Thesis (Ph. D.)--Miami University, Dept. of Psychology, 2005. / Title from second page of PDF document. Document formatted into pages; contains [3], vi, 75 p. : ill. Includes bibliographical references (p. 35-37).

O puerpério é considerado uma fase de modificações biossocioculturais que, muitas vezes, não são compreendidas pela mulher, o que exige maior atenção dos profissionais, dos familiares e das redes de contato envolvidos em seu cuidado. A literatura e a prática profissional mostram que as crenças sobre o cuidado da puérpera têm relevância em seu cotidiano e, muitas vezes, se sobrepõem às orientações recebidas na instituição de saúde. Diante desta situação, este estudo teve como objetivo: explorar as práticas de cuidado adotadas no pós-parto pela mulher usuária de uma Unidade Básica de Saúde da cidade de Rio Claro, SP. Trata-se de estudo qualitativo, que teve como referencial teórico o Modelo de Competência Cultural de Purnell e cujos dados foram tratados pelo Discurso do Sujeito Coletivo (DSC). A pesquisa foi aprovada por Comitê de Ética em Pesquisa e atendeu à Resolução 196/96. Os dados foram coletados em 2011, por meio de entrevistas realizadas com 20 puérperas entre o 30º e 45º dias de pós-parto. Identificou-se a condição sociodemográfica e familiar das entrevistadas, além de sua vivência no puerpério. Os dados mostraram que as puérperas eram jovens, apresentavam baixo índice de tabagismo, etilismo e drogadição, com renda média em torno de 3 salários mínimos. Os relatos obtidos originaram 21 DSC, cujos conteúdos mostraram a influência de crenças sobre as práticas de cuidado no puerpério; crenças que foram transmitidas intergerações pelos cuidadores de sua rede familiar e cultural. Os profissionais de saúde se fizeram presentes por meio de orientações de práticas, com enfoque no biológico, oferecidas de maneira verticalizada e, por vezes, fragmentada e divergente, o que demonstrou sua dificuldade em acompanhar as influências culturais envolvidas no processo. Por conta disso, as práticas de cuidado no puerpério sofreram maior influência das crenças e dos padrões da cultura da mulher, como também das informações obtidas na internet, que preencheram lacunas e apontaram caminhos para a mulher seguir com maior segurança nesta fase do ciclo gravídico-puerperal. Diante dos achados, propõem-se o estabelecimento de estratégias para incorporação da bagagem cultural da mulher à assistência prestada pelo profissional de saúde, de modo a prover o cuidado culturalmente competente; a programação de grupos voltados à educação em saúde, focados na vivência do puerpério, para a mulher e sua rede de contato; a implementação da Estratégia Saúde da Família; e a inclusão do egresso de curso de Obstetrícia nos programas de saúde dos municípios, para agregar este novo profissional no cuidado da mulher e de seu recém-nascido. / Puerperium is considered a phase with biological, social and cultural changes often not correctly understood by women, the main reason why requires special attention from professionals, and caregivers networks involved on the care. Literature and professional practice shows that beliefs about postpartum care has a strong relevance in a womans routine and often overlaps guidance received at the health institutions. From this perspective, this study had as objective to explore practices adopted in postpartum by women served in the Basic Health Unit in a city of Rio Claro state of São Paulo (Brazil). This is a qualitative study and followed Purnell Cultural Competence Model as a theoretical approach and whose data was treated by the Collective Subject Speech (CSS). The data was approved by Ethics in Research Committee and complied with Resolution 196/96. The data was collected in 2011 through interviews with 20 women in the puerperium between 30 and 45 days of postpartum. We identified social and demographic conditions from each interviewed as well as from her family, besides their experiences at the puerperal period. The data showed that women in the puerperium were young, had low smoking rates, alcoholism or drugs addictions, and on average had an income that was equivalent to 3 minimum salaries. The reports had originated 21 CSS, and the contents showed the stronger beliefs influence on postpartum care practices; beliefs that were passed by intergenerational family and cultural caregivers. Health professionals demonstrated their presence through guidelines with practices with a biological focus and offered in a vertical manner, and sometimes divergent and fragmented, which demonstrated difficulty in following the cultural influences involved in the process. For this reason, puerperal care practices had suffered greatly due to the influence of beliefs and cultural woman patterns, as well as information obtained from the Internet. The Internet filled gaps and provided greater security methods to follow at pregnancy stage, childbirth as well as at puerperium. Upon reviewing the results, it is suggested that the following take place to incorporate the cultures of women to the experiences of the health care professionals to provide a culturally competent care; programming groups on health education focused on the puerperium experience for women and her caregivers; the implementation of Family Health Program, and the inclusion of Midwifery in the health programs to allow this new professional to take care the woman and her newborn.

Abstract The goal of this research is to develop a research process that explores the role Inuit teachers play in the development of Inuit culture in the classroom. A participatory action research approach was used with the objectives of: (1) examining how Inuit teachers view their cultural role; and (2) exploring how Inuit teachers teach their culture. Research activities were grounded in Indigenous education, intercultural learning and postcolonial theories. From this frame of reference, two project activities were developed in partnership with the Kativik School Board in Nunavik, Canada: a teacher training course and a teacher survey. The teacher training course attempted to create a ‘third space’ in which decolonization could be discussed and teachers could reflect about cultural influences on their own practice. The teacher survey constructs a ‘snap-shot’ of Inuit teacher perspectives on the topic of Inuit culture in their classrooms. Analysis of data involved qualitative methodologies including content analysis for the course and a series of verification interviews with senior stakeholders. A quantitative approach was used for analysis of the teacher survey. Data suggest that Inuit culture is being taught in classrooms; however few opportunities exist for Inuit teachers to discuss the implications of their practice. Conclusions point to the need for further development of Inuit-specific and Inuit-led research spaces - third spaces - in which Inuit culture can be articulated, and reflected upon. Limiting factors exist, however, with regard to how these spaces can be developed including language used for dialogue, authority within the space and length of time for dialogue. Decolonizing cultural competency is introduced in concert with third space theory as a pathway toward articulating collaborative research spaces in which Inuit can work in their own language and construct Inuit-specific strategies and content to decolonize their educational systems. / Tiivistelmä Tämän tutkimuksen tavoite on paneutua natiivi inuiittiopettajien rooliin inuiittikulttuurin kehittämiseksi kouluopetuksessa. Tutkimuksessa käytettiin osallistavaa toimintatutkimusta, jonka tavoitteena oli selvittää: (1) miten inuiittiopettajat näkevät oman kulttuuriroolinsa ja (2) miten inuiittiopettajat opettavat omaa kulttuuriaan. Tutkimuksen teoriaperustana käytettiin alkuperäiskansojen opetuksen, monikulttuurikasvatuksen ja postkolonialismin teorioita. Tutkimus toteutettiin kahtena osaprojektina; opettajien koulutuskurssi ja kyselytutkimus. Nämä tutkimusprojektit suunniteltiin ja toteutettiin yhteistyössä Kativikin opetuslautakunnan kanssa Nunavikissa Kanadassa. Tutkimuksessa toteutetulla opettajankoulutuskurssilla pyrittiin luomaan ”kolmas tila”, jossa opettajat voivat syventyä keskustelemaan dekolonisaation käsitteistöstä ja voivat pohtia oman työnsä kulttuurisia vaikutuksia. Opettajien parissa tehty kyselytutkimus puolestaan on ’pikakatselmus’ inuiittiopettajien näkemyksiin inuiittikulttuurin roolista heidän luokkahuoneissaan. Tutkimusaineisto analysoitiin kvalitatiivisin ja kvantitatiivisin menetelmin. Opettajankoulutuskurssin tutkimusaineiston analysointiin käytettiin kvantitatiivista sisällönanalyysia, jonka tuloksia validoitiin haastattelemalla kokeneita inuiittiasiantuntijoita. Opettajainkyselytutkimus puolestaan analysoitiin kvantitatiivisesti. Tutkimus osoittaa, että inuiittikulttuuria opetetaan luokkahuoneissa mutta inuiittiopettajilla on harvoin mahdollisuus yhdessä pohtia työnsä merkityksiä. Tutkimustulosten perusteella voidaan tehdä johtopäätös, että olisi tarpeen kehittää inuiittikeskeisiä ja inuiittien johtamia tutkimusympäristöjä - kolmas tila – joissa inuiittikulttuuria voidaan artikuloida ja pohtia. Tätä pohdintaa rajoittavia tekijöitä ovat kuitenkin dialogissa käytettävä kieli, kolmannen tilan auktoriteettikysymykset ja dialogiin käytettävä aika. Kulttuurikompetenssin dekolonisaatio ja kolmas tila esitetään tutkimuksessa keinoina kuvata yhteistoiminnallisia tutkimustiloja, joissa inuiitit voivat toimia omalla kielellään sekä kehittää inuiittikeskeisiä strategioita ja sisältöjä inuiittiopetuksen rakenteiden dekoloniasoimiseksi.

Bakgrund Idag beräknas 200 miljoner flickor och kvinnor världen över ha utsatts för könsstympning. Det utövas med hänvisning till kultur men fyller inget medicinskt syfte utan orsakar somatiska såväl som psykiska komplikationer och kan i värsta fall leda till död. Övergreppet står i kontrast med mänskliga rättigheter. I dagens globaliserade värld sker transkulturella möten och som sjuksköterska världen över finns en sannolikhet att möta kvinnor som utsatts för könsstympning. Större förståelse och respekt för kulturella skillnader hos sjuksköterskan skulle kunna öka upplevelsen av en god och trygg vård. Sjuksköterskan har möjlighet att uppfylla patienternas behov genom ett transkulturellt omvårdnadsperspektiv och därav finns intresse att belysa vad som har betydelse för att transkulturell omvårdnad ska kunna genomföras för kvinnor som har utsatts för könsstympning. Syfte Syftet var att belysa vad som har betydelse för att transkulturell omvårdnad ska kunna genomföras för kvinnor som har utsatts för könsstympning. Metod I förevarande studie har en icke-systematisk litteraturöversikt genomförts med sökningar i databaserna PubMed och CINAHL. De 17 artiklar som inkluderades i resultatet har kvalitetsgranskats enligt Sophiahemmets bedömningsunderlag och analyserats genom en integrerad analysprocess. Både kvantitativa och kvalitativa vetenskapliga artiklar inkluderades. Resultat Huvudfynden var att bristande kunskap förekom kring kvinnlig könsstympning och förståelse för kulturella aspekter, att relationen var ett viktigt verktyg för att kunna ge en kulturell och individanpassad omvårdnad, kommunikation behövdes för att etablera god relation och kunna identifiera omvårdnadsbehov, och delaktighet kunde bidra till att kvinnorna kände sig trygga inför omvårdnaden. Slutsats Den slutsats som kunde dras baserat på resultaten var att sjuksköterskan kan applicera studiens huvudfynd för att möjliggöra en god transkulturell omvårdnad för kvinnor som utsatts för könsstympning.

Over 25 million Americans report limited English proficiency (LEP) since 2013, and this number has been steadily increasing over the past few decades as immigration to the United States continues to climb. Due to the expanding heterogeneity of the population, cultural and language barriers became more common in the healthcare field which led to worse patient outcomes, inappropriately ordering too many or too few tests, and decreased use of preventative services. This necessitated further resources and interventions to better accommodate individuals with LEP. In accordance with Title VI of the 1964 Civil Rights Act which was elaborated further in Executive Order 13166, federal agencies were required to provide language services to people with LEP. As a result, more medical institutions began implementing interpreter services. Despite these measures, there is lower-than-expected physician compliance with utilizing these services and considerable variability in services offered depending on the clinical setting. Not only does this perpetuate and potentiate the health disparities that this population already faces, but it can also negatively impact a patient’s agency as they do not have the proper resources to fully advocate for their health. Hence, it is integral to examine the potential reasons why the current infrastructure for interpreter services is still lacking and what can be done to optimize accessibility. This thesis will explore some of these limitations and then offer potential solutions that both institutions and medical professionals can implement in order to provide equitable care to patients with LEP. / Urban Bioethics

Due to the diversity within the healthcare system, it is important to promote cultural competency in healthcare providers. The integration of pedagogical approaches to cultural competency into health-related programs cannot be understated. Therefore, the purpose of this study was to develop an instrument to examine the student engagement in cultural competency-related activities within health-related degree programs and determine the relationship between engagement and cultural competency. Participants of the study included first- and fourth-year undergraduate students studying within a health-related program at a mid-sized, private university in the Midwestern US. Participants completed a cultural competency inventory questionnaire which included activities identified from prior studies that facilitated cultural competency learning. They also completed The Inventory for Assessing the Process of Cultural Competence For Healthcare Professionals -Student Version (IAPCC-SV, 2009); a measure of cultural competency. Using the exploratory factor analysis, the Cultural Learning Inventory (CLI) indicated a 4-factor construct with adequate construct detection. Overall, three of the four CLI constructs were positively associated with overall cultural competency. Further, first-year students had lower CLI and cultural competency scores compared to fourth year students. In conclusion, promoting learning activities and programs can positively impact future cultural competency in health-related professionals.

This dissertation examines how media literacy education can be implemented and practiced for North Korean refugees to enhance their cultural competency. It is conducted as a form of participatory action research, which pursues knowledge and progressive social change. As a participant researcher, I taught media literacy to North Korean refugees in five different institutions during the summer of 2008 for a period of three months. This dissertation reviews my strategies for gaining permission and access to these educational institutions to teach media literacy education. Since media literacy classes cannot be separated from current events nor from the media environments of the given period, the dissertation also presents the significant role that the issues of importing U.S. beef and the candlelight demonstration played in the design of media literacy lessons during the summer of 2008 and in the process illustrates the value of teachable moments. It is hoped that other media educators will see how I made a connection between current affairs and media literacy lessons. Since this dissertation aimed to address how media literacy education can be effectively used to enhance North Korean refugees' cultural competence, I as researcher adopted an emergent curriculum approach which incorporates what emerges in the classroom into the learning. Based on predetermined educational goals, on what emerged in the classroom, on students' reactions, and on my own reflections, I continuously modified lesson plans throughout the summer. While I tried various pedagogies and covered several themes in the class, I selectively presented six different lesson models in this dissertation. The first lesson model includes drawing and talking about the mapping of students' media experiences. I started the initial class at each institution with this media mapping. As students drew and shared their media maps, they were able to reflect upon their own media usage. I also was able to gain better knowledge and insight about their media experiences. This exercise also allowed me to set the tone of the class as a comfortable venue in which students could honestly share their stories; as a result, the students were able to gain confidence in sharing their thoughts and experiences. The second lesson model used the film Crossing, the fictional film about North Korean refugees. Using this film in the lesson created an atmosphere in which students could talk freely about issues of North Korea and North Korean refugees. While the issues of North Korea refugees and North Korea are very sensitive topics for discussion between native South Koreans and North Korean refugees, the act of discussing this film naturally led students to share their stories about being North Korean refugees. The groups' deconstruction of this film also provided an opportunity to learn how media stories are purposely crafted and represent only a certain part of reality. The third model incorporated in-class reviews of different media sources related to the film Crossing -such as articles in women's magazines, film magazines and newsmagazines, blogs, internet fan cafes, official sites of the film, and the star ratings at the portal site. Critically analyzing these media sources informed students of the various purposes of the media and offered the possibility of participation in the public discourse. Because North Korean refugees are not familiar with the various possible uses of the media, they found it helpful to see effective ways to utilize the media to accomplish various goals. In addition, this activity was a valuable way by which to teach the concept of target audience, helping the students to see how different target audiences influence the emphasis, format, and style of media content. The fourth lesson model incorporated comparisons of different news sources about the candlelight demonstration. This helped students to understand the variety of views and tones of different news sources that are influenced by their own history and political affiliations. By closely examining what factors impacted the creation of the news stories and their influence on the public, students started to acknowledge the importance of critically examining media messages and locating a reliable news source that they could trust. The fifth lesson model was the stereotyping activity. Students reflected upon their own stereotypes that they had toward others and how the prevalent images of certain groups of people are influenced by the media. This lesson encouraged students to think about the importance of conveying a balance of varied images of different groups of people so that these people could not be misunderstood and stereotyped by others. The six lesson model involved watching and discussing documentaries about North Korean refugees in order to help students to better learn how the same group of people can be differently represented based on the purpose of the film and the knowledge and perspective of the producers. As two of the four documentaries discussed were created by teenage North Korean refugees, students also were inspired and learned how direct participation in producing the stories which they felt were important could make a difference. Ultimately, students who earlier had considered themselves as inadequate and incapable started to see that they themselves are valuable and that their voices are important, and therefore they can have a meaningful impact on others and on society. / Mass Media and Communication

Abstract A STUDY OF A PROFESSIONAL DEVELOPMENT INITIATIVE TO INCREASE CULTURAL COMPETENCY By Jennifer Crowe Coleman, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2014 Major Director: Charol Shakeshaft, Ph.D. Professor, Department of Educational Leadership School of Education While there are broad, societal forces that contribute to achievement gaps, the professional development of teachers is one way educational leaders have sought to improve schools, improve teacher performance, and increase teacher knowledge and skills. Given the achievement and cultural gaps that exist between teachers and students, professional development that targets the development of teacher cultural competence in an effort to reach all students is necessary. The purpose of this study is to describe the implementation of a cultural competency professional development program across 62 schools in a large, suburban school district in central Virginia, comparing and contrasting implementation activities and outcomes over the 2-year period of its implementation with the initial expectations for the professional development initiative. This quantitative, nonexperimental study was carried out in two phases. The purpose of Phase 1 was a content analysis of the professional development plans of each of the district’s schools. Phase 2 consisted of a multiple choice, electronic survey of those who were trainers of the cultural competency professional development initiative in order to examine the implementation of the cultural competency professional development program and the relationship between the intended goal and the actual outcomes of the initiative. The survey was also used to collect demographic data, such as race and years of experience in education, in order to determine what, if any, impact these factors may have had on the implementation of the professional development initiative. Descriptive and inferential statistics were used to generalize the results to the population the sample represents. As this initiative was not designed to provide the training necessary to expect changes in classroom practice, this survey and its analysis focused on the trainers’ perspectives on the implementation of the professional development initiative. The results of this research were offered to frame a discussion around the fidelity of implementation; the factors that affected implementation; the relationship between the intended goals of the initiative and the actual outcomes of the initiative; and suggested next steps for the district as it moved toward a goal of a more culturally proficient workforce.

O presente estudo qualitativo teve como objetivo descrever e compreender o cuidado das crianças no processo saúde-doença sob a perspectiva das famílias de uma comunidade nativa do Peru. O Modelo para Competência Cultural de Purnell foi a base teórica que deu sustentação ao estudo. O método etnográfico com ênfase na etnoenfermagem, utilizando as técnicas da observação participante e da entrevista etnográfica, com cinco famílias durante um período de convivência de quatro meses em uma comunidade nativa; permitiu a compreensão da perspectiva dos informantes sobre o cuidado das crianças. Emergiram três temas culturais do conjunto dos dados: A estrutura sociocultural da comunidade Kabano e seu cotidiano, na qual a função desempenhada por cada membro representa um papel preponderante na estrutura sociocultural e no cotidiano da cultura. A promoção e preservação da saúde na comunidade Kabano é caracterizada por um cotidiano de limitações e dificuldades. Os papéis dos membros da família nuclear, da família ampliada, e do curandeiro e da parteira, referentes às atividades de cuidado cotidianas, visam à promoção da saúde e a vida do coletivo. As práticas no adoecimento das crianças são permeadas por grandes dificuldades apesar do suporte da rede social. As dificuldades são de natureza econômica e provêm das falhas no relacionamento e na comunicação do profissional de saúde com os membros da cultura e os déficits estruturais do estabelecimento de saúde. A assistência à saúde na cultura Kabano se encontra nas etapas iniciais do Modelo para Competência Cultural de Purnell, ou seja, um cuidado caracterizado pela inconsciência incompetente. Os resultados descritos neste estudo, se considerados, podem levar os profissionais a se aproximarem da competência inconsciente para o cuidado cultural da pessoa, da família e da comunidade. / This qualitative study aimed to describe and understand the care of children in the health-illness process from the perspective of the families of a native community in Peru. The Purnell Model for Cultural Competence was the theoretical framework that had supported the study. The ethnographic method with emphasis in the ethnonursing using the participant observation and ethnographic interview techniques with five families, during four months of coexistence in a native community; allowed to understand the informants perspective about the care of children. Three cultural themes emerged from the data set: The socio-cultural structure of Kabano\'s community and their everyday, in which the role played by each member represents a preponderant role in the socio-cultural structure and in the everyday of the culture. The promotion and preservation of health in Kabanos community is characterized by daily limitations and difficulties. The roles of the members of the nuclear family, extended family, and the healer and midwife, regarding the daily care activities, aim at promoting health and life of the collective. Practices in childrens illness are permeated by great difficulties despite the support of social network. The difficulties are of economic kind and come from failures in the relationship and communication between the health professional and the members of the culture and from the structural deficits of the health center. The health care in the Kabano culture is in the early stages of the Purnell Model for Cultural Competence, and characterized by a careful unconscious incompetent. The results described in this study, if they can bring to the professional approach the unconscious competence for cultural care of the person, family and community.

Despite reports of speech-language pathology graduate-level programs focusing on multicultural competence, the literature suggests speech-language pathologists are not adequately educated and trained to be culturally competent. The purpose of this study was to examine the experiences of public school-based speech-language pathologists' graduate-level academic instruction and the clinical practicum experiences in multicultural competence, specifically in the area of multicultural counseling. Guided by the theory of multicultural counseling and therapy, this study used a phenomenological approach, employing semistructured, in-person interviews with 7 participants. The inclusion criteria used for selecting study participants included: having a master's degree in speech-language pathology, graduation from an accredited, graduate-level speech-language pathology program, certification by American Speech-Language-Hearing Association, employment as a speech-language pathologist for at least 2 years, and employment within the public school setting for at least 2 years at the time of the study. Concept mapping was used to analyze the participants' responses which allowed the organization of themes and subthemes that emerged. The analyzed data revealed the 7 participants shared experiences and perceptions in the following 5 themes: (a) the role of clinical practicum supervisors, (b) the approaches used to address multicultural counseling in academic instruction and clinical practicum experiences, (c) the influences in developing cultural competence, (d) feelings of preparedness once in the workplace, and (e) the effect adjustment counseling has on service delivery. The findings of this study support the need for more focus on multicultural competency in the area of multicultural counseling in the academic instruction and clinical practicum experiences of speech-language pathologists programs.