For several decades, the field of nursing has focused on the integration of cultural competence content into its prelicensure educational programs. Despite this focus, little is known about the cultural competence of nurses extending their education past initial licensure into an advanced practice nursing specialty, such as nurse anesthesia. Researchers in other fields have found that provider race and previous cultural competence training are associated with higher levels of cultural competence. This research, guided by the culture care diversity and universality theory, sought to determine the relationship between the two subscales, Cultural Awareness and Sensitivity (CAS) and the Cultural Competence Behavior (CCB) of the Cultural Competence Assessment (CCA) tool, and describe the relationships that exist between selected demographic variables and the total cultural competence scores for nurse anesthetists. One hundred and fifty-eight members of the American Association of Nurse Anesthetists participated in the study. The total CCA score for the population was 4.98 out of a potential total score of 7 (SD = .79). Mean scores were 5.64 (SD = .73) and 4.38 (SD = 1.19) for the CAS and CCB subscales, respectively. Hierarchical multiple regression analysis confirmed a positive relationship between post graduate diversity training and total CCA score (B = .28, p < .05). Identifying the cultural competence of this population and the characteristics that are associated with high levels of cultural competence could lead to better provider awareness of their own interactions and perceptions of patients and improved patient-centered care for patients in minority populations who are served by certified registered nurse anesthetists, resulting in positive social change.

In a global environment, growing business corporations have recognized the role diversity plays in business development. However, the human resource development (HRD) profession charged with the responsibility for developing any organization's human resources, has not defined what cultural competence is and its role in improving the performance of HRD professionals. This study sought to define cultural competence and determine how it could be developed and assessed. The theoretical framework used was an intercultural perspective of intercultural competence, studies in HRD that focus on a training-culture context fit, and professional definitions of cultural competence. A mixed research method utilizing survey and personal interviews was employed to study Best Practice Learning and Diversity companies. Thirty-nine companies credited as American Society for Training and Development (ASTD) Best Award winners for workplace learning and performance were surveyed. The sample represented various sectors in the corporate industry such as information technology, financial services, manufacturing and retail. Due to a low response rate, eight senior global diversity officials from companies credited as Best Diversity companies by DiversityInc. were interviewed. Five of the companies studied were among the leading Top 10 global diversity companies. The other three ranked highly among the Top 50 diversity companies. The data collected was analyzed using grounded theory. Using this theory, the study identified attributes that describe cultural competence, and various approaches that are used to develop and assess it. Based on the study results, an HRD theory of cultural competence was developed. This theory includes: (a) a definition of cultural competence; (b) a cultural competence framework that provides performance indicators for HRD professionals; organizations, its leaders and employees; and (c) an assessment guide that provides a cultural competence inventory for HRD professionals. To ensure study validity, the survey instrument used in the study was pilot-tested among business scholars. In addition, the study addressed the issues of theoretical sensitivity such as the role of the literature reviewed, the researcher's biases, and the analytical process that was used for theory development. This study has implications for higher education and professional practice. The cultural competence framework developed in this study contributes to the standardization of HRD practices such as education, training and non-training HRD programs. The assessment guide provides a cultural competence inventory for HRD professionals. The results of this study would also be useful for companies that regularly benchmark their operations against best practices. In this way, the study contributes to the effort of aligning HRD practices to theory developed through HRD cross-cultural research

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South Asian people are less likely to have their mental health needs recognised and experience inequality in access to services, compared to the White British population in the UK. Attempts through government policy to improve equality in mental health care and outcomes have had limited success. The aim of this study was to explore access to and experiences of services among people of South Asian origin living in the UK who were experiencing distress. An anonymous survey was distributed in GP surgeries and online, collecting a community sample of 103 adults who self-identified as South Asian. The survey contained questionnaires measuring distress, quality of life, acculturation and access to and experience of services for mental health. Between 33% and 50% of the sample was above the threshold for distress, depending on the measure used, while 40% reported a low quality of life. Those who were unemployed had greater levels of distress. Half of the sample had sought help for emotional problems in the past, with the majority seeking help in the NHS. Greater acculturation was associated with reduced distress and a higher quality of life. Seeking help from services was predicted by experiencing distress, being female and having a physical health problem. Clinical implications for mental health service delivery as well as the need for further research relating to the recognition of mental health problems in primary care are discussed.

Sverige tar i dagsläget emot en stor andel flyktingar och flertalet av dessa flyktigar lider av psykisk ohälsa. Stress, ångesttillstånd, depression och posttraumatiskt stressyndrom (PTSD) är några diagnoser som förekommer bland flyktingar. För att hjälpa dessa patienter krävs både kulturell och språklig kompetens inom vården. Syftet med denna litteraturöversikt är att beskriva sjuksköterskors erfarenheter av att bemöta flyktingar med psykisk ohälsa. Nio kvalitativa studier och en mixed method studie har används för att presentera resultatet. Studierna är gjorda i Västeuropa och Australien och de utgår från ett sjuksköterskeperspektiv. Axelssons tillvägagångssätt för litteraturstudie valdes som metod för detta arbete. Resultatet beskrivs i två huvudrubriker, Svårigheter för sjuksköterskan i mötet med flyktingar och Det vårdande mötet i psykisk kontext. De svårigheter som identifierats beskrivs i fyra underkategorier: Att kommunicera med flyktingar, Att använda tolk, Att förstå patientens kulturella bakgrund och Att prata om traumatiska händelser. Det vårdande mötet i psykisk kontext beskrivs i två underkategorier: Behovet av kulturell kompetens och Att bedöma symptom. Resultatet visar att sjuksköterskor är i behov av ökad kunskap om kulturella skillnader för att vårda flyktingar med psykisk ohälsa. Symtombilden i psykisk ohälsa varierar beroende kulturellt ursprung och ämnet anses vara tabubelagt i vissa länder. Tolkar anses vara en stor tillgång till att bygga upp en vårdande relation mellan sjuksköterskan och en flyktingpatient, men kan även ses som ett hinder.

The changing demographic UK population in terms of cultural, racial and ethnic mix demands mental health nurses to be educated in ways that will enable them to provide care that is both efficient and culturally appropriate to the diverse population they will serve. However, reported studies indicate that professional nurses, particularly mental health nurses, are not ready to meet the challenges posed by an increasingly culturally diverse society. These have raised questions about the undergraduate nursing education's readiness to develop a mental health work force that is capable of delivering effective mental health services to a multicultural population. The aim of the study was to explore and gain an understanding of cultural competence education from the perspectives of the key participants involved in the undergraduate mental health nursing education within the UK context, and to use the findings to develop a conceptual framework of developing cultural competence. Qualitative grounded theory approach was the method of inquiry used to collect and analyse interview data from the experiences and views of senior lecturers, third year mental health student nurses, clinical sign-off mentors and student mentors within the universities that offer pre-registration mental health nurse training in the West Midlands Region. Analysis of the research findings resulted in an emergent conceptual framework that explains how cultural competence is developed in the undergraduate mental health nursing curriculum in terms of content, processes, strategies, actions and approaches that are considered effective. The findings of this study revealed a degree of consistency between the views of the current study participants and what the literature describes as frameworks for developing cultural competence. The main theoretical constructs emerging from the study fit into a cultural competence frameworks encompassing awareness, knowledge and skills. Whilst some of the themes and theoretical constructs emerging from the results of the interview data were generally consistent with those indicated in the cultural competence literature, there were some other themes that emerged from the study participants on what was required within the curriculum in order to educate student nurses in ways that will enable them to work effectively and culturally appropriately with clients from diverse cultural backgrounds. The additional bridging theoretical construct included ‘conscious of the dynamics and discourse of intercultural education’ which was a result of the differing ideological views about current curricula and how issues of cultural competence could best be addressed within the curricula. The strategies of ‘engagement of local experts to assist in teaching cultural competence specific areas’ and ‘creating educational activities that challenge stereotypes, prejudice, discrimination and religious intolerance’ also expands the current literature by providing evidence to support some of the conceptualisations regarding some of the educational intervention strategies to cultural competence. This study is significant as it represents the first attempt to develop a conceptual framework of developing cultural competence within the UK context based on the perspectives of those directly experiencing the undergraduate mental health nursing education, using qualitative grounded theory approaches. Exploring and developing the conceptual framework from the perspectives of the neglected silent voices of the key participants who are directly involved in the undergraduate nurse training within the UK context, contributes to the existing research in this area and provides a view not currently presented in the nursing literature.

The aim of this study was to investigate the principles and factors underlying the culturally competent nursing care of asylum applicants. Asylum applicants are a highly vulnerable group, whose health is often severely compromised prior to arrival in the UK due to exposure to torture, violence and rape. Although they are entitled to primary health care services whilst their asylum claim is under consideration, their level of welfare support has been significantly eroded over the last decade. An analysis of the nursing literature revealed mainly US notions of cultural competence, which were based on a private health care insurance system rather than a universal health care system of equitable, accessible and non-discriminatory service provision, such as the NHS. A Five Steps Model of cultural competence (Quickfall 2004) was later revised to provide a theoretical framework for this research study. Data for this ethnographic study were collected during 2005-2007 with asylum applicants and community nurses within one Health Board in Scotland, using participant observation, individual, narrative and group interview methods. The data were analysed for their categorical content. The findings are presented as vignettes to highlight cultural competence issues. Three major themes emerge from the study findings, which highlight the intermediary function of community nursing. The provision of equitable, accessible and non-discriminatory services remains pertinent in the 21st century. Secondly, the cross-cultural promotion of health involves a partnership process to ensure effective communication and the negotiation of person centred care. Thirdly, the delivery of socially inclusive services requires the aiding of asylum applicant adaptation to a new host environment. This study contributes to community nursing knowledge in explaining, through synthesis of the literature and study data, a model of cultural competence for the care of asylum applicants. It also provides a set of best practice statements, which require further investigation.

This study is an investigation of the relationship between the cultural competency of counselor supervisors and the satisfaction with supervision of their supervisees. This study is a quantitative analysis of the correlations between the variables of cultural competency, satisfaction with supervision, and supervisee ethnicity and supervisee gender. The chapters of this dissertation present an introduction to the study, a review of the relevant and related literature, and the research methodology that was utilized to conduct the study, together with results and discussions.

This case study of a Bronx, New York charter school drew upon Emdin’s (2016) book on pursuing school improvement as a secondary analysis of existing data from the school. The Principal Investigator is currently a teacher at the school and was participant-observer. The overall study can be considered an integration of qualitative fieldwork and survey methods. A strong implication from the highly significant quantitative results for 18 paired t-tests for nine Behaviors pre-/post-training is that professional development and special trainings had a strong positive effect. With Bonferroni Adjustment Significance (.05/18, p=.0003) level of .003, paired t-tests showed that staff ratings (knowledge and self-efficacy ratings) for all nine Behaviors exhibited a significant increase in mean rating from pre-training to post-training; thus, the intervention of professional development and special trainings had significant impact. Quantitative data supported the conclusion that significant progress was made toward the school’s original goal of transforming toward greater cultural competence and changing school climate to better meet the needs of urban learners from varied cultural backgrounds. Independent t-tests on dichotomous groups found one (of three) comparisons to be statistically significant (t= -.392, df=41.55, p= .000; Bonferroni Adjustment Significance, .05/3, p=.016) when comparing the means for people of color staff (n=29) of 8.934 (SD=1.254) versus for White staff (n=18) of 7.63 (SD=1.023). People of color staff had a significantly higher post-training self-efficacy for performing all nine specified behaviors compared to White staff. Qualitative data from five research questions produced via coding on 64 Emergent Themes, 15 Categories, and 12 Hierarchical Emergent themes—the last effectively coalescing all data into short statements to summarize all that school staff and teachers expressed about the training using Emdin’s book and other special training activities and discussions: acknowledge many book benefits; accept less ready White peers; learn bias, empathy; incomplete training, need to continue/action; impact of expanded awareness; retain many strengths to training model; plan to address barriers to success of training model; evidence of many improvements at school; ending oppression/biased discipline; training challenge of staff in different stages; expert facilitation of difficult conversations; and action for curriculum modifications.

Background The population in Israel is heterogeneous with inhabitants from diverse backgrounds with different religious affiliations, languages and customs. The diversity of cultural backgrounds can create a challenge for the healthcare system. Cultural competence is stated to be a necessary ability of a nurse when caring for culturally diverse persons, further promoted by the Israeli Ministry of health. Aim The aim of the study is to describe Registered Nurses experiences of working with cultural competence in caring for persons with culturally diverse backgrounds in Israel. Method A qualitative design was used. Five semi-structured telephone interviews with registered nurses working in a city in Israel, was conducted. The data was analysed using a qualitative content analysis with an inductive approach. Findings Four categories were identified in the findings: Understanding cultural needs, Addressing cultural needs, Challenges in caring for culturally diverse persons and Incidential finding: Risk of stereotyping, all further represented with the theme: Embracing patient’s cultural needs In healthcare. Approaches to understand cultural needs emphasised on seeing the whole person and being sensitive to their needs, depending on clear communication, although neglect of cultural needs occurred. Acceptance and respect for persons choices as well as adaptions made both in nurses encounter and hospital environment. Experiences of cultural differences evoked feelings of inconvenience and insecurities. Incidental findings show stereotyping as a challenge. Conclusion Approaches and behaviours in line with the values of cultural competence were learned through in-practice experiences. Implementation of the recommended guidelines in healthcare could further enhance nurse’s cultural competence and guidance when caring for culturally diverse persons.