Cultural competence in an HIV dedicated dental clinic: Application of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS)

This dissertation investigated perspectives on cultural competence among African-American women patients, staff, and the administrator of a dental clinic serving people living with HIV/AIDS; and evaluated the role of the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS) in advancing the provision of culturally competent care in the clinic. ^ The study was qualitative with data collection via focus groups and individual interviews with a sample of African-American women patients, and individual interviews with a sample of staff and the clinic administrator. Transcripts were coded and themes identified using the software program ATLAS.ti. A cultural audit template was developed and applied to evaluate cultural competency. ^ Among attitudes and behaviors that contributed to the provision of culturally competent care at the clinic were respect and empathic communication. Formal cultural competency was not featured strongly in the methods by which the staff learned to work with diverse populations. Instead cultural competence among the staff was based on thoughtful hiring practices, natural aptitude and a climate that encouraged learning through informal sharing of experiences. The staff and administrator felt that an African-American dentist would be an asset in improving culturally competent care at the clinic. Previous research and national policy also promote the provider-patient racial/ethnic concordance to improve care. In this study, however, the patients were happy with the care provided regardless of the race/ethnicity of the staff, probably reflecting the well developed cultural competence skills of clinic staff overall. ^ The clinic administrator was unaware of the CLAS standards although the clinic was implicitly operated under their mandates. This occurred because the clinic is supported by federal funding and the CLAS standards were incorporated into the requirements. Incorporation into and monitoring of the CLAS standards in federally funded programs therefore appears to be an effective means for ensuring that they are implemented. ^ This study illustrates that cultural competence, though not universally understood, can be systematically investigated to identify what constitutes appropriate care and the factors that support or inhibit it. Among important elements of culturally competent care are respect and empathic communication. ^

Cultural Competence

In this editorial the author describes the essential nature and characteristics of cultural competence.

The journey towards cultural competence

Graduates increasingly need to operate across national and cultural boundaries. This paper discusses the need to ensure that all students are equipped to operate within complex and diverse multicultural environments. The work builds on three earlier studies. Using these, the author has created a new theoretical framework and designed an intervention which aimed to increase diverse students' awareness of intercultural differences and their ability to function effectively in multicultural learning (and thus work) environments. The paper evaluates this highly innovative training. It concludes that it was effective in making a wide range of students aware of issues around cultural difference and competence. The training significantly changed the outlook of students who took part in it. Whilst the framework was robust, effective, and generalisable to other contexts, there are a number of issues which will be addressed in the re-running the programme.

The journey towards cultural competence: first interventions

Graduates worldwide are increasingly entering a global workplace which will require them to operate across national and cultural boundaries. This paper discusses the need to ensure that all students are equipped to work within this increasingly complex multi-cultural environment. It examines the issues which occur in preparing students within a UK Higher Education environment so that they are able to operate effectively within the international work situations in which they find themselves. This research builds on earlier research, which found that the effectiveness of an individual to work across cultural boundaries, in terms of work and communication, was increased by the number of international or intercultural experiences that a person has. Using this as a premise, an intervention was designed which aimed to increase students’ awareness of intercultural differences and their ability to function effectively in multicultural groups. This paper analyses the effectiveness of this highly innovative training intervention. It concludes that it was an effective way of making students aware of some of the issues around cultural competence is groups. In fact, the training was seen as most effective by students in addressing issues round group dynamics. The training obviously changed the outlook of a number students who took part it. There are, however, a number of issues which need to be addressed the re-running the training. These are notably, at what time in a student’s academic career such intervention is given, its integration into the curriculum and managing of student expectations.

Journey towards cultural competence:developing university teachers

Purpose - This paper examines the importance of intercultural training for lecturers; describes innovative training to address this, based on a new theoretical framework; and evaluates training and framework. Background - UK HE is becoming increasing internationally diverse. The UK HEI population is also very multicultural. The proportion of lecturers who come from outside the UK has risen. It is, therefore, important that students develop intercultural awareness. One way of doing this is to work with students. A more sustainable approach focusses training on lecturers who will embed cultural awareness into their practice. Method - This paper sets out a theoretical framework which underpins training developed for lecturers as part of a Postgraduate Certificate. The paper describes the training and evaluates the effectiveness of this. Findings and results - Findings show that participants were apprehensive about the training. Afterwards they expressed surprise at the participative approach, but were pleased with outcomes. They enjoyed the exercises and the training appeared to have opened up their outlook. They praised the freedom to share thoughts with others. Conclusions - Findings show that participants learnt intercultural skills to use in class. This was due to the design. The nature of the training encouraged reflection on cultural diversity and participants attested to the effects this would have on their teaching. These results replicate other studies Implications - The implications are immediate in the design of intercultural training in different contexts. It has already been used to design innovative training for students and managers. In both cases the same far-reaching results were achieved.

Cultural Competence in Health Care: Implications for Human Resource Development

This paper reviews the need for cultural competence in health care, the barriers faced by health care professionals as they attempt to deliver culturally competent care, and the implications for human resource development initiatives.

Factors influencing oncology nurses' approaches to accommodating cultural needs in palliative care

Aims and objectives: The purpose of this study is to explore the social construction of cultural issues in palliative care amongst oncology nurses. ---------- Background: Australia is a nation composed of people from different cultural origins with diverse linguistic, spiritual, religious and social backgrounds. The challenge of working with an increasingly culturally diverse population is a common theme expressed by many healthcare professionals from a variety of countries. ---------- Design: Grounded theory was used to investigate the processes by which nurses provide nursing care to cancer patients from diverse cultural backgrounds. ---------- Methods: Semi-structured interviews with seven Australian oncology nurses provided the data for the study; the data was analysed using grounded theory data analysis techniques. ---------- Results: The core category emerging from the study was that of accommodating cultural needs. This paper focuses on describing the series of subcategories that were identified as factors which could influence the process by which nurses would accommodate cultural needs. These factors included nurses' views and understandings of culture and cultural mores, their philosophy of cultural care, nurses' previous experiences with people from other cultures and organisational approaches to culture and cultural care. ---------- Conclusions: This study demonstrated that previous experiences with people from other cultures and organisational approaches to culture and cultural care often influenced nurses' views and understandings of culture and cultural mores and their beliefs, attitudes and behaviours in providing cultural care. ---------- Relevance to clinical practice: It is imperative to appreciate how nurses' experiences with people from other cultures can be recognised and built upon or, if necessary, challenged. Furthermore, nurses' cultural competence and experiences with people from other cultures need to be further investigated in clinical practice.

Collaborative voices: Ongoing reflections on cultural competency and the health care of Australian Indigenous people

The issue of cultural competency in health care continues to be a priority in Australia for health and human services professionals. Cultural competence in caring for Aboriginal and Torres Strait Islander peoples is of increasing interest, and is a priority in closing the gap in health disparities between Indigenous and non-Indigenous Australians. Through a collaborative conversation, the authors draw on a case study, personal experience and the literature to highlight some of the issues associated with employing culturally appropriate, culturally safe and culturally competent approaches when caring for Aboriginal and Torres Strait Islander peoples. The intent of this article is to encourage discussion on the topic of cultural competency, and to challenge health professionals and academics to think and act on racism, colonialism, historical circumstances and the political, social, economic, and geographical realms in which we live and work, and which all impact on cultural competency.