This study examined differences in cultural competency levels between undergraduate and graduate nursing students (age, ethnicity, gender, language at home, education level, program standing, program track, diversity encounters, and previous diversity training). Participants were 83% women, aged 20 to 62; 50% Hispanic/Latino; with a Bachelor of Science in Nursing (n = 82) and a Master of Science in Nursing (n = 62). Degrees included high school diplomas, associate/diplomas, bachelors’ degrees in or out of nursing, and medical doctorate degrees from outside the United States. Students spoke English (n = 82) or Spanish (n = 54). The study used a cross-sectional design guided by the three-dimensional cultural competency model. The Cultural Competency Assessment (CCA) tool is composed of two subscales: Cultural Awareness and Sensitivity (CAS) and Culturally Competent Behaviors (CCB). Multiple regressions, Pearson’s correlations, and ANOVAs determined relationships and differences among undergraduate and graduate students. Findings showed significant differences between undergraduate and graduate nursing students in CAS, p <.016. Students of Hispanic/White/European ethnicity scored higher on the CAS, while White/non-Hispanic students scored lower on the CAS, p < .05. One-way ANOVAs revealed cultural competency differences by program standing (grade-point averages), and by program tracks, between Master of Science in Nursing Advanced Registered Nurse Practitioners and both Traditional Bachelor of Science in Nursing and Registered Nurse-Bachelor of Science in Nursing. Univariate analysis revealed that higher cultural competency was associated with having previous diversity training and participation in diversity training as continuing education. After controlling for all predictors, multiple regression analysis found program level, program standing, and diversity training explained a significant amount of variance in overall cultural competency (p = .027; R2 = .18). Continuing education is crucial in achieving students’ cultural competency. Previous diversity training, graduate education, and higher grade-point average were correlated with higher cultural competency levels. However, increased diversity encounters were not associated with higher cultural competency levels.

Heart failure is a complex chronic disease affecting 6.6 million people in the United States, with an annual cost of $39.2 billion per year. African Americans are at an especially high risk for poor outcomes and readmissions from heart failure complications, as they are 2.5 times more likely to develop heart failure than other ethnic groups. This disease requires a high level of patient self-care management, and evidence suggests that African Americans do not always receive culturally sensitive education, which can lead to suboptimal self-care practices. The practice-focused question for this educational program asked whether nurses of African American patients with heart failure could use a culturally sensitive health education toolkit to improve patients’ knowledge of self-care management. The purpose of this doctoral project was to determine if a culturally sensitive toolkit could increase nursing knowledge. The population focus was nurses caring for African American heart failure patients with frequent readmissions from a high-risk heart failure clinic in New Jersey. The use of Hofstede’s cultural dimensions and an exhaustive literature review guided this doctoral project. The tool used to assess participants’ pre- and post-knowledge was the cultural awareness and sensitivity tool. There were 11 participants comprised of nurses, nurse case managers, and advanced practice nurses; they exhibited a 1.92% improvement in knowledge after the education session. This outcome shows that this educational program was effective and has the potential to contribute to social change by educating nurses on providing effective, culturally sensitive self-care education to African American heart failure patients to increase their adherence to self-care practices.

Data have consistently revealed a major problem with disproportionality in several academic and social climate measures for African American students compared to their White counterparts. Black students tend to have lower end-of-course (EOC) testing scores in mathematics and reading, a greater tendency to be suspended from school, lower average on-time graduation rates, and higher rates of absenteeism. The current investigative study examined the role of same race administrators and performance indicators among African American students. The findings demonstrated that significant differences between Black and White students existed in end-of-course testing in reading and math. The research also indicated significant relationships between race, school suspension, and attendance in schools with a Black administrative presence. Further qualitative and quantitative research investigating the variables that significantly indicate academic and social climate performance improvements, particularly among marginalized student groups, could be beneficial to students and education leaders alike. Data from this research study showed that student economic status predicted academic and social climate performance between Black and White students, regardless of the race of administrators. However, Black students in non-impoverished settings with a Black administrative presence outperformed their White counterparts in academic and social climate measures. This study could be a precursor to more expansive research on the ways in which improving economic conditions could improve Black student performance, especially with a more diverse administrative school presence.

Studies have looked at various factors that affect pronunciation including phonetic context (e.g., Canfield 1940), style variation (e.g., Diaz-Campos 2006, Gonzales-Bueno 1995, Major 2004, Shively 2008, Zampini 1994), L1 transfer (e.g., Major 2001), and experience abroad (e.g., Diaz-Campos 2004, 2006, Lafford 2006, Stevens 2001). Motivation has been shown to affect language learning in general (Gardner 1985) but its role in pronunciation has yet to be explored. The relationship between cultural sensitivity and the acquisition of pronunciation has also been relatively understudied. The current study further explores the relationship between these variables and pronunciation. Many studies have shown that students' pronunciation improves as they progress through levels of instruction (e.g. Face 2006, Rose 2010). Including this as a variable will provide an idea of the relative strength of the relationships of the other variables (i.e., motivation and cultural sensitivity) and pronunciation. The current study includes 102 adult learners of Spanish as a foreign language from 4 levels of instruction (i.e. 1st, 2nd, 3rd years and graduating majors). Students from the 3rd year were divided into two groups, those with extensive experience abroad and those without. The participants participated in a brief oral interview similar to ACTFL's Oral Proficiency Interview and completed a background questionnaire, the Survey of Motivational Intensity (Gardner 1985), and the Intercultural Development Inventory (IDI) as a measure of cultural sensitivity. Pronunciation scores were determined by a panel of seven native Spanish speakers who rated one-minute segments of the learners' speech on a 100-point scale (e.g., Munro and Derwing, 1995; Derwing and Munro, 1997; Derwing, Munro, and Rossiter, 2004). Multiple regression analyses examine the relationships that cultural sensitivity, motivation, level of instruction, and experience abroad have with pronunciation.

<p>Using a critical, feminist anti-oppressive framework approach this research study investigated the effects of restructuring on South Asian social workers in mainstream and ethno-specific agencies. This exploratory study examined the experiences of South Asian social workers and how restructuring has played a role in their practices. Semi-structured interviews were conducted with five participants. The results indicated that the participants were concerned with 1) increase in bureaucracy and decrease of the social aspect of their work; 2) influence of the Eurocentric foundations of social work and its racist undertones, as well as its implications regarding cultural sensitivity; 3) exercising resistance as a result of the negative impacts of restructuring. The findings demonstrated that the social work profession needs to consider how restructuring uniquely impacts South Asian social workers and their practice. Mainstream and ethno-specific agencies need to consider how increasing bureaucracy and integrating culturally sensitive approaches can be inter-laced with racist undertones. More importantly, these agencies must evaluate how this will impact workers’ practices. Implications for culturally sensitive social work practice and the impacts of restructuring on South Asian social workers and service users are discussed.</p> / Master of Social Work (MSW)

This thesis explores the role of formal bioethics instruction in preparing medical students to face ethical issues pertinent to diverse populations in clinical practice. The importance of bioethics education has been widely recognized and as a result, it is formally required in all medical schools. However, with little standardization on the actual logistics, ethics education in medical schools is extremely variable, producing students who are naïve and/or inconsistently capable of managing ethically complex situations. During medical school I pursued a Masters of Arts in Urban Bioethics (MAUB), which heavily focused on the social determinants of health and how they manifest in health care settings. I acquired new skills that gave me perspective and awareness into ethical issues that urban populations face, and during my clerkships I found I was better equipped and more comfortable navigating my patients’ non-medical complexities than my non-MAUB peers. Using three personal patient encounters as examples, I illustrate how a comprehensive urban bioethics education can positively impact patient care. Finally, I suggest improvements to medical schools’ bioethics curricula that will likely influence and mold each student’s thought processes to be more ethically-aware and culturally-sensitive. The goal of reforming bioethics education is to give students a set of real-world skills rather than a theoretical book of knowledge. Without a comprehensive and multifaceted approach to bioethics, students will likely lack the cultural sensitivity, awareness, and perspective necessary to treat a diverse patient population. / Urban Bioethics

Background: The purpose of this study was to examine the impact of a culturally sensitive, cognitive-behavioral family treatment (CBFT) for pediatric patients with Sickle Cell Disease (SCD) to improve pain symptoms, health-related quality of life, functionality, depression, and coping strategies. Individual cognitive-behavioral treatment has been shown previously to be effective at improving pain symptoms, functionality, adaptive coping, and health care utilization, but such benefits have not yet been shown for SCD patients. The present study aimed to address this limitation by modifying the intervention to both include the family and to utilize culturally sensitive practices, which may be particularly relevant for this population. Methods: A non-concurrent multiple baseline design was used to assess the effectiveness of the intervention. A sample of 4 children (ages 8 to 12) and 4 adolescents (ages 13 to 15) participated in the intervention. Manualized treatment consisted of five sessions (including child and parent) that targeted problem-solving skills, cognitive processes, coping strategies, goal setting, and family processes. Outcomes of interest including health-related quality of life, functionality, psychological adjustment, and coping strategies, were assessed by child and parent report at pre-treatment (baseline), post-treatment, and 2-, 4-, and 6-month follow-up. Participants completed daily diaries to quantify pain, anxiety, and functionality. Results: Repeated-measures general linear model analyses were run separately for all outcome variables. A significant main effect of time was found for youth-reported HRQoL, F(4, 20) = 4.6, p=.01, depressive symptomatology, F(4, 20) = 4.5, p=.01, and parent-reported Internalizing, F(4, 16) = 3.4, p=.03, Externalizing, F(4, 16) = 7.2, p=.00, and Total Behavior Problems, F(4, 16) = 7.7, p=.00 from baseline to 6-month post-treatment. The mean frequency of pain symptoms also decreased for five of the eight participants (i.e., visual inspection of the daily diaries from baseline to treatment). Conclusions: These results suggest the potential for clinical gains through the incorporation of culturally sensitive and family-based practices into existing cognitive-behavioral interventions for SCD. The symptomatic improvements observed in the present study indicate gains in both specific domains (i.e., pain), as well as general psychological outcomes (i.e., improvements in depression, health-related quality of life, internalizing and externalizing behaviors). / Ph. D.

Cardiovascular disease, including heart failure, is the leading cause of death among male and female Middle Eastern Americans. In 2016, a medical center located in the northeastern region of the United States had an estimated 35% of heart failure patients readmitted within 30 days of discharge, 10% of these readmitted patients belonged to the local Middle Eastern community. The gap in nursing practice noted by nursing staff, patients, and their families was that the patient education materials on heart failure were not tailored to the cultural beliefs and customs of this high-risk population. The purpose of this project was to adapt the American Heart Association teaching tools on heart failure education to the Middle Eastern community to enhance compliance with treatment care plans, minimize days spent in the hospital, and decrease the readmission rates. The practice-focused question explored whether a team of experts could adapt heart failure education materials for the Middle Eastern community. An expert team met weekly to adapt the teaching materials to include information regarding effective communication techniques, adaptation to religious strictures, and modification of behavioral risks specific to Middle Eastern cultures. The information gathered was compiled and will be shared with the host medical facility. The positive social change resulting from this project might include improved culturally appropriate communication and support for the medical center's Middle Eastern population of heart failure patients, which may result in improved health outcomes.

Social workers have no clear professional guidelines about the application of culturally competent mental health service delivery. Without culturally competent mental health service delivery, clients from diverse cultures do not access needed mental health services and they experience less effective therapy treatment outcomes and overall disparity of service delivery throughout the therapeutic process. The purpose of this descriptive case study was to better understand how community-based social workers are delivering culturally competent services to clients. The theoretical framework for the study was multiculturalism and the primary research questions addressed how associate clinical social workers who provide in-home mental health services in Los Angeles deliver culturally competent services to their clients. Through 8 interviews with associate clinical social workers, this descriptive case study revealed that without clear direction on what culturally competent services are, or how to deliver them, social workers are using a combination of personal experience and personal culture, educational and practice knowledge, and in some cases no attention to culture, to meet the mental health needs of their clients. This study emphasized the need for an industry wide understanding of the term cultural competency, so it could serve as the frame of reference by which practice professional skill level could be assessed, practice protocols measured, and could lead to social change through greater access to counseling services for clients.

Dental caries is the most prevalent childhood illness and disproportionately affects children from low socioeconomic backgrounds. Dental organizations are collaborating within communities to decrease oral health disparities among children by offering free preventive oral health events. These programs face the problem of low enrollment due to lack of informed parental consent. Also, gaps in the literature indicated the need to examine oral health perceptions and dental-care-seeking practices of culturally diverse low-income parents regarding preventive care for their children. The purpose of this qualitative case study was to explore the reasons why parents are not allowing their children to participate in the aforementioned programs. This inquiry examined how perceived barriers impede parents from seeking free preventive dental care for their children. The transtheoretical model and social cognitive theory were used in this study. Open-ended questions were used to interview 20 purposefully sampled parents regarding perceptions of free preventive dental care programs until saturation. Interviews were audio recorded, and all data were transcribed verbatim, coded, and analyzed thematically. The main themes revealed through this analysis were lack of trust and cultural dissimilarities as potential barriers. Additional themes of money, fear, lack of insurance, transportation, time, and access to care were also confirmed. This study may contribute to positive social change by increasing knowledge that may inform the development of clinical and policy solutions aimed at improving parents' awareness regarding children's oral health, ultimately enabling a reduction in childhood caries and oral health disparities.