Cultural theorist Campinha-Bacote describes cultural competency as a continuum

Cultural theorist Campinha-Bacote describes cultural competency as a continuum, which

Cultural theorist Campinha-Bacote describes cultural competency as a continuum, which implies continual growth and development (Kersey-Matusiak, 2019).

Discuss the following:

• What is cultural competence?
• Are there steps nurses can take to achieve it?
• How does it differ from cultural humility?
• Briefly describe how a lack of cultural sensitivity may impact patients’ health and well-being and their future encounters with the healthcare system.
• Why is it more important to focus on cultural humility rather than achieving cultural competence?

Expert Answer and Explanation

In the healthcare sector, cultural competence focuses on the ability of a nurse or any other medical professional to be aware of their cultural beliefs and values. Additionally, cultural competence also includes the awareness of how personal culture and perspectives are different from that of others (Kersey-Matusiak, 2018).

In the case of a nurse, cultural competence focuses on the ability to differentiate one’s cultural beliefs from that of the patient. Nurses can take different initiatives and steps to achieve cultural competence. The most efficient strategy is to interact with patients, improve self-awareness and learn about different cultures within the community. The strategies are key as they will create the needed awareness, and help improve the outcome of care.

Cultural competence differs from cultural humility in different ways. Cultural competence encompasses the ability to work with patients from different cultures while at the same time identifying the impact that cultural bias might have on care delivery. On the other hand, cultural humility entails the capacity for care providers to recognize their limitations, assumptions, or challenges when working with other cultures to avoid bias or predetermined patient care (Kersey-Matusiak, 2018).

When nurses are not sensitive to cultural differences, they tend to provide biased medical care that does not meet patient autonomy. As a result, patient satisfaction is negatively affected. With modernization, care providers are more likely to encounter patients from different cultures which requires the need for cultural competence. Focusing on cultural humility is more sustainable than trying to be more culturally competent as a nurse cannot be able to be aware of different cultures. However, a nurse can identify their biases and adjust their care depending on the needs of the patient through cultural humility (Kersey-Matusiak, 2018).

Reference

Kersey-Matusiak, G. (2018). Delivering culturally competent nursing care: Working with diverse and vulnerable populations (2nd ed.). Springer. ISBN: 9780826137272.

Alternative Answer

Cultural competence is the ability to appreciate, interact, and understand others cultures or beliefs that are different from their own (DeAngelis, 2015). “Cultural competence is defined as the attitudes, knowledge, and skills necessary for providing quality care to diverse populations” (Kersey-Matusiak, 2019, p.8). Culturally competent nurses are able to deliver care that values the beliefs of their patients (Kersey-Matusiak, 2019). Culturally competent care does not just happen; there are steps nurses must take to become culturally competent.

To become culturally competent, one must learn who they are first (Clay, 2010). Learn about your ancestors, personal background, be curious, and perform a self-assessment (Clay, 2010). Learn about different cultures by immersing yourself in their literature, language, and customs (Clay, 2010). Become comfortable in unfamiliar surroundings, converse with different religious groups, volunteer at community centers, and make friends with people of different cultures (Clay, 2010).

Attend diversity training seminars to collaborate with other professionals (Clay, 2010). If culturally competent training is not offered at your institution, submit a process to formalize educational material for your organization and peers (Clay, 2010).

Cultural humility recognizes that bias may occur and nurses need to understand and eliminate their own prejudices (Kersey-Matusiak, 2019). Healthcare providers need to recognize that their perspectives are influenced by policies that are dominated on the basis of whiteness and maleness (Kersey-Matusiak, 2019). Cultural humility addresses unconscious biases a nurse may possess and empowers the nurse to work towards eliminating these biases while providing culturally competent care.

Cultural sensitivity is having an attitude towards a specific culture or ethnic background and not saying offensive things directed at that background (Kersey-Matusiak, 2019). Cultural sensitivity can also include the avoidance of particular words, phrases, or categorizations of individuals (Kersey-Matusiak, 2019). An example of cultural sensitivity was the removal of the Washington Redskins name from the NFL due to the thoughts and feelings of the Native Americans.

Nursing is a trusted profession by the public. Nurses as well as other healthcare providers must provide culturally sensitive care to know how to communicate with their patients and develop professional relationships (The Role of Cultural Sensitivity in Building Patient Relationships, 2019). Nurses must understand nonverbal communication, inclusive language, cultural customs, relatable medical terms, and the use of personal touch (The Role of Cultural Sensitivity in Building Patient Relationships, 2019). Failure to utilize culturally sensitive care can create unwanted distress for patients and they may fail to seek medical attention when required as a result. Nurses must be able to make their patients feel comfortable in a healthcare setting.

Cultural competence is learning to accept and understand other cultures. Cultural humility is recognizing personal biases that may distort your perception of other cultures. Cultural sensitivity is recognizing those biases and behaving in an acceptable way towards different backgrounds. Providing care with “cultural sensitivity and cultural humility are both means to the end being cultural competence” (Kersey-Matusiak, 2019, p. 6).

References

Clay, R. (2010). https://www.apa.org/gradpsych/2010/09/culturally-competent. www.apa.org. https://www.apa.org/gradpsych/2010/09/culturally-competent.

DeAngelis, T. (2015, March). In search of cultural competence. American Psychological Association. https://www.apa.org/monitor/2015/03/cultural-competence.

Kersey-Matusiak, G. (2019). Delivering culturally competent nursing care: Working with diverse  and vulnerable populations (2nd ed.).

The Role of Cultural Sensitivity in Building Patient Relationships. (2019, July 11). Minority  Nurse. https://minoritynurse.com/the-role-of-cultural-sensitivity-in-building-patient-relationships/.

Module 1 Assignment

Assignment Description:

Part 1: For this assignment, conduct a cultural self-assessment using the Staircase Self-Assessment Model and write a 1250–1500-word reflection essay.

To understand culture and cultural diversity, you must understand your own culture and beliefs. Utilizing the Staircase Self-Assessment Model as a means of determining your level of cultural competency, write a 1250 to 1500-word essay outlining the six stages: cultural destructiveness, cultural incapacity, cultural blindness, pre-competency, basic cultural competency, and advance cultural competency. Determine your level on the staircase by answering the following questions. Please be mindful that your responses will not be judged; only your knowledge of the Staircase Self-Assessment Model will be evaluated:

Step 1:

• How much do I value becoming culturally competent?
• What actions have I taken recently or in the past when caring for culturally diverse patients that demonstrate my motivation?

Step 2:

• How much do I know about my cultural heritage or racial identity and its relationship to my own healthcare beliefs and practices?
• Have I discussed these issues with my parents, grandparents, or other relatives?

Step 3:

• How much do I know about cultural groups that differ from my own?

Step 4:

• How culturally diverse is my social network?
• How many encounters with cultural group members outside my social network do I have? Are these relationships superficial, or do I have social contact beyond the workplace?

Step 5:

• Am I able to independently identify the potential or actual problems that originate from cultural conflicts, or am I surprised by them?
• Do I serve as a culturally competent role model/mentor for others?

Step 6:

• Have I developed problem-solving strategies to manage cultural conflicts?
• Am I able to manage or resolve cultural problems or issues that arise, and what resources do I use?

Once you have completed the self-assessment, address the following questions:

1. Why are self-knowledge and understanding a critical step in achieving cultural competence?

2. How has the “cultural self-assessment” exercise influenced your awareness of personal and professional values, attitudes, and practices, including prejudices and biases?

3. How will your interactions with patients and families change as a result of this self-reflection?
Remember, you answer these questions from your perspective, so there is no right or wrong response. You must address each question. Although the information on your self-assessment paper is strictly confidential, if you do not wish to self-disclose a specific area from the Staircase, indicate that by explaining in detail why you do not want to disclose. You are not required to provide citations/references in this paper. Attention should be paid to grammar, spelling, and punctuation.

Part 2: Go to Think Cultural Health located on the U.S. Department of Health & Human Services Office of Minority Health website (you may access it from the following URL (https://thinkculturalhealth.hhs.gov/). Click on the Education tab. Select nurses and create your account (there are approximately seven questions to answer). Register for the Think Cultural Health program for nurses: Nurses – Culturally Competent Nursing Care: A Cornerstone of Caring.

For Module 1, you will only register and review the objectives of Course I. Throughout the next 7 Modules; you will complete the program. There are three (3) courses. The estimated time to complete the entire program is nine (9) hours.

When you register, please Do Not select the CNE Nursing option. You must select the option, Statement of Participation. You will submit the Statement of Participation in Module 7

Expert Answer and Explanation

Staircase Self-Assessment Model

Cultural diversity is a key factor for any medical professional and can be used to ensure efficient working relations. It is important that different interventions and models are applied to help improve the efficiency and outcome of care. The Staircase Self-Assessment Model can be used to help understand the aspect of cultural competency and how it can be applied within the healthcare sector. This paper will focus on the analysis of the Staircase Self-Assessment Model to explore the issue of cultural competency.

Stages of the Staircase Self-Assessment Model

Cultural Destructiveness

Cultural destructiveness occurs when a person denies patient healthcare services as of the difference in the culturally and linguistically diverse background. The aspect denotes that there can be challenges with the delivery of care when the nurse and patient come from different or diverse cultures, in this regard, the cultural difference would have facilitated the destruction of services that would have been rendered under other conditions.

Cultural Incapacity

The concept of cultural incapacity originates from the lack of capacity to meet the needs of patients from all ethnic, linguistic, and ethnic backgrounds. Incapacity is different from destructiveness since it focuses on the inability of the facility to meet different needs. The incapacity can be derived from the lack of resources or amenities to ensure that the facility meets all its services to different cultural different patients.

Cultural Blindness

The component of cultural blindness is the deliberate oversight of the aspect of culture and how it can be used to meet the different outcomes of care. When a care provider provides the same standard form of care to all patients regardless of their cultural background can be referred to as cultural blindness. The aspect denotes that the treatment is only based on the medical need of the patient and not the alignment with cultural norms. Blindness treats each person equally and care is not based on cultural and ethnic needs, but rather based on standard protocols that apply to all.

Cultural Pre-Competency

The pre-competence aspect focuses on the strategies within which agencies or individual care providers attempt to improve their cultural awareness. The process is essential as it creates a means by which a person can further improve their understanding of culture and its impact on others. Cultural awareness within the pre-competence level can be viewed as the early stages toward proficiency.

Basic Cultural Competency

The stage of cultural competency is the continued attempts for a person to make cultural adjustments when interacting with a patient from diverse cultures other than their own. It is important for individuals in this stage to learn how to identify the differences and work on improving the general outcome. The strategies would help in increasing self-awareness and cultural understanding.

Advance Cultural Competency

Also called cultural proficiency, this stage is based on the overall ability of a person to respect and accept the different cultural and linguistic backgrounds of the patient. The person can easily and efficiently adapt to the values of the patient and meet their specific and individual needs.

Evaluation of Staircase Self-Assessment

Step 1:

• How much do I value becoming culturally competent?

I believe cultural competence is the basis for the future of nursing and needs to be adopted by all nurses. Cultural competency can improve the efficiency of the healthcare sector and bring about the desired changes and positive outcomes.

• What actions have I taken recently or in the past when caring for culturally diverse patients that demonstrate my motivation?

The main strategy I have taken when caring for culturally diverse patients is to first create a relationship during the assessment where I intentionally ask about their culture and preferences in terms of medical care and treatment.

Step 2:

• How much do I know about my cultural heritage or racial identity and its relationship to my own healthcare beliefs and practices?

I have a strong and in-depth understanding of my cultural heritage and racial identity. I am also conversant with how my culture affects my personal healthcare beliefs and practices.

• Have I discussed these issues with my parents, grandparents, or other relatives?

I am yet to have a detailed and candid discussion of the issues with my immediate or extended family but I occasionally ask various questions regarding complex issues that I need clarification on about the culture.

Step 3:

• How much do I know about cultural groups that differ from my own?

Despite having been in the healthcare industry for a while, there are way too many cultures and I cannot have an excellent understanding of all. However, I can rate myself as having above-average awareness of cultural groups that are different from my own.

Step 4:

• How culturally diverse is my social network?

My social network is diverse as I have friends and colleagues from different cultural, ethnic, social, and economic classes. I tend to freely interact with people regardless of their backgrounds and affiliation.

• How many encounters with cultural group members outside my social network do I have? Are these relationships superficial, or do I have social contact beyond the workplace?

I encounter different cultural group members outside my social network very often within my workplace and personal life. While the majority of the interaction is superficial, some of them proceed beyond the workplace to become friends and become part of my social network.

Step 5:

• Am I able to independently identify the potential or actual problems that originate from cultural conflicts, or am I surprised by them?

Through my competency in cultural differences, I can identify problems that can originate from cultural conflicts. While some of the problems are repetitive, some cultures can come as a surprise and require an additional assessment to learn and adjust.

• Do I serve as a culturally competent role model/mentor for others?

I am yet to be proficient in terms of cultural competence and while I can help others learn and improve their level of competence, I am yet to be a mentor. However, I hope to one day attain the level where I can be able to mentor and guide others.

Step 6:

• Have I developed problem-solving strategies to manage cultural conflicts?

At the beginning of my practice, I had challenges accepting and understanding the essence of cultural integration. However, I have become more aware of the need for understanding and accepting diversity.

• Am I able to manage or resolve cultural problems or issues that arise, and what resources do I use?

I am in a position to efficiently and easily resolve cultural problems that might arise. I believe that communication is a key resource and understanding the diverse needs of the patient through active listening and communication can help resolve the issue.

Critical Step in Achieving Cultural Competence

Self-knowledge and understanding are the basis of a person’s ability to know their strengths and weaknesses. Understanding what can trigger a person and how they respond to external stimuli can help in shaping the correct attitude and response to cultural differences and help improve on the weaknesses. Embracing the strengths and working on the weaknesses is a key strategy that can be used by an individual to achieve greater cultural competence and by extension, better patient outcomes

Impact of Cultural Self-Assessment

Engaging in cultural self-assessment has had a positive impact on my awareness of personal and professional values in different ways. I have been able to identify the areas of strength, and overall perception concerning the issues around cultural diversity. The role of the care provider can be impactful if they identify and understand how a patient’s culture can impact the overall outcome of care.

The self-assessment has also impacted my attitude towards patients from different cultures and practices as they relate to the delivery of care practices. I have also learned the importance of culture and the need to eliminate or mitigate issues of prejudice and cultures through cultural differentiations.

Interactions with Patients and Family

Following the self-reflection, I believe that I will have a different and more profound relationship with patients. I have had a chance to understand my cultural awareness and how it affects my delivery of care. The process helps provide a profound understanding of cultures and how different cultures can lead to different outcomes in care.

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Understanding Campinha-Bacote’s Cultural Competency as a Continuum: A Comprehensive Framework for Healthcare Excellence

Introduction

In our increasingly diverse healthcare landscape, the concept of cultural competency has evolved from a nice-to-have skill to an essential requirement for quality patient care. Cultural theorist Campinha-Bacote describes cultural competency as a continuum, which implies continual growth and development, fundamentally challenging the traditional view of competence as a fixed endpoint. This paradigm shift recognizes that cultural competency in healthcare is not a destination but an ongoing journey of learning, self-reflection, and skill enhancement.

This model views cultural competence as the ongoing process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community). Understanding this framework is crucial for healthcare professionals, nursing students, and healthcare organizations committed to providing equitable, patient-centered care.

The Evolution of Cultural Competency in Healthcare

Historical Context and Current Relevance

The healthcare industry has witnessed dramatic demographic shifts over the past decades. The need to provide culturally competent healthcare in Europe and specifically in Austria is changing due to ongoing demographic changes. These changes aren’t limited to specific regions but represent a global phenomenon affecting healthcare delivery worldwide.

Cultural competence is the ability to collaborate effectively with individuals from different cultures; and such competence improves health care experiences and outcomes. This definition underscores the practical importance of cultural competency beyond theoretical understanding.

The Continuum Concept: Why It Matters

Traditional approaches to cultural competency often treated it as a checkbox—something to be achieved and then maintained. Campinha-Bacote’s revolutionary approach recognizes that cultural competency exists on a continuum, reflecting the dynamic nature of both cultures and individual growth. This perspective acknowledges that:

• Cultural knowledge is constantly evolving
• Personal biases require ongoing examination
• Patient populations and their needs change over time
• Healthcare providers must engage in lifelong learning

Campinha-Bacote’s Five Constructs Framework: The ASKED Model

Applying Campinha-Bacote’s Process of Cultural Competence Model using the mnemonic ASKED (awareness, skills, knowledge, encounters and desire) involves incorporating culturally appropriate assessments.

1. Cultural Awareness

Cultural awareness forms the foundation of the framework, requiring healthcare providers to conduct honest self-examinations of their own cultural background, biases, and assumptions. This construct involves:

Key Components:

• Recognition of personal cultural influences
• Identification of unconscious biases
• Understanding of how culture shapes worldviews
• Acknowledgment of privilege and power dynamics

Practical Applications:

• Regular self-reflection exercises
• Cultural autobiography development
• Bias recognition training
• Peer feedback sessions

2. Cultural Knowledge

This construct emphasizes the importance of acquiring information about different cultural groups, including their health-related beliefs, practices, and worldviews.

Essential Areas of Focus:

• Health beliefs and practices
• Communication patterns
• Family structures and dynamics
• Religious and spiritual considerations
• Historical trauma and its impact on healthcare

3. Cultural Skills

Cultural skills represent the ability to conduct culturally sensitive assessments and interventions. This practical component bridges knowledge and application.

Core Competencies Include:

• Cross-cultural communication techniques
• Culturally appropriate assessment methods
• Adaptation of interventions
• Use of interpreters and cultural mediators
• Non-verbal communication awareness

4. Cultural Encounters

Direct cross-cultural interactions provide opportunities to practice and refine cultural competency skills. These encounters serve as learning laboratories for healthcare providers.

Types of Encounters:

• Direct patient interactions
• Community engagement activities
• Cultural immersion experiences
• Professional development opportunities
• Interdisciplinary collaborations

5. Cultural Desire

Perhaps the most crucial construct, cultural desire represents the motivation and commitment to become culturally competent. Without genuine desire, the other constructs remain superficial.

Characteristics of Cultural Desire:

• Genuine interest in other cultures
• Commitment to lifelong learning
• Willingness to challenge personal assumptions
• Advocacy for cultural responsiveness

Statistical Evidence and Current Healthcare Demographics

Healthcare Diversity Statistics

Understanding the demographic landscape helps contextualize the urgency of cultural competency development:

Outcomes Related to Cultural Competency

Racial and ethnic minorities have higher morbidity and mortality from chronic diseases, highlighting the critical need for culturally competent care. Research demonstrates that culturally competent healthcare delivery results in:

• Improved patient satisfaction scores (15-25% increase)
• Better medication adherence rates
• Reduced healthcare disparities
• Enhanced patient safety outcomes
• Increased trust in healthcare systems

Implementation Strategies for Healthcare Organizations

Organizational Assessment Framework

Best Practices for Cultural Competency Development

1. Systematic Training Programs

• Multi-modal learning approaches
• Scenario-based learning
• Mentorship programs
• Ongoing competency validation

2. Policy Integration

• Incorporation into job descriptions
• Performance evaluation criteria
• Promotion requirements
• Quality improvement initiatives

3. Environmental Modifications

• Multilingual signage and materials
• Diverse artwork and cultural representations
• Flexible visiting policies
• Religious accommodation spaces

Challenges and Barriers to Implementation

Common Organizational Challenges

1. Resource Constraints: Limited budget allocation for training and development
2. Time Limitations: Competing priorities in fast-paced healthcare environments
3. Resistance to Change: Individual and organizational inertia
4. Measurement Difficulties: Challenges in quantifying cultural competency

Overcoming Implementation Barriers

Strategic Approaches:

• Phased implementation plans
• Champion identification and development
• Integration with existing quality initiatives
• Demonstration of return on investment

Cultural Competency in Nursing Education

Academic Integration Strategies

Cultural competence is one of the new areas of focus within nursing. In nursing, cultural competence is the dynamic process that enables nurses to provide effective, safe, and quality care to clients from diverse cultural backgrounds.

Curriculum Enhancement Methods:

• Case study integration
• Simulation exercises
• Clinical placement diversity
• Reflective journaling requirements
• Community engagement projects

Student Learning Outcomes

Expected competencies for nursing graduates include:

• Demonstration of cultural awareness
• Application of culturally appropriate assessment techniques
• Effective cross-cultural communication
• Advocacy for culturally responsive care
• Commitment to ongoing cultural learning

Measuring Cultural Competency Progress

Assessment Tools and Methodologies

Key Performance Indicators

Individual Level Metrics:

• Training completion rates
• Competency assessment scores
• Patient feedback ratings
• Peer evaluation results

Organizational Level Metrics:

• Cultural diversity of staff
• Language services utilization
• Health outcome disparities
• Patient satisfaction scores

The Future of Cultural Competency

Emerging Trends and Considerations

For over 30 decades, cultural competence has commanded significant attention, being viewed as the cornerstone of fostering cross-cultural communication, reducing health disparities, improving access to better care, increasing health literacy and promoting health equity.

Evolving Perspectives:

• Integration of cultural humility concepts
• Technology-enhanced learning approaches
• Precision medicine and cultural considerations
• Global health competency requirements

Technology Integration

Modern approaches to cultural competency development increasingly incorporate:

• Virtual reality cultural immersion experiences
• AI-powered cultural assessment tools
• Telehealth cultural competency protocols
• Mobile learning applications

Frequently Asked Questions

Q: How long does it take to develop cultural competency? A: Cultural competency is a lifelong journey rather than a destination. The continuum approach recognizes that development is ongoing, with different individuals progressing at different rates based on their experiences, motivation, and learning opportunities.

Q: Can cultural competency be measured objectively? A: While challenging, cultural competency can be assessed through multiple methods including self-assessments, knowledge tests, behavioral observations, and patient feedback. The key is using multiple measurement approaches for comprehensive evaluation.

Q: What’s the difference between cultural competence and cultural humility? A: Cultural humility and cultural competence must enter into a synergistic relationship, resulting in a combined effect that is greater than the sum of their separate effects. Cultural humility emphasizes ongoing self-reflection and power dynamics awareness, complementing the skill-building focus of cultural competence.

Q: How can small healthcare organizations implement cultural competency programs with limited resources? A: Start with leadership commitment and policy development, utilize free online resources, partner with community organizations, and focus on high-impact, low-cost interventions like cultural awareness training and environmental modifications.

Q: What role does cultural competency play in reducing healthcare disparities? A: Measures to improve cultural competence and ethnic diversity will help alleviate healthcare disparities and improve health outcomes. Culturally competent care directly addresses communication barriers, cultural misunderstandings, and bias-related issues that contribute to disparities.

Q: How should healthcare organizations handle situations where cultural practices conflict with medical recommendations? A: These situations require careful navigation, involving cultural liaisons when possible, exploring alternative approaches that respect both cultural values and medical needs, and maintaining open dialogue with patients and families.

Conclusion

Campinha-Bacote’s conceptualization of cultural competency as a continuum represents a fundamental shift in how healthcare professionals approach cross-cultural care. Rather than viewing cultural competence as a fixed skill set to be acquired, this framework emphasizes the dynamic, ongoing nature of cultural learning and development.

The five constructs of the ASKED model—awareness, skills, knowledge, encounters, and desire—provide a comprehensive roadmap for both individual practitioners and healthcare organizations committed to culturally responsive care. Working in a culturally diverse environment entails a moral and professional responsibility to provide culturally competent care. This has been recognised as an important measure to reduce health inequalities, improve the quality of care and increase patient satisfaction.

As our healthcare systems continue to serve increasingly diverse populations, the implementation of Campinha-Bacote’s framework becomes not just beneficial but essential. The continuum approach acknowledges that cultural competency development is a professional obligation that extends throughout one’s career, requiring continuous learning, self-reflection, and adaptation.

Healthcare organizations and educational institutions must embrace this perspective, creating systems and cultures that support ongoing cultural competency development. By doing so, they contribute to the broader goals of health equity, patient safety, and healthcare excellence.

The journey toward cultural competency may be ongoing, but each step taken along this continuum brings healthcare providers closer to their goal of providing truly patient-centered, culturally responsive care that honors the dignity and diversity of all patients served.

References

1. Campinha-Bacote, J. (2002). The Process of Cultural Competence in the Delivery of Healthcare Services: a model of care. Journal of Transcultural Nursing, 13(3), 181-184. https://pubmed.ncbi.nlm.nih.gov/12113146/
2. Kersey-Matusiak, G. (2019). Delivering Culturally Competent Nursing Care. Springer Publishing Company.
3. Transcultural C.A.R.E Associates. (2022). The Process of Cultural Competence in the Delivery of Healthcare Services. https://transculturalcare.net/the-process-of-cultural-competence-in-the-delivery-of-healthcare-services/
4. Campinha-Bacote, J. & Campinha-Bacote, D. (1999). A Framework for Providing Culturally Competent Health Care Services in Managed Care Organizations. Journal of Transcultural Nursing, 10(3), 291-292.
5. Georgetown University Health Policy Institute. (2019). Cultural Competence in Health Care: Is it important for people with chronic conditions? https://hpi.georgetown.edu/cultural/
6. BMC Health Services Research. (2023). Cultural competence among nursing students and nurses working in acute care settings: a cross-sectional study. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-023-09103-5
7. American Association of Colleges of Nursing. Enhancing Diversity in the Nursing Workforce. https://www.aacnnursing.org/news-data/fact-sheets/enhancing-diversity-in-the-nursing-workforce
8. Agency for Healthcare Research and Quality. Improving Cultural Competence to Reduce Health Disparities for Priority Populations. https://effectivehealthcare.ahrq.gov/products/cultural-competence/research-protocol