Teaching Cultural Competence in Nursing and Health Care

Jeffereys, M. R. (2010). Teaching cultural competence in nursing and health care. (2nd ed.) New York, NY: Springer. (ISBN 978-0-8261- 17878, paperback $75.00; 395 pages) Marianne R. Jeffreys, EdD, RN, along with various other nurses and interdisciplinary colleagues as contributors, has amassed information to aid nurses and other health care professionals in the development of not only cultural competence, but optimal cultural competence. This book serves as a how-to resource to achieve competence and teach competence via a variety of avenues including models, questionnaires, guides, educational activities, assessment tools, vignettes, tables, case examples, illustrations, sample research reports, and abstracts. Ideally, this book is supplemented with the Cultural Competence Education Resource Toolkit. A 7-step approach is conveyed in detail throughout this book and toolkit: (a) self-assessment, (b) active promotion, (c) systematic inquiry, (d) decisive action, (e) innovation, (f) measurement, and (g) evaluation. This book has been divided into three parts with 14 chapters. The three parts consist of Part I. Getting Started, Part II. Tools for Assessment and Evaluation, and Part III. Educational Activities for Easy Application. Part I provides a brief history of cultural evolution and an overview of key issues, concerns, new challenges, barriers, and factors influencing cultural competence. The key point in Part I emphasizes the goal of health care professionals of not only obtaining cultural competence, but optimal cultural competence. This key point is well illustrated with the example of transcultural self-efficacy (TSE). The concept of TSE stresses the role of confidence being a crucial impacting component in the development of optimal cultural competence. The acronym "COMPETENCE" is another way the author further explains cultural competence. This acronym serves as a tool to remember necessary components of cultural competence development: Caring, Ongoing, Multidimensional, Proactive, Ethics, Trust, Education, Networks, Confidence, and Evaluation. In order to provide harmonious care, cultural competence is described as a multidimensional learning process, and Jeffreys's Cultural Competence and Confidence (CCC) Model is explained. This model is yet another example of how optimal cultural competence can be obtained. The model incorporates the concept of TSE and combines three domains in which transcultural skills are used: cognitive, practical, and affective dimensions. After thoroughly describing the CCC Model, the key point of Part II of this book is how to assess and evaluate this model. Three separate tools are specifically suggested for assessment and evaluation. The Transcultural Self-Efficacy Tool (TSET), which is copyrighted by Jefferys, is the first tool introduced and is a quantitative 83 item questionnaire that assesses students' confidence in completing nursing activities among various cultures. Three subscales, cognitive (25 items), practical (28 items), and affective (30 items), combine to measure and evaluate this confidence and fit quite nicely with the three dimensions of the CCC Model mentioned in Part I of the book. Psychometric testing and scoring of the TSET are described in detail. Adaptations of the TSET by Jefferys and colleagues lead to the fruition of the second tool discussed, the Cultural Competence Clinical Evaluation Tool (CCCET). This tool adequately measures behaviors of clinical cultural competence using three subscales: provision of culture-specific care, cultural assessment, and cultural sensitivity. The Clinical Setting Assessment Tool-Diversity and Disparity (CSAT-DD), the final tool examined, is a two part tool used to collect data about client populations (Part I) and clinical sites (Part II). Also, several helpful guidelines are included in this section to prevent problems with the TSE plan and research applications. The key point of Part III is the application of educational strategies and activities. …