Existing evidence suggests that disparities exist in the use of mental health services by Arabs in the U.S. While there are likely many factors that contribute, lack of cultural competence of mental health providers is one potentially important barrier for mental health service use among racial/ethnic minorities, including Arabs. The primary purpose of this study was to identify and examine factors related to the development and existence of cultural competence toward Arabs. Variables measuring demographics, professional characteristics, familiarity with Arabs, prior experience and knowledge of Arabs, and readiness for change were tested with a randomly selected sample of mental health providers in Northern Virginia. In order to assess baseline levels of cultural competence toward Arabs, as well as further define the potential relationships of these variables to cultural competence, a new measure of cultural competence toward Arabs [CC-A] was developed and initially validated through a focus group and pilot test. It was subsequently administered to a group of mental health providers in Northern Virginia to further assess the validity of the underlying constructs being tested and to explore relationships between this measure and other key factors. Factor analyses revealed that a unidimensional construct of cultural competence toward Arabs was being measured. Bivariate and multivariate analyses examined the way this measure related to these constructs. Regression analyses revealed that higher levels of cultural competence were significantly related to higher readiness for change, higher prior levels of knowledge toward Arabs, a greater degree of familiarity with Arabs, and utilizing books as a source of knowledge about Arabs. A model inclusive of these factors explained 19% of the variance in mean scores on the CC-A. Implications of these findings for research, clinical practice, and graduate training are discussed. These include consideration of alternative models for cultural competence, an assessment of additional methodologies to measure cultural competence, and the development and implementation of cultural competence interventions.

This thesis overall is concerned with three cardinal considerations in relation to working with young people in a modern and fundamentally demographically changed Britain. These themes include considerations of how young people’s racial/ethnic origins and religious identity continue to shape how mainstream services interact with them as well as understanding how an increasingly globalised world changes how young people from Britain see or are seen in a new way at the personal, local, national and global levels. This thesis argues that the majority of these considerations are not currently well understood; hence the need for practitioners in youth and community development to gain cultural competency and global literacy. It has been evidenced that Black young people continue to be disadvantaged in education, employment, criminal justice and a host of other socialisation spaces in comparison to the rest of society. In addition, the furore raised constantly and continuously in relation to the vulnerability of young Muslims to violent extremism deserves more critical attention. Furthermore, globalisation means that the world is much closer economically, politically, environmentally, technologically and culturally and there is increasing consciousness about the repercussions of these connections at the personal, local, national and global levels. However, questions remain as to whether practitioners who work with young people have the required competency to work across these racial, religious and global considerations. This thesis, consisting of the author’s published works and this overview explores these three cardinal considerations of race, religion and globalisation when working with young people in a multicultural, multi-ethnic, multi-racial and multi-faith modern Britain. The thesis comprises an exploration of working with Black young people within a historical and social policy context, as well as presenting research that explores the views of young Black children and parents. The author’s key contributions consist of explaining how cultural relativism and dogmatism, as extreme positions, are constructed, with potentially fatal consequences. The second dimension of working with young people in Britain explored in this thesis is that arena of Global Youth Work within both a theoretical and practice setting, especially in relation to the training of practitioners. This section also reports on research in relation to how Global Youth Work is conceptualised and operationalised in British Higher Education Institutions delivering youth work training. The last section of the thesis focuses on the contemporary issue of working with young Muslims. Against a backdrop of the government’s policy context of the “Prevent" agenda, perceptions of barriers young Muslims face in accessing mainstream services are explored, as well as the wider implications of fostering a culturally and religiously competent way of working with young Muslims.

In our increasingly diverse global workforce, both employers and institutions of higher learning want to know if colleges and universities equip their students with adequate cultural competence skills. Reliable instruments to measure cultural competence levels for a general student body are not widely available, however. In this report, a self-developed 33-item instrument was designed to assess college seniors’ cultural competence levels, including sub-scales for cultural awareness and cultural knowledge. An expert panel was selected to establish content validity. A pilot study was conducted to improve the design of survey format. The Cronbach’s alpha was .770 according to the reliability test. Six hundred and twenty-one seniors from two 4-year, selective public universities participated in this initial study. Analysis revealed statistically significant differences in cultural competence levels among students of different academic fields and demographic backgrounds, according to the results of t-tests and ANOVA. The study found that the students of liberal arts field had a higher cultural competence level than those of professional/vocational field did. The data also noted that female students had higher competence scores than their counterparts did. Asian/Pacific Island students had a lower mean score on cultural competence than the students of both African American and Biracial/Multiracial did. Generalizing the findings of this study should be taken cautiously given that this research was limited to a sample of two public universities. Nevertheless, all findings indicated taking classes related to cultural diversity improve students’ cultural competence.

Bakgrund: Allt fler människor migrerar till Sverige och de flesta av dem kommer att komma i kontakt med sjukvården. Därför är det viktigt för sjuksköterskor att de är utrustade med kulturell kunskap.  Det ligger i en sjuksköterskas intresse att identifiera behovet som föreligger i situationer med patienter med en annan kulturell bakgrund för att kunna ge ett professionellt bemötande och en god omvårdnad. Syfte: Syftet med studien är att beskriva sjuksköterskans erfarenhet av transkulturell omvårdnad. Metod: En litteraturöversikt som är baserad på 15 vetenskapliga artiklar, varav 13 är kvalitativa och en kvantitativ samt en mixed method. Artiklarna hittades i databaserna Cinahl och PubMed. Resultat: Ett av det stora problem sjuksköterskor står inför är den kulturella mångfalden som är nödvändigt att sjuksköterskan är utrustad med kulturell kunskap. Sjuksköterskans erfarenheter som utmaning, brist kunskap om kulturella kompetens, osäkerhet, svårigheter att bedöma smärta, självkännedom och språkbarriär är de faktorer som beskrivs av sjuksköterskor som vårdar patienter med annan kulturell bakgrund. Att sjuksköterskan inte har kulturell kompetens kan leda till att relationen med patienten inte skapas. Slutsats: Kulturkompetens inom omvårdnad är en viktig aspekt vid omvårdnad av patienter med olika kulturer. Kulturell mångfald bland patienter är en av de utmaningar som sjuksköterskor står inför. Sjuksköterskor anser att vården av kulturellt olika patienter är en svår utmaning på grund av brist på kunskap om patientens olika kulturer. Sjuksköterskor behöver ha kulturell kunskap så att de kan ge individuell omvårdnad när de möter människor med olika åsikter, idéer och värderingar om hälsa, ohälsa och omvårdnad. På grund av detta finns det ett stort behov av ökad kunskap och fortbildning av transkulturell omvårdnad för att förbättra kulturella färdigheter inom sjuksköterskeutbildningen. / Background: More and more people are migrating to Sweden and most of them will come in contact with health care. It is important for the nurses that they are equipped with cultural knowledge. It is in the interest of a nurse to identify the need that exists in these nursing situations, such as security and safety, in order to be able to provide a professional treatment and a good nursing care. Aim: the aim of this study is to describe the nurse’s experience of transcultural nursing Method: a literature review based on 15 scientific articles, of which 13 are qualitative and one quantitative, one mixed method with both qualitative and quantitative. The articles were found in the databases CINAHL and PubMed. Results: One of the major problems nurses face is the cultural diversity that requires the nurse to be equipped with cultural knowledge. The nurse's experience as a challenge, lack of knowledge, uncertainty, religion, difficulties in assessing pain, cultural differences, seeing the individual and language barrier are the factors described by nurses who care for patients with different cultural backgrounds. The fact that the nurse does not have cultural competence can lead to the relationship with the patient not being created. Conclusion: Cultural competence in nursing is an important aspect in the care of patients with different cultures. Cultural diversity among patients is one of the challenges faced by nurses. Nurses believe that the care of culturally different patients is a difficult challenge because of a lack of knowledge about the patient's different cultures. Nurses need to have cultural knowledge so that they can provide individual care when they meet people with different opinions, ideas and values about health, illness and nursing. Because of this, there is a great need for increased knowledge and training of transcultural nursing in order to improve cultural skills in nursing education.

Att Sverige idag är ett mångkulturellt samhälle återspeglas i dagens sjukvård. Sjuksköterskor möter idag patienter med invandrarbakgrund och kan därmed uppleva svårigheter att förstå dessa patienters behov på grund av språkhinder och/eller kulturella skillnader. Syftet med studien var att beskriva sjuksköterskans upplevelser i mötet med patienter med invandrarbakgrund. Vi använde oss av en litteraturstudie där 11 kvalitativa vetenskapliga artiklar granskats och analyserats enligt Evans (2003) modell. Analysen resulterade i följande fem teman; Språkbarriär – ett hinder för god omvårdnad, Tolkens för - och nackdelar, Anhöriga - på gott och ont, Att uppleva bristfällig kulturkompetens, Upplevelsen av både positiva och negativa fördomar och förutfattade meningar. I diskussionen lyfter författarna fram samtliga teman för att de är av betydelse för sjuksköterskan i mötet med patienter med invandrarbakgrund. Sjuksköterskorna i dem studerade artiklarna upplevde frustration och missnöje eftersom de inte kunde tillgodose en god omvårdnad till patienter med invandrarbakgrund. / Program: Sjuksköterskeutbildning

Objetivos: Desenvolver um novo instrumento para avaliar espiritualidade e realizar análises psicométricas de validade e confiabilidade. Métodos: O instrumento foi elaborado através de quatro etapas: fundamentação teórica, investigação sobre definições de espiritualidade na população geral, elaboração da primeira versão por um comitê de especialistas e teste de compreensibilidade. Nas análises psicométricas, o instrumento foi submetido à avaliação de juízes e posteriormente, foi testado em estudantes de medicina (N=85) e em uma população de religiosos (N=85), para cálculo de consistência interna, análise fatorial exploratória e confiabilidade teste-reteste. Resultados: O instrumento desenvolvido, a Escala de Atitudes Relacionadas à Espiritualidade (ARES), apóia-se na compreensão sobre espiritualidade no contexto brasileiro e em bases teóricas. Apresentou análises psicométricas apropriadas: a análise fatorial exploratória apontou uma estrututura unidimensional, o alfa de Cronbach encontrado em cada item foi >= 0,98 e o Coeficiente de Correlação Intraclasse (CCI=0,98) apontou boa reprodutibilidade da escala. Conclusão: ARES é um instrumento unidimensional, desenvolvido em idioma português, que apresentou consistência interna excelente e indicou ser reprodutível na população avaliada. São necessários mais estudos para verificar se ARES é aplicável em amostra com baixa escolaridade e em outros contextos culturais e religiosos. A escala ARES permite operacionalizar o construto espiritualidade em pesquisas quantitativas / Objectives: Develop a new instrument devised to measure spirituality, able to perform psychometric analysis of validity and reliability. Methods: The instrument was elaborated through four processes: theoretical foundation, a population based investigation about possible definitions of spirituality, a first version was achieved by a committee of experts in Spirituality along with a comprehension test. In psychometric analysis, the analysis was evaluated by judges, then tested in a population of medical students (N = 85) and in a religious population (N = 85), in order to calculate internal consistency, exploratory factor analysis (EFA) and reliability, through test-retest. Results: The instrument, ARES, a Spirituality-Related Attitudes Scale, was based on theoretical understandings of spirituality in the Brazilian context. It presented an appropriate psychometric analysis: the EFA indicated a one-dimensional structure, the Cronbach\'s Alpha found each item at >= 0.98 and the Intraclass Correlation Coefficient (ICC = 0.98) indicated good reproducibility of the scale. Conclusion: ARES is a one-dimensional instrument, developed in the Portuguese language, which presented an excellent internal consistency and indicated to be reproducible in the evaluated population. Further studies are needed to verify if ARES is applicable to other population samples, for example, a low SES and other cultural/religious contexts. The ARES scale allows for operationalization of the construct of spirituality in quantitative researches

Cultural competence and ethical decision making are two separate, yet intrinsically related concepts which are central to services rendered by all health care professionals. Cultural competence is based on ethical principles and informs ethical decision making. In spite of this important connection, the interrelationship of these two concepts does not receive the attention it deserves in the literature. This issue is addressed by appraising the training and assessment of cultural competence and ethical decision making in the health care professions. The integrated relationship of these two concepts is illustrated within the broader contexts of higher education, research and clinical practice. Health care professionals who incorporate cultural competence and ethical decision making will be empowered to provide the best services to their clients/ patients in multicultural contexts to ensure optimum outcomes.

Undocumented end stage renal disease (ESRD) patients in the United States only have access to emergency dialysis. To compensate for the lack of regular dialysis these patients must follow strict renal dietary restrictions. However, nutrition counseling by a dietitian is not part of the renal management of patients on emergency dialysis. The purpose of this quantitative quasi-experimental treatment-control study was to assess how the application of nutritional counseling that is both culturally and linguistically competent affects dialysis frequency and biochemical lab values such as serum potassium, phosphorus, and vitamin D of patients in emergency dialysis. The study was grounded on the social cognitive theory and consisted of a secondary data analysis of information collected from electronic medical records. The sample size consisted of 96 emergency dialysis patients, 51 from the intervention group, and 45 from the control group. Results from Quade's test revealed there is statistically significant difference in serum levels of phosphorus [F(1,94) = 9.616, p = 0.003] and levels of Vitamin D [F(1,94) = 51.411, p = .000] between the intervention and control groups, controlling for age, gender, and time on dialysis. These findings suggest the implementation of nutrition counseling that is both culturally and linguistically competent can improve phosphorous and vitamin D levels among emergency dialysis patients. The potential social change implication of this study is that its findings may serve to assist health care professionals to design and implement interventions to improve the health status of emergency dialysis patients and reduce their impact on the public health system.

This DNP project addresses the healthcare issue of intimate partner, domestic, and sexual violence (IPDSV), its impact on survivors, and reducing the potential for retraumatization by those who care for them in the clinical, behavioral, and social settings. Trauma-informed care interventions are designed to address the sequelae of trauma, promote recovery, and support resilience. Since IPDSV is a global health issue, supporting cultural needs of all clients is an essential aspect of trauma-informed care. This project was guided by a central research question that examined if trauma-informed, culturally competent curriculum be viewed by community stakeholders as an appropriate intervention for the education of their workforce in preventing survivor retraumatization. The framework for this project was informed by the sanctuary model, the 4 major tenets of Leininger's theory of culture care diversity and universality, and the 5 constructs of cultural competence by Campinha-Bacote. The focal site was a domestic violence shelter that provides care for a multitude of culturally diverse trauma survivors. Demographic data were collected, and a descriptive analysis performed to determine the diversity and needs of the residents. These data were then used to develop a culturally competent program using trauma-informed principles to prevent the effects of recidivism, and to promote healing, empowerment, and resilience in survivors.

Like educators, speech-language pathologists can anticipate working with culturally and linguistically diverse students and their families. Data reported from the Study of Personnel Needs in Special Education (SPeNSE), 1999-2000, revealed that during the years 1999-2000 speech-language pathologists caseloads included students from various culturally and linguistically diverse groups (U.S. Department of Education, Office of Special Education Programs, 2001). Furthermore, on average, more than one-fourth of students seen by speech-language pathologists were from a culturally and/or linguistically diverse group than their own and 8.8% were English language learners (U.S. Department of Education, 2001). Thus, guaranteeing a highly qualified pool of speech-language pathologists to meet these students needs is essential. This study examined speech-language pathologists (a) beliefs about the language assessment of bilingual/bicultural/bidialectal students, (b) professional efficacy beliefs (both personal and general) as they relate to assessing the language skills of bilingual/bicultural/bidialectal students, and (c) reported supports and barriers to assessing the language skills of bilingual/bicultural/bidialectal students. It involved a mixed method research design (Tashakkori and Teddlie, 1998, 2002) and was organized into three central components that included a quantitative phase and a qualitative phase: (a) survey administration, (b) reflective analysis of the researchers experience as a speech-language pathologist, and (c) follow-up semi-structured interviews. Quantitative analyses of speech-language pathologists professional efficacy beliefs revealed that most speech-language pathologists believed they personally, and the field in general, were somewhat competent in assessing the language skills of bilingual/bicultural/bidialectal students. While none of the predictor variables were significantly related to personal efficacy, one of the predictor variables (Hispanic/Latino) was significantly related to general efficacy. Qualitative analysis of speech-language pathologists professional efficacy beliefs varied as a function of race/ethnicity. Higher beliefs of personal efficacy existed among speech-language pathologists of color. Perceived supports and barriers as well as the demographics of survey respondents, which highlight low numbers of speech-language pathologists from bilingual/bicultural/bidialectal backgrounds, confirmed the need to address assessment and intervention practices of bilingual/bicultural/bidialectal students.