Cultural Competency of Nurses

Cultural Competency of Nurses1.1 Cultural competencyThe con gradement to equality in wellness sympathize with supply is ingrained indoors the core values of the health c be profession and nurses argon expect to ful take on these fates. The breast feeding and Midwifery Councils (NMC) Code of Professional Conduct either the way states that nurses must treat every patient as individual, respect their arrogance and not to discriminate irrespective of succession, ethnicity or heathenish background (Husband and Torry 2004a). The NMC (2004) emphasises that ethnicly competent forethought is moral and legal requirement for nurses. Thus the requirement for the development of ethnical competence is to be found within the NMC command of conduct. Josipovic (2000) points unwrap that the delivery of individualised anguish, in consideration of phantasmal and ethnic requirements of Black and heathenish Minorities (BME) patients can assist nurses to fulfill their obligations.Ho wever, thither is no universal definition of heathen competence Campinha-Bacote (2002) defines ethnic competence as a routine, which requires the health business concern professional to continuously attempt to stool the top executive to induce competently with the cultural setting of the patient. Nevertheless Papadopoulas et. al. (1998) defines cultural competence as the ability to give printingive cargon trance taking into account patients specific cultural of necessity, carriages and beliefs. Narayata definitionNonetheless, there has been real banter of contrary models of cultural competence in nurse literary works (Gunaratnam, 2007). Campinha-Bacote (1998) model of cultural competence the process of cultural competence in the delivery of health vexation service, identifies five internal constructor of cultural competenceCultural awarenessCultural knowledgeCultural acquisitionCulturally encounterCulturally desireConversely the Papadopoulas et. al. (1998) model o f develop cultural competence consists of quaternity stages Cultural awareness, Cultural knowledge, Cultural sensitivity and Cultural competent. Rosenjack Burchum (2002) identified the attri merelyes of cultural competence as same as those of Papadopolos et al (1998) but adds cultural down the stairsstanding, and cultural skill as essential attributes. Cultural competence is, according to Rosenjack Burchum (2002), the development of knowledge and skill manifested by the synthesis of the above attributes and their respective dimensions in human interaction.Although there is sign in the models of cultural competence they all gestate common care of common chord main components cultural sensitivity, cultural knowledge and cultural skills (Gogwin et al. 2001). match to Garity (2000) cultural competence involves having apprehension and sensitivity toward polar cultural collections and factors that reckon their lives such(prenominal) as immigration, discrimination and the possi bility for these factors to improve or crucify professional practice. Hence, for a nurse to flummox cultural competent s/he necessitate to develop an understanding of ones own cultural involve, views, beliefs, behavior and those of the patient epoch avoiding stereotyping and generalisation (http//www.culturediversity.org/cultcomp.htm). The aim is to go over that the health care services and professionals are respectful and responsive to the health beliefs, practices, cultural and linguistic needs of diverse patients, which can help hold about(predicate) commanding health event (http//minorityhealth.hhs.gov/templates/browse.aspx?lvl=2lvl).Cultural competency is a process that needs to be continuously developed in nightspot to enhance ones ability to give affective health care (Papadopoulos 2006). All registered nurses afford the indebtedness to competently hold up professional knowledge and practice by ensuring up to date knowledge, skill and ability as surface as syn thetic rubber and effective practice (NMC2008). Although the NMC clearly places the individual with the responsibility of developing cultural competence, it should be acknowledged that individuals alone cannot be held responsible for the delivery of culturally safe and competent health care service if insufficient resources are not made available (Husband and Torry, 2004a). Nonetheless, Dreher and MacNaughton (2002) set forth cultural competence as the same as breast feeding competence the ability to deliver care individualised and therapeutic to severally patient despite well-disposed context or cultural background, this being the signature of contemporary nursing. However, the basic formula of providing nursing care to culturally diverse universe of discourses is not an entirely impudently idea, as the need for such was recognised in the United States in the late 1800s (Davis, 1996) and was also recognized by Florence Nightingale when advising British nurses workings in I ndia (Wilkins, 1993). In the put out century, most western countries saw world-shaking changes in the make up of their populations due to change magnitude trends in spherical migration that outleted in multiethnic and multi- phantasmal societies. In the UK BME pigeonholings make up 7.9 % of the total population (Office for matter Statistics, 2001). As the population becomes more diverse so does the complexness of the patients needs that the nurse must address (Black, 2008). Thus far, the need for the nurses to become culturally competent has become import (Black, 2008, Gunaratnam, 2007).The pertinent publications senior high schoollights that, in the last hardly a(prenominal) decades, scholars and seekers grow debated the issue relating to the delivery of appropriate nursing care to meet the needs of BME pigeonholings (refs). There is a growing consistency of induction that deliver there are inadequacies in the nursing care provided to these groups (Vydelingum, 2006, Cortis, 2004) and concerns about ethnic disparities in health in the UK (Aspinall and Jacboson, 2004). Studies on engagement of hospital services by BME patients, in particular the elderly develop consistently demonstrated level of dissatisfaction with the care provided from cultural and/or religious viewpoints (DoH, 2009 horsefly, 2003 Patel, 2001 Cortis, 2000, Vydelingum 2000) 1.2 BME EldersNevertheless, the concept of the ageing population is one that has riposted practically discussion in the UK (Caldwell et al, 2008) as this age group is the main expenditurers of both health and social care services ( discussion section of health, 2001). While all senior(a) people adopt common needs and experiences of hospitals, the needs and experiences of the BME older people are make by their race and ethnicity (Ahmad, 1993 Blakemore and Boneham, 1994). Majority of todays BME elders are yesterdays young migrants from the commonwealth countries (Patel, 2001), who came to the UK duri ng the twentieth century as a result of g everywherenment policy to fill labour shortage (Houston and Cowley, 2002). According to Evandrou, (2006) in 2001 4% of the BME population were over 65 and this minute is rapidly rising, from approximately 60 000 in 1981 to about 360 000 in 2001-2002 (Butt and ONeil, 2004, Beaven, 2006) and is expected to increase in the next 15 days (Evandrou, 2000). These elderly groups crap particularly been disadvantage by the cumulative effect of age, race and inaccessibility to services (Norman, 1985). However, newly arrived migrants are belike to persona similar concerns and experience in hospital care (Patel, 2001).The 2001 and earlier censuses ground that health disparities dwell in the UK and that levels of long term illness are higher in older BME groups than in the general population (From A Szczepura 2005).Older people from BME are report more chronic illnesses such as cardio-vascular disease, diabetes, hypertension and stroke when compar ed to the majority (Tilke, 1998 Ebrahim, 1999 Evandrou, 2000b). An appreciation of the health care needs of this group is vital in understanding the difficulties they face in accessing health care services (Toofany, 2007).One occurring theme connected with old age and ethnicity that has been repeatedly identified from the1980s until today is the lack of urgency over politics action for the group (Norman, 1985, Patel, 1990, Lindesay, 1997, Patel, 2001). The Policy Research Institution on senescent and Ethnicity (PRIAE) highlights that these groups are not normally considered in old age inquiry (Patel, 2003). Hoong Sin, (2003) points out that BME older people in the UK are disadvantaged by the lack of a reliable sampling frame. Although there are few national studies, most look projects are teensy and involve place specimens (Hoong Sin 2003). Therefore the infrastructure for doing query with such population groups is inadequately set up (Hoon Sin, 2003). In PRIAEs view we spe nd a penny had too much discussion, action is overdue (Patel, 2001). This affirmation suggests that BME elderly groups have never been a priority on the agenda for research or policy makers in the health care services. Saleh (2009) suggests that the introduction of the Race Relations (Amendment) Act 2000 increased pressure on health care organisations to adapt services to ensure equitable access for local all BME groups.On the new(prenominal) hand, division of Health (DoH) ensures that reducing health disadvantage and social exclusion for BME elders is primeval to UK health and social policy (DoH, 2001b). The DoH made specific commitments, in the National Standards, Local Action, to improve quality of service for BME where they are disadvantaged in terms of health (refs). This betterment according to Papadopoulos et al. (2006) is a sign that the NHS is undergoing modernization.Unfortunately, the last two National Patient Survey Programme reports (2008 2009) show the experience s of all BME groups (with the exception of those from the Irish community) are significantly less likely to be positive than those of the indigenous populations. From a nursing aspect this outcome heads the nurses competence in delivering culturally appropriate care.The books available identifies cultural competency as one of the main factor that can help cease the inequalities in health care system (refs). According to Papadopoulos et al. (1999) although evoke of the term cultural competence in DoH and National Health Services (NHS) documents has increased, there is no attention to what this actually means for patients or nurses and how it could be measured. Having and implementing clear, strong policies on race and equality is essential for health and social care organisations but this has to be supported with training and fosterage (PRIAE, 2005). Consequently, Dreher and MacNaughton (2002) doubted whether cultural knowledge translated into culturally specific care would neces sarily result in improved clinical outcomes or the reduction of health disparities.2. The appraise Aim and Research Strategies2.1 AimNurses are at the front stemma of care for BME older people in hospital and then it is grievous that the care delivered is in line with what is viewed as appropriate by the patients to their needs. The Department of Health openly acknowledges that much trunk to be done in terms of measuring older patients experiences of the process of care, respect, dignity, information and information (Shaw and Wilson, 2008).This review, and then, intends to bring together the literature concerning nurses views of what is essential in delivering culturally appropriate care to BME older patients as well as this groups expectations and experiences of nursing care. The aim is to look the cultural competency of nurses in compassionate for BME elderly patients in hospital setting.2.2 seek Strategy (Include inclusion/exclusion criteria, entropybases searched, k eywords, lectures and inclusive dates of the literature searched.)Search TermSearch was carried out exploitation combination of keywords such as Nurses, Cultural Competence/Awareness/Sensitivity, Geriatric, Elderly/Older, Black and Minority Ethnic and Experiences/Views. Furthermore, concepts relevant to hospital care such as Dignity, Respect and conquer Care were searched in combination with the above key terms.DatabasesThe electronic selective informationbases British Nursing Index, PsycINFO, MEDLINE, the Cumulative Index to Nursing and Allied Health belles-lettres (CINAHL), Assia and Cochrane Library were searched to attain peer-reviewed literature published in the English language between 1990 and 2010 that are UK based. The informationbases yielded XXX potential studies relevant to the topic under review.Further search was conducted in the World Wide Web utilize the same key words and it produced xxx studies. The websites of the Department of Health, Transcultural Nursing Society, Royal Collage of Nursing and relevant Third Sector Organisations such as Age Concern, and PRIAE were also accessed which yielded XXX literature. Further literature was gained from the bring up and the bibliography of the gathered information as well as the library of the University.The titles and abstracts of the obtained literature were examined and studies focusing on care provided by nurses to BME elderly patients as well as studies examining the views/experiences of hospital care by this particular geriatric group were selected. For the purpose of the literature review an older person is defined as person older than 50 years. NSF considers an older person as a person who is over the age of 50 years. Yet, a limited numbers racket of studies (how many) about BME elders in hospital setting were identified. For this reason studies focusing on the topic that had a wide range of age sample group i.e. 30-80 were included as it would assist in identifying additional pertinen t literature. In total, XX studies were identified to meet the inclusion criteria for the literature review.The literature selected were chiefly primary empirical studies using soft approach. A qualitative research aims to understand the feelings, values, and perceptions that under lie and influence behavior (xxxx). Therefore the use of a qualitative conveningology is seen to be appropriate as all the studies examine the experiences of the BME patients through their own eyes and those of the nurses (from internet).2.3 Critical Appraisal of triplet Qualitative Studies on the Experiences of Nurses in Caring for BME Patients and BME patients Experiences of Nursing CareCortis (2004) group meeting the Needs of Minority Ethnic Patients horse tick (2003) Older South Asiatic patients and Care Perceptions of Culturally Sensitive Care In a friendship Hospital SettingHamilton and Essat (2008) Minority Ethnic Users Experiences and Expectations of NursingUsing Caldwells frameworks for cr itiquing health research, the three above stated studies will be analyzed systematically and supporting/contradicting evidence from other studies will be offered. WHY workout THIS FRAME WORK? Following the discussion of the review themes will be identified.TitleAlthough the title of the contract of Cortis is brief and conveys the nature of the area (Polit and Beck, 2010), it could be viewed as misleading as it gave the impression that the sample group was example of different communities of BME groups. However, the claim specifically focuses on the Pakistani ethnic community. Conversely, the titles of the researches by horsefly (2003) and Hamilton and Essat (2008) are short, accurate and clearly specifies what and who is being studied while reflecting the take on bailiwick (Burns, 2000).The Researchers Academic and Professional QualificationThe authors of the three researches have particular interest about the topic in question, which gives the assumption that they are fami liar or have professional insights. The qualification (PhD, MsC) of the researchers is relevant as it indicates that they are competent and have creditability to carry out researches.Further evidence to support researchers knowledge and interest of the topic was demonstrated as they are all nurses with extensive experience Cortis is a senior lecturer at the University of Leeds with Qualitative Research interest in ethnicity and BME issues. Clegg is a advisor in older peoples services and intermediate care at Leeds principle Hospital NHS Trust. Hamilton was a principal lecturer at De Montfort University with research interests in multi-ethnic care and Essat was research assistant at the same university working on a project exploring the instructional preparation of student nurses to work in a culturally diverse way.Abstract and RationaleA qualitative reputation must offer an abstract containing summary of study aim/objectives, research approach, methods adapted and the result of the study including the clinical applications (Cormack, 1996). cry (out) the abstract there should be key words related to the study offering the reader an overview of the research question. All studies have offered a broad abstract with key words relevant to their topics.Clear principle for confinement the study was given by all researchers Cortis rationale was the fact that there is little exploration of nurses experiences of caring for specific BME community while Cleggs rationale was that there is a lack of research defining the concept of cultural sensitive care from patient/care perspective. Lastly, the rationale provided by Hamilton and summation is that, nationally, there is an evidence to suggest that care provided doesnt always meet the needs of BME patients.LRAll three researchers did review pertinent literature (classics up to date), which was clear in the studies as well as the reference list. According to Doordan (1999) the literature offered should have discuss ed and critically reviewed related literature to find out what questions remains to be answered. Nevertheless, only Clegg (2003) provided a separate section for LR, which she must be praised for (Morse, 1994). In grounded possible action studies, researchers start with data collection initiatory and as the data is analysed and as the theory takes shape researchers then swallow to search the literature in order to link it to the emerging theory (Polit and Beck, 2010), which was evident in Cleggs study.AimThe three studies clearly identify and rid their aims. Cortiss (2004) argues that in a number of studies BME are seen as homogeneous therefore the aim of his study is to investigate a specific communitys uniqueness the experiences of nurses caring for Pakistani patients in northmost England. However, this aim is inconsistence with the title of study, which clearly treats BME as a homogeneously. WHAT DOES THIS MEAN?While the aim of the Clegg (2003), was to identify older south As ian patients and carers perception of culturally sensitive care. Lastly, the aim of the research by Hamilton and asset (2008) was to give the minority ethnic groups the opportunity to articulatio their opinions on nursing care and to inform future nursing education.honorable IssuesBoth Cortis and Clegg clearly highlight that permission to do the study was sought from the Local Research Ethics Committee (LREC), which is an imperative rate before conducting any research. However, Hamilton and Essat (2008) omit to mention whether appropriate approval was gained from LRECs who exist to examine proposed research projects in order to guard peoples rights and interests (Cormack, 2000).All the researchers have to be praised for specifying the process and purpose of the study was explained to the participants before the study in order to obtain informed admit. Cortis (2004) clearly specifies that assurance was given to maintain confidentiality and anonymity of the sample group, which is s omething Hamilton and Essat (2008) fail to address in their study. Both Cortis and Hamilton Asset dont comment on the associated ethical issues of autonomy, non-maleficience and beneficence, (Cormack, 20000).Nevertheless, Clegg considered the vulnerability of the participants (Gerrish and Lacey 2006, Speziale and Carpenter 2007) and therefore committed to the ethical principles of autonomy, non-maleficience and beneficence (RCN, 2004), but fails to mention how confidentiality and anonymity was maintained. Clegg showed sensitivity towards the participants by informing them the voluntary nature of the research with the selection of being able to withdraw at any metre. This implies a non-coerciveness approach which was important in this study as this was vulnerable group. Conversely,The three studies inform that permission was sought from the participant to audio-tape the references but omit to identify where data was stored and the disposal procedure apply (Polit and Beck, 2008). This supports the premise that data used for a particular project should not be used for another without consent (Gerrish and Lacey, 2006).methodologicalBoth Cortis and Hamilton Essat (2008) fail to specify that the method used was phenomenological-exploratory, which is efficacious when studying individuals lived experiences (Crookes and Davies, 1998). The main methodological specialization of using phenomenological in these studies is that it is an inducive and holistic approach that looks at what occurs within (Crookes and Davies, 1998). Both of the studies focus was on the unique experiences of providing care by nurses to BME patients and perception of BME older patient views/expectations of nursing care. The biggest methodological limitation for using phenomenological in these studies is that it is labour intensive and time consuming for the researchers in terms of data collection and analysis (Crookes and Davies, 1998). Clegg, on the other hand, identifies the methodology u tilized as grounded theory, which is effective when studying individuals XXXX (GG). Methodological strength associated with the use of this approach in this study is xxxxx.Methodological weakness associated with the use of this approach in this study isThe three studies clearly identify the major concepts of the design used and their concepts, which are what?Sampling Technique and methodAccording to Polit and Beck, (2010) in qualitative research there is no rule for sample size as long as data intensity level achieved. The sample number (n=30) used by Cortis was considered to be suitable for qualitative research (Cormack 1999) why? However, the sample number by Clegg was four patients and three relatives. Clegg states in her study that she is not sure if data colour has been achieved. Morse (2000 in polit and beck book) suggests that number of participants required to reach saturation is a firmed by number of factors, such as the wider the research question the more participants necessary. This gives the impression that the sample size could have been too small for the scope of the research question hence why saturation was not reached (Morse 2000) possibly due to time or budget constraints (ref). Sampling number for Hamilton and Essat six focus groups, member of which range from 8 to 15 (? banging sample number for qualitative).All three researches state how many participants were recruited and from where areas with high population of BME. Cortis participants were recruited from a large acute hospital in north England and Clegg recruited this sample from a two community Hospital knowledgeable city and Hamilton and Essat recruited their sample of 6 diverse BME communities groups. The researchers must be praised for providing a clear indication of inclusive/exclusive criteria, in the process of recruiting participants.In contrast the three studies fail to identify the sampling methods and techniques used but inferred from the research studies is that non- probability method of purposive sampling was employed (Cormack, 1996). The method of purposive/judgmental sampling relies on the belief that researcher have passable knowledge about the population to be able to pick sample members (Polit and Bechk, 2010).The main strength associated with the use of purposive sampling in these studies is that the researchers purposively charter the participants knowing they would give relevant information about the topic in question (Polit and Beck, 2008). However, one main limitation is that this technique relies upon the researchers knowledge of cultural competence of nurses (Polit and Beck, 2008).Method of Data CollectionAll researchers collected data by audio taping query and transcription. Cortis, Clegg and Hamilton Assset adapted different types qualitative self-reporting technique, which is flexible in gathering self-reported information as it allows the participants to express their views in a naturalistic way (Polit and Beck, 2008).Data collection is described by Cortis as semi-structured interviews and supplementary questions to follow-up for clarification. Cortis informs that most interviews were done in the clinical area implying that participant had choice of venue, which he must be commend for. However, he omits to state where the rest of the interviews were done. WHY IS VITAL TO select PARTICIPANTS CHOICE OF VENUE?Nevertheless, Cleggs choice of data collection was unstructured interview that were done in the first language of the interviewee. Cross validation of the taped interviews was under taken by a second linguist. Both Cortis and Clegg fail to point out who/how many people performed the interview. Interview performed by one person provides uniformity and consistency (Denscombe, 2003).On the contrary, method of data collection used by Hamilton and Essat was focus group, which was sub-divided into 6 groups where each group had facilitator. The advantage with use of this method in this study is it can g enerate a lot of dialogue but the disadvantage is that not everyone is well-situated experiences their experiences/view in front of others (Polit and Beck, 2010).Overall, an advantage associated with the use of all interview technique utilized is that the interviewer can observe the participants non-verbal responses, which can provide worth(predicate) information (Burns 2000). Some of the main methodological limitation with the use of this method in these studies is that it was done in face to face, which could jeopardize the participants anonymity since they were placeable for the interviewer (Cormack, 1996).Method of Data AnalysisAll the researches used thematic content analysis, which is creditable method of data collection (xxxx). Only Hamilton and Asset clearly stated the method used and who analysed the data two members of the team. What does this mean for the research?Cortis transcribed the interviews himself to became personally immersed in the information. What does this mean for the research? Clegg points out that Micro-analysis of the data were used to identify categories but fail to say who analysed data. Having different people conducting the interview and the analysis of the texts can have an impact on the richness of the analysis performed (Strauss and Corbin, 1998).Nonetheless, steps were taken by all researchers to come to the rigour of the interpretation by checking the transcript with the participants to ensure correctness, which gave the data conformability and credibleness (Forchuk and Roberts, 1993). They also must be praised for indicating that the data was analysed systematically in some(prenominal) steps. However, they all fail to state the type of qualitative software used to categorise the information i.e. Ethnograph and if it was positive or negative to the analysis (Barnard, 1991).(Clegg Triangulation was introduced into the process of data analysis, which was carried out by a colleague from India).The methodological strength linked to the utilisation of this thematic content analysis in these studies is that it is commonly used in qualitative research and is suitable the three study aims. Limitation would be this analysis includes gathering statements on the bases of similarity and oftenness with the aim of making them to themes (Barnard, 1991). It could be argued that by doing so the researchers are using a quantities method of analysis for qualitative data as each data is not being treated uniquely (Barnard, 1991).Study ResultsThe three studies identified themes based on the participants experience which implies themes were not based on presumption authors (Cormack, 1996). Each studies result relate to its aim, which they must be praised for. The finding of each study uses the participants precise statement from the interview, which demonstrates analytical points and allows the reader to envision the voices of the participants. This demonstrates conformability and credibility (Burns, 2000) and let s the reader to get in-depth understanding of topics in discussion (Morse1196).Hamilton and Essats results highlight the view held by BME groups regarding nursing communitys lack of knowledge of cultural and religious beliefs. Cortiss findings agree with this as majority of the nurse participants did not deem that the provision of care was affected by culture and spirituality/ devotion was viewed narrowly by identifying the need for patients to perform prayers with no lack of recognition of other religious requirements. Participants in Cleggs study described the fundamental importance of theology and its effect on health and hospitalization. Other references re culture and religion to be added.All three studies highlighted communicational problem between patients and nurses, which as an issue hinders the development of relationship. However, problems in this area have been covered in many other studies such as (add referennces). And proposals and provisions to address them have bee n made by the DoH in order to reduce health inequalities (reference).Study DiscussionAll researchers offer a comprehensive discussion of their topics while comparing and contrasting their results relating to themes with other similar literature, which puts their finding in context making it more objective (Meltzoff, 1998). However, only Clegg specifies the study limitation which was the sample size- a larger sample size would have enhanced the probability of reaching saturation and increase the importance of the finding. lastThe three studies offer comprehensive conclusions which summarises the main results while suggesting area of throw out research or implementation.Cortis suggests that holism needs further conceptualization as his study highlighted nurses understanding of culture as part of holistic care was superficial, which presents a challenge for educators, nursing management, researchers and nursing practice in general. Clegg suggested further research needs to be carried out in order to define the nature of culturally sensitive services. She also points out that nurses understanding of culture and cultural sensitivity needs clarification. Hamilton and Asset suggests that nursing education must ensure that nurses initial training and post training education prepares them to become culturally understanding and sensitive.It could be argued that these three studies make useful recommendation for practice for nurses working with BME patients, which are based on education and research on cultural sensitivity. The three studies suggests that nurses are not culturally competent as required by professional bodies and the Government (English National Board for Nursing and Midwifery and Health Visiting 1997, DoH, 1997, United solid ground Central Council for Nursing, Midwifery and Health Visiting 1999, Quality Assurence Agency 2001).Cortis (2004) conducted a phenomenological study investigating the experiences of 30 registered nurses who had nursed Pakistani patients in a large acute hospital in north England within the last three months. Semi-structure interviews and supplementary questions to follow up were the main method of da