LT_REVISION

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Daystar University, Machakos *

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Nursing

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Nov 24, 2024

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Literature review: Cultural Competence Student's Name Institution Course Instructors' Name Date

Introduction Cultural competence refers to understanding, appreciating, and interacting with people from different cultures. It involves knowledge, attitudes, and skills that enable nurses to provide high-quality, equitable care to diverse populations. As societies become increasingly multicultural, developing cultural competence is essential for nurses today (Young & Guo, 2020). This literature review will examine current evidence on strategies to improve cultural competence through nursing education and practice. Theoretical background Cultural competence in healthcare is grounded in critical cultural theory, which examines how power structures, contextual factors, and the diversity of human experiences shape health beliefs and behaviours between different cultural groups (Young & Guo, 2020). Developing cultural competence aligns with social justice principles to provide equitable care and reduce disparities. Theoretical models describe cultural competence as an ongoing process requiring consciousness of one's culture, appreciation for other cultures, and system and individual advocacy to adapt services to meet social and cultural needs (Campinha-Bacote, 2002). Nurses develop cultural awareness through self-reflection and an understanding of how their own cultural biases impact care. Patient-centred care, health equity, and transcultural nursing models also provide frameworks guiding nurses to be sensitive to patients' diverse cultural values, practices, and needs (Ray, 2019). A competent nursing workforce is critical to providing culturally tailored, high-quality care. Key Findings Cultural Competence Education

Improving cultural competence education prepares nurses to provide equitable, high- quality care to diverse patient populations. Developing cultural humility and awareness begins during students' academic training and continues throughout their careers. Schools of nursing are integrating cultural competence into curricula through various teaching approaches. A key concept in cultural competence education is cultural humility, defined as the lifelong process of self-reflection to understand personal biases while respecting patients' beliefs without assuming superiority (Foronda et al., 2018). Teaching cultural humility in nursing schools encourages self- awareness, challenges preconceived stereotypes and equips students to be lifelong learners regarding cultural competence (Kaihlanen et al., 2019). However, some health educators have gaps in their cultural competence, indicating a need for improved training programs (Erkkilä et al., 2023). Immersion experiences are impactful educational strategies to improve students' cultural competence. International clinical placements significantly improved nursing students' cultural knowledge, sensitivity, and confidence (Matthews et al., 2021). Experiential learning paired with guided reflection enables students to optimize learning. Nursing faculty need specific training to facilitate immersion experiences and role model cultural humility (Soares & Santos, 2023). Ongoing Education Foundational cultural competence education begins during academic nursing programs. However, developing cultural competence must be ongoing throughout a nurse's career as populations and their needs evolve. Cultural competence is not an end goal but rather a lifelong commitment to advancing one's knowledge, attitudes, and skills related to culture (Sharifi et al., 2019). Health organizations are responsible for providing continual cultural competence development opportunities to employed nurses and other healthcare providers. Training

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programs should keep pace with changing community demographics, health disparities, and cultural needs (Srivastava, 2022). For example, Narayan and Mallinson (2022) found that even experienced transcultural nurses desired more education, specifically on conducting culturally sensitive health assessments and individualizing care plans. This indicates the need for regular advancement of cultural knowledge. Ongoing education can be provided through in-person workshops, online modules, professional conferences, and daily learning opportunities. Annual competence assessments help identify strengths, weaknesses, and goals for improvement. Reflective discussions encourage nurses to challenge assumptions and share experiences. Leadership support promotes participation and models openness to learning. Culturally Sensitive Care Improving cultural competence in nursing practice enables the delivery of high-quality, equitable, patient-centered care that aligns with diverse populations' cultural contexts, preferences, and values. Critical components of culturally sensitive care include making concerted efforts to understand patients' cultural beliefs, norms, and lived experiences; identifying and removing potential barriers to care access and quality that marginalized groups may face; and thoughtfully adapting interventions, education approaches, communication styles, and organizational policies to be harmonious with patients' cultural needs (Foronda et al., 2018). Even minor adjustments like displaying diversity symbols in waiting areas and using more inclusive, less stigmatizing language can significantly improve healthcare experiences for minority populations (Cipollina & Sanchez, 2023). Providing individualized, holistic nursing care is essential for cultural competence. Nurses should integrate detailed cultural assessment questions into routine health assessments to

comprehensively explore patients' cultural identities, practices, beliefs, views on health/illness, preferred traditional remedies, spirituality needs, and other factors that may substantially impact their care. For example, understanding patients' norms around physical touch, diet preferences, family roles, gender dynamics, and decision-making processes helps guide patient education and collaborative care planning in a culturally respectful manner (Narayan & Mallinson, 2022). Developing personalized care plans based on cultural insights demonstrates value for patients' preferences. At an organizational level, nurse leaders promote policies, environments, and behaviours that enable culturally sensitive care. Ray (2021) identified regular nursing leader rounds on patient units as an impactful strategy to role model cultural awareness, encourage open dialogue, and strengthen an equitable culture of care. Frequent, compassionate interactions between nursing managers, frontline nurses, and diverse patients can reinforce cultural sensitivity while identifying opportunities for improvement. Conclusion Cultural competence is an essential skill set that enables nurses to serve increasingly diverse patient populations equitably. Current evidence supports strategies like integrating cultural humility education into curricula, providing immersion experiences, offering continual workplace training, conducting holistic assessments, individualizing care plans, and utilizing leader rounds. Advancing nurses' cultural knowledge, attitudes, and practices through education and culturally appropriate interventions will empower health systems to meet the needs of multicultural communities now and in the future.

References Brottman, M. R., Char, D. M., Hattori, R. A., Heeb, R., & Taff, S. D. (2020). Toward cultural competency in health care: a scoping review of the diversity and inclusion education literature. Academic Medicine , 95 (5), 803-813. https://www.ingentaconnect.com/content/wk/acm/2020/00000095/00000005/art00037 Cipollina, R., & Sanchez, D. T. (2023). Racial identity safety cues and healthcare provider expectations. Stigma and Health , 8 (2), 159. https://psycnet.apa.org/doi/10.1037/sah0000265 Erkkilä, P., Koskenranta, M., Kuivila, H., Oikarainen, A., Kamau, S., Kaarlela, V., ... & Mikkonen, K. (2023). Ethical and cultural competence of social‐and health care educators from educational institutions–Cross‐sectional study. Scandinavian Journal of Caring Sciences . https://doi.org/10.1111/scs.13145 Foronda, C., Baptiste, D. L., Reinholdt, M. M., & Ousman, K. (2018). Cultural humility: A concept analysis. Journal of Transcultural Nursing , 27 (3), 210-217. https://doi.org/10.1177/1043659615592677 Kaihlanen, A. M., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC nursing , 18 (1), 1-9. https://doi.org/10.1186/s12912-019-0363-x LoBiondo-Wood, G., & Haber, J. (2021). Nursing research E-book: Methods and critical appraisal for evidence-based practice . Elsevier Health Sciences. https://books.google.co.ke/books? hl=en&lr=&id=l8M1EAAAQBAJ&oi=fnd&pg=PP1&dq=LoBiondo-Wood,+G.+ %26+Haber,+J.+(2018)+Nursing+Research:

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+Methods+and+Critical+Appraisal+for+Evidence- +Based+Practice.&ots=NHxBxbl3Ed&sig=1ONoAXiF5B_cGiqh2CVdEj_hzo4&redir_e sc=y#v=onepage&q=LoBiondo-Wood%2C%20G.%20%26%20Haber%2C%20J. %20(2018)%20Nursing%20Research%3A%20Methods%20and%20Critical %20Appraisal%20for%20Evidence-%20Based%20Practice.&f=false Matthews, E. J., Clune, L., Luhanga, F., & Loewen, R. (2021). The impact of cultural immersion international learning experiences on cultural competence of nursing students: A critical integrative review. Journal of Professional Nursing , 37 (5), 875-884. https://www.sciencedirect.com/science/article/abs/pii/S8755722321001034 Narayan, M. C., & Mallinson, R. K. (2022). Transcultural nurse views on culture- sensitive/patient-centered assessment and care planning: A descriptive study. Journal of Transcultural nursing , 33 (2), 150-160. https://doi.org/10.1177/10436596211046986 Ray, H. D. (2021). Impact of Leader Rounds on Perceptions of the Culture of Safety. https://digitalcommons.acu.edu/etd/370/ Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International journal of nursing studies , 99 , 103386. https://doi.org/10.1016/j.ijnurstu.2019.103386 Soares, F. J. P., & Santos, L. F. P. B. (2023, January). Competencies for Considering Cultural Diversity in Primary Care and Nursing Education. In World Conference on Qualitative Research (pp. 281-300). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-31346-2_18 Srivastava, R. H. (2022). The Health Care Professional's Guide to Cultural Competence-E-Book . Elsevier Health Sciences. https://books.google.co.uk/books?

hl=en&lr=&id=FgxvEAAAQBAJ&oi=fnd&pg=PP1&dq=Improving+cultural+competen ce+in+nursing+care&ots=4hMlM5jUU- &sig=2u35cCsPEXdQG0rEMEo2iVeY9fM&redir_esc=y#v=onepage&q=Improving %20cultural%20competence%20in%20nursing%20care&f=false Young, S., & Guo, K. L. (2020). Cultural diversity training: the necessity of cultural competence for health care providers and in nursing practice. The health care manager , 39 (2), 100– 108. https://journals.lww.com/healthcaremanagerjournal/abstract/2020/04000/cultural_diversit y_training__the_necessity_of.7.aspx

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