As a result of global migration, nursing has faced new challenges. Apart from its major task, which is to provide high-quality care, nursing obtained a significant cultural aspect. In recent decades, cultural competence became an integral component of nursing education and work. Still, researchers speak about the ambiguity od this concept and claim it needs further research (Cai, 2016). Another concept that is relatively new in the nursing context is cultural safety (Browne et al., 2009). Moreover, researchers relate cultural safety to critically oriented knowledge. This research analyzes the concepts of cultural competence and cultural safety and their application in contemporary nursing practice.
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Background for the Study
The concept of cultural safety emerged in New Zealand in the early 1990s. It was used by Maori nurse leaders and educators as an organizing concept aimed at the reorientation of health professionals’ training “towards a more critical understanding of colonial structures and their impacts on contemporary Maori” (Browne et al., 2009, p. 169). The concept was integrated into the nursing curricula and obtained a broader meaning. Consequently, it is used not only for the Maori population but to address diverse groups of people in New Zealand (Browne et al., 2009). On the whole, cultural safety can be studied in the context of critically oriented knowledge and translating in the practice setting in particular. Cultural competence, in its turn, is integral to nursing education. This concept is frequently analyzed about cultural evolution and cultural revolution that change the attitude to cultural peculiarities in different spheres including nursing (Jeffreys, 2016). Currently, the concept of cultural competence is actively discussed in academic literature.
The research questions for this study are as follows:
- What is the essence of concepts of cultural competence and cultural safety?
- How are the concepts of cultural competence and cultural safety used in contemporary nursing research and practice?
Current literature dedicated to the issues of cultural competence and cultural safety is varied. It comprises research articles and books that disclose both concepts from different angles. For example, cultural competence and cultural safety are studied in the educational aspect, from their potential to improve care delivery and make a change, as a tool in the clinical setting, and from the perspective of international experience. The following literature review synthesizes evidence from research and data from books to empower further analysis of the concepts of cultural competence and cultural safety.
While cultural competence is a common concept for nursing worldwide, the concept of cultural safety is used less frequently. It was introduced in the New Zealand nursing context and was adopted in diverse Canadian health care discourses (Browne, 2009). The experience of Canadian Nursing schools related to the concepts of cultural competence and cultural safety is provided in a mixed-method study by Rowan et al. (2013). Speaking in more detail, the study investigates the degree of integration of cultural competence and cultural safety into the undergraduate nursing curricula at Anglophone Schools of Nursing. Research findings reveal such facilitating factors that are typical of Canadian Nursing School as leadership, partnerships and linkages, and educational supports for students. Moreover, researchers focus on the challenges related to recruiting and retaining Aboriginal faculty, financial resources, and outcome evaluation indicators. In turn. Kirmayer (2013) analyzes the concepts of cultural competence and safety in the context of clinical training.
To support future nurses and empower their culturally competent practice, several textbooks are issued and used in nurse education. For example, Purnell (2014) developed a guide to culturally competent health care where he included major information about the ethnic and racial background of population groups found in the United States. The evident value of this guide is to focus on culture-related peculiarities that are useful for nursing practice. A similar textbook is suggested by Giger (2013). The author presents the concept of transcultural nursing and focuses on the necessity to adjust care to the cultural background of patients thus improving their health outcomes.
On the whole, the involvement of culture in healthcare resulted in the necessity of cultural competence training (Thachrah & Thompson, 2013). Moreover, there is a need to evaluate the results of culturally competent education. Loftin, Hartin, Branson, and Reyes (2013) suggest instruments that can be used to measure nurses’ self-perceptions and self-reported levels of cultural competence. Still, this assessment cannot be considered an objective measure of culturally competent care from a patient’s perspective, which demands additional research. A similar idea of assessment is presented by Shan (2014). The researcher builds assessment instruments based on cultural competence models.
The aspect of Change and Improvement
The improvement of cultural competence in healthcare has been a research focus of many studies. Truong, Paradies, and Priest (2014) present a systematic review of reviews that treat cultural competence as a tool to improve the provision of health care to racial/ethnic minorities in the community and thus reduce racial/ethnic health disparities. The findings of the reviews provide evidence that interventions on improving the cultural competence of nurse staff have the potential to improve patient health outcomes.
The effectiveness of cultural competence programs for patient-centered health care for ethnic minorities is studied by Renzaho, Romios, Crock, and Sonderlund (2013). One of the evident benefits of introducing the cultural competence component into a patient-centered care model is the improvement of knowledge the staff possesses and their readiness to interact with culturally diverse patients. Nevertheless, the review lacks evidence to support the idea that cultural competence has a significant impact on patient outcomes.
Cultural competence is also discussed in the context of the healthcare system transformation as an opportunity to address disparities and achieve equity. Betancourt, Corbett, and Bondaryk (2014) claim that the improvement of the cultural competence of health-care providers and the health-care system as a whole has the potential to reduce racial and ethnic healthcare disparities.
One of the issues that relate to clinical practice and cultural competence is staff training. For example, Delgado et al. (2013) state that care provision across cultures is crucial in conditions of changing demographics and the related health care disparities. Consequently, there is a need for culturally competent staff able to provide high-quality care. The research provides evidence that cultural competence education interventions result in a statistically significant increase in the cultural competence of the clinical staff (Delgado et al., 2013). Cultural competence as well as racial disparities can be significant for providing care to patients with certain diagnoses. Thus, the research by Saha et al. (2013) focuses on the impact that cultural competence and racial health disparities have on HIV patients’ care and outcomes in conditions of primary care providers. Generally speaking, cultural competence contributes to evidence-based clinical care for diverse populations (Huey, Tilley, Jones, & Smith, 2014).
The concept of cultural competence is used not only in the context of care for patients of other ethnicities. Sometimes, the lack of cultural competence cannot be addressed until specific local problems are resolved. For example, Herring, Spangaro, Lauw, and McNamara (2013) claim that in the case of Australian aborigines, the incidence of racism and trauma as well as the distance from some tribes to care facilities results in the underuse of care opportunities by this population group. Consequently, culturally competent approaches will be effective only after the problem of racism and trauma is addressed.
Cultural competence is particularly important in conditions of a multicultural society. Almutairi, McCarthy, and Gardner (2015) analyze the concept of cultural competence in the context of a multicultural nursing workforce on the experience of Saudi Arabia. The study reveals that nurses within a specific culturally diverse environment can face a challenge in understanding the notion of cultural competence due to the need to meet cultural expectations of other cultures as well as those of Saudi culture, which is dominant in this region. Cultural awareness in nursing and health care is also stressed by Holland (2017). The author attracts attention to the interrelation of culture, race, and ethnicity as well as their impact in the process of care.
The theoretical framework for this study is grounded on the epistemological stance of a pragmatic philosophical paradigm. It involves multiple approaches to the way reality is known (Creswell, 2013). Therefore, it applies to the investigation of the concepts of cultural competence and cultural safety that are studied in different contexts and settings. For example, both concepts are reviewed as related to schools of nursing (Rowan et al., 2013), used as a focus of improvement interventions (Truong et al., 2014), as a tool for patient-centered care for minorities (Renzaho et al., 2013), and many other real settings.
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The study will implement a phenomenological approach because it aims to investigate the essence of concepts and analyze their application in nursing research and practice. Phenomenological research is usually focused on the nature of the meaning of concepts or objects. The research sample will comprise research articles and books that deal with the concepts of cultural competence and cultural safety as related to nursing. Materials included in the sample must be articles from peer-reviewed journals or books issued within the last ten years.
Research Design and Method
This research is non-experimental and follows a qualitative design. It allows selecting, analyzing, and describing the concepts of cultural competence and cultural safety that are the focus of the study. Qualitative research is more suitable when the goal is to better understand the selected concepts and reveal the ways they are used in contemporary nursing research and practice. The method selected for this study is a literature review. It provides researchers with relevant data that can be further analyzed and described.
Significance of Research
Current research has both practical and theoretical value for contemporary nursing. From the theoretical perspective, it provides a comprehensive summary of the situations in which the concepts of cultural competence and cultural safety are used. Moreover, the analysis of recent studies dedicated to cultural competence and cultural safety allows collecting evidence-based data that can be applied to further research on the topic. Also, it provides a researcher with an opportunity to select a narrower aspect of the problem such as education or implementation of change and develop an experimental project. As for the practical value, the findings of this study can be used to enhance the cultural component of nurse education curricula and thus contribute to the successful implementation of both concepts.
Almutairi, A., McCarthy, A., & Gardner, G. (2015). Understanding cultural competence in a multicultural nursing workforce. Journal of Transcultural Nursing, 26(1), 16-23. Web.
Betancourt, J., Corbett, J., & Bondaryk, M. (2014). Addressing disparities and achieving equity. Chest, 145(1), 143-148. Web.
Browne, A., Varcoe, C., Smye, V., Reimer-Kirkham, S., Lynam, M., & Wong, S. (2009). Cultural safety and the challenges of translating critically oriented knowledge in practice. Nursing Philosophy, 10(3), 167-179. Web.
Cai, D. (2016). A concept analysis of cultural competence. International Journal of Nursing Sciences, 3(3), 268-273. doi: 10.1016/j.ijnss.2016.08.002
Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.
Delgado, D., Ness, S., Ferguson, K., Engstrom, P., Gannon, T., & Gillett, C. (2013). Cultural competence training for clinical staff. Journal of Transcultural Nursing, 24(2), 204-213. Web.
Giger, J. (2013). Transcultural nursing. St. Louis, Mo.: Elsevier/Mosby.
Herring, S., Spangaro, J., Lauw, M., & McNamara, L. (2013). The intersection of trauma, racism, and cultural competence in effective work with aboriginal people: Waiting for trust. Australian Social Work, 66(1), 104-117. Web.
Holland, K. (2017). Cultural awareness in nursing and health care (3rd ed.). New York: Routledge.
Huey, S., Tilley, J., Jones, E., & Smith, C. (2014). The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annual Review of Clinical Psychology, 10(1), 305-338. Web.
Jeffreys, M. (2016). Teaching cultural competence in nursing and health care (3rd ed.). New York: Springer.
Kirmayer, L. (2013). Embracing uncertainty as a path to competence: Cultural safety, empathy, and alterity in clinical training. Culture, Medicine, And Psychiatry, 37(2), 365-372. Web.
Loftin, C., Hartin, V., Branson, M., & Reyes, H. (2013). Measures of cultural competence in nurses: An integrative review. The Scientific World Journal, 2013, article ID 289101, 1-10. Web.
Purnell, L. (2014). Guide to culturally competent health care (3rd ed.). Philadelphia: F. A. Davis Company.
Renzaho, A., Romios, P., Crock, C., & Sonderlund, A. (2013). The effectiveness of cultural competence programs in ethnic minority patient-centered health care: A systematic review of the literature. International Journal for Quality in Health Care, 25(3), 261-269. Web.
Rowan, M., Rukholm, E., Bourque-Bearskin, L., Baker, C., Voyageur, E., & Robitaille, A. (2013). Cultural competence and cultural safety in Canadian schools of nursing: A mixed methods study. International Journal of Nursing Education Scholarship, 10(1), 1-10. Web.
Saha, S., Korthuis, P., Cohn, J., Sharp, V., Moore, R., & Beach, M. (2013). Primary care provider cultural competence and racial disparities in HIV care and outcomes. Journal of General Internal Medicine, 28(5), 622-629. Web.
Shen, Z. (2014). Cultural competence models and cultural competence assessment instruments in nursing. Journal of Transcultural Nursing, 26(3), 308-321. Web.
Thackrah, R., & Thompson, S. (2013). Refining the concept of cultural competence: building on decades of progress. The Medical Journal of Australia, 199(1), 35-38. Web.
Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research, 14(1). Web.