Ruth Davidhizar

American Academy of Nursing Expert Panel Report Developing Cultural Competence to Eliminate Health Disparities in Ethnic Minorities and Other Vulnerable Populations

The members of the Expert Panel on Cultural Competence of the American Academy of Nursing (AAN) envisioned this article to serve as a catalyst to action by the Academy to take the lead in ensuring that measurable outcomes be achieved that reduce or eliminate health disparities commonly found among racial, ethnic, uninsured, underserved, and underrepresented populations residing throughout the United States. The purposes of this article are to (a) assess current issues related to closing the gap in health disparities and achieving cultural competence, (b) discuss a beginning plan of action from the Expert Panel on Cultural Competence for future endeavors and continued work in these areas beyond the 2002 annual conference on Closing the Gap in Health Disparities, and (c) provide clearly delineated recommendations to assist the Academy to plan strategies and to step forward in taking the lead in reshaping health care policies to eliminate health care and health disparities.

The Giger and Davidhizar Transcultural Assessment Model.

The Giger and Davidhizar Transcultural Assessment Model was developed in 1988 in response to the need for nursing students in an undergraduate program to assess and provide care for patients that were culturally diverse. The model includes six cultural phenomena: communication, time, space, social organization, environmental control, and biological variations. These provide a framework for patient assessment and from which culturally sensitive care can be designed.

Church and Spirituality in the Lives of the African American Community

The African American church is held in the highest esteem by most African Americans. Although the influence of the African American church has been underestimated by physicians and nurses, it could be pivotal in optimizing health status among African Americans. Because of this influence, health care practitioners, including nurses, are now recognizing the important role that the African American church plays in improving the health status of individuals in the African American community. This article illuminates the health and health care concerns of the African American community by considering the traditional lack of equal access for this population and the role that the church can play in not only offering church-based health care services but also improving the health status of church congregations. Future roles of the African American church for improved health status are also suggested.

Storytelling as a teaching technique.

For centuries storytelling has been used a powerful communication vehicle. It is also useful in nursing education to enhance self-esteem, develop critical thinking, model behaviors, and to teach cultural sensitivity and communication skills. The authors discuss the use of storytelling in the nursing literature and in a nursing course.

Problem-based learning in a competency-based world.

This article addresses the needed shift in nursing education from an information-driven approach in teaching to a process that promotes higher level thinking and clinical judgement. Strengths and weaknesses of problem-based learning and competency-based education in nursing are presented. Whereas the former focuses on critical thinking and clinical judgement, the latters emphasis is on clinical competency. The appropriateness of the philosophies in both academic and practice settings is discussed.

Using role play to develop cultural competence.

Role play is a useful teaching strategy for nursing education. This strategy can simulate patient behaviors, as well as demonstrate nursing interventions that students must learn to be clinically competent. Role play is a dramatic technique that encourages participation to improvise behaviors that may be encountered in nurse-patient situations. Using this technique, participants may test behaviors and decisions in an experimental atmosphere without risk of negative effects in a relationship. Role play is useful in developing cultural competence because participants may experience diverse roles. Cultural competence is the ability to care for patients in a culturally sensitive and appropriate manner. In role play, students may participate as culturally diverse patients or as nurses encountering patients from different cultures. Various teaching strategies facilitate successful use of role play in the classroom, including defining a time frame, selected roles, specific objectives, references, and grading criteria. To optimize learning, the importance of exploration and analysis must be emphasized. Many benefits and potential problems accompany use of role play.

The changing role of grandparenthood.

For many grandparents in America, caring for grandchildren has become a full-time responsibility that has led to multiple stresses. Raising grandchildren may cause financial stress, cramped living quarters, role restriction, and social isolation among this group. However, advantages to this role among grandparents can include greater life satisfaction and a positive influence on the other generations within the family. Nurses and other health providers can play an essential role in assisting grandparents caring for grandchildren by strategically building family strengths and cohesiveness.

Using case studies to teach clinical problem-solving.

The case study method is a useful student-centered learning strategy that allows students to solve real-world problems in the safe environment of the classroom. The authors discuss the strengths and limitations of this method and strategies for developing and using case studies in the classroom.

Conflict management styles of Asian and Asian American nurses: implications for the nurse manager.

About 4% of the 2.7 million U.S. registered nurses were internationally educated (Spratley, Johnson, Sochalski, Fritz, & Spencer, 2000). Among foreign nurses in the United States, the majority of them came from Asia, especially the Philippines and India. For instance, in the last National Sample Survey of Registered Nurses, 38.9% and 10.9% of sampled foreign nurses came from the Philippines and India, respectively (Spratley et al., 2000). With the growing nurse shortage in the United States, recruitment of nurses from other countries is bound to intensify in the years ahead. Based on the research literature, this article reviews the challenges facing Asian nurses in a foreign health care environment. The purpose is to inform health care administrators and American coworkers about these unique challenges and to improve understanding of this special segment of the U.S. nurse workforce.

Educating the Culturally Diverse Healthcare Student

Diversity among healthcare students is increasing as the population of the United States changes in composition. Preparation of the culturally diverse healthcare student presents a challenge for recruitment, education, and retention. The problems of education can be ameliorated by a thorough assessment of the culturally diverse student using the Giger and Davidhizar model. The student should be assessed for differences by considering six interrelated factors: communication, space, time, social organization, environmental control, and biological variations. Understanding the differences that exist in these areas is a first step toward appreciating the diversity among people of varied cultures.