Jan 25, 2018 in Research

Cultural Competence

A summary of your area of interest, an identification of the problem that you have selected, and an explanation of the significance of this problem for nursing practice

What is cultural competence care in nursing?

Cultural competence healthcare is the ability of systems to provide patients with diverse values, beliefs, and behaviors to meet their socio-cultural and linguistic needs. Experts in cultural competence healthcare describe it as a tool to increase access to quality care for patients as a business strategy to attract new patients and gain market share (Betancourt et al, 2002). Competent cultural healthcare can also be termed as an individual family, community, and entire population standards set in accordance to social justice. It has an aim to reduce inequalities in health outcomes. Social justice in this case refers to beliefs entitling people and groups for fair and equal rights. Ensuring free participation in social events, education, and both economic and health opportunities is extremely important. Cultural competence standards acts are a guiding factor in training nurses, conducting research, administrating, and educating nursing schools' nurses to increase their cultural competence (White, 2011). This is a part of priority care to the entire population in existence. These cultural competence standards exist in political, economic, and social systems (Expert Panel on Global Nursing Health, 2010).

This field of cultural competence has emerged in many countries, especially in the USA, due to countries becoming more racially and ethnically diverse. This has called for healthcare systems and providers to respond to varied perspectives, values, and behaviors regarding health and general well-being (Leahy, 2005). Failure to recognize and understand cultural competences has negatively influenced minority groups. This field of cultural competence has lately emerged as a strategy to reduce existing disparities in access to quality healthcare. Principles of cultural competent care have not been formulated (Betancourt et al, 2002).

There are certain impediments to cultural competent care. Cultural competent care directed to patients, healthcare providers, and entire healthcare system is a likely possibility. These barriers affect quality of services delivered. They also contribute to racial/ethnic disparities in medical care. These barriers include lack of diversity in healthcare’s leadership and workforce. Poorly designed systems rarely meet the needs of diverse patient population. In addition, communication between providers and patients of different racial, ethnic, and cultural backgrounds is poor. The shortcomings that have to be addressed to obtain major benefits are discussed further in this paper (Betancourt et al, 2002).

The main benefit of cultural competence is direct elimination of racial/ethnic disparities in healthcare sector. Healthcare experts in the government and managed care as well as community healthcare practitioners must join hands in order to ensure development of cultural competence through continuous improvement of services (Betancourt et al, 2002). Targets of competence healthcare attained through implementation of standards set for medical care by expert panel on global nursing and health (Leahy, 2005). These standards include social justice, critical reflection, knowledge of cultures, cultural competent practices in healthcare systems and organizations, patient advocacy and empowerment, multicultural workforce, educational training on cross-cultural care leadership, policy developments, and evidence-based practices (Expert Panel on Global Nursing Health, 2010).

When achieved, these standards will bring positive outcomes that will ensure effective leadership maintenance. This leadership based on principles of dignity and humanity will be racism-free. This, therefore, ensures high quality life as patient advocacy forums become efficient enough to address their issues without intimidation. In addition, patients' empowerment will entitle them with their rights to social justice and equity (Barthum, 2007). Good educational policy implementation allows practicing nurses to continue their education, develop evidence-based practices, and conduct research in culturally diverse environment to study both racial and ethnic characteristics and their role in health outcomes (Douglas, 2009).

This is a major problem in nursing because currently in the USA 28% of its population are minority groups. The irony is that only 3% of medical facilities allocation is set aside for them. In addition, minorities only possess 16% of public heath school facilities, and only 17% of all city and health officers. Almost all healthcare management leaders are white, making up to 98%, ignoring cultural diversity and population composition. This is the reasons why the minority competence care systems negligence is evident where social factors of organizing healthcare delivery may be unavailable (Betancourt, 2002). Studies and researches have proved that there are connections between racial and ethnic diversities on healthcare quality and racial concordance between a doctor and a patient mainly in competence healthcare (Leahy, 2005).

The 5 questions that you have generated and a description of how you analyzed them for feasibility

To perform an evidence-based practice, it is important for a researcher to understand what cultural factors affect healthcare provided to the population, what are the implications attached to the practice, who are the professionals to play key roles, what intervention measures are taken, what outcomes are expected and in which setting should it be enhanced (Booth, 2006). Based on Patient, Intervention, Professionals, Outcome, and Setting (PIPOS), culturally competent healthcare can be engaged in a manner that there would be a reflection of all PIPOS factors contributing to evidence-based practices. Determination of PIPOS variables equips one with knowledge of what training for nurses working on competent care issues are appropriate. These factors will therefore, be: Patient - population that is competently cared for, Intervention - competent care training, Professional - training nurses, Outcome - expected competent care, and Setting - competent care issue (Karen Sue Davis, 2011) are considered in such a manner. Hence, the PIPOS variables supported by the evidence- based research conducted on the competence health care shows the validity of the research findings.

Possible 10 keywords used in conducting a literature search for your PICO question and a rationale for your selections

Among the keywords that can be used for my literature review are competent care, competent training, patient, evident based practice, social justice, cultural differences, policy development, leadership, patient advocacy, and patient empowerment (Leahy, 2005). These keywords in reference to the competent care research question above aims at providing culturally appropriate services and also, linguistic approaches which are sensitive and responsive to the patient needs (White, 2011).  Patient needs cared for must include his beliefs, values, ethnicity and his religion rights to enhance cross-cultural situations. The rationales for selection of these keywords of competent care on health systems, consider both cultural care and linguistic services to enhance inappropriate communication due to variation in cultural understandings. This will increase client satisfaction, which in turn gives him confidence to his heath provider (Anderson, 2003).

Topic 2

Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings

According to cultural competence model practice site visits, authors have studied academic, government, managed care, and community healthcare program to obtain information on how these models qualify for cultural competence. The models studied included White Memorial Medical Centre Family Practice Residency program, Los Angeles, CA. This was an academic site used to conduct this research. This model emphasized curriculum orientation to introduce family medicine residents to the community. More hours spending on issues related to cultural competence that initiated self-reflective exercises are evident in this research (Leahy, 2005). Assessment outcome of interventions of this study was to be at a future date conducted. In the second model, the government Language Interpreter in the Washington State study. Introduction of the Language Interpreter and Translator (LIST) took place in 1991 and has not been changed despite increase in immigrant numbers. LIST has been running a training and certificate program, which is the only one of its kind in Washington. The school is for citizens willing to be interpreters and translators. It checks quality control systems while the Government provides reimbursements for either certified or qualified interpreter or translator services to all Medicaid recipients who need them. 

Any request for translation by the provider direction to the LIST and the rest is to the department for services. LIST also provides document translation services. Moreover, in the managed care site, Kaiser Permanente, San Francisco, CA, Keiser had established multicultural services that provide on-site interpreters for patients in all languages with internal staffing capabilities of different languages and dialects. They also had Chinese interpreter call center for interpretation and making appointments to obtain medical advice. Translation materials in this firm ensure that written materials and signs translation to necessary languages. They also have cultural advisory board established to oversee and consult when a need arises. The firm has also segmented culturally targeting healthcare delivery care in San Francisco facility having Chinese and Spanish bilingual modules and both multispecialty and multi-disciplinary to handle specific cultural and linguistic capacities for Chinese and Latino patients. Their services are a wider range since they include diabetes nurses, case managers, and health educators with all entire staff recruited on cultural understanding and language proficiency. The firm has also linguistic and cultural programs on national levels endorsed by Californian government to offer these services nationally (Betancourt, 2002).

In reference to the community health site’s visit, Sunset Park Family Health Centre Network of Lutheran Medical Centre, Brooklyn (SPFHC), NY studied. The center was built in early 1990s with an aim to expand access to care by Chinese immigrants in the area. This Asian initiative became the first one to create culturally competent healthcare, though most viewed it as a leadership intervention community self-owned primary care. It had a well-established organization philosophy, mission, and history. It aimed at reducing barriers of care and offering flexible hour’s service, interpretation services, and translation. This formed a strong connection with the community leadership and its key resources and training Chinese educated nurses to pass state licensing exams carried out in English. SPFHC made cultural competence an important goal where they funded regular staff trainings programs, offering patient navigators, creating close ties with communities, and always participated in cultural diversity awareness events (Betancourt, 2002).

In the studies discussed above, the cultural competent care can be enhanced using diverse methods as shown above. Interpretation and translation provided by linguistics services to clients/patients is considered to a part of competent care. Curriculum orientation to include family medicines to the community competent care discussed in case studies above indicates the need for effective care deliverance. The studies do not provide specific or similar measure to achieve competent cultural care. Besides, it offers related concepts to acquire competent care as shown above. Further research aimed to formulate scientific method/principles of ensuring competent care proves to be strong drive in future to enhance competent care.

Using the question that you selected in (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICO question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source.

Based on the models discussed above, cultural competence care was not successful, as it ought to be despite all the efforts implementation to acknowledge its need (White, 2011). Patient, Intervention, Professionals, Outcome, and Setting (PIPOS), as seen in topic 1, suggest that competence care, as seen in topic 2, model site visits shows a correlation between them. Evidence-based practices and research as implemented in various models listed above provide, measures to ensure competent care have facilitated success in different fields recognizing the need for cultural divergence.


Connecting research evidence and findings to actual decisions and tasks that nurses complete in their daily practice is essentially what evidence-based practice is all about.

Based on the research conducted above, evidence-based models in topic 2 shows that nursing practices have tried to embark on social justice to reach larger society. Cultural competence care is a central role in the nursing practice. It recognizes cultural support for patients affected. This allows an advocate nurse to intervene when patients rights’ are denied. Culturally competent care nursing involves patients, families, healthcare professionals, and entire society. This has led to conflict between different groups seeking social justice. Social justice allows nurses to practice desired leadership skills as based on social justice policies. Social justice has values of impartiality and objectiveness in government levels having basic principles. The principles of competent care are fairness, equality, self-respect, human dignity, and tolerance (Orem, 1971).

Various cultural factors affect healthcare provided to the population, implications attached to the practice, professionals to play key roles, intervention measures that are taken, the outcomes that are expected, and setting that should be enhanced (Booth, 2006). PIPOS significance in nursing practice has advanced cultural competent care. Patient, Intervention, Professionals, Outcome, and Setting (PIPOS) support education and training in culturally competent care. PIPOS significance entitles nurses to education that promotes culturally congruent healthcare. This knowledge and skills are necessary for ensuring that nursing care is culturally congruent as endorsed in the global healthcare agenda. Continuous nursing education ensures mandatory formal and clinical training (White, 2011).  

How the evidence-based practice that you identified contributes to better outcomes

Evidence based practice refers to the base of practice on intervention, is a systematically tested and shown effective in serving culturally diverse population of patients. In case there is no evidence of efficacy, nurse researchers investigates and test interventions that will become most effective in reducing disparities of health outcomes. Evidence-based approach contributes in making of clinical and administrative decisions. Its competent care obtained thus is a practice strategy to combine various sources of evidence, which can be best available from research findings, clinical expertise, also patient values.

Potential negative outcomes that could result from failing to use the evidence-based practice

Failure to inclusion evidence-based practice denies nursing resources needed research studies. This incapacitates unit base for staff nurses to review cross-cultural nursing and health literature. This can also lead to lack of research-based practice protocol developed by specialty and organization as guides. In addition, researchers’ faculty teams capitalizing on varied expertise for funding application is prone to denial. This can cause inconvenience as raising capital requires an outlay of past performances supported by varied evidence (Expert Panel on Global Nursing & Health, 2010).

The two articles reviewed show that competent care on the expert panel on global nursing and health and evidence based model practices have embarked on social justice in enhancing competent cultural care advocating for patient rights (Orem, 1971). Replication of the same is evident in the expert panel of global nursing that insists on research bases practice derived from specialty and organization guiding practices towards competent care. 

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