does anyone teach a transcultural course?

Havin' A Party!, ASN, RN · Jan 5, 2004

Vicky -- Not exactly clear what's meant by "cultural competence." Can you clarify? Thanks.

vickynurse · Jan 5, 2004

This is a relatively new term that encompasses care strategies for diverse clients, cultural assessment, cultural barriers, health care beliefs and practices.:)

Havin' A Party!, ASN, RN · Jan 6, 2004

That's what I thought, but didn't wanna jump the gun.

Even the CNA course I just completed had a section on this. (See "Mosby's Textbook for Long-Term Assistants," by Sorentino.)

Think there'd be a ton of info out there on this topic.

Just about all cultures have their own particular beliefs on treatments, rituals, the role of healers, the significance of disease, death, etc. Should be volumes available on this stuff.

Good luck!

gwenith, BSN, RN · Jan 6, 2004

Haven't taught a course but this link is to SBS which was set up and maintains - under law - provision of multicultural programming and awareness in Australia . It is a very very rich resource for mulitculturalism. Hope this helps.

suzanne4, RN · Jan 20, 2004

This is one of the main topics of my program over here in Bangkok. If there is anything that I can help you with directly please send me a PM.

teeituptom, BSN, RN · Jan 20, 2004

My hospital has a daylong program on trans cultural awareness. So far I havent gone.

Cant you tell.

barb4575 · Jan 22, 2004

Vicky,

I hope you received that brief cultural handout that I faxed to you and that it helps.

Barbara

Kyriaka · Apr 5, 2004

Hi Vicky,

I just wanted to say that I think this is an excellent idea.

I can give two major examples where a lack of understanding in this area caused a problem. One is my own case.

First, let me say that I am going back to school to change careers. I will be getting a BSN and will be working critical care burns. I am a former burn patient (60% burns). Eventually I want to teach Bioethics.

I am a Greek Orthodox Christian. When I was in the burn center family & friends would bring in icons. One of the staff tried to have them removed from my room with the impression that these "religious" items were bad for me! That is totally not true! NEVER EVER remove these items. If they need to be moved because they are in the way, ask someone of the family (or Priest) to move them to a differant location.

I do know of a case of an Iranian girl who needed to be cather. Her parents were educated. However, a woman's anatomy is just not discussed in islamic countries. The family refused. The reason?? They thought a bladder cath. would "deflower" her. This was a major concern to them because returning to their own country she could be put to death for this "crime" (even if a medical procedure). The head nurse was brought in. They would not speak with her because she was a women. So a male nurse had to explain to the men of the family.

VickyRN, MSN, DNP, RN · Jul 23, 2004

:) I teach in an ASN program and am considering proposing an elective course on the topic of cultural competence. We discuss this in a med surg course, but I would like to take it deeper. Does anyone know of an ASN program with this type of course? I am only finding this type of offering in BSN and MSN programs. Feedback is appreciated.

We have no such course in our ADN program. However, respect for all different cultures/ religious expressions is woven throughout our 5 semesters of curriculum. We have also been enriched with multicultural students in our program: we have had student(s) from Zimbabwe, the Philippines, England, and other 'far-away' lands. We have to be careful how to phrase test questions: for instance, one test question included the term "Cracker Jacks" with which our international student was unfamiliar.

This may be of some help:

http://www.highbeam.com/library/doc3.asp?DOCID=1G1:90306172&num=3&ctrlInfo=Round5%3AProd%3ASR%3AResult&ao=

"Thoughts on cultural competence. (President's Message).(Brief Article)

Nursing Education Perspectives; 7/1/2002; Zungolo, Eileen

Commitment to the tenets of respect for all people and providing care that is based on thoughtful and sensitive assessment of their needs is the hallmark of nursing. The extent to which this can be achieved for individuals from the international community, who present with an array of values, beliefs, and patterns of behavior that may be alien to most American nurses, is dependent on our appreciation of the complexity of the analysis required.

AS THE "MELTING POT" OF MODERN SOCIETY, the United States has long been associated with diversity of peoples--ethnic variety, racial multiplicity, religious mixtures--and the complexity of values these represent. Within the profession of nursing, we have embraced a commitment to providing care to people who represent diverse value systems and to exploring ways in which the various needs individuals present can be assessed and managed within the health care system.

While these goals are laudable, I fear that we may have become somewhat glib. This is an era of globalization characterized by high mobility of populations. Our commitment to the provision of culturally competent care to all people may not be realistic. Indeed, if it is realistic, it is appropriate to ask at what level of authenticity this goal can be achieved.

It is simply not possible for any one person to be cognizant of all of the intricacies and need patterns that all cultural groups bring to daily life. Further, the way in which these needs change or are altered in health and disease increases that complexity by quantum leaps. One need only look at the pioneering work of Madeleine Leininger in the identification of culture care values, linguistic meanings, and action modes to discern the massive body of knowledge that is needed to fully provide culturally responsive care.

Commitment to the tenets of respect for all people and providing care that is based on thoughtful and sensitive assessment of their needs is the hallmark of nursing. The extent to which this can be achieved for individuals from the international community, who present with an array of values, beliefs, and patterns of behavior that may be alien to most American nurses, is dependent on our appreciation of the complexity of the analysis required.

While the provision of culturally sensitive care to individuals entrusted to us in health services is a complex task, the demand is equally onerous and equally fraught with problems for faculty members working with students from multiple cultures. In addition to considerable variation in values and beliefs, cultural differences are also reflected in "ways of thinking." Academic standards developed to provide educational markers within a western framework may be alien to students who learn at different paces, use language in ways atypical to institutions of higher education, and communicate in unique styles.

Fostering the learning of students from other cultures is a demanding, time-consuming challenge for the profession that must be met. The development of a corps of culturally diverse professional nurses is the ingredient needed to assure the continued expansion of the knowledge base of our profession.

Reference Leininger, M. M. (2001). Selected culture care findings of diverse cultures using culture care theory and ethnomethods. In M. M. Leininger (Ed.), Culture care diversity and universality:A theory of nursing (pp. 345-371). Sudbury, MA: Jones and Bartlett/National League for Nursing.

VickyRN, MSN, DNP, RN · Jul 23, 2004

This article may also be of benefit:

http://www.highbeam.com/library/doc3.asp?DOCID=1G1:96619979&num=2&ctrlInfo=Round5%3AProd%3ASR%3AResult&ao=

Cultural competence: an evolutionary perspective.

Nursing Forum; 10/1/2002; Burchum, Jacqueline L. Rosenjack

PROBLEM. The need for conceptual clarity, which is essential for effective communication related to cultural competence. Practice, education, administration, and research are identified.

METHODS. Rodgers' (2000) method of concept analysis.

FINDINGS. Attributes of cultural competence were identified as cultural awareness, cultural knowledge, cultural understanding, cultural sensitivity, and cultural skill.

CONCLUSIONS. Cultural competence can best be identified as a nonlinear dynamic process that is never ending and ever expanding. It is built on increases in knowledge and skill development related to its attributes.

Search terms: Concept analysis, cultural competence

**********

Cultural competence is a concept that has become a prevalent idiom in nursing literature. Almost every contemporary journal has published at least one article in which nurses are urged to engage in culturally competent practice, research, administration, or education. The precise meaning of the term, however, is often left open to each reader's interpretation. This is problematic because personal assumptions lead to relativistic interpretations, and divergent perspectives hinder discourse. Therefore, conceptual clarity is essential for effective communication related to cultural competence. Conceptual clarity can be enhanced through concept analysis.

In this article, Rodgers' (2000) method of concept analysis is used to provide an evolutionary perspective to the development of the term "cultural competence." The decision to use Rodgers' method, incorporating elements of an integrative review of the literature (Broome, 2000), was made after reading a concept analysis of cultural competence (Smith, 1998) based on criteria advocated by Wilson (1963) and Walker and Avant (1995). A number of nursing scholars (Morse, 1995; Morse, Hupcey, Mitcham, & Lenz, 1996; Rodgers) have remarked on the inability of the essentialist methods of concept analysis developed by Wilson and adapted by Walker and Avant to adequately capture the depth and complexity of a concept. The evolutionary perspective, as espoused by Rodgers, incorporates the realization that concepts change over time and across situations relative to associated contextual factors. The objective of using a different methodology was to uncover aspects that might provide a more meaningful and in-depth understanding of the concept.

Methods

Choosing the Setting and Example

The sample selection came from English-language journals and texts, as well as from academic and government Web sites concerned with issues of cultural competency. With the exception of key foundational works, most of the literature used in this analysis was published between 1995 and 2001. The primary reason for the prevalence of more current literature was the recent increase in publication of articles related to cultural competence. Because the principal concern was cultural competence in relation to nursing practice, most of the references were from the discipline of nursing. Relevant references from the disciplines of anthropology, education, medicine, psychology, sociology, and other related fields also were obtained. Databases used in the process of data collection included CINAHL, Medline, EBSCO, and InfoTrac. This comprehensive literature search yielded 854 references related to issues of cultural competence. One fifth of these articles were randomly selected for review. Additional resources referenced in an article's bibliography were consulted if they were the contributors of essential core points in the article.

In addition to references retrieved in this manner, nursing texts that were frequently referenced in the review of the literature or that were recommended by professional specialty organizations such as the Transculrural Nursing Society were consulted in order to grasp a greater understanding of cultural competency as it relates specifically to nursing practice. Finally, because Web sites are capable of immediate updates and can thus be the most current resource for information, discriminatory selection of authoritative Web sites also were included in the review. Applicable Web sites were located via Web ferret (http://www.zdnet.com/ferret/index.html), a utility tool that simultaneously queries multiple Internet search engines. Academic and government Web sites having cultural competence as a primary concern were selected for inclusion.

Collecting and Managing the Data

Because assimilation of information from such a large number of articles, texts, and Web sites was unwieldy, the main points from each article, text, and Web site were summarized and entered into a computer database along with associated identification information for referencing. All information was maintained in the author's original terminology, thereby eliminating one source of possible inferential inaccuracy as these summaries were being used in the process of concept analysis.

Analyzing the Data

For ease in data analysis, information in each summary was categorized. This was accomplished by using the high-lighter function to color-code sections of the computerized synopses according to thematic categories such as concept attributes and contexts. Separate pages devoted to common categories were then created by copying and pasting the like-colored passages along with their corresponding information for referencing. Finally, all information was organized according to dates in order to identify evolution of the concept over time. This was completed for both the article summary pages and for information in the category pages.

Interpreting the Results

Rodgers (2000) emphasizes the importance of using a heuristic approach to provide insight into a concept. A definition of the concept is not the objective; rather, the objective is to provide "the foundation and clarity necessary to enhance the continuing cycle of concept development" (p. 97). This is especially relevant when analyzing a dynamic concept such as cultural competence. What follows is a discussion of the attributes of cultural competence.

Findings

Origins of the Concept of Cultural Competence

In a 1993 letter to the editor of Nursing Outlook, Leininger notes that the term cultural competence was "first coined by me" (p. 281). While this is not disputed, a document in which Leininger defined the concept in earlier years was not located. The first published mention of the concept identified for this analysis was by Cross, Bazron, Dennis, and Isaacs (1989). Green's (1982) still earlier definition of "ethnic competence" contains elements of a beginning definition for cultural competence, despite the misnomer and the tendency to equate ethnicity with culture.

Definitions of culture, as used in modern parlance, generally include components given in the following explication. Culture is a learned (Axelson, 1993; Leininger, 1991, 1995; Purnell & Paulanka, 1998) worldview or paradigm (Leininger, 1991, 1995; Purnell & Paulanka) shared by a population or group (Axelson; Leininger, 1991, 1995; Pauwels, 1995; Purnell & Paulanka; Salmond, 2000; Schriver, 1995) and transmitted socially (Axelson; Leininger, 1990; Pumell & Paulanka) that influences values, beliefs, customs, and behaviors (Andrews & Boyle, 1999; Axelson; Leininger, 1991, 1995; Mead, 1955; Pauwels; Purnell & Paulanka; Salmond; Schriver) and is reflected in the language, dress, food, materials, and social institutions of a group (Leininger, 1991, 1995; Mead). Stated more simply, without references: Culture is a learned worldview or paradigm shared by a population or group and transmitted socially that influences values, beliefs, customs, and behaviors, and is reflected in the language, dress, food, materials, and social institutions of a group.

"Cultural," a derivative of culture, is the adjectival component of the concept of cultural competence. The term "competence" refers to performance that is sufficient and adequate. Synonyms for competence include capability, skill, fitness, aptitude, and expertise.

The Meaning of Cultural Competence

When using Rodgers' (2000) evolutionary method of concept analysis, it is the conceptual attributes that formulate the meaning of a concept, rather than definitions. The goal of this analysis, therefore, focuses on the identification of attributes of cultural competence rather than the development of a definition of the concept.

The following attributes of cultural competence are most consistently identified in the literature. For clarity in reading, references are provided separately in Table 1. Although some scholars may categorize certain dimensions differently; the attributes given below include all dimensions.

Attributes of Cultural Competence

Cultural awareness refers to the developing consciousness of culture and the ways in which culture shapes values and beliefs. Cultural awareness encompasses an understanding of the influences of one's own culture. Through an examination of personal heritage and values, one can begin to identify individual beliefs that are ethnocentric, biased, or prejudiced. This understanding provides a foundation for the appreciation of the values and beliefs of others and forms a basis by which one can begin to identify similarities and differences of cultures other than one's own.

Cultural knowledge refers to the continued acquisition of information about different cultures. Additionally, this phase incorporates learning related to conceptual and theoretical frameworks that can assist in the processing of facts and data. Cultural knowledge is an essential underpinning for cultural understanding.

Cultural understanding refers to the ongoing development of insights related to the influence of culture on the beliefs, values, and behavior of diverse groups of people. Through cultural understanding, one comes to recognize that with multiple perspectives come multiple truths, solutions, and ways of knowing. Also, through the process of cultural understanding, one can grasp the dynamics that lead to conflict between those of diverse cultures. Cultural understanding, then, forms the basis by which one can begin to address problems such as marginalization and subjection that may result when the beliefs and values of one culture differ from those of the dominant culture.

Cultural sensitivity develops as one comes to appreciate, respect, and value cultural diversity. In so doing, one also comes to realize how one's own personal and professional cultural identity influences practice. This stage is essential if one is to experience effective cultural interaction.

Cultural interaction refers to the personal contact, communication, and exchanges that occur between individuals of different cultures. One cannot develop cultural competency merely through reading or other intellectual exercise; rather, one must directly and actively develop personal or professional relationships. Through continued cultural interaction, one can progress in the development of cultural skill.

Cultural skill begins with the ability to communicate effectively with those of other cultures. For nurses and other professionals, cultural skill additionally includes the ability to incorporate the client's beliefs, values, and practices into the provision and planning of care. Additionally, one who is skilled culturally will be able to vary procedures and techniques to accommodate cultural beliefs and to vary health assessment to take into consideration any racial variations.

Cultural competence is a process of development that is built on the ongoing increase in knowledge and skill development related to the attributes of cultural awareness, knowledge, understanding, sensitivity, interaction, and skill. Cultural competence is manifested by the synthesis of these attributes and their respective dimensions in human interaction. It requires a caring and respectful provider-client relationship. For nurses, cultural competence assures care that is culturally relevant and accommodating to the beliefs, values, and practices of clients. Thus, care that is culturally competent is beneficial, safe, and satisfying to clients. Finally, care that is culturally competent equips clients with strategies for meeting their unique cultural needs and thus provides for self-empowerment.

Cultural proficiency, an additional construct included in some schemas as an attribute that follows cultural competence, represents a commitment to change. Activities that are considered evidence of cultural proficiency include those that provide for new knowledge and cultural skill, as well as the sharing of this information through publication, education, and other means.

The antecedent terms for cultural competence are cultural awareness, cultural knowledge, cultural understanding, cultural sensitivity, cultural interaction, and cultural skill. Some scholars (Cross et al., 1989; Orlandi, 1992; Villarruel, 1999) consider cultural proficiency to be an outgrowth of cultural competency and thus cultural proficiency would be considered a consequential term. On closer analysis, however, it is apparent that conduction of research and dissemination of new knowledge do not necessarily require that one possess cultural competence or, for that matter, any of the antecedent concepts. From an evolutionary perspective, this attribute is one that has begun appearing less often in the literature over time. Figure 1 provides a graphic representation of the process of cultural competence that incorporates the antecedent and consequential terms.

Although there has been a tendency by some to use terms such as cultural sensitivity to denote a conceptual equivalence to cultural competency, this and similar terms are actually components of cultural competence. The most closely related term uncovered in this concept analysis is that of cultural congruence as defined by Leininger (1999).

Culturally congruent care means to provide care that is meaningful and fits

with cultural beliefs and lifeway.... It refers to the use of emic (local

cultural knowledge and lifeways) in meaningful and tailored ways that fit

with etic (largely professional outsiders' knowledge) to help specific

cultures, whether ill, disabled, facing death, or facing other human

conditions.... Total or holistic lifeways of human beings, religion

(spiritual), kinship, politico-legal, education, technology, language,

environmental context, and worldview are all considered. This knowledge is

thoughtfully and selectively integrated with medical and nursing physical,

psychological, and other knowledge to provide congruent care. (p. 9)

Empirical Referents

Empirical referents to measure cultural competence consist primarily of self-evaluation tools. Examples include the Inventory for Assessing the Process of Cultural Competence (LAPCC) Among Health Care Professionals (Campinha-Bacote, 1997), the Program Self-Assessment for Cultural Competence (Weiss & Minsky, 1994), and the Cultural Competence Self-Assessment Questionnaire (Roizner, 1996). Additionally, there are several instruments that evaluate selected aspects of cultural competence, such as the Cultural Diversity Awareness Inventory (Henry, 1985), which measures one's attitudes, beliefs, and behaviors, and the Self-Examination in Transcultural Issues (Davis, 1994), which measures one's general cultural knowledge. Perhaps the best method to ascertain culturally competent care, however, is to incorporate healthcare recipients in the evaluation process. Although Warda (2000) relied on the perceptions of Mexican Americans in her qualitative analysis of culturally competent care, no quantitative instruments relying on client evaluations were discovered in the literature.

Identifying an Exemplar

According to Rodgers (2000), the purpose of an exemplar is to "illustrate the characteristics of the concept in relevant contexts and, as a result, enhance the clarity and effective application of the concept of interest" (p. 96). This exemplar, she emphasizes, must not be manufactured as is done with some methods of concept analysis. Providing an exemplar for cultural competence is a difficult task because cultural competence is dependent on the culture of the recipient of cam. Therefore, it is essential to recognize that examples of what is culturally competent can provided to a client of one culture might be culturally incompetent if provided to another. With this in mind, the following examples from a specific case am offered as exemplars.

Warda (2000) met with Mexican-American focus groups to obtain their perceptions of culturally competent care as provided by non-Hispanic healthcare providers. The following excerpts and quotes from Warda's article provide an example for manifestations of cultural competence.

* Focus group participants noted the manifestation of cultural skill pertaining to cultural interaction in communication, particularly in relation to the use of Spanish language. Beyond linguistics, however, participants recognized the importance of personalismo, which was defined as a "formal friendliness" and was characterized through evidence of respect, caring, and understanding. One participant mentioned, "What made it possible for me to share private things with the nurse was that she made me feel comfortable.... The nurse will say, `Let's talk.' It is a friendship" (p. 212). In this instance, personalismo additionally manifested the cultural competence components of cultural sensitivity and cultural interaction.

* The manifestation of cultural knowledge and cultural understanding was evident in the example of another focus group participant. He shared, "One thing that has probably helped is that he has taken courses in Latin America, and he is more conscious of all the problems...." (p. 212).

* The manifestation of cultural awareness, cultural knowledge, cultural understanding, and cultural sensitivity were recognized in an instance in which a physician demonstrated that he valued the patient's cultural beliefs regarding home remedies. "[The doctor] told me, `Take this medicine,' and he wrote it down. He then told me, `When we get the medicine, we will call you. In the meantime, if you want to use yerba buena or manzanilla tea, it is OK.'" (p. 212).

Rodgers (2000) writes, "The ultimate goal [of identifying exemplars] is to illustrate the characteristics of the concept in relevant contexts and, as a result, enhance the clarity and effective application of the concept of interest" (p. 96). Through these examples of various attributes of cultural competence, one can see how each attribute contributes to cultural competence. It is important to emphasize, however, that cultural competence embodies all attributes: cultural awareness, cultural knowledge, cultural understanding, cultural sensitivity, cultural interaction, and cultural skill. Thus, the exemplar in this instance is the combination of all the examples given rather than any single example.

Contextual Basis of the Concept

The concept of cultural competence is relatively new, with a significant evolution in its conceptualization between 1989 and 2001. From its inception, the concept has been used in reference to an individual's ability to provide culturally competent care. A trend in the later 1990s is that of also using the term cultural competence in relation to systems and organizations (Bureau of Primary Health Care, 2000; Center for Substance Abuse Prevention, 1999; National Center for Cultural Competence, 2000; U.S. Department of Health and Human Services [uSDHHS], 2000b).

Government associations generate the preponderance of literature supporting this perspective in an effort to reduce health disparities and to provide guidelines for compliance with standards such as Title VI of the Civil Rights Act (1964). A set of more recent recommendations, the National Standards on Culturally and Linguistically Appropriate Services (CLAS) in Health Care (USDHHS, 2000b) were established to assure compliance for healthcare agencies receiving federal reimbursement. These standards "provide guidelines for accreditation and credentialing" (http://www.omhrc.gov/clas/finalcultural 1a.htm). However, while these organization standards provide system supports for the provision of culturally competent care, they cannot ensure that those practicing within the agencies possess the attributes necessary to provide culturally competent care.

Identifying Implications

Implications for cultural competence in practice, education, administration, and research are readily apparent. Implications for nursing practice. Nurses practice from a wholistic perspective that does not focus solely on the body. Culture is inseparable from the person; thus, consideration of culture is an essential component of care. The ability of the nurse to deliver appropriate care to culturally diverse clients requires commitment to the process of becoming culturally competent. Culturally competent care will be better received by the client and will result in increased client satisfaction (Leininger, 1991, 1995). Perhaps the most obvious implication of in- corporating cultural competence in practice is that it improves quality and health outcomes (Denboba, Bragdon, Epstein, Garthright, & Goldman, 1998; USDHHS, 2000b). Another implication lies within the realm of social justice. Because people of nondominant cultures may experience oppression or marginalization, the culturally competent nurse must equip clients with self-empowerment strategies. Additionally, the nurse must be cognizant of opportunities to promote the development of attributes of cultural competence within the organization and community. Finally, the nurse should seek out opportunities in which professional and political power may be used to promote effective health policy.

Implications for nursing education. If nursing education is to prepare nurses adequately to take care of diverse populations, the task of beginning the process falls to those in the academic arena. Because nursing views the client from a wholistic perspective, the incorporation of cultural aspects of care will not pose a philosophical dilemma. Nursing educators will need to provide an increased focus on incorporation of cultural concepts into the educational process in order to provide a firm foundation on which the process of cultural competency may advance.

Implications for nursing administration. Those in administrative positions will need to ensure that personnel are adequately prepared to meet the unique needs of a culturally diverse client population. This may involve additional training and consultation by those who are specialists in this area. This also will require that adequate resources (e.g., medical interpreters, culturally appropriate written/audiovisual materials) are available as needed. Some authors recommend that organizations acquire a culturally diverse staff as a means to help ensure cultural competence (Brach & Fraser, 2000; Oyedeji, 1999; USDHHS, 2000a).

Implications for nursing research. There are great needs for research related to cultural competence. It is imperative that instruments be developed that progress beyond subjective self-assessments of nursing personnel. Certainly more studies need to be done to assess cultural competence from the perspective of the healthcare recipients, for it is they who can truly identify care that is culturally competent. Further, it is important to know exactly how cultural competency affects health outcomes. Similarly, more studies need to be undertaken to identify negative outcomes associated with the lack of provider cultural competence.

A Model for Cultural Competence

This concept analysis resulted in the discovery that the attributes of cultural competence can best be identified in terms of a process. This finding contradicts Capers' (1994) contention that cultural competence refers to end capabilities rather than process, and supports the assertions of others that cultural competence is a dynamic process or journey (Campinha-Bacote, 1998; Degazon, 2000; Like, 1998; Lister, 1999; Wenger, 1999).

This author has developed a model to demonstrate cultural competency as a process that manifests and implements all attributes that compose the process (see Figure 1). Unique to this model are the inextricable linkage of cultural competency and all its component attributes. The model depicts the concept as a nonlinear and expansive process of becoming that was earlier defined as being "built on the ongoing increase in knowledge and skill development related to the attributes of cultural awareness, knowledge, understanding, sensitivity, interaction, and skill."

Further Development of the Concept of Cultural Competence

One aspect of cultural competence that requires further development is the conceptualization of organizational cultural competence. Ideally, if nurses are to best meet the needs of those we serve, a model needs to be developed that provides for integration of provider cultural competence and organizational cultural competence.

Another area that bears investigation is the concept of cultural proficiency. As noted in the discussion, there may be conflicting perspectives regarding whether the concept of cultural proficiency as identified by its dimensions in the literature, is truly an outgrowth of the process of cultural competency. As additional qualities of this concept are delineated, clarity regarding the fit, or lack of fit, of this concept into the schema of the process of cultural competence can be determined.

Perhaps the most important implication lies within the understanding of the evolution of concepts. Cultural competency is not a static concept. Rodgers (2000) writes, "The cluster of attributes that constitutes the definition of the concept may change over time, by convention or by purposeful redefinition, to maintain a useful, applicable, and effective concept" (p. 81). As the people of the world become more mobile and populations more diverse, and as practice and research related to cultural competence discloses additional attributes, understanding of the concept will continue to develop and evolve. It will be necessary, therefore, that subsequent conceptual analyses be performed in order that clarity may continue over time.

Conclusion

Concept analysis methods can be used to provide clarity of meaning. The concept of cultural competence was analyzed through application of Rodgers' evolutionary method. This analysis revealed that cultural competence is developed as a nonlinear process that is never ending and ever expanding. Because culture is inseparable from the person and because nursing incorporates a wholistic perspective, cultural competence has important and implications for nursing practice, education, administration, and research.

VickyRN, MSN, DNP, RN · Jul 23, 2004

Numerous links for Cultural Competency on this web page:

http://www.bsn-gn.eku.edu/BEGLEY/nsglinks4.html#Cultural%20Competency