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Posts tagged ‘cultural diversity’

Ethnic Diversity and Advanced Health-related Decisions

Our latest featured article it titles “Health-Related Decisions for Serious Illness Among Ethnically Diverse Older Adults” by Zahra Rahemi, PhD, RN; Christine Lisa Williams, DNSc, RN, PMHCNS; Ruth Marchand Tappen, EdD, RN, FAAN and Gabriella Anna Engstrom, PhD. The article is available for free download while it is featured, and we welcome your comments here! In this article, the authors discuss the evidence from their study that supports the great variability in individual situations at the end of life, and the importance of nursing care that remains responsive to each particular situation.  Dr. Rahemi provided this background for ANS reviewers:

Universally, the population of older adults is dramatically growing. In the United States, culturally and ethnically diverse older adults are one of the fastest growing population. Cultural factors, including ethnicity, acculturation, and spirituality, have significant influence on diverse older adults and how and what they plan for their healthcare. Therefore, there is a need for multiple care options to avoid predetermined clinical practice guidelines for ethnically diverse older adults.

Cultural beliefs and value systems frequently prevent people from healthcare service use and healthcare decision making, which contribute to healthcare disparities for ethnically diverse older adults. In my current studies, I am interested in investigating factors that are pivotal for communication of decisions in advance. Innovative strategies to help individuals determine their goals of care are needed to clarify health-related decisions that ethnically diverse individuals may find challenging to articulate. Because ethnically diverse communities have strong family ties in general, the authors encourage informal and general discussions about goals of care among these communities. These conversations may ultimately inform significant others who are called upon to make decisions when older adults cannot. The new strategies recommended in this study may open new venues for professional development in nursing and ultimately promote culturally competent care.

In the field of ethnically diverse older adults and their healthcare decisions and preferences, the I started with a broad literature review and an integrative review that was published in ANS. Later, I continued my research in different ethnically diverse communities using different lenses, such as end-of-life preferences, health-related decisions for serious illness, and attitudes and behaviors regarding planning ahead for end-of-life care. I hope to introduce more innovative strategies to encourage ethnically diverse older adults to communicate their desired care choice when they are capable to communicate.


Promoting Health for Hispanic Women

The current featured ANS artice addresses the challenge of cultural diversity and understanding cultural factors that influence health.  This article, titled “Evaluation of 3 Behavioral Theories for Application in Health Promotion Strategies for Hispanic Women” by Daisy S. Garcia, PhD, MSN, examines these complex issues.  The article is available to download at no cost while it is featured on the ANS website, and we invite you to read this article and return here to share your comments!  Here is

Daisy Garcia

Daisy Garcia

Dr. Garcia’s message for ANS readers about her work:

I want to thank ANS for giving me the opportunity to share this article with its readers—particularly with those who work in finding ways to enhance the health of Hispanic/Latino women living in the Unites States.

Behavior modification is key for a healthy life, free of diseases. This task can be difficult to achieve in diverse populations such as Hispanic women. There are a variety of ways in which this group of women differs. For example, independent of the number of years that Hispanic women have lived in the U.S., some women maintain strong cultural believes, while others easily acculturate and adopt new behaviors to function effectively in different environments. The obstacles that Hispanic women need to overcome to access health care are additional factors that may limit health practitioners’ ability to reach these women in order to educate and inform them about practicing healthy behaviors. Health education through health promotion programs are instruments that can successfully achieve health-enhancing behavioral change—specifically, those programs designed using a theoretical framework that suggests ways to attain positive behavior change.    

My experience working with Hispanic women and my background as an educator led me to look into health promotion strategies addressing Hispanic women as well as to identify the theories guiding these strategies so that I could incorporate them into my teachings. Through this quest, I found that information on the selection of theories suitable for developing a health strategy catering to the diverse population of Hispanic women was scarce. In this article, I analytically evaluate two of the most common behavioral theories in health promotion and a nursing theory in the context of access to U.S. health care by Hispanic women. This evaluation is completed using a practical instrument, as the purpose of this article is also to offer readers an example of theory evaluation with a less complex, yet complete and reliable theory evaluation instrument to fit health promotion strategies.

Critical Cultural Competence

In the current, very timely “Editor’s Pick” article titled “Critical Cultural Competence for Culturally Diverse Workforces: Toward Equitable and Peaceful Health Care, Dr. Adel F. Almutairi and Dr. Patricia Rodney describe the concept of “critical cultural competence” as essential to peace and health.  In their analysis, they view peace as not only a political responsibility of the state, but also a sociocultural concept that is relevant to all human encounters, animated by the ideal of human dignity.  The basis for this perspective is described in the article as follows:

The theoretical underpinnings of the approach to critical  cultural competence that we articulate in this article is an extension of the findings from Almutairi’s doctoral research project, which was a qualitative exploration of the cultural competence of a multicultural nursing workforce in a tertiary hospital in Saudi Arabia.  The nursing workforce in that Saudi tertiary hospital includes nurses from more than 25 nationalities from different parts of the world who provide care to the indigenous people of Saudi Arabia. The findings in Almutairi’s doctoral research project explicated the complex nature of cultural and linguistic diversity during clinical encounters. He found that this diversity poses threats to the physical, psychological, emotional, spiritual, and cultural safety of nurses, patients, families, and their communities. Such threats are caused by the increased potential for cultural clashes, negative attitude, and misunderstandings related to both communication and behavior. (p. 203)

Using evidence from Dr. Almutairi’s research, they present an analysis of the challenges of working in a multicultural environment, as well globe300as insights that can lead to peace in health care delivery.  They conclude:

 In this article, we have argued that because of its foundations in postcolonial theory and cultural safety—as well as its operationalization through critical awareness, critical knowledge, critical skills, and empowerment—critical cultural competence offers an action orientation from which to enact our shared responsibility and address structural injustices. It is our conviction that as a nursing profession we are well positioned to look toward the future and share responsibility locally, nationally, and globally to foster equitable and peaceful heath care. (p. 209)

I hope that ANS readers will find this message relevant, will share this work broadly, and will join the challenge to foster equitable and peaceful health care.  To download your copy of the article at no cost, visit the ANS web site now!


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