Here is one of our papers on death and dying from an existential philosophical perspective:

Here is one of our papers on death and dying from an existential philosophical perspective:

Thank for for supplying the paper, which I will read with great interest.

We know that Swiss-American psychiatrist Elisabeth Kübler-Ross opened important dialog about the topic in her 1969 book On Death and Dying inspired by her work with terminally ill patients. She was criticized by her peers at the time -- perhaps because her work was exploratory, perhaps because she was a female scientist? Seriously. It's interesting to me that the work was qualitative; thus, much of the criticism that has come since is focused on a 'lack of empirical evidence' and/or U.S. based cultural beliefs of the time. While both are legitimate arguments, I would like to hear more about others' experiences across the globe. Thanks!

In what ways do philosophers clarify?

Perhaps by framing the discussion, philosophers could help to extend our collective understanding. Included in this discussion should be theologians, anthropologists, healers, shaman, and teachers of all types.

Question: Would you be open to an idea that posits: all deaths are suicides?

OUP has a very good handbook on the philosophy of death. Here is the introduction, which may also answer Dennis Mazur's question:

http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780195388923.001.0001/oxfordhb-9780195388923-e-1

Regarding the general question of how to develop philosophical competence in health services, the faculty of medicine at one of the universities at which I worked had a philosopher/ethicist on staff who conducted seminars for the residents and others, not only on ethical issues but also on general philosophical issues pertaining to health services of the sort you would like. So I guess the answer to your question is that the person responsible for delivering the ethics material shouldn't simply be a cleric or a counsellor or a well-meaning doctor or nurse but someone with broad philosophical training in biomedical issues who can deliver the more general philosophical material in addition to the ethics and can create a regular program (e.g. weekly seminars) that integrates the two. Alas, I realize this would involve budgetary resources so it may not be a solution for you.

Elisabeth Kübler-Ross is useful in that sense that you observe her four stages and understand e.g. aggression. As long as I cannot regulate my telomers I do not agree with your statement: "all deaths are suicides". I attach another example from the health care:

Developing a Competent Workforce for Integrated Health and Social Care: What Does It Take?

Reflecting on the knowledge, skills and attitudes necessary to work in integrated care, this perspectives paper explores the competencies required to implement and deliver integrated care and analyses how current education and training approaches fall short of conveying these competencies on all levels. By defining the differences between knowledge, skills and attitudes, and outlining the key ingredients for a competent workforce, this paper brings to light one of the most neglected topics in integrated care.

Developing a culturally competent health care workforce in Japan: implications for education.

In recent years, the population of foreign nationals and individuals from diverse cultural, racial, ethnic, and linguistic populations has consistently increased in Japan. An apparent failure by the health care workforce to deliver culturally congruent health care services has resulted in dissatisfaction with the health care system on the part of foreign nationals and increased potential for negative health care outcomes. Primary hindrances to the development of a culturally competent health care workforce include limited exposure to foreigners, cultural factors, and language difficulties. Recommendations are proposed for strategic educational actions to address these obstacles and develop in Japan a culturally competent health care workforce.

https://www.ncbi.nlm.nih.gov/pubmed/17557635

Cultural competency: From philosophy to research and practice

Cultural competency in the delivery of mental health services has gained considerable momentum. This momentum has been accompanied by questions about the meaning, usefulness, and precision of cultural competency. The author argues that cultural competency is composed of general processes (scientific mindedness, dynamic sizing, and culture‐specific skills), as well as a series of concrete and trainable strategies. The incorporation of these processes and strategies into treatment can improve treatment outcomes with clients from diverse cultural backgrounds. © 2006 Wiley Periodicals, Inc.

Developing Cultural Competence

Cultural Competency and Health Education: A Window of Opportunity

Stages and Levels of Cultural Competency Development

Developing Cultural Competence in Reproductive Health Care: Understanding Every Woman

Pursuing Organizational Cultural Competence

Cavin, a 42-year-old African American man, arrived at a well-known private substance abuse treatment center confused and unable to provide his medical history at intake. Referred to the center through his employee assistance program, he was accompanied by his spouse and 14-year-old son. Cavin's wife provided his medical history and recounted her husband's 2-year decline from a promising career as a journalist, researcher, and social commentator to a bitter, often paranoid man who abused cocaine and alcohol. Cavin, she explained, had become increasingly unpredictable.

Upon admission, Cavin was initially cooperative and grateful to his spouse for her efforts, but as withdrawal continued, he became increasingly agitated, insisting that he could detoxify on his own. He resisted any intervention by staff members whom he perceived to be critical or patronizing. On his fourth day in treatment, Cavin began to note the treatment center's “White” environment. There were almost no African American employees—none at the clinical level. He noted how decor reflected only White American culture. Driven in part by his substance use disorder, he was looking for reasons to leave. Later that evening, he checked out.

Cavin was unable to relate to his treatment. He found no cultural cues with which to identify or connect. Therefore, he started searching for reasons to leave—behavior typical in persons who abuse substances. People often leave treatment with the conscious hope of managing their substance abuse themselves and the unconscious drive to relive positive experiences associated with substance use; meanwhile, they all too easily forget the pain imposed by the use of alcohol and other substances. Cavin may have remained in treatment if services had been more culturally responsive. This is an example of how behavioral health programs benefit from commitment to culturally responsive services, staffing, and treatment—if they make no such commitment, their services may be underused, unwelcome, and ineffective.

https://www.ncbi.nlm.nih.gov/books/NBK248430/

Interventions to improve cultural competency in healthcare: a systematic review of reviews

Background

Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area.

Methods

A systematic review of review articles published between January 2000 and June 2012 was conducted. Electronic databases (including Medline, Cinahl and PsycINFO), reference lists of articles, and key websites were searched. Reviews of cultural competency in health settings only were included. Each review was critically appraised by two authors using a study appraisal tool and were given a quality assessment rating of weak, moderate or strong.

Results

Nineteen published reviews were identified. Reviews consisted of between 5 and 38 studies, included a variety of health care settings/contexts and a range of study types. There were three main categories of study outcomes: patient-related outcomes, provider-related outcomes, and health service access and utilization outcomes. The majority of reviews found moderate evidence of improvement in provider outcomes and health care access and utilization outcomes but weaker evidence for improvements in patient/client outcomes.

Conclusion

This review of reviews indicates that there is some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare. Future research should measure both healthcare provider and patient/client health outcomes, consider organizational factors, and utilize more rigorous study designs.

Keywords: Cultural competency, Healthcare, Health outcomes, Health disparities, Minority health, Systematic review

Cultural competence education for health professionals.

BACKGROUND:

Cultural competence education for health professionals aims to ensure all people receive equitable, effective health care, particularly those from culturally and linguistically diverse (CALD) backgrounds. It has emerged as a strategy in high-income English-speaking countries in response to evidence of health disparities, structural inequalities, and poorer quality health care and outcomes among people from minority CALD backgrounds. However there is a paucity of evidence to link cultural competence education with patient, professional and organisational outcomes. To assess efficacy, for this review we developed a four-dimensional conceptual framework comprising educational content, pedagogical approach, structure of the intervention, and participant characteristics to provide consistency in describing and assessing interventions. We use the term 'CALD participants' when referring to minority CALD populations as a whole. When referring to participants in included studies we describe them in terms used by study authors.

OBJECTIVES:

To assess the effects of cultural competence education interventions for health professionals on patient-related outcomes, health professional outcomes, and healthcare organisation outcomes.

SEARCH METHODS:

We searched: MEDLINE (OvidSP) (1946 to June 2012); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) (June 2012); EMBASE (OvidSP) (1988 to June 2012); CINAHL (EbscoHOST) (1981 to June 2012); PsycINFO (OvidSP) (1806 to June 2012); Proquest Dissertations and Theses database (1861 to October 2011); ERIC (CSA) (1966 to October 2011); LILACS (1982 to March 2012); and Current Contents (OvidSP) (1993 Week 27 to June 2012).Searches in MEDLINE, CENTRAL, PsycINFO, EMBASE, Proquest Dissertations and Theses, ERIC and Current Contents were updated in February 2014. Searches in CINAHL were updated in March 2014.There were no language restrictions.

SELECTION CRITERIA:

We included randomised controlled trials (RCTs), cluster RCTs, and controlled clinical trials of educational interventions for health professionals working in health settings that aimed to improve: health outcomes of patients/consumers of minority cultural and linguistic backgrounds; knowledge, skills and attitudes of health professionals in delivering culturally competent care; and healthcare organisation performance in culturally competent care.

DATA COLLECTION AND ANALYSIS:

We used the conceptual framework as the basis for data extraction. Two review authors independently extracted data on interventions, methods, and outcome measures and mapped them against the framework. Additional information was sought from study authors. We present results in narrative and tabular form.

MAIN RESULTS:

We included five RCTs involving 337 healthcare professionals and 8400 patients; at least 3463 (41%) were from CALD backgrounds. Trials compared the effects of cultural competence training for health professionals, with no training. Three studies were from the USA, one from Canada and one from The Netherlands. They involved health professionals of diverse backgrounds, although most were not from CALD minorities. Cultural background was determined using a validated scale (one study), self-report (two studies) or not reported (two studies). The design effect from clustering meant an effective minimum sample size of 3164 CALD participants. No meta-analyses were performed. The quality of evidence for each outcome was judged to be low.Two trials comparing cultural competence training with no training found no evidence of effect for treatment outcomes, including the proportion of patients with diabetes achieving LDL cholesterol control targets (risk difference (RD) -0.02, 95% CI -0.06 to 0.02; 1 study, USA, 2699 "black" patients, moderate quality), or change in weight loss (standardised mean difference (SMD) 0.07, 95% CI -0.41 to 0.55, 1 study, USA, effective sample size (ESS) 68 patients, low quality).Health behaviour (client concordance with attendance) improved significantly among intervention participants compared with controls (relative risk (RR) 1.53, 95% CI 1.03 to 2.27, 1 study, USA, ESS 28 women, low quality). Involvement in care by "non-Western" patients (described as "mainly Turkish, Moroccan, Cape Verdean and Surinamese patients") with largely "Western" doctors improved in terms of mutual understanding (SMD 0.21, 95% CI 0.00 to 0.42, 1 study, The Netherlands, 109 patients, low quality). Evaluations of care were mixed (three studies). Two studies found no evidence of effect in: proportion of patients reporting satisfaction with consultations (RD 0.14, 95% CI -0.03 to 0.31, 1 study, The Netherlands, 109 patients, low quality); patient scores of physician cultural competency (SMD 0.11 95% CI -0.63 to 0.85, 1 study, USA, ESS 68 "Caucasian" and "non-Causcasian" patients (described as Latino, African American, Asian and other, low quality). Client perceptions of health professionals were significantly higher in the intervention group (SMD 1.60 95% CI 1.05 to 2.15, 1 study, USA, ESS 28 "Black" women, low quality).No study assessed adverse outcomes.There was no evidence of effect on clinician awareness of "racial" differences in quality of care among clients at a USA health centre (RR 1.37, 95% CI 0.97 to 1.94. P = 0.07) with no adjustment for clustering. Included studies did not measure other outcomes of interest. Sensitivity analyses using different values for the Intra-cluster coefficient (ICC) did not substantially alter the magnitude or significance of summary effect sizes.All four domains of the conceptual framework were addressed, suggesting agreement on core components of cultural competence education interventions may be possible.

AUTHORS' CONCLUSIONS:

Cultural competence continues to be developed as a major strategy to address health inequities. Five studies assessed the effects of cultural competence education for health professionals on patient-related outcomes. There was positive, albeit low-quality evidence, showing improvements in the involvement of CALD patients. Findings either showed support for the educational interventions or no evidence of effect. No studies assessed adverse outcomes. The quality of evidence is insufficient to draw generalisable conclusions, largely due to heterogeneity of the interventions in content, scope, design, duration, implementation and outcomes selected.Further research is required to establish greater methodological rigour and uniformity on core components of education interventions, including how they are described and evaluated. Our conceptual framework provides a basis for establishing consensus to improve reporting and allow assessment across studies and populations. Future studies should measure the patient outcomes used: treatment outcomes; health behaviours; involvement in care and evaluations of care. Studies should also measure the impact of these types of interventions on healthcare organisations, as these are likely to affect uptake and sustainability.

PMID: 24793445 DOI: 10.1002/14651858.CD009405.pub2[Indexed for MEDLINE]

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Article Cultural competence education for health professionals

Cultural competency and patient engagement

Cultural Competency for Health Care Providers

Cultural Competence in Health A Review of the Evidence

How to Strengthen Cultural Competence in Nursing Practice?

FEBRUARY 13, 2018

Being a nurse, your main focus is to provide skilled patient care to the best of your ability. As the cultural landscape of our world continues to diversify, practicing cultural competence in nursing practice has become more relevant than ever before.

What is cultural competence in nursing?

According to Georgetown University:

Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.

Why is cultural competency important in nursing?

Cultural competency in nursing practice is the cornerstone of providing superior care for people of all cultures. It is relevant in our everyday lives, but even more so for nurses who regularly care for patients in their most vulnerable state.

When a patient enters medical care, they may be highly stressed because of pain, nerves, fear, and worry. If they are accompanied by family members, the stress is intensified as these emotions are compounded.

Comforting patients during this time is crucial.

It’s easy to understand the importance of cultural competence in nursing as it allows you to comfort those with different beliefs and gives you an opportunity to provide care at the highest level.

📷BONUS: Download Our Free Cultural Competence Guide!

Respecting the different cultures of patients is an important and necessary skill. Above and beyond inclusion and respect, the effects of cultural competence in nursing practice extend to the actual medical care provided to patients.

Keep in mind: distinct cultural practices may influence the care plan and even how a patient perceives his or her illness. This is another reason why effective nursing and cultural competence go hand in hand.

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Increasing Cultural Competence in Nursing Practice

Through years of research and education, many medical scholars have shared knowledge and techniques that nurses can employ to practice cultural competence.

Cultural competencies for nurses these techniques are built upon three pillars:

• knowledge
• attitude
• skills

1. Knowledge

Learning about the culture base of those in your area is the first step to strengthening your cultural competence.

Depending on your location, the number of cultures you encounter will vary. Seek out information on topics such as shared traditions and values of each cultural group.

SEE ALSO: Where Can Nurses Work for the Best Overall Experience?

In larger cities, you may be able to accomplish this by:

• researching your city website for demographic information
• visiting the local library or university
• doing specific research within cultural groups around town

Maintaining a level of awareness of the cultures around a service area enables a nurse to quickly assess the medical needs of a patient.

In the event a patient cannot confirm his or her culture, having a thorough understanding of genetic elements shared by people of the same ancestry ensures proper diagnosis and treatment.

For example, culture is incredibly important in the mental health field. Nursing and culture cannot be separated. According to the National Center for Biotechnology Information, “culture bears on whether people even seek help in the first place, what types of help they seek, what types of coping styles and social supports they have, and how much stigma they attach to mental illness.”

Part of enhancing your culturally competent care nursing knowledge includes the ability to conduct a cultural assessment. In the following section, you will learn the importance and techniques used to master this skill.

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Patient-Centered Care and Cultural Competence In Nursing Practice: Cultural Assessment

Conducting a Cultural Assessment is an essential step in delivering patient-centered care. Madeleine Leininger defines cultural assessment as a “systematic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values, and practices to determine explicit needs and intervention practices within the context of the people being served”.

The goal of a cultural assessment is for a nurse to formulate an acceptable treatment plan for each patient based on the information provided by that patient regarding their beliefs.

Berlin and Fowkes designed the mnemonic, LEARN, in conducting a cultural assessment. This mnemonic stands for 5 steps outlined below:

Listen Listen to the patient’s perception of the presenting problem.

Explain Explain your perception of the patient’s problem. Is it physiological, psychological, spiritual, and/or cultural? It can and often will be more than one.

Acknowledge Acknowledge the similarities and differences between the patient’s perception and your perceptions. In certain cases, it may be easier to focus on the similarities while working towards bridging the gap between the differences.

Recommend Recommendations are built upon the knowledge gained from the first three steps. It is inevitable that culture will affect the recommendations, and the patient must be involved in this process.

Negotiate In some instances, the patient may require negotiating a treatment plan. It is imperative that nurses are sensitive to the cultural practices of each patient while still providing the best care possible.

Cultural competency in nursing is an ongoing practice. Having the ability to execute an analysis ensures you can handle each unique situation as it arises.

2. Attitude

Attitude plays a large role in the ability to become and serve as a culturally competent caregiver. In this case, “attitude” refers to a level of awareness in yourself and your patients in regards to stereotypes, rules of interaction and communication customs.

It’s a fact that culture influences a person’s behavior and decision-making.

Become aware of your cultural attitude. Being sensitive to those of other cultures allows you to plan the best care for your patients.

Seek to understand the basics of all cultures with which you will engage, such as spirituality, customs, and family hierarchy. Having this general knowledge will help you understand the attitudes of your incoming patients and their families.

A caregiver will likely identify most with the culture in which they were raised. With that comes a need to identify and debunk stereotypes from other cultures. There are situations in which we may portray a lack of sensitivity without knowing how our actions may affect others. Reflect on your own cultural attitude, so that even the most subtle of stereotypical tendencies do not affect the level of care provided to your patients.

SEE ALSO: Why A Personal Philosophy of Nursing Can Help Your Career

Taking an active role in encouraging diversity and cultural inclusion is an excellent way to become (and stay) aware of the many similarities and differences among your community of co-workers, peers, and patients. According to MinorityNurse.com, The Pacific region has the highest percentage of minority nurses, with 30.5% of nurses identifying themselves as belonging to a minority.

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3. Skills

Developing a skill set based on increasing your cultural competency can be accomplished by focusing on skills like communication and conflict-resolution.

Communication is a key component of skilled nursing.

Clear communication between different cultures when medical treatment is taking place is critical.

An example of cultural competence through communication is making an effort to use layman’s terms with patients and patient families who do not speak your native language. Medical terminology can be difficult to understand in your own language, let alone a foreign language.

It also involves learning to adapt to new and different situations in a flexible way. Remember that the hospital environment may not be familiar ground for your patients. Especially when it’s outside the realm of their cultural identity.

As stated earlier in the article, culturally-driven medical attitudes can create issues in patient care plans. This inevitably gives rise to the need for effective conflict-resolution skills.

Author and scholar Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CTN-A, FAAN points out that, “Ironically, conflict can provide nurses with an excellent opportunity for developing compassion, the emotional task of sharing in one’s suffering. When cross-cultural conflict arises, the goal is to respond with compassion.”

Her article provides a detailed example of how cultural beliefs play a large role in medical decision-making. The overwhelming evidence concludes that a “nurse can deliver patient-centered care when the patient’s health beliefs, practices, and values are in direct conflict with medical and nursing guidelines”.

Practicing the techniques in this article and its cited sources can help you enhance nurse cultural competence.

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Tools and Resources to Strengthen Your Cultural Competence in Nursing Practice

For further detailed information about cultural competence, visit the U.S. Department of Health and Human Services Office of Minority Health.

This website provides a wealth of knowledge on a variety of topics. It includes a library of over 50,000 documents, books, journal articles, and media related to the health status of racial and ethnic minority populations.

Additionally, the website includes a vast amount of data and issue briefs that may prove interesting to nurses who are seeking to learn about new cultures.

Another excellent list is provided by The National Association of School Nurses; this comprehensive resource guide includes a variety of articles and websites dedicated to cultural competency.

📷

Conclusion

Cultural competence in nursing practice focuses on knowledge, attitude, and skill. Consistently working towards being culturally competent is an exercise in compassion and respect.

Employ these techniques on a regular basis to grow your level of competency:

• Ask questions and take time to learn about what the answers mean in different cultures.
• Use clear, descriptive communication that aligns with the communication practices of your patient’s culture.
• Keep an open mind and employ the skills you practice when the occasional conflict arises.
• Acknowledge and be aware of any situations in which you may portray a lack of sensitivity, and work to keep from doing so.
• Actively seek out colleagues and peers of different cultures to learn more about interacting and respecting your differences.

https://www.masmedicalstaffing.com/blog/nursing/cultural-competence-in-nursing-practice/

Cultural Competence – Transforming Policy, Services, Programs and Practice

This chapter discusses some of the complex issues surrounding the notion of cultural competence—and the critical need for practitioners to develop knowledge, skills, understandings and attributes to be responsive in diverse cultural settings. The argument for culturally competent mental health practitioners and services is situated within a human rights framework which underpins the principles, standards and practice frameworks intended to facilitate/contribute to the capacity and empowerment of mental health practitioners and clients, families and communities. The National Practice Standards for the Mental Health Workforce 2013 (the practice standards)1 outline core competencies (including cultural competence) regarded as essential for the mental health workforce: mental health nursing, occupational therapy, psychiatry, psychology and social work. The documented impact of these disciplines/professions on Aboriginal people requires new ways of working that are empowering, respectful and ethical. A case is made for the importance of practitioners providing more culturally inclusive and appropriate care to increase the likelihood that clients and their carers will experience a sense of cultural safety (as well as culturally appropriate services) for Aboriginal clients, their families and communities. The practice standards are complemented by professional guidelines and the National Standards for Mental Health Services 2010 (the service standards). 2 This chapter provides a range of tools and strategies and a Critical Reflection Framework for Analysis to assist students or practitioners to adopt a critical standpoint in order to develop key competencies (knowledge, skills, attitudes and values) to be culturally respectful and effective in their practice in Aboriginal and Torres Strait Islander mental health. Equally important is the need for strategies for self-care and support such as mentoring, journaling, peer support, counselling and engaging in self-reflective, transformative practice.

Establishing Standards for Culturally Competent Mental Health Care

Deena Nardi, PhD, PMHCNS-BC, FAAN; Roberta Waite, EdD, APRN, CNS-BC, FAAN; Priscilla Killian, MSN, RN, CPNP

• Journal of Psychosocial Nursing and Mental Health Services. 2012;50(7):3-5
• https://doi.org/10.3928/02793695-20120608-01
• Posted July 1, 2012

The authors have disclosed no potential conflicts of interest, financial or otherwise. The authors are members of the Mental Health Task Force of the National Nursing Centers Consortium.

The past 2 decades have witnessed a sharp increase in the global migration of health care providers, along with an increasingly diverse patient population. Since culture fundamentally influences all health-related behaviors, an understanding of patient perspectives, values, beliefs, and approaches to health and well-being is critical to ensuring the best possible health outcomes. In addition, providers must be willing to work within these diverse frameworks. When culture is ignored, the results are disparities in outcomes and unequal distribution of mental illness burden. Much work still needs to be done to identify and apply standards for cultural competence in all health care settings where mental health services are provided. Given the multilingual, multiracial, and multicultural needs of an expanding diverse population in the United States, cultural competence is a relevant component to reducing disparities in health care and health outcomes (Echeverri, Brookover, & Kennedy, 2010).

Moreover, clinical skills need to be extended to incorporate awareness of health statistics that highlight mental health disparities, training, and cross-cultural health care delivery at the individual and system levels (Núñez & Robertson, 2003). Cross-cultural expertise is the ability to work within several cultural systems (i.e., different patients, populations, providers, organizations, community systems) that generate and promulgate their own culture. Cross-cultural expertise also enables one to compare, integrate, and differentiate these cultural systems according to patient goals and needs. Notably, cross-cultural expertise is a vital component to delivering quality mental health care and services, especially in two essential areas: (a) establishing standards for culturally competent mental health care and (b) proposing a global model of cultural competence for mental health providers.

Establishing Standards for Culturally Competent Mental Health Care