Dissertationen zum Thema „Culturally competent care“

This narrative research offers an inquiry that intends to inspire thinking about a culturally competent dementia care framework in the United States. The main research question is: How does a culture hold dementia care? A subquestion is: What can we in the United States learn from other cultures about dementia care to enhance this care for all? The inquiry was designed to conduct narrative research focusing on Japanese culture in the context of caregiving to people with dementia; 4 professional and 4 family caregivers from this culture, who have cared or have been caring for persons with dementia, were interviewed. The narratives reflected the caregivers' lived experiences and how they were culturally compelled to give and sustain care.

This inquiry assumes that a person-centered dementia care model is challenging for the U.S. healthcare system, despite attempts to do so, due to the prevailing values and beliefs in the United States that center around a cure model as opposed to a care model. It also assumes that ideal person-centered dementia care in the United States needs to pay close attention to the cultural competence of caregivers and healthcare professionals, as their clients identify as persons through their cultural ways of being. These assumptions are grounded in the literature review.

As a result of narrative data analysis, 5 themes emerged from the data among family caregivers, and 2 themes among professional caregivers as the commonality. In addition, 4 themes emerged not as common themes but as unique themes. This dissertation examined Japanese interdependent construal of the self and demonstrated that these themes could be explained through understanding Japanese sense of self.

It is evident that interdependence between the self and others is deeply embedded in Japanese culture. Without a doubt, interdependence uniquely manifests in the caregivers’ attitudes, values and worldviews of caregiving in Japanese culture. Although the limited number of participants should be considered, these findings/caregivers’ insights generated from this study aim to promote and encourage dialogues regarding what culturally competent dementia care looks like among caregivers and beyond in the United States when taking care of people from different cultures.

Cultural competence has become an important topic since the society has evolved to be more multicultural, these societies have a big problem with their healthcare systems and it is said that primary care in Sweden must become better adjusted to the needs of minorities. The objective of this study was to investigate the degree of cultural competence in primary care in Sweden and to examine if the degree of cultural competence had a relation to the providers personality, gender, age ethnicity and educational level. Three different county councils were asked to participate but only one agreed. From 13 different primary care wards, 111 participants filled in three different instruments measuring personality, cultural competence and social desirability. The result of Pearson correlations, partial correlations, two-tailed independent t-tests and a χ²- test show that the degree of cultural competence is relatively low. Also, persons who are more conscientious and open, less neurotic, and educated at a university are more prone to be culturally competent. This investigation shows that there is a need to make individuals who work in primary care more aware of these issues. The focus should not lie on personnel level alone, but on organizational level as well.

Leaders of organizations continually experience challenges when attempting to implement new strategies by aligning staff at various organizational levels to the new strategies. The effectiveness of alignment to strategy is demonstrated especially in how strategy manifests on the front line as staff respond to the mandate of the strategic changes. Organizational dynamics analyzed through a psychodynamic "lens" further explain the challenges of alignment to strategy. The health care industry experiences pressure to adjust their strategies to ensure quality patient care, especially because hospitals are under scrutiny to reduce hospital readmissions and address health disparities for disadvantaged groups of patients in surrounding communities. One strategy adjustment that hospitals are implementing is improving culturally competent care, which requires transformational changes in practice, especially at the front line: nurses. This qualitative, single-case study at a hospital in the eastern United States focuses on exploring nurses' experiences as they respond to a hospital's mandate of changes related to providing culturally competent care. Data were collected through 25 semistructured interviews, two focus groups, and historical and archival data. The findings from this study support literature on the challenges and tensions related to this transformative change in how care is delivered. The findings also reveal the anxiety that these challenges and tensions trigger at the institutional and individual levels and the resulting behaviors, interpreted by psychodynamic theory of basic assumption, where nurses fluctuated between approach and avoidance of the work.

This retrospective study was conducted to evaluate whether culturally competent resources, such as Vietnamese-speaking healthcare providers, one-on-one public health nurse (PHN) education session(s), and free healthcare services would affect the results of the following questions: (a) Will the 114 study subjects achieve HbAIC reduction at 6-month and 12-month periods? (b) Is there a correlation between HbA1C reduction and the number of the provider visits? and (c) Is there a significant HbA1C reduction for the one-on-one PHN education participants compared to the non-participants? The result findings were analyzed using the Chi-Square tests and the two-sample t-tests. On average, the 114 subjects achieved HbA1C reductions of0.57% and 0.63% at 6-month and 12-month periods, respectively. However, there was no direct correlation between the HbA1C reductions and the frequency of provider visits. Furthermore, the PHN education session(s) did not significantly affect the rate of HbA1C reduction for the attendees. In conclusion, future studies on culturally competent interventions should be studied in the Vietnamese patients diagnosed with diabetes mellitus.

The U.S. healthcare industry seeks to improve patient satisfaction as the national trend of increasing diversity and ethnic representation continues. The provision of culturally sensitive health care will not only increase patient satisfaction and outcome metrics but also allow healthcare organizations to thrive financially by meeting patient needs and payer requirements. Just Culture Consulting, LLC. is a start-up, for-profit healthcare consulting firm that will provide cultural competency and language training services for healthcare professionals. Just Culture Consulting, LLC. aims to build a regionally and potentially a nationally recognized brand in specialty healthcare consulting by capitalizing on the growing need for culturally competent providers in healthcare. The Firm will retain a large client base through aggressive marketing and by leveraging the skills of its multicultural staff who possess significant career and native exposure to language, cultural sensitivity, healthcare delivery, and administration.

Ethical ED nurse leadership is faced with persisting challenges to delivering culturally competent care, which is crucial in reducing widespread racial healthcare disparities. Implicit biases are continually cited as key sources driving these inequities. However, research is lacking as how to effectively reduce implicit biases and increase health provider cultural competence. This quantitative, pretest-posttest project evaluated the efficacy of a cultural competency education by investigating if and to what extent the intervention decreased implicit biases and increased perceived cultural competence. Survey data were collected from a convenience sample of 36 ED nurse staff employed at a large urban medical center in California. Data included participant scores on the Race Implicit Association Test (IAT) and the Clinical Cultural Competence Questionnaire (CCCQ). Two-tailed paired samples t-test (CI = 95%; p < .05) indicated that the overall CCCQ score change of 5.5 points was statistically significant (p = .001) and linked to Knowledge (p = .000) and Attitudes subscales (p = .012) improvement. Race IAT changes were not statistically significant. No correlation was found between Race IAT and CCCQ scores. One-way repeated ANOVAs were used to investigate demographic variable impacts on scoring with limited value. Overall cultural competence scores were poor and Race IAT scores differed substantially from prior findings. Based on project results, the education was promising, supporting a solid, theory-based platform for strategically optimizing cultural competence and reducing health disparities in the ED care setting.

Racial and ethnic health disparities are highest in communities of color; providing culturally competent care could address these disparities. Culturally competent communication between the healthcare provider and the patient is an essential behavior that may improve health in racially and ethnically diverse women. A quality improvement project was completed with guidance from the 5 constructs of the Campinha-Bacote model as the conceptual framework, and the method used was the Consumer Assessment of Healthcare Providers and Systems survey. The perspective of 20 Mexican American and 20 African American women in El Paso, Texas between ages 45 and 72 with menopausal symptoms was surveyed to determine if culture had an impact on the presence or absence of communication with their healthcare providers. Results showed women’s perceptions of positive and negative communication behaviors with their healthcare providers was inconclusive; however, results showed that provider communication about health promotions, use of alternative medicine, and shared-decision making regarding health management needs improvement to promote adherence to medical regimen and feelings of mutual respect. Integrating cultural competence into existing evidence-based care can positively impact the delivery of services and help improve the quality of care. Healthcare providers can impact positive social change through the lessening of burdens associated with the lack of diversity in the workforce by including cultural competence training into the curriculum of nursing and medical schools.

In the United States, the patient population has substantially grown more ethnically diverse. Many of these patients present with ailments, such as heart disease, diabetes, and stroke, at a higher rate than their Anglo-European counterparts. Subsequent research has established a link between the health disparities of ethnically diverse communities and the lack of culturally competent physicians. Further investigation reveals cultural competency curriculum that omits the course element of self-reflection was less effective in achieving program objectives than those that provide an opportunity to explore one's own cultural background. This study proposes cultural competence curricula that include a structured self-reflective element, or opportunities to revisit past behaviors of one's self within the context of ethnic and cultural diversity, will assist undergraduate healthcare students develop their cultural skill through awareness of their own cultural values, biases, assumptions and belief systems, and how these aspects direct subsequent patient interactions. Pre- and post-course surveys and questionnaires were used to obtain data from 45 undergraduate respondents for this mixed methods study.

The results of this study, as analyzed by the Mann-Whitney U test, were unable to definitively prove that there is a statistically significant difference in the level of cultural competence between those who participate in training that includes a structured self-reflective component and those who do not. However, this research shows there is an observable movement away from 0 on the z-distribution curve, which is closer to the critical threshold, and an increase in the median IDI v3 scores on the cultural competence continuum by participants who enroll in an interpersonal communication course where structured self-reflective activities or opportunities to examine concepts of self are imbedded within the curriculum. Therefore, this study concludes the integration of structured self-reflective activities into intercultural curricula improve cultural competence acquisition. This improved cultural competence can be applied in the delivery of health care to ethnically diverse patient populations. Further investigation about the influences of power and privilege on personal identity, and the effects of time on cultural competence acquisition, will add to the breadth and depth of self-reflection, health care, and leadership studies.

Key words: structured self-reflection, health disparities, health care, leadership, leadership development, ethical leadership, relational leadership, authentic leadership, culture, cultural competence, pre-health care curriculum, education, social justice