Aim. To identify the core components of cultural competence from a Swedish perspective.Background. The cultural diversity of Swedish society raises challenges for nursing practice. Nurses need to be culturally competent, i.e. demonstrate the effective application of knowledge, skills and attitudes to practice safely and effectively in a multicultural society. Existing frameworks of cultural competence reflect the socio-cultural, historical and political context they were developed in. To date, there has been no research examining cultural competence within a Swedish context.Design. A Delphi survey.Methods. A purposeful sample of 24 experts (eight nurses, eight researchers and eight lecturers) knowledgeable in multicultural issues was recruited. Interviews were undertaken to identify the knowledge, skills and attitudes that formed the components of cultural competence. Content analysis yielded statements which were developed into a questionnaire. Respondents scored questionnaire items in terms of perceived importance. Statements which reached consensus were removed from questionnaires used in subsequent rounds. Three rounds of questionnaires were distributed during 2006.Results. A total of 118 out of 137 components reached a consensus level of 75%. The components were categorised into five areas, cultural sensitivity, cultural understanding, cultural encounters, understanding of health, ill-health and healthcare and social and cultural contexts with 17 associated subcategories.Conclusions. There are some similarities between the issues raised in the current study and existing frameworks of cultural competence from the USA and the UK. However, Swedish experts placed less emphasis on ethnohistory and on developing skills to challenge discrimination and racism.Relevance to clinical practice. This study identified the core components of cultural competence important to nurses practising within a multicultural society such as Sweden. Acquisition of the knowledge, skills and attitudes identified should enable nurses to meet the needs of patients from different cultural backgrounds. The components of cultural competence can form the basis of nursing curricula.

Identifying the core components of cultural competence: findings from a Delphi study

Since the early 1980s, there has been increasing recognition that the health of individuals and communities is affected by social disadvantage. Following the election of the New Labour Government in 1997, social exclusion became a key concept in UK policymaking. Social exclusion approaches consider health outcomes to be linked to living and working conditions rather than, primarily, to healthcare interventions. Social exclusion is thus an important concept for nursing scholarship for understanding how people’s life circumstances may have an impact on their health. This paper analyses some of the theoretical underpinnings which may lead to recognition of the concept of lesbian, gay, bisexual and trans (LGBT) social exclusion. The paper goes on to propose a model of the multidimensional aspects of lesbian, gay, bisexual and trans social exclusion drawing on research evidence of the social, political and global inequalities experienced by lesbian, gay, bisexual and trans people. In conclusion, it considers t...

Conceptualising social exclusion and lesbian, gay, bisexual, and transgender people: the implications for promoting equity in nursing policy and practice

Background
Health workers’ attitudes toward immigrant patients influence behaviour, medical decisions, quality of care and health outcomes. Despite the increasing number of immigrant patients in health services and the potential influence of health workers’ attitudes, there is little research in this area. This study aimed to examine attitudes of different health workers’ groups toward immigrant patients and to identify the associated factors.

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Health workers’ attitudes toward immigrant patients: a cross-sectional survey in primary health care services

The purpose of this article is to discuss the ethical issues impacting the phenomenon of patient safety and to present implications for nursing management. Previous knowledge of this perspective is fragmented. In this discussion, the main drivers are identified and formulated in 'the ethical imperative' of patient safety. Underlying values and principles are considered, with the aim of increasing their visibility for nurse managers' decision-making. The contradictory nature of individual and utilitarian safety is identified as a challenge in nurse management practice, together with the context of shared responsibility and identification of future challenges. As a conclusion, nurse managers play a strategic role in patient safety. Their role is to incorporate ethical values of patient safety into decision-making at all levels in an organization, and also to encourage clinical nurses to consider values in the provision of care to patients. Patient safety that is sensitive to ethics provides sustainable practice where the humanity and dignity of all stakeholders are respected.

Ethical issues in patient safety Implications for nursing management

Growing ethnic and cultural diversity is widely recognized (Schim, Doorenbos, & Borse, 2005; Schim, Doorenbos, Miller, & Benkert, 2003). The increasing number of people moving from one country to another (OECD, 2011) highlights the need for culturally competent health care. Healthcare organizations have to face complex differences in patients' communication styles, attitudes, expectations, and worldviews, multiple languages, different socioeconomic classes, gender, and sexual orientation have become equally important (Abrums & Leppa, 2001; Fortier & Bishop, 2003). Health professionals need to be adequately trained and prepared to care for immigrant patients (European Intercultural Workplace, 2007). Cultural competence in nursing is defined as the incorporation of personal cultural diversity experience, awareness, and sensitivity into everyday clinical practice (Schim & Doorenbos, 2010; Schim, Doorenbos, Benkert, & Miller, 2007). In addition to sensitivity to self and others, competence behaviors are dependent on personal exposure, work experience with people from different ethnical groups, and awareness of individual and group similarities and differences (Schim, Doorenbos, & Borse, 2006). Providing culturally competent care has been associated with improved provider-client communication (Kelly & Papadopoulos, 2009), higher satisfaction with care (Bussema & Nemec, 2006), and health status improvement, as full comprehension of health status, adherence to medications and lifestyle recommendations, and appropriate utilization of the health system (Fortier & Bishop, 2003; Weech-Maldonado et al., 2012).Research suggests that cultural competence training impacts intermediate outcomes such as knowledge, attitudes, and skills of health workers (Beach et al., 2005), and patients' satisfaction (Beach et al., 2006). Nurses who regularly practice culturally competent care can effect positive healthcare changes for clients (Casillas et al., 2014; Leininger & McFarland, 2006; van Ryn, 2002), while the lack of knowledge can lead to prejudice and discrimination (Betancourt, Green, Carrillo, & AnanehFirempog, 2003; Fortier & Bishop, 2003; Hamilton & Essat, 2008), difficulties in planning care, and participation to the individualized care process (Helms & Cook, 1999). The lack of knowledge can also lead to a misinterpretation of patients' needs, with risks for diagnostic and therapeutic errors (Alpers & Hanssen, 2014; Canto et al., 2000; Dias, Gama, Gargaleiro, & Martins, 2012). Several studies among nurses showed a positive correlation between educational training and cultural competence in different multi-ethnic countries such as the United States and Canada (Delgado et al., 2013; Doorenbos & Schim, 2004; Schim et al., 2005, 2006; Starr & Wallace, 2009, 2011; Weech-Maldonado et al., 2012), the United Kingdom (Gerrish, 2001), Switzerland (Casillas et al., 2014), and Sweden (Berlin, Johansson, & Tornkvist, 2006; Berlin, Nilsson, & Tornkvist, 2010). Recently, in Italy, the number of immigrants has been increasing, and foreign residents account for 8% of the entire registered Italian population (OECD, 2013). It is becoming increasingly common and frequent for Italian nurses to establish relationships with patients with different cultural backgrounds (Manara, Isernia, & Buzzetti, 2013), but no studies have been carried out to assess Italian nurses' cultural competence. This study was aimed at evaluating the level of cultural competence among Italian nurses.MethodsDesignA multicentric, cross-sectional study was carried out from September 2013 to May 2014.Sample SizeThe primary end point of the study was to assess nurses' cultural competence. Because we did not know the percentage of participation and in order to ensure that all Italian areas (North, Center, South, and Islands) were represented, we estimated that 450 questionnaires per area would be sufficient to ensure an adequate assessment (Doorenbos & Schim, 2004; Schim et al. …

Cultural Competence Among Italian Nurses: A Multicentric Survey.

:During the last two decades, there has been a growing emphasis on the delivery of health care to meet the needs of minority ethnic patients, but there is less emphasis on the views of the patients themselves. This paper aimed to give minority ethnic groups the opportunity to voice their opinions on nursing care and to inform future nurse education. Focus groups were used to collect data. Six community groups, some of mixed ethnicity and some of specific ethnic identity, were included in the study. Data were analysed using a thematic approach and three themes were identified as representing the views of the participants. Participants identified that knowledge of cultural and religious practices were essential for nurses in order for them to understand the basis of their beliefs and practices. They also highlighted how the actions and behaviour of nurses either confirmed or ignored their specific requirements. They also recognised the inherent communication problems for those who had difficulty in ...

Mary Hamilton

Papers

Minority ethnic users experiences and expectations of nursing care