Disparities clearly exist in the health care of racial and ethnic minorities. This position paper of the American College of Physicians (ACP) provides ample evidence illustrating that minorities do not always receive the same quality of health care, do not have the same access to health care, are less represented in the health professions, and have poorer overall health status than nonminorities. The ACP finds this to be a major problem in our nation's health system that must be addressed. The ACP is dedicated to working toward eliminating all disparities in health care. This position paper sets forth specific positions for reducing these disparities and will be the foundation for public policy advocacy by ACP for eliminating racial and ethnic disparities in health care.

/pdf/racial-and-ethnic-disparities-in-health-care-a-position-1nq6mxulmx.pdf

Racial and ethnic disparities in health care: a position paper of the American College of Physicians.

The global migration of populations presents nurses with the challenge of delivering care to unprecedented numbers of patients with health care beliefs and practices that may differ from their own. The global migration of nurses to meet worldwide shortages places migrating nurses in the similar situation of caring for patients with different cultural backgrounds. There is growing evidence of increasing inequalities in access to health care and health outcomes among populations in local, national, and global contexts. There is a need to advocate for vulnerable populations to lessen the impact of social inequalities on their health. These challenges heighten the need to identify guidelines for the delivery of culturally competent care for an increasingly diverse population and minimize health inequities regardless of geographic location (Miller et al., 2008; Rosenkoetter & Nardi, 2007). The purpose of this document is to present universally applicable guidelines for implementing culturally competent care. These guidelines can serve as a resource for nurses in various roles—clinicians, administrators, researchers, and educators—by emphasizing cultural competence as a priority of care for the populations they serve. The guidelines are designed to be adapted to the sociocultural context and unique health care delivery system of the user. They are not meant, however, to supersede ethical codes, human rights conventions, or legal requirements. Culturally competent care is based on the principles of social justice (Rawls, 1971) and human rights. These principles are interwoven within the guidelines presented below. By focusing on social justice as a framework for cultural competence, we are consistent with the perspective addressed by the International Council of Nurses (ICN): “We speak as advocates for all those we serve, and for all the underserved, insisting that social justice, prevention, care, and cure be the right of every human being” (ICN, 2007a). Social justice, within the context of health care delivery, is grounded in the belief that every individual is entitled to fair and equal opportunities for healthcare. Promoting culturally competent health care within the social justice framework protects the dignity of all people. Human rights protect the inherent dignity of all people and their right to access quality care, to participate in care decisions, and be assured of safe health care, which includes prevention of harmful traditional practices. However, socioeconomic and environmental disadvantages produce inequities in accessing quality care, resulting in disparities in health outcomes in populations worldwide (Marmot & Bell, 2009; U.S. Department of Health and Human Services, 2007). Solely improving access to quality health care services can decrease some of this inequity but does not eliminate health disparities entirely (Schroeder, 2007). Culturally competent nursing care contributes to the reduction of health disparities through patient empowerment, integration of cultural beliefs into patient care, and expanded access for vulnerable groups to health care 520998 TCNXXX10.1177/1043659614520998Douglas et al.Journal of Transcultural Nursing research-article2014 Douglas et al.

Guidelines for Implementing Culturally Competent Nursing Care

University of California, San Francisco, San Francisco, CA, USA Pierce and Associates Nursing Consultants, Knoxville, TN, USA Georgia Health Sciences University, Augusta, GA, USA University of Medicine and Dentistry of New Jersey, Newark, NJ, USA Brigham Young University, Provo, UT, USA California State University, Northridge, CA, USA Vanderbilt University, Nashville, TN, USA University of Toledo, Toledo, OH, USA University of St. Francis, Joliet, IL, USA University of Delaware, Newark, DE, USA

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Standards of practice for culturally competent nursing care: 2011 update.

Patient-centeredness and cultural competence have been promoted extensively in recent years as approaches to improving health care quality. This paper explores the historical evolution of both concepts, demonstrating that early conceptual models focused on how health care providers and patients interact at the interpersonal level, while later models were expanded to consider how patients were treated by the health care system as a whole. The models are compared at both the interpersonal and health care system levels to demonstrate similarities and differences. Although the two concepts have grown out of separate traditions, each with its own focus, many of the core features of patient-centeredness and cultural competence are the same. Each approach holds promise for improving the quality of health care for individual patients, communities, and populations. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. This report and other Fund publications are available online at www.cmwf.org. To learn more about new publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 960.

https://courses.washington.edu/conj515/files/Beach_Saha_Cooper.pdf

The Role and Relationship of Cultural Competence and Patient-Centeredness in Health Care Quality

This report reviews the evidence base for the impact of cultural and linguistic competence in health and mental health care on health outcomes and well-being and the costs and benefits to the system. The authors conducted a structured search of Medline from January 1995 to March 2006 to identify primary research articles on health outcomes and well-being. An exploratory search of multiple databases was performed to identify evidence related to the business case. The review of the health outcomes literature indicated that the field is in the early stages of development, with the preponderance of literature defining the concepts and identifying research questions. Some promising studies support the efficacy of cultural and linguistic competence affecting health and mental health outcomes. Evidence of decreased systems costs is not currently present in the literature. The authors identify key gaps in the current literature and specific methodological and funding limitations to be addressed. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. This report and other Fund publications are available online at www.cmwf.org. To learn more about new publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 962.

/pdf/the-evidence-base-for-cultural-and-linguistic-competency-in-4oef9nxcw8.pdf

The Evidence Base for Cultural and Linguistic Competency in Health Care

This paper provides principles and recommendations for implementing cultural competency in the field. The following six principles are key to a successful cultural competency effort: 1) community representation and feedback at all stages of implementation; 2) cultural competency integrated into all systems of the health care organization, particularly quality improvement efforts; 3) ensuring that changes made are manageable, measurable, and sustainable; 4) making the business case for implementation of cultural competency polices; 5) commitment from leadership; and 6) staff training on an ongoing basis. Based on interviews with leaders in the field of cultural competency, the authors discuss best practices and important lessons in the implementation of cultural competency initiatives. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. This report and other Fund publications are available online at www.cmwf.org. To learn more about new publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 964.

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