Concept analysis plays a central within theory development in the nursing profession. Typically, concepts help a great deal in the provision of the much-needed basic foundation theoretical frameworks, as well as scientific knowledge for any given discipline, including nursing. In essence, the strength associated with theories tasked with the responsibility of guiding the nursing profession remains dependent on the very quality of approach of concept analysis. Cultural competence serves as a common concept that employees and other responsible stakeholders utilize in nursing and other specialties. The concept in question is demonstrated in Madeleine Leininger’s theory, which encourages nurses to access cultural knowledge that would resonate with patients’ cultural expectation (Betancourt, 2016). In this sense, individual nurses should understand the concept of cultural competence since the healthcare sector has been influenced by the population demographic diversity, such as gender, ethnicity, sexual orientation, nationality among other aspects. According to Betancourt (2016), cultural competence addresses the different cultural values (culture-specific) or similar cultural values of individuals or groups of people.
Cultural competence requires the nurse to devise methods that are in harmony with the patient’s beliefs and meets patients’ cultural requirements. A comprehensive analysis of cultural competence goes a long way in providing a deeper understanding of how this concept plays a significant role in not only improving but also promoting the desired health outcomes. As a result, the primary purpose or aim of this paper revolves around defining cultural competence, as well as examining its underlying implications for nursing practice. The paper achieves this by identifying and describing the concept’s empirical referents, essential attributes, consequences, and antecedents in addition to discussing three forms of construct cases: model, borderline, and contrary.
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Definition/Explanation
Despite the rapidly growing acknowledgment, as appreciation of the important role played by cultural competence in the attainment of the desired health outcomes among different patient populations, responsible stakeholders, including scholars and health care practitioners (HCPs) have failed to agree on a shared definition of the term and concept. According to the Medical Dictionary, cultural competence refers to the ability of HCPs, such as nurses to not only understand and appreciate but also interact with people with and from different belief systems and cultures, respectively, other than their own. Matteliano and Street (2012) define cultural competence as the ability of individual health facilities and providers to deliver holistic care services that have the capacity to meet the various linguistic, social, and cultural needs of their clients or patients.
According to Leininger, nurses must understand that different cultures tend to have a variety of caring behaviors, as well as different perspectives on health values, patterns, and beliefs (Cai, 2016). In this context, a culturally competent nurse or HCP assumes a leading role in not only improving health outcomes but also elimination any forms of ethnic or racial disparities in health care delivery. Concisely, cultural competence serves as an umbrella term that describes a nurse’s ability to develop and maintain effective relationships with patients, colleagues, and other players in the present-day’s multicultural healthcare settings.
Literature review
Several studies have so far defined, described the need, as well as emphasized the importune of cultural competence in nursing. In a recent qualitative study by Soule (2014), the researcher defines cultural competence as a unique way through which HCPs provide the much-needed care in a manner that not only respect’s an individual’s values, but also beliefs. The study sampled participants from a broad range of fields, including social sciences, nursing, as well as medicine. According to the study findings, cultural competence revolves around three major themes; application, awareness, and engagement. In essence, the results obtained by Soule (2014) remain in concert with Barello et al. (2014) finding that cultural competence allows HCPs to improve both patient involvement and engagement.
In addition, Cicolini et al. (2015) recently conducted a multicentric survey with the sole purpose of assessing cultural competence among individual Italian nurses; given the country’s growing diversity when it comes to the patient population. Overall, the survey established that cultural competence among the nurses was moderate. For this reason, the researchers suggest the need for culturally preparing nurses to address the ever changing health requests by patients from different cultural background. On the same note, McElfish et al. (2017) employed a mixed-methods evaluation framework to examine the role of cultural competency training in improving nurses’ competence. According to study results, performance, knowledge, as well as competence among nurses improved following cultural competency programs, meaning health care facilities and organizations should adopt and implement policies aimed at enhancing their employees’ cultural competence.
A study undertaken approximately 15 years ago by Flowers (2004) has proved relevant today, as its findings tend to align perfectly well with recent quantitative and qualitative studies. Prompted by the demographic changes and diverse patient population in Sweden and many other countries, Flowers (2004) revealed that the provision of culturally competent care remains important for individual HCPs, especially nurses in high-stress, as well as high-acuity healthcare environments. According to the researcher, critical care nurses should remain culturally competence, which, in turn, allows them to establish the correct rapport with their patients. Cultural competence further enhances a nurse’s ability to asses and implement relevant nursing interventions.
Attributes
Attributes are characteristics associated with cultural competence, which differentiates concepts from other related theories. According Shirazi et al. (2012), the cultural competence dimensions include awareness, behavior, and attitude. At the same time, its attributes comprise flexibility, ability, and openness. Awareness means knowledge of the various cultural variations and any resemblances (Cai, 2016). Ability refers to the HCP’s capacity to effectively provide the much-needed care to people, as well as communities of diverse ethnicities. Openness revolves around having an objective or a broader outlook in addition to a nonjudgmental attitude when it comes to executing their nursing roles in a multicultural setting. Flexibility means a nurse’s adaptation and evolution abilities, especially when faced with different situations and associated circumstances. Hence, cultural competence attributes should be developed to offer culturally-based care to patients.
Antecedent and Consequence
Antecedents refer to incidences that arise before the concept occurs. One of the antecedents is a cultural encounter, which entails the interaction of patients and nurses of varying cultures. Such an encounter allows nurses to study various cultural groups and assist them in changing their previous beliefs to avoid stereotyping. One of the consequences of cultural competence is that it can close disparity gaps of different cultural groups when providing health care (Cai, 2016). Hence, cultural competence is expected to meet clients’ need and improve the quality of care.
Empirical Referents
Some of the empirical referents include inventory for assessing the process of cultural competence in the delivery of health care and nurse cultural competence scale (Cai, 2016). Cultural competence is applicable in nursing theory in nurturing respect and appreciating patients’ diversity. In addition, it assists in understanding the implication, causes, treatment, and final results of illnesses of a particular individual (Mallela, 2015). Therefore, nurses should be informed about the concept of cultural competence to identify and realize the cultural needs of patients and hence apply the culturally acceptable strategies in nursing care.
Construct Cases
Model Case . A Hispanic woman, together with her son, enters a local health facility. She needs hysterectomy services, which typically require the patient’s informed consent. Since the client spoke no English, the nurse asked her bilingual colleague to help with interpretation. The nurse-turned translator did an excellent job that impressed both patient and her son. The patient finally signed the form willingly. Her uterus, which had been adversely affected by the tumor, was removed successfully. Although the client accepted the outcome of the procedure, she was not as happy since she could no longer have children, yet the Hispanic culture values a woman based on the number of her children.
In this case, it is evident that the nurse practitioner demonstrated all the attributes of cultural competence. In particular, she showed flexibility by engaging a female, bilingual colleague as the interpreter as opposed to the patient’s son. According to the Hispanic culture, it remains embarrassing to discuss issues involving private parts with their mothers. Additionally, the nurse showed ability by offering the much-needed care indiscriminately. At the same time, the president proved her cultural competency skills by remaining open and nonjudgmental to the client concerning hysterectomy, which led to the removal of her womb.
Borderline Case . Peteri is a nurse at Bila Hospital, and her patient, Liu is 75-year old Chinese man, who places great emphasis on practicing Yin and Yang, universe energies. Liu fluently speaks English, and she informed the nurse of his traditional beliefs. For this reason, Peteri understands that Yin or cold symbolizes negative energy, while Yang, hot, typically represents positive energy. Given his busy schedule, the nurse hurriedly gave Liu his medication with cold water to help him swallow the tablets. Liu refused. Peteri did not bother to address the client’s need and reason for refusal, but rather proceeded to document that Liu refused to take his medication. In this case, Peteri only demonstrated one attribute, ability, by attending to the patient regardless of his ethnicity. However, the nurse failed to show flexibility and openness since he understood the patient’s cultural needs, but ignored or overlooked them.
Contrary Case . Rodriguez is a 31-year-old Mexican man, who has just visited Jack, a white nurse in a local hospital. Having injured his left foot, the patient needs to undergo debridement. As usual, Jack was asked by the podiatry resident to give Rodriguez pain medication before he could change the wound. The patient refused the medication, compelling Jack to insist. He even blamed the patient of being stubborn. With these assumptions, is evident that the nurse failed to inquire and gain a deeper understanding of what constitutes machismo, being manly, among Mexican men. He also failed to show flexibility by insisting that the patient takes the drugs. At the same time, he did not exercise openness, judging Rodriguez as a difficult patient.
Theoretical Applications
Concept analysis, as stated earlier, plays a fundamental role in developing theories, which, in turn, enhances people’s understanding the various meanings of terms used in a given profession, such as nursing. In essence, concept analysis remains a vital tool in the whole process of theory development, as it presents researchers with the best possible opportunity to clearly define particular concepts in addition to enhancing their comprehension. In this context, cultural competence applies perfectly well to Leininger’s nursing theory since the theory’s primary objective revolves around discovering and explaining a variety of culturally based care determinants or factors, which influence health, sickness, individuals, as wells groups (Matteliano & Street, D2012). In other words, Leininger proposed that nurses should emphasize on the provision of culturally meaningful and competent care. Given the rapidly changing world demographics in addition to the diverse patient population in countries from across the globe, culturally responsible and congruent care, as well as the sensitive concept of cultural competency remains a necessity in health care delivery. Notably, most healthcare services are now offered to culturally diverse people, including refugees and immigrants.
Conclusion
Conclusively, it is evident that remarkable HCPs, including nurses should not only place great emphasis on mastering diagnosis and treatment processes, but also remain sensitive to cultural sensitivity. In essence, they can only deliver the much-needed quality and holistic care by acknowledging and appreciating the important role played by their patients’ cultural beliefs and associated values. Nurses should focus on remaining culturally competent; given the shifts in global demographics in addition to the increasing diversity witnessed in patient population. Based on Leininger’s theory, cultural competence allows an individual nurse to provide care services that address the various linguistic, social, as well as cultural needs of any given patient. Concisely, I firmly believe that culturally competent nurses prioritize the achievement of desired health outcomes in addition to playing a central role in eliminating ethnic health disparities.
References
Betancourt, D. A. (2016). Madeline Leininger and transcultural nursing theory of nursing. The Downtown Review , 2 (1), 1-7.
Cai, D. Y. (2016). Concept analysis of cultural competence. International Journal of Nursing Sciences, 3 (3), 268-273. doi:10.1016/j.ijnss.2016.08.002
Cicolini, G., et al. (2015). Cultural competence among Italian nurses: A multicentric survey. Journal of Nursing Scholarship, 47 (6), 536-543.
Flowers, D. (2004). Culturally competent nursing care: A challenge for the 21 st century. Critical Care Nurse, 24 (4), 48-52.
Matteliano, M. & Street, D. (2012). Nurse practitioners’ contributions to cultural competence. Journal of the American Association of Nurse Practitioners, 24 (7), 425-345.
McElfish, P. et al. (2017). Improving culturally appropriate care using a community-based participatory research approach: Evaluation of a multicomponent cultural competency training program, Arkansas, 2015-2016. Preventing Chronic Disease, 14 , E62.
Shirazi, M., et al. (2017). Cultural competency: A concept analysis in TMS (Tehran University of Medical Science). Journal of Family Medicine, 15 (7), 146-153.
