Week8 health assignment HSCI 430

Open Posted By: highheaven1 Date: 14/10/2020 High School Case Study Writing


This week you read about how cultural competence training should focus on learning knowledge and skills with an emphasis on developing these as time progresses. Training should also be specific to the unique roles employees have within an organization. Imagine that you are a CME instructor and you are giving a day-long training on breastfeeding to a group of obstetrical nurses. Your supervisor provides you with Chapter Six from this text and tells you to integrate the training and cultural competency principles into your training or you may not receive your employee bonus for the year.

A. Describe at least four concepts and skills from chapter six that you would integrate in your training and how exactly you will do this.  *Be sure to describe both what you will use and how, or points may be deducted. 

B. Describe four activities you would include in the training that integrate concepts from the chapter (such as the eight questions or the Healing-by-Heart Model). Review chapter six for ideas of activities to use. 

Category: Mathematics & Physics Subjects: Algebra Deadline: 24 Hours Budget: $80 - $120 Pages: 2-3 Pages (Short Assignment)

Attachment 1

Training for Knowledge and Skills in Culturally Competent Care for Diverse Populations


To distinguish between cultural competence training focused on attitudes and training focused on knowledge and skills

To clarify principles that support knowledge and skills training in health care

To examine the essential knowledge and skills training for health care management

To examine the essential knowledge and skills training for persons involved in direct patient care

To describe how cultural competence knowledge and skills can enhance the therapeutic encounter

To describe how support service employees in health care can benefit from skills and knowledge training

To examine factors involved in assessing cultural competence training

To list some of the cultural competence training resources available


Goals of Cultural Competence Skills and Knowledge Training

Increased quality of care to diverse populations

Clinical excellence and strong therapeutic alliances with patients

Reduction of health care disparities among the population served

Workforce that performs effectively within a diverse service community

Eight Principles for Knowledge
and Skills Training

1. There should be a broad and inclusive definition of cultural and population diversity including consideration of races, ethnic groups, social classes, age cohorts, genders, and LGBTs.

2. Training should not be a one-time undertaking but should be developmental and ongoing, moving from general information to the more specific.

8 Principles for Knowledge
and Skills Training

3. Knowledge and skills training should not be one-size-fits-all but should be focused on specific job-related functions and health care disciplines.

4. Knowledge and skill training should be focused on factual information and how-tos with practical application rather than theory or didactics. The training should be viewed as augmenting existing skills and knowledge bases.

8 Principles for Knowledge
and Skills Training

5. Cultural competence knowledge and skills training should be integrated into as many other types of training as possible.

6. Knowledge and skill training should be buttressed by ongoing self-assessment as well as feedback to the trainers and organization.


8 Principles for Knowledge
and Skills Training

7. Whenever possible, there should be an attempt to build an evidence base for the training by looking at health outcomes, costs, and patient, provider, and consumer satisfaction data following implementation of training.

8. No cultural competence trainings should take place until and unless the sponsoring health care organization or institution is ready and able to support the knowledge and skills that are taught in the training.

Cultural Competence Knowledge & Skills for Administrators & Directors

Data – census data, community-based training, demographics of service area compared to market share

Diversity epidemiology – health care needs of specific groups within population base

HEDIS measures – health care outcomes by ethnic and racial groups, and other diversity dimensions

Cultural Competence Knowledge & Skills for Administrators & Directors

Legislation – national and state level

Accreditation requirements – Joint Commission, NCQA, etc.

Know enough to make good hires in key positions – see guide by the Industry Collaborate Effort (2006)

Oversee HR in selection of trainers

Must model the cultural competence they want to see from all staff

Diversity Training for Administrators

Often includes generational/gender differences in communication, LGBT employee concerns, mediating disputes, managing religious diversity

Case examples and interaction are excellent training tools

Executive coaches as needed

Only administrators who model cultural competence themselves can create a culture, climate, and infrastructure for culturally competent patient care and develop and lead a culturally competent health care organization.

Cultural Competence Training for Health Care Professional in Direct Patient Care

Good training models have been developed for nurses and physicians

Support exists from accrediting bodies (e.g. AACN, AAMC), practice organizations (ANA, ADA, NLN), and professional bodies of literature for cultural and linguistic competence education as part of professional knowledge and practice

Trends in Clinical Education

Legislation exists to require cultural competence training for physicians in NJ, CA, WA, NY, AZ and OH

More web-based programs and webinars now exist

Essential focus on care-giving relationship between provider and patient, as well as service delivery to diverse patient populations

Motivated by desire to deliver high quality care with good outcomes

Cultural Competence in Clinical Education

Model programs:

Medical education – Harvard Medical School

Nursing educators – National League of Nursing toolkit

Residency programs – White Memorial Medical center

Cultural Competence Training in Clinical Education

For those already in practice:

  • Continuing education in-house
  • Specialty-based conferences and seminars
  • Integrated into existing training, i.e. cardiology, diabetes, HIV/AIDS

Universal Aspects of Culture Affecting Health Care

Cultural, trait-based lists promote stereotypes and have limits

Universal factors exist that are found in all cultures

Considering these allows for more personalized patient care

Cultural Factors Affecting
Health Care - 1

Meaning of symptoms

Perceptions of anatomy and bodily functions

Perceptions of appropriate treatment

Autonomy and self-efficacy

Gender roles

Childbirth and reproduction

Cultural Factors Affecting
Health Care - 2

Family involvement and inclusion

Orientation to prevention

Pain expression and management

Diets and dietary practices

Concepts of death and dying

Expectations of health professionals

Patient Care Impacts

Aspects of diagnosis

Treatment expectations

Ability to follow treatment plan

Expectations of family and care team

Training Implications

Developmental training – focusing on specific areas of service delivery

Cultural epidemiology – study of the way in which cultural norms, values, and behavior affects the onset, course, and outcome of disease, as well as its incidence and prevalence

The Eight Questions

Kleinman, Eisenberg, and Good (1978):

1. What do you think caused your sickness or problem?

2. Why do you think it started when it did?

3. What do you think the sickness does to you? How does it work?

4. How severe is your sickness? Do you think it will last a short time or a long time?

The Eight Questions

5. What are the chief problems the sickness has caused you?

6. What do you fear most about this sickness?

7. What kind of treatment do you think you need?

8. What are the most important results you hope from the treatment?

The Eight Questions

Yield insight into patient’s explanatory model

Provide an understanding of the patient’s subjective experience of the condition

Provide an opportunity to acknowledge differences between the patient’s and provider’s models for the illness

Negotiate agreement about treatment

Build trust and therapeutic alliance

LEARN (Berlin & Fowkes, 1983)

L = listen with empathy and understanding to the patient’s problem

E = explain your perception of problem

A = acknowledge and discuss differences and similarities

R = recommend treatment

N = negotiate treatment when necessary

Use of case studies

Can provide context

Form a basis for discussion

Interprofessional learning allowing for a collaborative approach

Lend themselves to video presentations to enhance discussion

Figure 6.1 - The Healing-by-Heart Model for Culturally Responsive Health Care
Source: Culhane-Pera, K. A., Vawter, D. E., Xiong, P., Babbett, B., & Solberg, M. M. (2003). Reprinted with permission

Training Obstacles

Provider resistance

Perception of “soft skill” training vs. evidence based medical training

Skill and experience level of the trainer

Cultural Competence Training for Support Staff

Support staff = service workers (security, food service, environmental service), non-clinical (clerks, transporters, receptionist)

Often left out of training, but are often the first and last point of contact for patients

Resource – Cultural Competence: It All Starts at the Front Desk from the National Center for Cultural Competence

Role of Assessment

Final step – feeds back into the training loop

Can be at the individual or organizational level, but difficult to measure and assess

Using pre- and post-test measures

Patient satisfaction surveys

Self-assessment instruments

Key Terms

Case studies

Community-based training

Continuing education

Cultural epidemiology

Developmental training


Ethnomedical syndromes


Evidence based medicine

Executive coaches

Job function

Market share




Therapeutic alliance