Diversity and equality in health and care 

About: Diversity and equality in health and care is an academic journal. The journal publishes majorly in the area(s): Health care & Population. It has an ISSN identifier of 2049-5471. It is also open access. Over the lifetime, 485 publications have been published receiving 3305 citations.

The social reproduction of institutional racism: internationally recruited nurses’ experiences of the British health services

Abstract: In an increasingly competitive global labour market, more countries with nursing shortages are recruiting from abroad. The UK is no exception. However, little research has been conducted into the experiences of racism and discrimination among internationally recruited nurses in the UK. The empirical data in this paper contribute to understanding how immigrant workers from Black and other minority ethnic backgrounds experience working in British health services and provide empirically grounded accounts of individual and institutional racism. A total of 67 internationally recruited nurses (IRNs) participated in 11 focus group interviews which were held at three sites in the UK: Leeds, Cardiff and London. These focus groups were audio-taped and analysed using NVivo, version 1.3. In focus groups, IRNs described discrimination and racism as central to their experiences as IRNs working in the UK. This study demonstrates the ways in which racism and institutional racism work in healthcare practice from the perspective of IRNs and how they cope with these negative experiences. The data suggest that racism and institutional racism are understood in more complex ways than previously reported and that institutional racism may be reproduced through negative stereotypes of foreigners and professional hierarchies which are forms of structured social relations. These structured social relations are reproduced in complex professional relationships and hierarchies, in the meaning of ethnicity and stereotypes for individuals and the relationship between racist attitudes and racist behaviours. Based on these findings, we argue that racism and institutional racism are reproduced through personal and interpersonal as well as structured social relationships, and provide working examples of the concept of institutional racism in practice. We discuss the implications of the findings for equal opportunities policies in the health services.

Promoting cultural competence in health care through a research based intervention in the UK.

Abstract: There is an urgent need to develop cultural competence among nurses and other care workers if they are to meet the needs of the diverse populations they serve, yet there is limited clarity about what this means, or how it can be measured. To date few attempts have been made to measure the effectiveness of education and training programmes which are designed to promote cultural competence. A research project commissioned by mental health service providers was undertaken to deal with the increasing need for cultural competence in a number of mental health care settings. It involved the delivery of a training intervention with an assessment of cultural competence before and after the intervention. The training intervention was negotiated with the participating teams and was based on the Papadopoulos, Tilki & Taylor model (1998). The project included the design and development of a tool for assessing cultural competence (CCATool). The paper discusses the challenges faced by the trainers during this intervention and proposes a set of principles for the development of effective cultural competence programmes.

Cultural racism, language prejudice and discrimination in hospital contexts : an Australian study

Abstract: This article explores the idea that racial and ethnic disparities in healthcare may be expressive of unacknowledgedpractices of cultural racism. In conducting this exploration, the researchers identify, describe and discuss the practice of language prejudice and discrimination by health service providers, discovered serendipitously in the context of a broader study exploring cultural safety and cultural competency in an Australian healthcare context. The original study involved individual and focus groups interviews with 145 participants recruited from over 17 different organisational and domestichome sites. Participants included health service managers, ethnic liaison officers, qualified health interpreters, cultural trainers/educators, ethnic welfare organisation staff, registered nurses, allied health professionals, and healthcare consumers. Participants self-identified as being from over 27 different ethnocultural and language backgrounds.Analysis of the data revealed that English language proficiency, like skin colour, was used as a social marker to classify, categorise, and negatively evaluate people of non-English speaking backgrounds (NESB) in the contexts studied. Negative evaluations, in turn, were used to justify the exclusion of NESB people from healthcare relationships and resources. Further data analysis revealed that underpinning the negative attitudes and behaviours in hospital domains concerning people who spoke accented English or who did not speak English proficiently were a dislike of difference, fear of difference, intolerance of difference, fear of competition for scarce healthcare resources, repressed hostility toward difference, and ignorance.Highlighting the implications of language prejudice for the safety and quality care of NESB people, the researchers call for further internationally comparative research and debate on the subject.

Achieving cultural safety in Aboriginal health services: implementation of a crosscultural safety model in a hospital setting

Abstract: Genuine cross-cultural competency in health requires the effective integration of traditional and contemporary knowledge and practices. This paper presents an analytical framework that aims to enhance the ability of patients/clients, providers, administrators and policy makers to make appropriate choices, and to find pathways to true healing while ensuring that the required care is competently, safely and successfully provided. The examples presented are primarily based on the experience of the Sioux Lookout Meno Ya Win Health Centre (SLMHC), which serves a diverse, primarily Anishnabe population living in 32 northern Ontario communities spread over an area of 385 000 km2 of Canada. The SLMHC has a specific mandate, among Ontario hospitals, to provide a broad set of services that address the health and cultural needs of a largely First Nations population. We describe our journey to date to implement our comprehensive minoyawin model of care, including an evaluation of the initial outcomes. Minoyawin is an Anishnabe term that denotes health, wellness or well-being – a state of wholeness in the spiritual, mental, emotional and physical make-up of the person. The model focuses on cross-cultural integration in five key aspects of all of our services: Odabidamageg (governance and leadership) Wiichi’iwewin (patient and client supports) . Andaw’iwewin (traditional healing practices) Mashkiki (traditional medicines) Miichim (traditional foods). The paper outlines a continuum of programme development and implementation that has allowed core elements of our programming to be effectively integrated into the fabric of all that we do. Outcomes to date and practices that are potentially transferable are identified.

The cultural lived experience of internationally recruited nurses: a phenomenological study

Abstract: The aim of the study was to investigate the cultural experiences of internationally recruited nurses (IRNs) in the UK within the Trent region. This study examined the cultural adaptation process, both from a personal and a nursing perspective. The paper is based on interviews with 12 nurses – seven female and five male. A phenomenological approach was adopted using a semi-structured interview technique. For the purpose of this study culture has been categorised as either ‘primary’ or ‘secondary’ culture. The findings demonstrated that how the nurses perceived their own culture influenced their adaptation process significantly. The data clearly showed how the IRNs felt deskilled and devalued. Significant cultural issues were identified which had an influence on their experience. This included the preparation in their country of origin, the quality of the induction programmes in the UK, language issues and life outside work, all of which were seen as having a distinct effect on the adaptation process.