964 resultados para Culturally Competent Practice


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Entendemos que desde el área de Educación Artística podemos trabajar el arte de cientos de culturas y en cualquier momento de la historia, un aspecto que nos permite sensibilizar al alumnado hacia la comprensión de las distintas manifestaciones que adquiere un mismo aspecto cultural, el arte, como fenómeno universal. Hemos centrado el objetivo principal de nuestra investigación en la exploración de los caminos y las posibilidades que nos ofrece la educación artística en relación a la diversidad (cultural, de clase, minusvalía, de edad, raza, de género, etc.). Partíamos de la percepción que, en el ámbito de la educación artística y de la cultura en general, existe una tendencia que describe los hechos artísticos y las prácticas estéticas a partir de unas categorías únicas y universalmente válidas. Estas provocan a menudo el olvido de algunos valores específicos y sobre todo la falta de reconocimiento de otras propuestas artísticas igual de interesantes (oficios artísticos, arte de las/os niñas/os, arte popular, artesanias, etc. Hemos buscado caminos que nos conduzcan a asumir una visión contemporánea del hecho artístico y una concepción incluyente del arte (diseño, indumentaria, decoración, artes funcionales, arte popular, arte de las mujeres, net art, gastronomia, etc.). Entendemos que la educación es el lugar desde donde avanzar hacia otra forma de mirar y comprender el mundo. Una visión que, desde el arte, facilite elementos para el encuentro y las relaciones sociales, donde la propia diferencia y la conservación "crítica" de las propias identidades culturales sean celebradas desde la convicción del verdadero enriquecimiento cultural. Estas consideraciones y la ausencia de un marco teórico previo que nos permitiera analizar, desarrollar y evaluar la perspectiva multicultural en la educación artística fueron la causa y la coyuntura para dirigir este trabajo hacia lo que podríamos llamar "educador artístico culturalmente competente" (Andrus, 2001). En esa perspectiva de comptencia es donde hemos ubicado nuestro trabajo, así como en las necesidades de formación de las maestras y los maestros, con la convicción de que cualquier mejora en la etapa educativa donde estos actúan, redundará en todo el proceso educativo.

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This article engages with the claims of Anne Brubaker that “[n]ow that the dust has settled after the so-called ‘Science Wars’ […] it is an opportune time to reassess the ways in which poststructural theory both argues persuasively for mathematics as a culturally embedded practice – a method as opposed to a metaphysics – and, at the same time, reinscribes realist notions of mathematics as a noise-free description of a mind independent reality.” Through a close re-reading of Jacques Derrida’s work I argue, in alliance with Vicki Kirby’s critique of the work of Brian Rotman, not only that Brubaker misunderstands Derrida’s “writing” but also that her argument constitutes a typical instance of much wider misreadings of Derrida and “poststructuralism” across a range of disciplines in terms of the ways in which her text re-institutes the very stabilities it itself attributes to Derrida’s texts.

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Success! At the 2005 White House Conference on Aging, three-quarters of the 1,200 national delegates voted to improve “recognition, assessment, and treatment of mental illness and depression among older Americans.” This resulted in mental health being ranked as #8 of the final 50 WHCoA policy resolutions resulting from the conference. Joining this resolution in the “top ten” were two resolutions intimately tied to hopes for addressing the mental health needs of older adults—at #6 “Support Geriatric Education and Training for Health Care Professionals, Paraprofessionals, Health Profession Students and Direct Care Workers,” and #9 “Attain Adequate Numbers of Healthcare Personnel in All Professions Who are Skilled, Culturally Competent, and Specialized in Geriatrics.”

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Although – or because – social work education in Italy has for some 15 years now been exclusively in the domain of the university the relationship between the academic world and that of practice has been highly tenuous. Research is indeed being conducted by universities, but rarely on issues that are of immediate practice relevance. This means that forms of practice develop and become established habitually which are not checked against rigorous standards of research and that the creation of knowledge at academic level pays scant attention to the practice implications of social changes. This situation has been made even worse by the dwindling resources both in social services and at the level of the universities which means that bureaucratic procedures or imports of specialisations from other disciplines frequently dominate the development of practice instead of a theory-based approach to methodology. This development does not do justice to the actual requirements of Italian society faced with ever increasing post-modern complexity which is reflected also in the nature of social problems because it implies a continuation of a faith in modernity with its idea of technical, clear-cut solutions while social relations have decidedly moved beyond that belief. This discrepancy puts even greater strain on the personnel of welfare agencies and does ultimately not satisfy the ever increasing demands for quality and accountability of services on the part of users and the general public. Social workers badly lack fundamental theoretical reference points which could guide them in their difficult work to arrive at autonomous, situation-specific methodological answers not based on procedures but on analytical knowledge. Thirty years ago, in 1977, a Presidential Decree created the legal basis for the establishment of social service departments at the level of municipalities which created opportunities for the direct involvement of the community in the fight against exclusion. For this potential to be fully utilized it would have required the bringing together of three dimensions, the organizational structure, the opportunities for learning and research in the territory and the contribution by the professional community. As this did not occur social services in Italy still often retain the character of charity which does not concern itself with the actual causes of poverty and exclusion. This in turn affects the relationship with citizens in general who cannot develop trust in those services. Through uncritical processes of interaction Edgar Morin’s dictum manifests itself which is that without resorting to critical reflection on complexity interventions can often have an effect that totally the opposite to the original intention. An important element in setting up a dynamic interchange between academia and practice is the placement on professional social work courses. Here the looping of theory to practice and back to theory etc. can actually take place under the right organizational and conceptual conditions, more so than in abstract, and for practitioners often useless debates about the theory-practice connection. Furthermore, research projects at the University of Florence Social Work Department for instance aim at fostering theoretical reflection at the level of and with the involvement of municipal social service agencies. With a general constructive disposition towards research and some financial investment students were facilitated to undertake social service practice related research for their degree theses for instance in the city of Pistoia. In this way it was also possible to strengthen the confidence and professional identity of social workers as they became aware of the contribution their own discipline can make to practice-relevant research instead of having to move over to disciplines like psychology for those purposes. Examples of this fruitful collaboration were presented at a conference in Pistoia on 25 June 2007. One example is a thesis entitled ‘The object of social work’ and examines the difficult development of definitions of social work and comes to the conclusion that ‘nothing is more practical than a theory’. Another is on coping abilities as a necessary precondition for the utilization of resources supplied by social services in exceptional circumstances. Others deal with the actual sequence of interventions in crisis situations, and one very interestingly looks at time and how it is being constructed often differently by professionals and clients. At the same time as this collaboration on research gathers momentum in the Toscana, supervision is also being demanded more forcefully as complementary to research and with the same aim of profiling more strongly the professional identity of social work. Collaboration between university and social service filed is for mutual benefit. At a time when professional practice is under threat of being defined from the outside through bureaucratic prescriptions a sound grounding in theory is a necessary precondition for competent practice.

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Purpose of the study. The purpose of this randomized controlled clinical trial was to determine if a brief intervention would improve foot self-care behaviors in adult patients with Type 2 diabetes who presented to the emergency department for non-emergent care in a predominantly Hispanic southwestern border community. ^ Methods. A pre-post-test, three-group design was used to compare the foot self-care behaviors of patients who received usual care to those who received lower extremity amputation (LEA) risk assessment and to those who received LEA risk assessment plus a brief foot self-care intervention. After being randomized into 3 groups (N = 167), baseline assessments of demographics, diabetes history, acculturation, and the Summary of Diabetes Self Care Activities (SDSCA) questionnaire and Modified Insulin Management Diabetes Self Efficacy Scale (MIMDSES) were completed in English or Spanish. At one-month, 144 (84%) participants were available for follow-up by the research assistant masked to group assignment. ^ Results. At baseline, significant differences in foot self-care behaviors and self monitoring blood glucose were noted based on ethnicity and gender. Men had significantly lower confidence in their ability to manage their diabetes overall. There was a significant difference between baseline and follow up self reported foot self-care behaviors within the intervention group (t (47) = −4.32, p < .01) and the control group (t (46) = −2.06, p < .05). There were no significant differences between groups for self-reported foot self-care behaviors. There was a significant difference in observed foot self-care behaviors between groups (F(2,135) = 2.99, p < .05). Self-efficacy scores were positively correlated with self-reported self-care behaviors. ^ Conclusions. This predominantly Hispanic population with type 2 diabetes reported performing diabetes self-care behaviors less than five days a week. There were within group changes, but no significant between group changes in reported self-care behaviors. However, at the one month follow up, there were significant differences between groups in observed foot self-care behaviors with the intervention group demonstrating the most accurate behaviors. Differences based on gender and ethnicity emphasize the need to individualize diabetes education. Priorities for culturally competent diabetes education, approaches to increasing self-efficacy and future research directions are suggested. ^

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Purpose of the study. This study had two components. The first component of the study was the development and implementation of an infrastructure that integrated Promotores who teach diabetes self-management into a community clinic. The second component was a six-month randomized clinical trial (RCT) designed to test the effectiveness of the Promotores in changing knowledge, beliefs, and HbA1c levels among Mexican American patients with type 2 diabetes. ^ Methods. Starfield's adaptation of the Donbedian structure, process, and outcome methodology was used to develop a clinic infrastructure that allowed the integration of Promotores as diabetes educators. The RCT of the culturally sensitive Promotores-led 10-week diabetes self-management program compared the outcomes of 63 patients in the intervention group with 68 patients in a wait-list, usual care control group. Participants were Mexican Americans, at least 18 years of age, with type 2 diabetes, who were patients at a Federally Qualified Health Center on the Texas-Mexico border. At baseline, three months, and six months, data were collected using the Diabetes Knowledge Questionnaire (DKQ, the Health Beliefs Questionnaire (HBQ, and HbA1c levels were drawn by the clinic laboratory. A mixed model methodology was used to analyze the data. ^ Results. The infrastructure to support a Promotores-led diabetes self-management course designed in concert with administration, the physicians, and the CDE, resulted in (1) employment of Promotores to teach diabetes self-management courses; (2) integration of provider and nurse oversight of course design and implementation; (3) management of Promotora training, and the development of teaching competencies and skills; (4) coordination of care through communication and documentation policies and procedures; (5) utilization of quality control mechanisms to maintain patient safety; and (6) promotion of a culturally competent approach to the educational process. The RCT resulted in a significant improvement in the intervention group's DKQ scores over time (F [1, 129] = 4.77, p = 0.0308), and in treatment by time (F [2, 168] = 5.85, p = 0.0035). Neither the HBQ scores nor the HbA1c changed over time. However, the baseline HbA1c was 7.49, almost at the therapeutic level. The DKQ, HBQ, and HbA1c results were significantly affected by age; the DKQ and HbA1c by years with diabetes. ^ Conclusions. The clinic model provides a systematic approach to safely address the educational needs of large numbers of patients with type 2 diabetes who live in communities that suffer from a lack of health care professionals. The Promotores-led diabetes self-management course improved the knowledge of patients with diabetes and may be a culturally sensitive strategy for meeting patient educational needs. The low baseline HbA1c levels in this border community suggested that patients in this Federally Qualified Health Center on the Texas-Mexico border were experiencing good medical management of their diabetes. ^

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Between the 1990 and 2000 Censuses, the Latino population accounted for 40% of the increase in the nation’s total population. The growing population of Latinos underscores the importance for understanding factors that influence whether and how Latinos take care of their health. According to the U.S. Department of Human Health Service’s Office of Minority Health (OMH), Latinos are at greater risk for health disparities (2003). Factors such as lack of health insurance and access to preventive care play a major role in limiting Latino use of primary health care (Institute of Medicine, 2005). Other significant barriers to preventive health care maintenance behaviors have been identified in current literature such as primary care physician interaction, self-perceived health status, and socio-cultural beliefs and traditions (Rojas-Guyler, King, Montieth and 2008; Meir, Medina, and Ory, 2007; Black, 1999). Despite these studies, there remains less information regarding interpersonal perceptions, environmental dynamics and individual and cultural attitudes relevant to utilization of healthcare (Rojas-Guyler, King, Montieth and 2008; Aguirre-Molina, Molina and Zambrana, 2001). Understanding the perceptions of Latinos and the barriers to health care could directly affect healthcare delivery. Improved healthcare utilization among Latinos could reduce the long term health consequences of many preventable and manageable diseases. The purpose of this study was to explore Latino perceptions of U.S. health care and desired changes by Latinos in the U.S. healthcare system. The study had several objectives, including to explore perceived barriers to healthcare utilization and the resulting effects on health among Latinos, to describe culturally influenced attitudes about health care and use of health care services among Latinos, and to make recommendations for reducing disparities by improving healthcare and its utilization. The current study utilized data that were collected as part of a larger study to examine multidimensional, cross-cultural issues relevant to interactions between healthcare consumers and providers. Qualitative methods were used to analyze four Spanish-language focus group transcripts to interpret cultural influences on perceptions and beliefs among Latinos. Direct coding of transcript content was carried out by two reviewers, who conducted independent reviews of each transcript. Team members developed and refined thematic categories, positive and negative cases, and example text segments for each theme and sub-theme. Incongruities of interpretations were resolved through extensive discussion. Study participants included 44 self-identified Latino adults (16 male, 28 female) between age 18 and 64 years. Thirty seven (84.1%) of the participants were immigrants. The study population comprised eight ethnic subgroups. While 31% of the participants reported being employed on a full-time basis, only 18.4% had medical insurance that was private or employee sponsored. Five major themes regarding the perceptions and healthcare utilization behaviors of Latinos were consistent across all focus groups and were identified during the analysis. These were: (1) healthcare utilization, experience, and access; (2) organizational and institutional systems; (3) communication and interpersonal interactions between healthcare provider, staff, and patient; (4) Latinos’ perception of their own health status; (5) cultural influences on healthcare utilization, which included an innovation termed culturally-bound locus of control. Healthcare utilization was directly influenced by healthcare experience, access, current health status, and cultural factors and indirectly influenced by organizational systems. There was a strong interdependence among the main themes. The ability to communicate and interact effectively with healthcare providers and navigate healthcare systems (organizational and institutional access) significantly influenced the participant’s health care experience, most often (indirectly) impacting utilization negatively. ^ Research such as this can help to identify those perceptions and attitudes held by Latinos concerning utilization or underutilization of healthcare systems. These data suggest that for healthcare utilization to improve among Latinos, healthcare systems must create more culturally competent environments by providing better language services at the organizational level and more culturally sensitive providers at the interpersonal level. Better understanding of the complex interactions between these impediments can aid intervention developments, and help health providers and researchers in determining appropriate, adequate, and effective measurers of care to better increase overall health of Latinos.^

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This research documents the perspective of 100 parents who had an open case with the Department of Children and Family Service’s (DCFS) regarding their family’s well-being, reasons for referral and satisfaction with services. Two DCFS services, Family Preservation (FP) and routine Family Maintenance (FM) were examined using standardized instruments. Parents’ responses regarding reasons for involvement with the system differed from DCFS administrative data. FP parents had more children, were more likely to be monolingual Spanish speakers, and perceived greater improvement in discipline and emotional care of children and housing than FM parents. FP parents reported being satisfied with services. Implications include supporting community based culturally competent FP programs.

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Thesis (Ph.D.)--University of Washington, 2016-06

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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.

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This study examined differences in cultural competency levels between undergraduate and graduate nursing students (age, ethnicity, gender, language at home, education level, program standing, program track, diversity encounters, and previous diversity training). Participants were 83% women, aged 20 to 62; 50% Hispanic/Latino; with a Bachelor of Science in Nursing (n = 82) and a Master of Science in Nursing (n = 62). Degrees included high school diplomas, associate/diplomas, bachelors' degrees in or out of nursing, and medical doctorate degrees from outside the United States. Students spoke English (n = 82) or Spanish ( n = 54). The study used a cross-sectional design guided by the three-dimensional cultural competency model. The Cultural Competency Assessment (CCA) tool is composed of two subscales: Cultural Awareness and Sensitivity (CAS) and Culturally Competent Behaviors (CCB). Multiple regressions, Pearson's correlations, and ANOVAs determined relationships and differences among undergraduate and graduate students. Findings showed significant differences between undergraduate and graduate nursing students in CAS, p <.016. Students of Hispanic/White/European ethnicity scored higher on the CAS, while White/non-Hispanic students scored lower on the CAS, p < .05. One-way ANOVAs revealed cultural competency differences by program standing (grade-point averages), and by program tracks, between Master of Science in Nursing Advanced Registered Nurse Practitioners and both Traditional Bachelor of Science in Nursing and Registered Nurse-Bachelor of Science in Nursing. Univariate analysis revealed that higher cultural competency was associated with having previous diversity training and participation in diversity training as continuing education. After controlling for all predictors, multiple regression analysis found program level, program standing, and diversity training explained a significant amount of variance in overall cultural competency (p = .027; R2 = .18). Continuing education is crucial in achieving students' cultural competency. Previous diversity training, graduate education, and higher grade-point average were correlated with higher cultural competency levels. However, increased diversity encounters were not associated with higher cultural competency levels.^

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Niche construction is the process by which organisms construct important components of their local environment in ways that introduce novel selection pressures. Lactase persistence is one of the clearest examples of niche construction in humans. Lactase is the enzyme responsible for the digestion of the milk sugar lactose and its production decreases after the weaning phase in most mammals, including most humans. Some humans, however, continue to produce lactase throughout adulthood, a trait known as lactase persistence. In European populations, a single mutation (−13910*T) explains the distribution of the phenotype, whereas several mutations are associated with it in Africa and the Middle East. Current estimates for the age of lactase persistence-associated alleles bracket those for the origins of animal domestication and the culturally transmitted practice of dairying. We report new data on the distribution of −13910*T and summarize genetic studies on the diversity of lactase persistence worldwide. We review relevant archaeological data and describe three simulation studies that have shed light on the evolution of this trait in Europe. These studies illustrate how genetic and archaeological information can be integrated to bring new insights to the origins and spread of lactase persistence. Finally, we discuss possible improvements to these models.

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Thesis (Ph.D.)--University of Washington, 2016-08

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This study examined differences in cultural competency levels between undergraduate and graduate nursing students (age, ethnicity, gender, language at home, education level, program standing, program track, diversity encounters, and previous diversity training). Participants were 83% women, aged 20 to 62; 50% Hispanic/Latino; with a Bachelor of Science in Nursing (n = 82) and a Master of Science in Nursing (n = 62). Degrees included high school diplomas, associate/diplomas, bachelors’ degrees in or out of nursing, and medical doctorate degrees from outside the United States. Students spoke English (n = 82) or Spanish (n = 54). The study used a cross-sectional design guided by the three-dimensional cultural competency model. The Cultural Competency Assessment (CCA) tool is composed of two subscales: Cultural Awareness and Sensitivity (CAS) and Culturally Competent Behaviors (CCB). Multiple regressions, Pearson’s correlations, and ANOVAs determined relationships and differences among undergraduate and graduate students. Findings showed significant differences between undergraduate and graduate nursing students in CAS, p <.016. Students of Hispanic/White/European ethnicity scored higher on the CAS, while White/non-Hispanic students scored lower on the CAS, p < .05. One-way ANOVAs revealed cultural competency differences by program standing (grade-point averages), and by program tracks, between Master of Science in Nursing Advanced Registered Nurse Practitioners and both Traditional Bachelor of Science in Nursing and Registered Nurse-Bachelor of Science in Nursing. Univariate analysis revealed that higher cultural competency was associated with having previous diversity training and participation in diversity training as continuing education. After controlling for all predictors, multiple regression analysis found program level, program standing, and diversity training explained a significant amount of variance in overall cultural competency (p = .027; R2 = .18). Continuing education is crucial in achieving students’ cultural competency. Previous diversity training, graduate education, and higher grade-point average were correlated with higher cultural competency levels. However, increased diversity encounters were not associated with higher cultural competency levels.

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14 principles of best practice for Service Delivery: An Interculturally Competent Approach to Meeting the Needs of Victims/Survivors of Gender-based Violence Click here to download PDF 390kb This is a publication of the Womens Health Council