The information presented here highlights resources that assist with independent learning to help nursing faculty and other interested professionals incorporate cultural competence skills into nursing curricula and practice.

What is culturally competent health care?

CIRRIE - Center for International Rehabilitation Research Information and Exchange
Index to published research conducted outside of the United States . The downloadable monograph series is worth a look. The computer based tutorial, Successful Outreach to Foreign-Born Consumers through Culture Brokering, in CD Rom format for PC platforms, is available online for a fee, and at the Health Sciences Library. It features video clips from a Culture Brokering workshop, a multiple choice test, and certificate of completion. The tutorial is an adaptation of the monograph Culture Brokering: Providing Culturally Competent Rehabilitation Services to Foreign-Born Persons by Mary Ann Jezewski and Paula Sotnik. Although it has incorporated terminology, examples and case studies in a context relevant to independent living services for people with disabilities, the basic information is relevant to other situations.

Hospitals, Language, and Culture: A Snapshot of the Nation
The Joint Commission

The Center for Cross-Cultural Health (CCCH)
The library component contains excellent profiles, but the whole site was recently revamped and provides limited information at present. The research page is currently under construction.

Center for Healthy Families and Cultural Diversity
Department of Family Medicine/UMDNJ-Robert Wood Johnson Medical School

National Center for Cultural Competence (NCCC)
Georgetown University Center for Child and Human Development
Maintains a searchable database and excellent documents and policy briefs.

Think Cultural Health
U.S. Department of Health and Human Services, Office of Minority Health
Offers the latest resources and tools to promote cultural competency in health care. Their flagship program, A Family Physician's Practical Guide to Culturally Competent Care, is a free online educational program accredited for physicians, nurses, and pharmacists.

Allied and Complementary Medicine database

Continuum Center for Health and Healing
Initiative of Beth Israel Medical Center in New York City.

National Center for Complementary and Alternative Medicine

The Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine

Crosswalk of Joint Commission and CLAS Standards (pdf)

Joint Commission Standards that Support the Provision of Culturally and Linguistically Appropriate Services (May 2007, pdf)

Centers for Medicare and Medicaid Services
Excellent series of downloadable files on many areas essential to promoting cultural competence.

National Council on Interpreting in Health Care
Good Working Paper series.

Office of Minority Health: Center for Linguistic and Cultural Competence in Health Care
In 2000, the United States Department of Health and Human Services (DHHS) Office of Minority Health (OMH) released national standards for culturally and linguistically appropriate services (CLAS) as a means to address and correct inequities that exist in the provision of health care to culturally and ethnically diverse groups. These standards are found here (National Standards for Culturally and Linguistically Appropriate Services in Health Care EXECUTIVE SUMMARY) . Another report available at OMHRC is National Standards on Culturally and Linguistically Appropriate Services (CLAS).

Reflections on the CLAS Standards: Best Practices, Innovations and Horizons, October 2003, Cross Cultural Health Care Program and Office of Minority Health, Office of Public Health and Science. 93 pages.
A report on “best practices” based on the CLAS standards.

SPIRAL: Selected Patient Information Resources in Asian Languages
Health resource for Asian Americans whose first language is not English. Detailed health information is available in Chinese, Hmong, Khmer, Korean, Laotian, Thai and Vietnamese. Designed for use by health care workers as well as patients.

The Yamada WWW Language Guides Contains information about 140 languages. There are 112 fonts in the archives for 40 languages.

Good work is coming out of The California Endowment – see California Endowment Publications and California Endowment Resources for more information. They espouse a multicultural approach to health, which is defined not only by race and ethnicity, but financial status, cultural beliefs, gender, age, sexual orientation, geographic location, immigration status, and physical or mental abilities. Intended as companion pieces, the following three items are worth printing and contain excellent information:

• A Manager's Guide to Cultural Competence Education for Health Care Professionals - 2003, 54 pages Resource Section 2 - Guidebooks and Manuals (pages 14-20) are especially useful
  Resource Section 3 - Models for Culturally Competent Health Care - excellent bibliography
  Resource Section 4 - Assessing the Cultural Competence of Organizations and Health Care Personnel - contains an excellent annotated list

• One Size Does Not Fit All - pdf. With Joint Commission, framework for hospitals to develop and employ practices for meeting diverse patient needs and organizational cultural competence

• Principles and Recommended Standards for Cultural Competence Education of Health Care Professionals - 2003, 94 pages. Excellent video and web site list in appendices. Intended for use with the companion piece above.

• Resources in Cultural Competence Education for Health Care Professionals - 2003, 146 pages

Cultural Competence Resources
Supported by the Center for Effective Collaboration and Practice

Cross-Cultural Issues in Primary Care Module
A downloadable workshop on issues of ethnocentrism, language and communication in health care and culturally appropriate medicine. 68 pages, 1994, revised 1999.

Resources for Infusing Diversity in Coursework, Practice & Training, 7 page pdf file, undated.

Self-Administered Instruments to Measure Cultural Competence of Health Professionals: A Systematic Review by Aysegul Gozu, Mary Catherine Beach, Eboni G. Price, Tiffany L. Gary, Karen Robinson, Ana Palacio, Carole Smarth, Mollie Jenckes, Carolyn Feuerstein, Eric B. Bass, Neil R. Powe, Lisa A. Cooper. Teaching and Learning in Medicine, Volume 19, Issue 2 May 2007 , pages 180 - 190
DOI: 10.1080/10401330701333654

Toward Culturally Competent Care: A Toolbox for Teaching Communication Strategies
170-page curriculum is organized into eleven sections that focus on teaching clinicians to recognize cultural differences in patient interactions and use specific communication skills to improve patient care. The materials organized can be adapted for sequential one-hour sessions or for daylong seminars. Need to buy, no pdf.

CIRRIE - Center for International Rehabilitation Research Information and Exchange
Provides a downloadable monograph series that is definitely worth a look. The computer based tutorial, Successful Outreach to Foreign-Born Consumers through Culture Brokering, in CD Rom format for PC platforms, is available online for a fee, and at the Health Sciences Library. It features video clips from a Culture Brokering workshop, a multiple choice test, and certificate of completion. The tutorial is an adaptation of the monograph Culture Brokering: Providing Culturally Competent Rehabilitation Services to Foreign-Born Persons by Mary Ann Jezewski and Paula Sotnik. Although it has incorporated terminology, examples and case studies in a context relevant to independent living services for people with disabilities, the basic information is relevant to other situations.

Instruments

Bernal H., Froman R. Influences on the cultural self-efficacy of community health nurses. Journal of Transcultural Nursing. 4(2):24-31, 1993 Winter. [Note: this v. is not online]
Presents the results of factor and regression analyses conducted on the Cultural Self-Efficacy Scale to determine the underlying conceptual structure, and relationship to demographic variables.

Bernal H, Froman R. The confidence of community health nurses in caring for ethnically diverse populations. Journal of Nursing Scholarship. 19(4):201-3, 1987 Winter . [note: this article not online in this database]Community health nurses (N = 190) responded to a Likert-type cultural self-efficacy scale to determine their degree of confidence in caring for three distinct populations (blacks, Puerto Ricans and Southeast Asians). Broome B, McGuinness T. A CRASH course in cultural competence for nurses. Urologic Nursing. 27(4):292-4, 304; quiz 295, 2007 Aug.

Brown SA, Hanis CL. Culturally competent diabetes education for Mexican Americans: the Starr County Study. Diabetes Educator. 25(2):226-36, 1999 Mar-Apr.
In Starr County , a Texas-Mexico border community, investigators designed and tested a culturally competent intervention aimed at improving the health of Mexican Americans.

Carter KF, Xu Y. Addressing the hidden dimension in nursing education: promoting cultural competence. Nurse Educator. 32(4):149-53, 2007 Jul-Aug.

Connolly IM, Darby ML, Tolle-Watts L, Thomson-Lakey E. The cultural adaptability of health sciences faculty. Journal of Dental Hygiene. 74(2):102-9, 2000 Spring.

Cornelius LJ, Booker NC, Arthur TE, Reeves I, Morgan O. The validity and reliability testing of a consumer-based cultural competency inventory. Research on Social Work Practice. 14(3):201-9, 2004 May. (33 ref).
A statewide data collection effort was implemented to assess the validity and reliability of a 52-item consumer assessment instrument of the cultural competency mental health providers.

Doorenbos AZ, Schim SM, Benkert R, Borse NN. Psychometric evaluation of the cultural competence assessment instrument among healthcare providers. Nursing Research. 54(5):324-31, 2005 Sep-Oct.Examines the test-retest reliability of the cultural competence assessment instrument among both hospice, and non-hospice, providers

Rorie JA, Paine LL, Barger MK. Primary care for women. Cultural competence in primary care services. Journal of Nurse-Midwifery 41(2):92-100, 1996 Mar-Apr.

Schim SM, Doorenbos AZ , Miller J, Benkert R. Development of a Cultural Competence Assessment instrument. Journal of Nursing Measurement 11(1):29-40, 2003 Spring-Summer. [Note: this title is not online]
Describes initial testing of an instrument, the Cultural Competence Assessment (CCA) instrument, designed to provide evidence of cultural competence among health care providers and staff.

Warda MR. Development of a measure of culturally competent care. University of California , San Francisco, PH.D. (165 p) 1997.
The purpose of this research was to develop and test an instrument to measure the components of culturally competent care for Mexican-Americans.

Models

Campinha-Bacote, J. (1998). The process of cultural competence in the delivery healthcare services: A culturally competent Model of care (3rd ed.). Cincinnati , OH : Transcultural C.A.R.E. Associates.
HSL owns: WA 300 C195p 1998

Capell J, Veenstra G, Dean E. Cultural competence in healthcare: critical analysis of the construct, its assessment and implications. Journal of Theory Construction & Testing. 11(1): 30-37, 2007 Spring-Summer. A critical review of models and assessment tools related to cultural competence, identifying four models with assessment tools.

Griswold K, Zayas LE, Kernan JB, Wagner CM. Cultural awareness through medical student and refugee patient encounters. Journal of Immigrant and Minority Health. 9(1): 55-60, 2007 Jan. Findings from a qualitative investigation of cultural awareness that medical students developed in the context of providing medical care to refugees.

Harper MG. Ethical multiculturalism: an evolutionary concept analysis. Advances in Nursing Science. 29(2): 110-24, 2006 Apr.

Hobgood C, Sawning S, bowen J, Savage K. Teaching and culturally appropriate care: a review of educational models and methods. Academic Emergency Medicine. 13(12): 1288-95, 2006 Dec. Highlights the rationale for, and current problems in, teaching cultural competency. The article examines several different models implemented to teach and promote cultural competency along the continuum of emergency medicine learners.

Lipson JG, DeSantis LA. Current approaches to integrating elements of cultural competence in nursing education. Journal of Transcultural Nursing. 18(1): 10s-20s [supplement], 2007 Jan. Describes five teaching and learning methods–specialty focus, required courses, models, immersion experiences, and distance learning or simulation.

Purnell L. The Purnell Model for Cultural Competence. Journal of Multicultural Nursing and Health. 11(2): 7-15, 2005 Summer.

Shen Z. Cultural competence models in nursing: a selected annotated bibliography. Journal of Transcultural Nursing. 15(4): 317-22. 2004 Oct. Provides bibliographic entries to books, book chapters, and journal articles that deal with the construction, development, or conceptualization of cultural competence and cultural assessment models.

Suh EE. The model of cultural competence through an evolutionary concept analysis. Journal of Transcultural Nursing. 15(2): 93-102, 2004 Apr.

Tools for Cultural Brokers/Explanatory Model Assessment Questions for Rehabilitation Service Providers

Theories

Giger JN. Davidhizar R. The Giger and Davidhizar Transcultural Assessment Model. Journal of Transcultural Nursing. 13(3):185-8, 2002 Jul.

Purnell L. The Purnell Model for Cultural Competence. Journal of Transcultural Nursing. 13(3):193-6; discussion 200-1, 2002 Jul. Provides an overview of the Purnell Model for Cultural Competence and the assumptions on which the model is based.

Campinha-Bacote J. A model and instrument for addressing cultural competence in health care. Journal of Nursing Education. 38(5):203-7, 1999 May.

Jezewski, M.A. Evolution of a grounded theory: Conflict resolution through culture brokering. Advances in Nursing Science. 17 (3), 14-30, 1995. Good information about the Cultural Brokering Model in Successful Outreach to Foreign-Born Consumers Through Culture Brokering, a tutorial on CD-ROM available in the Digital Media Resources Center at HSL (check BISON) and Jezewski's Culture-Brokering Model.

Shapiro ML, Miller J, White K. Community transformation through culturally competent nursing leadership: application of theory of culture care diversity and universality and tri-dimensional leader effectiveness model. Journal of Transcultural Nursing. 17(2): 113-8, 2006 Apr.

CIRRIE - Center for International Rehabilitation Research Information and Exchange
The computer based tutorial, Successful Outreach to Foreign-Born Consumers through Culture Brokering, in CD Rom format for PC platforms, is *available online for a fee*, and at the Health Sciences Library. It features video clips from a Culture Brokering workshop, a multiple choice test, and certificate of completion. The tutorial is an adaptation of the monograph Culture Brokering: Providing Culturally Competent Rehabilitation Services to Foreign-Born Persons by Mary Ann Jezewski and Paula Sotnik. Although it has incorporated terminology, examples and case studies in a context relevant to independent living services for people with disabilities, the basic information is relevant to other situations.

Communicate to Make a Difference: Exploring Cross-Cultural Communication
Web-based course in three modules introducing many facets of culture and communication in a stimulating format. Learners must make decisions in a real-world public health scenario, while discovering communication strategies they can employ in their daily work. This free course may be completed at one’s own pace within a 30-day period. Registration required. Sponsored by the NYNJ Public HealthTraining Center.

Cross-Cultural Issues in Primary Care Module
A downloadable workshop on issues of ethnocentrism, language and communication in health care and culturally appropriate medicine. 68 pages, 1994, revised 1999.

Cultural Diversity In Healthcare (Geri-Ann Galanti, Professor of Anthropology and Nursing)
Has 30 case studies of conflicts and misunderstandings in healthcare settings due to cultural differences that addresses both religious and ethnic groups.

Interdisciplinary Student Community-Oriented Prevention Enhancement Service (ISCOPES) project, Cultural Competence module for School of Medicine students, 2003. Collaborative effort between George Washington University (GWU) and George Mason University GMU). Has useful self-reflection picture exercises.

The Diversity Shuffle (Power Shuffle), American Medical Student Association, 1999. Exercise to encourage discussion about differences and similarities within our communities.

The Provider's Guide to Quality and Culture
Features an interactive quiz (23 questions - takes about 10 minutes) and guide with modules on topics such as common health problems in selected minority, ethnic and cultural groups, and understanding immigrant, refugee and minority populations. Also has audio clips of practitioners describing their experiences.

Using Anne Fadiman’s book, “The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures” to teach cultural competence.

Lee, MNM. Book Review: The Spirit Catches You and You Fall Down by Anne Fadiman. Retrieved 20 August 2004 .

Yang, Y. Practicing Modern Medicine: "A little medicine, a little neeb". Review of The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman Retrieved 20 August 2004.

Anderson , KL. Teaching cultural competence using an exemplar from literary journalism. Journal of Nursing Education 43(6) 2004: 253-9. (The Spirit Catches You and You Fall Down by Anne Fadiman) Used with 45 undergraduate nursing students.

Lie D. Rucker L. Cohn F. Using literature as the framework for a new course. Academic Medicine. 77(11):1170, 2002 Nov. (The Spirit Catches You and You Fall Down by Anne Fadiman - used as a required text for 184 first and second year medical students.)

Clark L, Zuk J, and Baramee, J. A literary approach to teaching cultural competence. Journal of Transcultural Nursing 11(3) July 2000 : 199-203. (The Spirit Catches You and You Fall Down by Anne Fadiman - contains Discussion Guide; used with 2 graduate students)

Catlin AJ. [Book Review] The Spirit Catches You and You Fall Down by Anne Fadiman. Pediatric Nursing 24(2) 1998: 170.
Response from the Chair of the Nursing Department, California State University , Stanislaus who worked at Merced Community Medical Center during the time discussed in Fadiman’s book.

Fadiman A. The Spirit Catches You and You Fall Down : A Hmong child, Her American Doctors, and The Collision of Two Cultures. New York : Farrar, Straus, and Giroux, 1998.
Owned by HSL: WA300 F145s 1998

Nuland SB. [Book Review] The Spirit Catches You and You Fall Down by Anne Fadiman. Medicine, Multiculturalism, and the Duty of Physicans: Doctors and Deities. The New Republic 217(15) October 13, 1997 :31-39.

Twiss SB. On cross-cultural conflict and pediatric intervention. The Journal of Religious Ethics. 34(1) March 2006: 163-75.

Taylor JS. The story catches you and you fall down: tragedy, ethnography, and “cultural competence”. Medical Anthropology Quarterly. 17(2) June 2003: 159-81.

Malina D. Compliance, caricature, and culturally aware care. New England Journal of Medicine. 353(13) September 2005: 1317-1318.

Smith R. An extreme failure of concordance. BMJ: British Medical Journal. 327(7419) October 2003: 818.

Association of Asian Pacific Community Health Organizations

Health Information in Multiple Languages
A quality resource from the National Library of Medicine - MedlinePlus

Multicultural Health Communication Service Australia

New York Online Access to Health (NOAH)

Culturally Competent Care: 2004 Research & Clinical Scholarship Conference. University of Arizona College of Nursing, March 31, 2004.
Requires real player. Streaming video. Excellent offerings.

Ethnic American. Health Professions IT Partnership at the University at Buffalo.
Contains video of conference: AccessHealth: Collaborative Solutions for Health Care Disparities, A SUNY Conversation in the Disciplines. Features the School of Nursing’s Nancy Campbell-Heider and Tammy Austin-Ketch.

See CULTURAL COMPETENCE IN HEALTHCARE: a guide to media resources at the Health Sciences Library which lists videos available in the Digital Media Resources Center, Health Sciences Library.

Cross Cultural Health Care

Diversity Rx
Comprehensive clearinghouse of information on model programs, policies and legal issues related to cross cultural health, in collaboration with the National Conference of State Legislatures and the Kaiser Family Foundation.

EthnoMed

Multicultural Health Clearinghouse

Refugee Health Information Network - RHIN
Offers health information in multiple languages, refugee health information for providers, and information about health services available to refugees.

Society for Medical Anthropology Academic Resources on Cultural Competence
Concise list of web resources.

Transcultural and Multicultural Health Links
Ellen Bosman - New Mexico State University Library

Transcultural C.A.R.E. Associates
Worth it for the reference and website links alone. Excellent info on Josepha Campinha-Bacote.

Transcultural Nursing Society

Developed in support of a Cultural Competence Workshop, “Incorporating Cultural Competence Skills into Nursing Curricula/Practice,” held on November 5, 2004; sponsored by the Dept. of Health and Human Services, the Health Resources and Services Administration, and the Advanced Education Nursing Program; presenters: Mary Ann Jezewski, Associate Dean for Research, UB School of Nursing; Sharon Murphy, Associate Librarian, Health Sciences Library, and Patricia M. Sarchet, Medical Anthropologist, UB Health Professions IT Partnership.

Compiled by Sharon Murphy, M.L.S. Revised by K Kelly, February 2008.