Cultural Competency Challenges Certified Nursing Assistants Experience in Providing Palliative Care.

PURPOSE: Increasing racial and ethnic diversity in U.S. nursing facilities has necessitated the provision of more culturally competent care. This study explored the cultural challenges in providing palliative care from the perspective of certified nursing assistants (CNAs) and nurses in nursing facilities. METHOD: A thematic analysis approach was used to examine data from semi-structured interviews with 12 CNAs and 11 nurses from six nursing facilities in a U.S. Midwestern state. RESULTS: Four themes emerged from the data: Cultural Needs Expressed by Residents, Cultural Needs Expressed by Family Members, Accommodating Residents' Cultural Needs, and Organizational Responses to Cultural Competency Challenges. CONCLUSION: Results highlighted the training variations on diversity and cultural competency issues and the varying cultural competency levels possessed by staff. To support residents' culture-related needs, staff need education and support. Organizations can provide foundational resources for this diversity of cultural expression, including providing more culturally diverse programming facilities. [Journal of Gerontological Nursing, 50(7), 35-41.].

The Role of Culturally Appropriate Mediated Communication Strategies to Reduce Hepatitis B and Liver Cancer Disparities.

Asian, Pacific Islander, African, and Caribbean communities in the U.S. are heavily impacted by chronic hepatitis B (HBV) and hepatocellular carcinoma (HCC). Educating these groups about the link between the two diseases is imperative to improve screening rates and health outcomes. This study aims to identify and incorporate preferred mediated communication methods into community-specific educational campaigns which emphasize the connection between the conditions, to promote uptake of prevention and management behaviors for HBV and HCC. Fifteen focus groups and two key informant interviews were conducted with Micronesian, Chinese, Hmong, Nigerian, Ghanaian, Vietnamese, Korean, Somali, Ethiopian, Filipino, Haitian, and Francophone West African communities. Data were analyzed using thematic coding and analysis. Findings demonstrate that all communities preferred materials be offered in both English and native languages and requested that materials highlight the connection between HBV and HCC. Delivery channel preferences and messaging themes varied by group. This study provides insight into community-specific preferences for learning about HBV and HCC. The findings can be used to design culturally and linguistically tailored, multi-platform, health education campaigns to facilitate improved HBV screening and vaccination rates and increase knowledge about HCC risk among highly impacted communities in the U.S.

Factors influencing intercultural competences of hospital workers for multicultural patients in South Korea.

Objectives: This study aims to assess the intercultural competence of general hospital workers in South Korea by examining their understanding of cultural diversity in healthcare and to identify factors influencing their intercultural competence. Methods: A cross-institutional survey was conducted with 439 participants from four South Korean general hospitals, employing inferential statistics such as one-way Analysis of Variance, Mann-Whitney U, and Kruskal-Wallis test followed by post-hoc, and multiple linear regression analyses. Results: While 85% (n = 362) of participants acknowledged the significance of multiculturalism in Korean society, only 11% (n = 49) felt competent in treating multicultural patients. Additionally, 72% (n = 315) experienced significant linguistic difficulties in medical communication. Multiple regression analysis identified advanced English competency, multicultural training experiences, and peer support with organizational awareness of multicultural importance as significant positive contributors to intercultural competence. Conclusions: Despite recognizing the importance of multiculturalism, general hospital workers face significant language barriers and low self-efficacy in providing care to multicultural patients. To address these challenges, hospitals should designate resident translators for culturally appropriate communication. Furthermore, a tri-tiered training approach is proposed to enhance the five domains of intercultural competence among general hospital workers in Korea, including overarching multicultural training, occupation-specific courses, and long-term managerial programs aimed at managing cultural diversity effectively in healthcare settings.

Nature prescribing: emerging insights about reconciliation-based and culturally inclusive approaches from a tricultural community health centre. / Prescription d'exposition à la nature : nouvelles perspectives sur les approches fondées sur la réconciliation et l'inclusivité culturelle dans un centre de santé communautaire triculturel.

This commentary highlights the importance of social and nature prescribing programs reflecting culturally diverse perspectives and practices. Creating and holding space for Indigenous and other worldviews should be a key priority of nature prescribing, a relatively recent practice in Canada that recognizes and promotes health benefits associated with engaging in a variety of activities in natural settings. Central to designing and delivering nature prescribing that is culturally inclusive and grounded in fulfilling obligations of reconciliation is recognizing the ongoing dominance of Western worldviews and their associated implications for decolonizing and Indigenizing nature-based programming. Consciously working to expand Western values, with the aim of extending nature prescribing practices beyond mere nature exposure to fostering emotional connections to nature, is a critically important part of the ongoing development of nature-based interventions and nature prescribing.

Nature prescribing is an increasingly recognized aspect of social prescribing that acknowledges and promotes enhanced health benefits associated with natural settings to address illness and promote health and wellness. The Western worldview maintains a narrow view of human relations with nature, consisting of humancentric needs and interests. The limited priority that the Western worldview places on the relationship with nature and the importance of establishing and maintaining nature connection, may limit the potential reach and benefits of nature prescribing. Nature prescribing efforts should recognize pre-existing, nature-based approaches such as land-based healing practised by Indigenous people and ensure culturally inclusive design and practices.

La prescription d'exposition à la nature, une dimension de plus en plus reconnue de la prescription sociale, reconnaît et promeut les bienfaits de l'environnement naturel pour la santé, le bien-être et le traitement des maladies. Le monde occidental entretient une vision étroite des relations entre la nature et l'être humain, qui se résume aux besoins et aux intérêts de ce dernier. La priorité limitée accordée dans le monde occidental à la relation avec la nature et à l'importance des liens avec la nature risque de limiter la portée et les avantages des prescriptions d'exposition à la nature. Les efforts en matière de prescription d'exposition à la nature devraient tenir compte des approches antérieures fondées sur la nature, comme la guérison par la terre pratiquée par les Autochtones, et assurer l'inclusivité culturelle sur le plan de la conception et des pratiques.

Mapa de Competencias sobre sistemas de información y salud digital para el personal de las instituciones de salud: Un marco de referencia basado en conocimientos, habilidades y experiencias necesarias para desarrollarse funcionalmente en la era de la interdependencia digital

En el entendido de que una competencia es la capacidad observable del conocimiento, la habilidad y los valores o las actitudes para el desarrollo de algo, un mapa de competencias es un instrumento a través del cual se puede observar qué conocimientos son los requeridos en el trabajo para lograr los resultados que el sector y la organización, finalmente, en su conjunto, se proponen. A los efectos del presente mapa, las competencias se agrupan en transversales y específicas, en cuyo caso las primeras son las que afectan a todo el personal de salud con independencia de su puesto de trabajo o categoría y las segundas, las que deben estar presentes en un individuo o grupo conforme a un puesto de trabajo o rol profesional concreto.

"Trying to write a story together": general practitioners' perspectives on culturally sensitive care.

BACKGROUND: Culturally sensitive care is integral to effective and equitable healthcare delivery, necessitating an understanding and acknowledgment of patients' cultural needs, preferences, and expectations. This study investigates the perceptions of cultural sensitivity among general practitioners (GPs), focusing on their intentions, willingness and perceived responsibilities in providing care tailored to cultural needs. METHODS: In-depth interviews were conducted with 21 Flemish GPs to explore their perspectives on culturally sensitive care. Data analysis followed a conventional qualitative content analysis approach within a constructivist framework. A coding scheme was developed to identify recurring themes and patterns in the GPs' responses. RESULTS: Findings reveal that culturally sensitive care provision is perceived as a multifaceted process, initiated by an exploration phase where GPs inquire about patients' cultural needs and preferences. Two pivotal factors shaping culturally sensitive care emerged: patients' specific cultural expectations and GPs' perceived responsibilities. These factors guided the process of culturally sensitive care towards three distinct outcomes, ranging from complete adaptation to patients' cultural requirements driven by a high sense of responsibility, through negotiation and compromise, to a paternalistic approach where GPs expect patients to conform to GPs' values and expectations. Three typologies of GPs in providing culturally sensitive care were identified: genuinely culturally sensitive, surface-level culturally sensitive, and those perceiving diversity as a threat. Stereotyping and othering persist in healthcare, underscoring the importance of critical consciousness and cultural reflexivity in providing patient-centered and equitable care. CONCLUSIONS: This study emphasizes the significance of empathy and underscores the necessity for GPs to embrace the exploration and acknowledgement of patients' preferences and cultural needs as integral aspects of their professional role. It highlights the importance of shared decision-making, critical consciousness, cultural desire and empathy. Understanding these nuances is essential for enhancing culturally sensitive care and mitigating healthcare disparities.

Centering students' voices in the exploration of in-classroom culturally responsive practices.

Scholars have developed culturally responsive frameworks and interventions to support educators as they aim to create inclusive and equitable classroom environments. Despite the number of frameworks on the topic, research on culturally responsive practices (CRPs) is limited by the lack of clear definitions or evidence on the effectiveness of in-classroom culturally responsive interventions. With the aim to understand which characteristics are important for in-classroom CRPs, this qualitative study explored students' perceptions of practices teachers use to respond to students' learning and cultural identities. We conducted 23 focus groups with 103 Black, Latine, and White students in middle and high school from two midwestern schools. After analyzing the data, we identified four overarching themes: (a) inclusive classroom instruction, (b) emotional safety in the classroom, (c) relational quality with the teachers, and (d) racism and other "isms" in the classroom. Students consistently commented on the importance of teacher support for students' emotional and academic well-being while also describing teachers that demeaned them or their peers, in turn, obstructing their learning. The findings hold promise to clarify and strengthen professional development CRP interventions as students offer insight about teacher cultural responsiveness and non-responsiveness.

Cultural competences among future nurses and midwives: a case of attitudes toward Jehovah's witnesses' stance on blood transfusion.

BACKGROUND: Transcultural nursing recognises the significance of cultural backgrounds in providing patients with quality care. This study investigates the opinions of master's students in nursing and midwifery regarding the attitudes of Jehovah's Witnesses towards refusing blood transfusions. METHODS: 349 master's students in nursing and midwifery participated in a quantitative study and were surveyed via the Web to evaluate their awareness of the stance of Jehovah's Witnesses on blood transfusions and the ethical and legal dilemmas associated with caring for Jehovah's Witness (JW) patients. RESULTS: The study yielded three significant findings. It unequivocally demonstrates that nursing and midwifery students possess inadequate knowledge regarding Jehovah's Witnesses' stance on blood transfusions and their acceptance of specific blood products and medical procedures. Despite being cognisant of the ethical and legal dilemmas of caring for JW patients, students lack an understanding of patients' autonomy to reject blood transfusions and their need for bloodless medicine. Students also articulated educational needs regarding cultural competencies regarding the Jehovah's Witnesses' beliefs on blood transfusions and non-blood management techniques. CONCLUSIONS: Healthcare professionals need the knowledge and skills necessary to provide holistic, patient-centred and culturally sensitive care. This study emphasises the urgent need for university curricula and nursing postgraduate training to include modules on transcultural nursing and strategies for minimising blood loss.

Toward Culturally Responsive Mentoring of Muslim Research Mentees in the Sciences.

Research experiences are an integral part of training future scientists and fostering diversity in science. Providing culturally responsive research mentorship, defined as mentorship that incorporates cultural knowledge to improve learning experiences for a particular group, is a critical step in this endeavor. While culturally responsive mentoring is most commonly associated with mentoring students with underrepresented races and ethnicities in the sciences, it can also be helpful for mentees with a diversity of abilities, sexualities, economic backgrounds, and religions. In this essay, we discuss how mentors can provide more culturally responsive mentoring of Muslim research mentees in the sciences. Muslims are a stigmatized minority group in the United States who participate in a religious culture that often differs from the secular culture of science. Notably, there are few resources for how to engage in culturally responsive mentoring of Muslim research mentees. To address this gap, we drew from the extant literature on the challenges that Muslims encounter in the United States, which likely extends to the context of scientific research, and identified potential culturally responsive accommodations in research.

An evaluation and refinement of the "Hep B Story" app, tailored to meet the community's cultural needs.

BACKGROUND: Hepatitis B is endemic amongst the Australian Aboriginal population in the Northern Territory. A participatory action research project identified the lack of culturally appropriate education tools and led to the development of the "Hep B Story" app in the Aboriginal language Yolŋu Matha. This paper describes a formal evaluation of the app's first version, which informed improvements and translation into a further ten Aboriginal languages. METHODS: The evaluation employed Participatory Action Research (PAR) principles to work within Indigenous research methodologies and prioritise Indigenous knowledge to improve the app iteratively. Semi-structured interviews and focus groups were conducted across the Northern Territory with 11 different language groups. Local Community Based Researchers and Aboriginal Research team members coordinated sessions. The recorded, translated conversations were transcribed verbatim and thematically analysed using an inductive and deductive approach. RESULTS: Between November 2018 and September 2020, 94 individuals from 11 language groups participated in 25 semi-structured interviews and 10 focus groups. All participants identified as Aboriginal. Most participants felt the app would be culturally appropriate for Aboriginal communities in the Northern Territory and improve knowledge surrounding hepatitis B. The information gathered from these interviews allowed for identifying five main themes: support for app, relationships, concept versus language, shame, and perceptions of images, along with errors that required modification. CONCLUSIONS: A "real-life" evaluation of the app was comprehensively completed using a PAR approach blended with Indigenous research methods. This evaluation allowed us to develop an updated and enhanced version of the app before creating the additional ten language versions. An iterative approach alongside strong community engagement was pivotal in ensuring the app's cultural safety and appropriateness. We recommend avoiding the use of knowledge-based evaluations in an Aboriginal setting to ensure relevant and culturally appropriate feedback is obtained.

The patient perspective on diversity-sensitive care: a systematic review.

BACKGROUND: The provision of diversity-sensitive care is a promising approach towards reducing health disparities. Recent criticism and a scientific gap demonstrate the need for the patient perspective on diversity-sensitive care. This systematic review aims to describe the patient perspective, including patient experiences, expectations, and satisfaction with diversity-sensitive care provided by healthcare providers. METHODS: In December 2022 the Medline ALL, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO and additionally Google Scholar were searched for original studies that described or measured patient expectations, experiences, and/or satisfaction, specifically focusing on cultural or diversity competence of healthcare providers. Analysis of the collected data was performed using a convergent mixed-methods design based on thematic synthesis. RESULTS: From initially 5,387 articles, 117 were selected for full-text screening, and ultimately, 34 articles were included in this study. The concept of diversity-sensitive care was observed to comprise three components. The first component is focused on patient-centered care and includes competencies such as clear and direct communication, shared decision-making, individualized care, empathy, and consideration. The second component centers on providing culturally tailored information, adjusting care to cultural needs, working with interpreters, allyship, community partnerships, self-awareness, and cultural knowledge, and builds upon the first component. Across the first two components of diversity-sensitive care, patients have reported experiencing dissatisfaction and encountering shortcomings in their healthcare providers, sometimes resulting in the third and final component pertaining to provider care. This component underscores the importance of linguistic, ethnic, cultural, and gender concordance in delivering quality care. CONCLUSION: In conclusion, the patient perspective on diversity-sensitive care encompasses multiple components, from patient-centered care to concordant care. The components incorporate various competencies as communication skills, empathy, self-awareness and adjusting care to cultural needs. Patients reported experiencing dissatisfaction and shortcomings across all components of diversity-sensitive care provided by healthcare providers.

Obsessive-compulsive disorder among individuals of Hispanic and Latin American ancestry: Cultural considerations for assessment and psychotherapy.

Research specific to obsessive-compulsive disorder (OCD) among individuals of Hispanic and Latin American (H/L) ancestry is limited, as are culturally relevant assessment and treatment recommendations. This article discusses the implications of underrepresentation of H/L populations in OCD research and emphasizes the need to consider issues related to assessment, treatment, and structural barriers that hinder delivery of culturally appropriate first-line psychotherapy. Recommendations for assessment and treatment are provided to aid clinicians in distinguishing culturally normative thoughts and behaviors from OCD, as well as to inform the implementation of psychotherapeutic interventions with cultural humility. This manuscript offers recommendations for future research to tackle health equity concerns with respect to assessment and treatment and structural factors limiting access to culturally appropriate psychotherapy. Wide-scale efforts are needed to comprehensively understand how H/L cultures intersect with various OCD presentations and to further disseminate treatments to populations that have historically lacked access to mental health care.

Embedding Public Health Practice Amongst Allied Health Professionals: A Rapid Scoping Review of International Approaches.

The UK Allied Health Professions Public Health Strategic Framework outlines their commitment to embed disease prevention and public health into allied health practice roles. Yet there is no clear guidance on how best to embed public health into practice. The aim of this study was to examine international approaches which embed public health practices amongst allied health professionals (AHPs). Given the exploratory nature of this study, a rapid scoping review was conducted. Seventy unique references reporting 69 studies were included representing a breadth of countries, extensive timeline (1987-2022) and different AHPs. Worldwide, AHPs are involved in all four domains of public health outlined in the UK Allied Health Professions Public Health Strategic Framework model. Best practice was evidenced in the form of well-designed studies (n=21) which reported the effectiveness of AHPs public health practice. Nine key success factors for embedding public health approaches within AHP practice were identified. Embedding public health practice should involve interventions targeting AHPs' behaviour change and behaviour change techniques targeting barriers to and facilitators for AHPs' public health practice. Multi/interdisciplinary working, innovative settings/roles, culturally tailored public health interventions along with cultural competence as a core skill should also be encouraged.

Co-development of breast cancer health promotion educational materials for ethnically diverse women working with hairdressing and beauty salons: BELONG study.

BACKGROUND: Improved screening uptake is essential for early breast cancer detection, women's health and reducing health disparities. However, minority ethnic and deprived communities often face lower breast cancer screening rates and limited access to culturally tailored educational materials. A recent review found limited culturally tailored materials for breast cancer education. AIM: To investigate the culturally appropriate interfaces and preferences of salon staff in educating their clients about breast cancer METHOD: We used a two-stage approach, following the Double Diamond framework; discover and define phases. Relevant breast cancer materials (i.e., based on cultural appropriateness, English language presentation, and alignment with the UK context) were assessed using the Suitability Assessment of Materials (SAM) toolkit. Interviews with ethnically diverse salon staff provided insights into their needs and preferences for client education materials. Thematic analysis was applied to interview transcripts. RESULTS: Cultural appropriateness was evident in 9/14 (64%) of the materials identified (e.g., targeting black ethnicities with positive representations). Of those, six of them demonstrated an overall SAM rating of 76% ("Superior"). Thematic analysis of interviews identified seven key themes, including the importance of engagement strategies, education and awareness for health promotion, salon staff's role, preferred training methods, supportive materials, inclusivity, representation, and participant satisfaction. CONCLUSION: This study highlights the SAM toolkit's role in selecting suitable educational materials for breast cancer prevention. The research offers prospects for improving breast cancer awareness in ethnically diverse communities and addressing healthcare access disparities, with salon hairdressers emerging as crucial advocates for health promotion.

Cultural safety in paramedic practice: experiences of Maori and their whanau who have received acute pre-hospital care for cardiac symptoms from paramedics.

Background Cardiovascular disease is a major health issue for Maori that requires timely and effective first-response care. Maori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Maori and their whanau who received acute pre-hospital cardiovascular care from paramedics. Methods Utilising a qualitative descriptive methodology and Kaupapa Maori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Maori patients and/or whanau, and a general inductive approach was used for analysis. Results Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Maori. Participants described paramedics' clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health. Conclusion Maori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Maori.

Brochure: Diálogos de saberes

Los diálogos de saberes, también llamados diálogos interculturales, son procesos de comunicación e intercambio entre personas, grupos o comunidades que provienen de diferentes orígenes o culturas. En el caso del sector de la salud, los intercambios se realizan entre determinados grupos o personas y personal de salud capacitado. Su objetivo es, entre otros, mejorar el acceso a los servicios de salud y construir una salud intercultural, con énfasis en la resolución de problemas previamente planteados y sus causas, la comprensión mutua y la creación de vínculos sólidos. Este brochure describe de manera general el proceso que tienen los diálogos de saberes.

Healthcare social network research and the ECHO model™: Exploring a community of practice to support cultural brokers and transfer cultural knowledge.

BACKGROUND: Project ECHO® networks at Children's Health Queensland Hospital and Health Service (CHQHHS) are communities of practice designed to mitigate services and systems fragmentation by building collaborative partnerships addressing priority child and youth health needs. Aboriginal and Torres Strait Islander people experience the negative impacts of fragmentation in addition to historical challenges of absent or culturally inappropriate health services. Access to culturally safe and responsive services can be improved by engaging Aboriginal and Torres Strait Islander Health Workers and similar roles in an online community of practice, supporting the integration of cultural and clinical knowledge and self-determination of Aboriginal and Torres Strait Islander consumers in decisions affecting their health. Analysing professional support networks and knowledge sharing patterns helps identify enablers and barriers to partnerships. Using social network research, the multilevel network inclusive of ECHO network members and their colleagues was studied to identify interdisciplinary and cross-sector advice exchange patterns, explore the position of cultural brokers and identify common relational tendencies. METHODS: Social network theories and methods informed the collection of network data and analysis of advice-seeking relationships among ECHO network members and their nominees. Registered members from two ECHO networks were invited to complete the Qualtrics survey. Networks analysed comprised 398 professionals from mainstream health, Aboriginal and Torres Strait Islander Community Controlled Health Organisation, education, disability and child safety service settings. RESULTS: Brokers were well represented, both those who hold knowledge brokerage positions as well as cultural brokers who incorporate clinical and cultural knowledge enabling holistic care for Aboriginal and Torres Strait Islander patients (38 individuals, 17% of network). Professionals who occupy brokerage positions outside the ECHO network tend to be more connected with co-members within the network. CONCLUSIONS: This study is the first application of contemporary social network theories and methods to investigate an ECHO network. The findings highlight the connectivity afforded by brokers, enabling the coordination and collaboration necessary for effective care integration. Inclusion of cultural brokers in an ECHO network provides sustained peer group support while also cultivating relationships that facilitate the integration of cultural and clinical knowledge.