Cultural support workers and long day care services

In Australia, eligible long day care services may apply for support at the state level to assist with the transition of children from culturally or linguistically diverse backgrounds into childcare settings. For staff in childcare services, this support comes in the form of a cultural support worker (CSW). The primary role of a CSW is to build capacity in childcare staff to support children and families as they enter the childcare program. This paper draws on interview data and documentation from multiple sources to report the perspectives of key stakeholders affiliated with a cultural support program in an Australian childcare setting. It concludes that a more flexible approach to policy that directs the work of CSWs is needed, as well as further research into ways to build capacity for cultural competence for both CSWs and childcare staff who work collaboratively to support young children as they transition to childcare.

A case study examination of the influence of cultural diversity in the multicultural nursing workforce on the quality of care and patient safety in a Saudi Arabian hospital

The purpose of the study: The purpose of this study is to investigate the influence of cultural diversity, in a multicultural nursing workforce, on the quality and safety of patient care and the work environment at King Abdul-Aziz Medical City, Riyadh region. Study background: Due to global migration and workforce mobility, to varying degrees, cultural diversity exists in most health services around the world, particularly occurring where the health care workforce is multicultural or where the domestic population comprises minority groups from different cultures speaking different languages. Further complexities occur when countries have a multicultural workforce which is different from the population for whom they care, in addition to the workers being from culturally diverse countries and with different languages. In Saudi Arabia the health system is mainly staffed by expatriate nurses who comprise 67.7% of the total number of nurses. Study design: This research utilised a case study design which incorporated multiple methods including survey, qualitative interviews and document review. Methods: The participant nurses were selected for the survey via a population sampling strategy; 319 nurses returned their completed Safety Climate Survey questionnaires. Descriptive and inferential statistics (Kruskal–Wallis test) were used to analyse survey data. For the qualitative component of the study, a purposive sampling strategy was used; 24 nurses were interviewed using a semi-structured interview technique. The documentary review included KAMC-R policy documents that met the inclusion criteria using a predetermined data abstraction instrument. Content analysis was used to analyse the policy documents data. Results: The data revealed the nurses‘ perceptions of the clinical climate in this multicultural environment is that it was unsafe, with a mean score of 3.9 out of 5. No significant difference was detected between the age groups or years of experience of the nurses and the perception of safety climate in this context; the study did reveal a statistically significant difference between the cultural background categories and the perception of safety climate. The qualitative phase indicated that the nurses within this environment were struggling to achieve cultural competence; consequently, they were having difficulties in meeting the patients‘ cultural and spiritual needs as well as maintaining a high standard of care. The results also indicated that nurses were disempowered in this context. Importantly, there was inadequate support by the organisation to manage the cultural diversity issue and to protect patients from any associated risks, as demonstrated by the policy documents and supported by the nurses‘ experiences. The study also illustrated the limitations of the conceptual framework of cultural competence when tested in this multicultural workforce context. Therefore, this study generated amendments to the model that is suitable to be used in the context of a multicultural nursing workforce. Conclusion: The multicultural nature of this nursing work environment is inherently risky due to the conflicts that arise from the different cultural norms, beliefs, behaviours and languages. Further, there was uncertainty within the multicultural nursing workforce about the clinical and cultural safety of the patient care environment and about the cultural safety of the nursing workforce. The findings of the study contribute important new knowledge to the area of patient and nurse safety in a multicultural environment and contribute theoretical development to the field of cultural competence. Specifically, the findings will inform policy and practice related to patient care in the context of cultural diversity.

Intercultural competence in engineering education : who are we teaching?

BACKGROUND There is little doubt that our engineering graduates’ ability to identify cultural differences and their potential to impact on engineering projects, and to work effectively with these differences is of key importance in the modern engineering practice. Within engineering degree programs themselves there is also a significant need to recognise the impact of changing student and staff profiles on what happens in the classroom. The research described in this paper forms part of a larger project exploring issues of intercultural competence in engineering. PURPOSE This paper presents an observational and survey study of undergraduate and postgraduate engineering students from four institutions working in groups on tasks with a purely technical focus, or with a cultural and humanitarian element. The study sought to explore how students rate their own intercultural competence and team process and whether any differences exist depending on the nature of the task they are working on. We also investigated whether any differences were evident between groups of first year, second year and postgraduate students. DESIGN/METHOD The study used the miniCQS instrument (Ang & Van Dyne, 2008) and a Bales Interaction Process Analysis based scale (Bales, 1950; Carney, 1976) to collect students self ratings of group process, task management, and cultural experience and behaviour. The Bales IPA was also used for coding video observations of students working in groups. Survey data were used to form descriptive variables to compare outcomes across the different tasks and contexts. Observations analysed in Nvivo were used to provide commentary and additional detail on the quantitative data. RESULTS The results of the survey indicated consistent mean scores on each survey item for each group of students, despite vastly different tasks, student backgrounds and educational contexts. Some small, statistically significant mean differences existed, offering some basic insights into how task and student group composition could affect self ratings. Overall though, the results suggest minimal shift in how students view group function and their intercultural experience, irrespective of differing educational experience. CONCLUSIONS The survey results, contrasted with group observations, indicate that either students are not translating their experience (in the group tasks) into critical self assessment of their cultural competence and teamwork, or that they become more critical of team performance and cultural competence as their competence in these areas grows, so their ratings remain consistent. Both outcomes indicate that students need more intensive guidance to build their critical self and peer assessment skills in these areas irrespective of their year level of study.

A multicultural nursing workforce and cultural perspectives in Saudi Arabia : an overview

This paper provides an overview of the cultural perspectives and practices in Saudi Arabia that could help expatriate health care providers to understand Saudi culture and enhance cultural competence. The healthcare system in Gulf countries, particularly, Saudi Arabia, is mainly staffed by expatriate nurses, who account for 67.7% of the total number of nurses. This gives rise to a multicultural environment in the hospital, where people of different cultures interact with each other and take care of Saudi patients who are from the dominant culture. In this scenario, a lack of knowledge of Saudi culture among nurses can lead to cultural conflicts and misunderstanding of some of the behaviors and practices of the indigenous Saudi people. Culture is a complex notion; however, being aware of cultural differences and having cultural knowledge can help people to interact safely. Educating expatriate nurses about the cultural heritage of the Saudi people, which is mainly influenced by Islamic teachings, is important to increase cultural harmony.

Perceived safety, quality and cultural competency of maternity care for culturally and linguistically diverse women in Queensland

Various policies, plans, and initiatives have been implemented to provide safe, quality, and culturally competent care to patients within Queensland’s healthcare system. A series of models of maternity care are available in Queensland that range from standard public care to private midwifery care. The current study aimed to determine whether identifying as Culturally or Linguistically Diverse (CALD) was associated with the perceived safety, quality, and cultural competency of maternity care from a consumer perspective, and to identify specific needs and preferences of CALD maternity care consumers. Secondary analysis of data collected in the Having a Baby in Queensland Survey 2012 was used to compare the experiences of 655 CALD women to those of 4049 non-CALD women in Queensland, Australia, across three stages of maternity care: pregnancy, labour and birth, and after birth. After adjustment for model of maternity care received and socio-demographic characteristics, CALD women were significantly more likely than non-CALD women to experience suboptimal staff technical competence in pregnancy, overall perceived safety in pregnancy and labour/birth, and interpersonal sensitivity in pregnancy and labour/birth. Approximately 50% of CALD women did not have the choice to use a translator or interpreter, or the gender of their care provider, during labour and birth. Thirteen themes of preferences and needs of CALD maternity care consumers based on ethnicity, cultural beliefs, or traditions were identified, however, these were rarely met. Findings imply that CALD women in Queensland experience disadvantageous maternity care with regards to perceived staff technical competence, safety, and interpersonal sensitivity, and receive care that lacks cultural competence. Improved access to support persons, continuity and choice of carer, and staff availability and training is recommended.

A cultural assessment of family dispute resolution: Findings about access, retention and outcomes from the evaluation of a Family Relationship Centre

The cultural appropriateness of human service processes is a major factor in determining the effectiveness of their delivery. Sensitivity to issues of culture is particularly critical in dealing with family disputes, which are generally highly emotive and require difficult decisions to be made regarding children, material assets and ongoing relationships. In this article we draw on findings from an evaluation of the Family Relationship Centre at Broadmeadows (FRCB) to offer some insights into and suggestions about managing cultural matters in the current practice of family dispute resolution (FDR) in Australia. The brief for the original research was to evaluate the cultural appropriateness of FDR services offered to culturally and linguistically diverse (CALD) communities living within the FRCB’s catchment area, specifically members of the Lebanese, Turkish and Iraqi communities. The conclusions of the evaluations were substantially positive. The work of the Centre was found to illustrate many aspects of best practice but also raised questions worthy of future exploration. The current article reports on issues of access, retention and outcomes obtained by CALD clients at various stages of the FRCB service.

Gender, religion, and sociopolitical issues in cross-cultural online education

Cross-cultural education is thought to develop critical consciousness of how unequal distributions of power and privilege affect people’s health. Learners in different sociopolitical settings can join together in developing critical consciousness – awareness of power and privilege dynamics in society – by means of communication technology. The aim of this research was to define strengths and limitations of existing cross-cultural discussions in generating critical consciousness. The setting was the FAIMER international fellowship program for mid-career interdisciplinary health faculty, whose goal is to foster global advancement of health professions education. Fellows take part in participant-led, online, written, task-focused discussions on topics like professionalism, community health, and leadership. We reflexively identified text that brought sociopolitical topics into the online environment during the years 2011 and 2012 and used a discourse analysis toolset to make our content analysis relevant to critical consciousness. While references to participants’ cultures and backgrounds were infrequent, narratives of political-, gender-, religion-, and other culture-related topics did emerge. When participants gave accounts of their experiences and exchanged cross-cultural stories, they were more likely to develop ad hoc networks to support one another in facing those issues than explore issues relating to the development of critical consciousness. We suggest that cross-cultural discussions need to be facilitated actively to transform learners’ frames of reference, create critical consciousness, and develop cultural competence. Further research is needed into how to provide a safe environment for such learning and provide faculty development for the skills needed to facilitate these exchanges.

Developing an Understanding of Cultural Diversity: How an Experience Living in a Multicultural Nation and an Experience Teaching Abroad Contribute to Southern Ontario Teachers' Identities

This is a narrative design study focusing on the understandings that a group of 6 Southern Ontario teachers have of cultural diversity and how these understandings integrated into their development of teacher identity. Given the high culturally diverse population of Canada and its national multicultural values, conducting this study on Canadian pre-service and in-service teachers offers an interesting contribution to the field. In efforts to explore the participants’ understandings, the research examined a teaching abroad experience. The aim was to investigate how these participants gained insight from their experiences with cultural diversity and whether these insights stimulated a greater culturally conscious teacher identity. Narratives provided a description of the lived experiences of these 6 teachers and identified meanings made from these experiences. Participants included 2 pre-service teachers who were in a teacher education program at the time of the interview, and 4 certified teachers who graduated from a teacher education program within the past 5 years. One on one interviews focused on lived experiences within a participant’s home, school community, and teaching abroad. The researcher used grounded theory during the data analysis to assist in identifying themes, and then compared these themes among participants. Overall, this study suggests that even though these participants live in a multicultural nation, experiences varied greatly based on contributing factors such as heritage and exposure to cultural diversity through their home and school life. Despite their varying level of cultural competence, all participants gained insight from their teaching abroad experience, contributing to a teacher identity that considered inclusive practices. This study suggests that there are some important factors to consider when preparing teachers to teach in a multicultural society.

Moving towards increased cultural competency in public health research

There has been a renewed focus in recent decades on collaborative approaches in community-based public health research and interventions. This is an important grounding for addressing the needs of culturally and linguistically diverse (CALD) communities. But how well do we as researchers prepare for the complexities of working with CALD communities? And what sort of support do we need to meet the challenges of the task? Cultural competence refers to the extent to which researchers, practitioners and organisations have the necessary skills, knowledge, attitudes and policies to work effectively in cross-cultural situations. The shift towards cultural competence in public health is evidenced by the development of policies and guidelines by government bodies and leading research institutions in countries such as Canada, the United States, Australia and New Zealand. This chapter will draw on these guidelines, on models of cultural competency used in welfare and health service delivery, and on collaborative research approaches. A framework for moving towards cultural competence in public health research and health promotion interventions will be discussed, drawing case study examples from the co-authors' community-based experiences. This will highlight the complexities but also the importance of adopting culturally competent strategies in public health research and health promotion interventions. The need for supporting government and funding structures will also be proposed .

An exploration of the notion and nature of the construct of cultural safety and its applicability to the Australian health care context

Cultural safety has been promoted by its New Zealand proponents as an effective process for managing cultural risk in health care and improving the cultural responsiveness of mainstream health services when delivering care to culturally diverse populations. Its effectiveness in this regard has not, however, been comprehensively investigated. A key purpose of this study was to explore and describe what is known and understood about the notion of cultural safety and its possible application to and in Australian health care domains. Findings from the study indicate that the notion of cultural safety is conceptually problematic, poorly understood, and underresearched and, unless substantially revised, cannot be meaningfully applied to the cultural context of Australia.

Detecting conflictive cultural factors in complex scenarios of intervention: Military and local actors in interaction

The integration of cultural elements into the operational planning process is a complex task that requires practical and theroretical tools for a wide comprehension of the context to help solve the problem. This article shows the results of an empirical research which presents conflicting cultural factors as the starting point for the construction of mediating structures. The main result of our research is a partial cognitive structure, a system of ideas, represented in a template listing the basic conflictive factors at the tactical level that military could find in the development of their tasks. The template is also a valuable aid to design military training curricula and to be applied to any post-conflict stability operation in complex environments resulting from irregular or asymmetric conflicts.

Cultural respect encompassing simulation training: being heard about health through broadband

BACKGROUND: Cultural Respect Encompassing Simulation Training (CREST) is a learning program that uses simulation to provide health professional students and practitioners with strategies to communicate sensitively with culturally and linguistically diverse (CALD) patients. It consists of training modules with a cultural competency evaluation framework and CALD simulated patients to interact with trainees in immersive simulation scenarios. The aim of this study was to test the feasibility of expanding the delivery of CREST to rural Australia using live video streaming; and to investigate the fidelity of cultural sensitivity - defined within the process of cultural competency which includes awareness, knowledge, skills, encounters and desire - of the streamed simulations. DESIGN AND METHODS: In this mixed-methods evaluative study, health professional trainees were recruited at three rural academic campuses and one rural hospital to pilot CREST sessions via live video streaming and simulation from the city campus in 2014. Cultural competency, teaching and learning evaluations were conducted. RESULTS: Forty-five participants rated 26 reliable items before and after each session and reported statistically significant improvement in 4 of 5 cultural competency domains, particularly in cultural skills (P<0.05). Qualitative data indicated an overall acknowledgement amongst participants of the importance of communication training and the quality of the simulation training provided remotely by CREST. CONCLUSIONS: Cultural sensitivity education using live video-streaming and simulation can contribute to health professionals' learning and is effective in improving cultural competency. CREST has the potential to be embedded within health professional curricula across Australian universities to address issues of health inequalities arising from a lack of cultural sensitivity training. Significance for public healthThere are significant health inequalities for migrant populations. They commonly have poorer access to health services and poorer health outcomes than the Australian-born population. The factors are multiple, complex and include language and cultural barriers. To address these disparities, culturally competent patient-centred care is increasingly recognised to be critical to improving care quality, patient satisfaction, patient compliance and patient outcomes. Yet there is a lack of quality in the teaching and learning of cultural competence in healthcare education curricula, particularly in rural settings where qualified trainers and resources can be limited. The Cultural Respect Encompassing Simulation Training (CREST) program offers opportunities to health professional students and practitioners to learn and develop communication skills with professionally trained culturally and linguistically diverse simulated patients who contribute their experiences and health perspectives. It has already been shown to contribute to health professionals' learning and is effective in improving cultural competency in urban settings. This study demonstrates that CREST when delivered via live video-streaming and simulation can achieve similar results in rural settings.

Rethinking the notion of culture in the national history curriculum

Major global changes are placing new demands on the Australian education system. Recent statements by the Prime Minister, together with current education policy and national curriculum documents available in the public domain, look to education’s role in promoting economic prosperity and social cohesion. Collectively, they emphasise the need to equip young Australians with the knowledge, understandings and skills required to compete in the global economy and participate as engaged citizens in a culturally diverse world. However, the decision to prioritise discipline-based learning in the forthcoming Australian history curriculum without specifically encompassing culture as a referent, raises the following question. How will students acquire the cultural knowledge, understandings and skills necessary for this process? This paper addresses this question by situating the current push for a national history curriculum, with specific reference to the study of Indigenous history and the study of Asia in Australia.

The experiences of African women giving birth in Brisbane, Australia

Our purpose in this research was to uncover first-person descriptions of the birth experiences of African refugee women in Brisbane, Australia, and to explore the common themes that emerged from their experiences. We conducted semistructured interviews with 10 African refugees who had given birth in Brisbane. Essences universal to childbirth such as pain, control, and experiences of caregivers featured prominently in participants’ descriptions of their experiences. Their experiences, however, were further overshadowed by issues such as language barriers, the refugee experience, female genital mutilation (FGM), and encounters with health services with limited cultural competence.