Cultural
Competency: The Building Blocks
(1.25 contact hours)
Read the course for free. This is an introductory course in cultural
competency. It is strongly recommended to start with this course before
proceeding to the culture-specific courses.
If you would like to receive a certificate of completion (or contact
hours), please register after you read the course. This course is free
for course
evaluators, and with any purchased course. If you were referred by
our associate websites, please indicate this on your registration so we
can give you access to the course.
________________________________________________________________
Start the course:
Lessons:
I.. Cultural Competency: Rationale
for cultural competency
II. Cultural Competency: Terminology
III. The CLAS standards.
IV. History of Cultural Competency in Nursing
V. Developing cultural competence: awareness, knowledge and
skills.
VI. References (available with registration)
I. Rationale for
cultural competency in healthcare:
The United States population is increasingly more diverse racially and
ethnically. In the 1990s, over 26 percent of the US population
constituted of linguistic and cultural minority populations. It is
predicted that by 2010, the minority populations will constitute over
30 percent of the population and by 2050, almost 50 percent of the
total population will be members of ethnic and racial minorities (US
Census 2004).
Research has shown that culture shapes a person's attitudes, beliefs,
and practices toward health and disease; culture influences the
patient-caregiver relationships; and cultural differences contribute to
the health disparities in society.
This course introduces the basic concepts of cultural and linguistic
competency, the guidelines and mandates for cultural competency in
practice, the development of cultural competency in nursing, and basic
concepts of culturally competent attitudes, knowledge and skills.
1:
Objectives of the course
After completion of the module, the participant will be able to:
1. Define culture, cultural competence, and linguistic competence in
healthcare.
2. Explain at least 4 CLAS standards that affect nursing practice
(Standards 1,2,3,4).
3. Discuss the history of cultural competency in nursing.
4. Describe culturally competent attitudes, knowledge and skills.
II.
Terminology
A. Definition
of culture.
In order to understand cultural competency, we must first define what
culture is. Culture has many definitions. One of the definitions is
that culture is the shared beliefs,
values and practices that are learned and transmitted throughout
a society, and influence the way that a group of people live and make
decisions and interact.
Culture has been described as the learned and shared patterns of
information that a group uses to generate meaning among its members.
(Diversity.org 2001)
B. Definition
of cultural competency.
Just as there are different definitions of culture, there are also
different ways of defining cultural competency.
One of the generally accepted descriptions of cultural competency is that it is a developmental process that is
developed over time in order to increase understanding and knowledge of
cultural differences that affect the healthcare experience.
According to some sources, the U.S. healthcare profession has not been
very well-prepared to provide culturally competent care (Surgeon
General Report 2005).
According to Cross (1991), cultural competency is: a set of congruent
behaviors, attitudes and policies that enable a system, agency or
professionals to work effectively in cross-cultural situations.
Cultural situations are encounters with
cultural differences that may or may not include race and ethnicity.
The concept of cultural diversity in healthcare includes not only race,
ethnicity, national origin, age, gender and religion,
but also language, sexual orientation, mental or physical abilities,
social class, educational level, and other
attributes of society that result in different perspectives about
health and disease.
Biology and culture
are equally important in the person’s experience of illness. In
addition, society’s economic and political structures play a critical
part in the risks of diseases and availability and accessibility of
treatments.
Every encounter with a healthcare provider is shaped by the cultural
frameworks of both the client and the medical professional. In today’s
increasingly diverse society, cultural competence becomes a critical
skill in our personal, professional and social environment (Joralemon
1999).
C. Linguistic
competence means communicating effectively.
Linguistic competence is the capacity of an organization and its
personnel to communicate effectively, and convey information in a
manner that is easily understood by diverse audiences .(Source: NCCC
2004).
D.The goal of
cultural competency is to make healthcare more efficient and more
effective.
It is reducing costs of unnecessary tests and procedures, gaining trust
and compliance with treatment in order to promote positive outcomes,
and respecting and acknowledging that beliefs, practices, and genetic
heritage of clients can affect their treatments and outcomes.
It is not learning everything about all the different cultures that you
will encounter; it is developing the skills and resources to deal with
the differences. It is not learning all the different languages that
clients speak, but the knowledge and skills to communicate effectively
with and without interpreters.
E. Some of the
benefits of cultural competence in healthcare (MCC 2005):
Improves
communication with patients
Helps with negotiating differences
Promotes disclosure of patient information
Makes more effective use of time with patients
Promotes patient adherence to treatment
Decreases health worker and patient stress
Builds trust in a relationship
Increases patient and provider satisfaction
Meets increasingly stringent government regulations and
standards
Positively affects clinical outcomes
III.
The CLAS standards
Required
Reading: Final Report on
the CLAS standards. PDF file pages 14, 15, 16 and
17. Locate the page number on the lower left side of the page. http://www.omhrc.gov/assets/pdf/checked/finalreport.pdf
A. CLAS stands
for Culturally and Linguistically Appropriate Services.
The CLAS standards were
developed and issued by the U.S Department of Health and Human
Services’ Office of Minority Health in 2000.
The standards are guidelines
for accreditation and credentialing agencies:
- to assess and compare providers who say
they provide culturally
competent services, and
- to assure quality for diverse
populations.
(Please refer to CLAS link recommended reading pages 7-12).
The 14 standards are
organized by themes:
Standards 1-3: Culturally competent care
Standards 4-7: Linguistic competency
Stamdards 8-14: Organizational supports for cultural competency. (UMCC
2005)
B. Standards 1, 2
and 3 (Culturally Competent Care “Guidelines”): Health
organizations should: (Source: OMH 2005)
Standard 1: ensure that
patients/consumers receive from all staff members effective,
understandable, and respectful care that is provided in a manner
compatible with their cultural health beliefs and practices and
preferred language;
Standard 2:
implement strategies to recruit, retain, and promote at all levels of
the organization diverse staff and leadership that are representative
of the demographic characteristics of the service area;
Standard 3: ensure
that staff at all levels and across all disciplines receive ongoing
education and training in culturally and linguistically appropriate
service delivery
Language access service: Title VI of the Civil Rights Act of 1964
mandates linguistic competency.
Standard 4: describes language
access, stating that the healthcare organization must offer and provide
linguistically appropriate services.
C. Title VI of
the 1964 Civil Rights Act states that services provided with
funding from the federal government must be delivered without regard to
race, color, or national origin.
To comply with Title VI, a program, service or agency must
provide "meaningful access" at no cost to the LEP individual.
Recipients covered by the Guidance include all public and private
entities that receive federal financial assistance.
Examples of such health and social service entities are hospitals,
managed care organizations, state and local welfare agencies,
physicians, and research programs.
They include providers of services funded through Medicaid, Temporary
Assistance for Needy Families (TANF), the State Children's Health
Insurance Program (SCHIP), Head Start, and other programs for families
and youth.
IV. History of
Cultural Competency in nursing.
A. In the
1950s, nurse theorist Madeline
Leininger started to develop the
concepts of cultural competency in nursing, based on cultural care
diversity and universality.
After completing her doctorate degree in anthropology, she established
the field of Transcultural Nursing, which is focused on comparative
cultural caring, health and nursing phenomena and cultures worldwide
(Leininger, 1991).
B. Leininger coined
the term Transcultural. Today it is used interchangeably with
cross-cultural, intercultural and multicultural or ethnic nursing.She
has mentored over 200 transcultural nursing studies and today some of
the nurses she has mentored are making advances in the Transcultural
nursing field (Boyle, Andrews, & Carr, 2002).
The goal of Transcultural nursing is to develop a scientific and
humanistic body of knowledge in order to provide culturally congruent
care. Transcultural nursing blends nursing and similarities and
differences in human care and caring. Transcultural nursing is not
anthropology or medical anthropology.
Although Transcultural nursing studies cultural behavior patterns, the
focus is on the cultural caring phenomena and not with diseases or
specific cultural practices (Leininger, 1991).
C. According to
Leininger (1991), culture consists of the learned, shared and
transmitted values, beliefs, norms and lifeways of a particular
group that guide their thinking, decisions, and actions in patterned
ways.
The nurse and the client engage in decisions to: maintain or preserve,
accommodate or negotiate, or repattern or restructure the client’s
behavior in congruence with his/her values, beliefs and lifeways.
Transcultural nursing theory recognizes that clients and caregivers are
cultural beings and bring their own beliefs, values and lifeways to the
cultural encounter, within the context of the healthcare setting.
D. The
interrelationship of the three cultures, the nurse, the patient, and
the setting, is complex and requires cultural sensitivity,
research-based knowledge of cultural differences, and
interpersonal skills in order to prevent inappropriate and unethical
cultural imposition.
E. Personal
experience as an ethnic minority does not confer expertise in
practicing Transcultural nursing if not accompanied with a background
in theory and research-based cultural knowledge.
V. Developing
cultural competence: awareness, knowledge and skills.
Culturally competent attitudes, knowledge and skills are the affective,
cognitive, and behavioral domains that influence the nurse’s caregiving
practices. The Campinha-Bacote Model views cultural competence
as a journey, with the following dimensions (ASKED):
1. A is for
AWARENESS: Awareness of the impact of cultural differences on
patient’s health and illness necessitates self-assessment and
self-knowledge one’s own values, beliefs and practices. Caregivers
need to examine their biases and preconceptions and how they
potentially impact the care and treatment of clients.
Promoting mutual respect, awareness of the varying degrees of
acculturation, a client-centered perspective, acceptance that
beliefs may influence a patient’s response to health, illness, disease
and death. (From the Seven Domains of Cultural Competence.)
2. S is for SKILLS:
Culturally competent skills include the ability to conduct cultural
assessment of individual clients, groups, families, communities and
institutions as well as culturally-based physical assessment.
The nurse needs to be knowledgeable in biological variations (Mongolian
spot in infants), genetic traits and disorders, such as Tay Sachs
disease and Sickle Cell Anemia, risk factors for particular diseases
and injuries (for example occupational hazards), health conditions, and
variations in drug metabolism among different ethnic and cultural
groups.
Culturally competent behaviors and skills include development of new
behavior patterns based on cultural knowledge. For example, it includes
the ability to send and receive verbal and nonverbal messages
accurately and appropriately. It also requires adaptation of the
environment, processes service delivery to meet the needs of diverse
clients (for example, keeping longer office hours to accommodate
working women).
Providing alternatives to written communication; accomodating the
physical environment to the client's needs; culturally appropriate
materials, resources, and interior design; literacy sensitive
magazines, brochures, audio and visual materials.
(From the Seven Domains), )
3. K is for
KNOWLEDGE: The professional needs to base his/her practice on
theory and research-based knowledge of cultural differences in beliefs,
traditions and other cultural dimensions such as communication
patterns, space and time variations.
The professional healthcare provider needs to possess specific
knowledge about the particular group with which he or she is working,
their history and experiences (for example, political refugee or
high-tech immigrant worker), lifestyle and values, (for example, New
Age belief in alternative healthcare practices or expectations of
high-tech care), and how these factors potentially impact the
healthcare experience.
Population-based clinical practice; culturally skilled clinicians avoid
misapplication of scientific knowledge; avoiding stereotyping while
appreciating the importance of culture; knowing one's own worldviews;
learning about the changes in demographics; understanding
sociopolitical infuences; practicing intervention skills and strategies.
(From the Seven Domains)
4. E is for
ENCOUNTERS: The process where the healthcare professional
engages in face-to-face encounters with diverse clients in order to
gain first-hand knowledge and experience, and to modify preconceptions
about cultural groups. Learning about cultural differences is not a
substitute for personal knowledge from experience.
Continuous, active involvement of community leaders and members;
written policies and procedures and mission statements reflect
engagement in the community; multicultural and multilingual staff
reflecting the community.
(From the Seven Domains)
5. D is for DESIRE:
According to Campinha-Bacote, "Cultural desire is the motivation of the
healthcare professional to “want to” engage in the process of becoming
culturally aware, culturally knowledgeable, culturally skillful and
seeking cultural encounters; not the “have to.” "
The professional engages in life-learning not only for professional,
but also for continued personal development.
Conclusion:
Developing cultural competence requires the integration of
cultural awareness, knowledge and skills in the practice of
professional nursing. Culturally competent care requires the ability
and the capacity to provide respectful and effective patient care.
Congratulations! You
are now ready for the exam!
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Register here: http://www.culture-advantage.com/etraining/register.php,
or log in if you already a registered user.
Faculty
and other accreditation:
Culture Advantage is approved as a provider of continuing
nursing education by the Kansas State Board of Nursing. This course is
approved for 1.25 contact hour applicable for relicensure for RNs,
LPNs, and LMHTs.
Kansas State Board of Nursing: Provider # LT0243-1250.
Please read our
policies as approved by KSBN.
FAQs.
Course requirements:
1. Complete the lessons and the required reading.
2. Log in and complete the exam with a passing grade.
The required passing grade is 70% on the exam. Exams may be repeated
twice. Please email me if you need to retake an exam so I can reset
your account.
3. Provide a valid name, state of licensure and license number.
4. Keep track of the time spent on the course.
5. Complete the evaluation.
6. Completion of the course indicates agreement to the course
requirements. Thank you.
Questions of comments about the course? Send us a note below:
Frequently missed
questions:
1. All of the following are dimensions of cultural competency
except:
a. Values and attitudes
b. Communication styles
c. Culturally appropriate environment.
d. Culturally competent persons do not have to examine their prejudices
and biases.
2. All of the following statements about cultural competence are
true except (choose one answer only):
a. Knowledge-based skills
b. No single definition of cultural competence.
c. Set of academic and interpersonal skills
d. Cultural competence can be developed after attending a single
educational program
3. Which CLAS standard does the statement refer to: Healthcare
organizations should ensure ongoing CEU-accredited education or
other training in cultural competency.
a. Standard 1
b. Standard 2
c. Standard 3
d. Standard 4
4. Choose the CLAS standard that is described: Ability to provide
effective, understandable, and respectful care.
a. Standard 1
b. Standard 2
c. Standard 3
d. Standard 4
The passing score is 70%. You may retake the exam twice. Please email
me to reset your account in order to retake the exam.
Register here: http://www.culture-advantage.com/etraining/register.php,
or log in if you already a registered user.
Please make sure complete the evaluation if
you are going to use this course for relicensure. It is required for
contact hours. Click here.
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