all courses with content appropriate for the course. In addition, resources for teaching culture are included.

1.1 Course Description

Components of this course can be used in in-service and continuing education classes as deemed relevant or pertinent by the organization. A comprehensive course should include theories and models focused on culture, social and material determinants of health, health disparities, selected culturally specific groups commonly found in the catchment area of the school or organization, and common research methodologies used in cultural research. Evidence-based practice must be incorporated in discussions and formal scholarly papers (see Chap. 30). Students will critically reflect on their own cultural beliefs and values. Assignments should include group discussions on cultural and religious groups with an application to nursing practice. A formal team paper with four to six students is recommended because it increases learning knowledge. The team paper should be on a cultural or subcultural group different from anyone on the team.

1.2 Suggested Course Objectives

Upon completion of this course, the student will be able to:

• 1. Articulate the concepts that explain cultural diversity and their relevance for nursing practice

• 2. Examine cultural issues and trends in nursing practice

• 3. Analyze selected population group cultural patterns and behavioral manifestations of cultural values

• 4. Evaluate the socioeconomic impact of client’s cultural needs upon levels of care: primary, secondary, and tertiary

• 5. Articulate theory, research methods, and advanced multicultural-sensitive nursing practice concepts

• 6. Formulate a model of care integrating culturally sensitive assessment, planning, intervention, and evaluation

• 7. Analyze impact of public and organizational policies on health of individuals and populations

• 8. Develop collaborative engagement with individuals and groups to mitigate health inequity

• 9. Promote engagement of individuals, groups, and organizations in health promotion for disadvantaged populations

• 10. Develop cross-cultural leadership to promote culturally competent care and retention of multicultural workforce

1.3 Possible Teaching Strategies

PowerPoint lectures

Live classroom or online discussions of cultural, ethnic, or subcultural groups

Required and recommended readings determined by the faculty teaching the course

Recommended Web sites

1.4 Topical Outline

• A. Introduction to culture and related concepts

  • 1. Values and culture

  • 2. Vulnerability as a framework

  • 3. Expanding definitions of cultural groups and underserved populations

  • 4. Review of common cultural terms: collectivism, individualism and individuality; cultural awareness, sensitivity, competence and congruency; cultural imposition, relativism, and imperialism; cultural assimilation and accommodation, ethnocentrism, stereotyping, and generalizing; individual and organizational cultural competence; interpretation versus translation; and ethnicity and subculture.

• B. Selected theoretical models for nursing practice

  • 1. Andrews and Boyle Assessment Guide

  • 2. Campinha-Bacote’s Model The Process of Cultural Competence in the Delivery of Healthcare Services

  • 3. Giger and Davidhizar Transcultural Assessment Model

  • 4. Leininger’s Culture Care Diversity and Universality Theory

  • 5. Jeffrey’s Cultural Competence and Confidence (CCC) Model: Transcultural Self-Efficiency

  • 6. Papadopoulos, Tilki, and Taylor Model for Developing Culturally Competent and Compassionate Healthcare

  • 7. Purnell Model for Cultural Competence

  • 8. Schim, Dorenbos, Benkert, and Miller Dimensional Puzzle Model of Culturally Competent Care

• C. Managing health disparities through culturally competent research

  • 1. Minorities, migrants, and refugees

  • 2. Health disparities in the catchment area where students do clinical

• D. Cultural patterns and values of select cultural and ethnic, or subcultural groups: Hispanic/Latino, Arab/Muslim, Jewish, Haitian, Lesbian Gay Bisexual Transgender, Alcoholics Anonymous, and/or others. Some should come from the catchment area where the students practice and at least one that is not common among the community to give the course a global perspective.

1.5 Scholarly Formal Paper on a Specific Cultural, Ethnic, or Subcultural Group

• 1. Conduct a literature review on four domains of a cultural, ethnic, or subcultural group different from your own culture. The domains for the literature review can include:

  • Heritage overview (as the introduction)

  • Communication

  • Family roles and organization

  • Workforce issues

  • Biocultural ecology

  • High-risk health behaviors

  • Nutrition and the meaning of food

  • Pregnancy and the childbearing family

  • Death and dying rituals

  • Spirituality and religion

  • Healthcare practices including complementary and alternative practices

• 2. In a team paper, each team should have no more than four to six members.

• 3. Most references should come from the last 6 years, although classic references are acceptable.

• 4. Most of the references should come from the research literature. Internet sources are acceptable as long as they come from governmental organizations, universities, or professional associations and organizations. Wikipedia is not an acceptable reference because content has not been refereed. Blogs and travel sites are not acceptable.

• 5. Once the literature review is completed, create a list of at least four recommendations for research based on gaps in the literature. The research questions must be something that a graduate student can accomplish. For each question, identify if the research is qualitative or quantitative research, the specific methodology (phenomenology, grounded theory, correlational, quasi-experimental, etc.), and a brief description of the methods to carry out this research.

• 6. Identify applications to practice. Be specific, not something general that would be the same for any cultural group.

1.6 Resources for Advanced Courses in Cultural Competency Education

• American Association of Colleges of Nursing. (2017). Essentials of Baccalaureate and Graduate Education in Nursing. Available at http://www.aacnnursing.org/. [Accessed 7 December 2017].

• Andrews, M.M., and Boyle, J.S. (2016). Transcultural concepts and nursing care (7ed.). Philadelphia, Wolters Kluwer.

• Campinha-Bacote, J. Transcultural C.A.R.E. Associates. Available at http://transculturalcare.net/the-process-of-cultural-competence-in-the-delivery-of-healthcare-services/. [Accessed 7 December 2017].

• Douglas, M. and Pacquiao, D. (2010). Core Curriculum for Transcultural Nursing and Health Care. Sage Publications. http://www.tcns.org/TCNCoreCurriculum.html. [Accessed 7 December, 2017].

• CIA World Factbook. Available at http://rubyworldfactbook.com/, [Accessed 7 December, 2017].

• Giger, J., and Davidhizar, R. (eds.) (2012). Transcultural nursing: assessment and intervention (3rd. ed.). Philadelphia, PA: Elsevier.

• Jeffreys, M.R. (2010). Teaching cultural competence in nursing and health care. NY: Springer.

• European Transcultural Nursing Society. Available at http://europeantransculturalnurses.eu/. [Accessed 7 December 2017].

• McFarland, M and Wehbe-Alamah, HB. (eds). (2015). Leininger’s culture care diversity and universality: a worldwide nursing theory, (3e). Burlington, ME: Jones & Bartlett Learning.

• Papadopoulos, Tilki, and Taylor Model for Developing Culturally Competent and Compassionate Healthcare. Available at http://cultureandcompassion.com/what-is-culturally-competent-compassion-2/, [Accessed 7 December 2017].

• Purnell, L. (2013). Transcultural health care: a culturally competent approach. Philadelphia: F.A. Davis.

• Sagar, P. (2014). Transcultural nursing education strategies. NY: Springer Publishing Company.

• Schim, Dorenbos, Benkert, & Miller, (2007). Dimensional Puzzle Model of Culturally Competent Care Available at http://europepmc.org/articles/PMC3074191. [Accessed 7 December 2017].

• Transcultural Nursing Society. Available at http://www.tcns.org/. [Accessed 7 December 2017].

• United Nations Millennium Development Goals. (n.d.). Available at http://www.un.org/millenniumgoals/. [Accessed 7 December, 2017].

• U.S. Department of Health and Human Services Office of Minority Health, (n.d.). National CLAS Standards. Available at https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53. [Accessed 7 December 2017].