Nov 21, · Oral Surgery, Oral Medicine, Oral Pathology Oral Radiology is required reading for practitioners in the fields of oral surgery, oral medicine, oral pathology, oral radiology or advanced general practice blogger.com is the only major dental journal that provides a practical and complete overview of the medical and surgical techniques of dental practice in four areas Apr 19, · The studies under review show that obesity is responsible for a large fraction of costs, both for health care systems and for society. Heterogeneity is a major limitation among the COI literature in general and the COO literature in particular, which hinders a The Irish Journal of Medical Science is the official organ of the Royal Academy of Medicine in Ireland. Established in , this quarterly journal is a contribution to medical science and an ideal forum for the younger medical/scientific professional to enter world literature and an ideal launching platform now, as in the past, for many a young research worker
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International Journal for Equity in Health volume 18medical literature review service, Article number: Cite this article. Metrics details. Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care.
Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them. A literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken.
Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, medical literature review service, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa — Māori Medical Practitioners Association Te ORA and consultation with Māori medical practitioners via Te ORA.
Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. The objective of cultural safety activities also needs to be clearly linked to achieving health equity.
Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity. A move to cultural safety rather than cultural competency is recommended, medical literature review service.
We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development.
The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important. Internationally, Indigenous and minoritorised ethnic groups experience inequities in their exposure to the determinants of health, access to and through healthcare and receipt of high quality healthcare [ 1 ].
The role of health providers and health systems in creating and maintaining these inequities is increasingly under investigation [ 2 ]. As such, the cultural competency and cultural safety of healthcare providers are now key areas of concern and issues around how to define these terms have become paramount, particularly within a Aotearoa New Zealand NZ context [ 3 ]. This article explores international literature to clarify the concepts of cultural competency and cultural safety in order to better inform both local and international contexts.
In NZ, Māori experience significant inequities in health compared to the non-Indigenous population. In —, Māori life expectancy at birth was 7. Although Māori experience a high level of health care need, Māori receive less access to, and poorer care throughout, the full spectrum of health care services from preventative to tertiary care [ 78 ].
This is reflected in lower levels of investigations, interventions, and medicines prescriptions when adjusted for need [ 89 ].
Māori are consistently and significantly less likely to: get understandable answers to important questions asked of health professionals; have health conditions explained in understandable terms; or feel listened to by doctors or nurses [ 10 ]. There are multiple and complex factors that drive Indigenous and ethnic health inequities including a violent colonial history that resulted in decimation of the Māori population and the appropriation of Māori wealth and power, which in turn has led to Māori now having differential exposure to the determinants of health [ 13 ] [ 14 ] and inequities in access to health services and the quality of the care received.
Framing ethnic health inequities as being predominantly driven by genetic, cultural or biological differences provides a limited platform for in-depth understanding [ 1516 ]. In addition, medical literature review service, whilst socio-economic deprivation is associated with poorer health outcomes, inequities remain even after adjusting for socio-economic deprivation or position [ 17 ]. Health professionals and health care organisations are important contributors to racial and ethnic inequities in health care [ 213 ].
Equitable care is further compromised by poor communication, a lack of partnership via participatory or shared decision-making, a lack of respect, familiarity or affiliation and an overall lack of trust [ 18 ]. Healthcare organisations can influence the structure of the healthcare environment to be less likely to facilitate implicit and explicit bias for health providers.
Health professional education and health institutions therefore need to address these factors through health professional education and training, organisational policies and practices, as well as broader systemic and structural reform. Eliminating Indigenous and ethnic health inequities requires addressing the social determinants of health inequities including institutional racism, medical literature review service, in addition to ensuring a health care system that delivers appropriate and equitable care.
There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care delivery.
Some jurisdictions have included cultural competency in health professional licensing legislation [ 21 ], medical literature review service, health professional accreditation standards, medical literature review service pre-service and in-service training programmes [ 22232425 ].
This article reviews how concepts of cultural competency and cultural safety and related terms such as cultural sensitivity, cultural humility etc have been interpreted. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for why broader conceptualisation of these terms is needed to achieve health equity.
A move to cultural safety is recommended, medical literature review service, with a rationale for why this approach is necessary. We propose a definition for cultural safety and clarify the essential principles of this approach in healthcare organisations and workforce development. This review was originally conducted to inform the Medical Council of New Zealand, in reviewing and updating its approach to cultural competency requirements for medical practitioners in New Zealand Aotearoa.
The review and its recommendations are based on the following methods:. A review of cultural competency legislation, statements and initiatives in NZ, including of the Medical Council of New Medical literature review service MCNZ.
Inputs from a national Symposium on Cultural Competence and Māori Health, convened for this purpose by the MCNZ and Te Ohu Rata o Aotearoa — Māori Medical Practitioners Association Te ORA [ 26 ]. The authors reflect expertise that includes Te ORA membership, membership of the Australasian Leaders in Indigenous Medical Education LIME a network to ensure the quality and effectiveness of teaching and learning of Indigenous health in medical educationmedical educationalist expertise and Indigenous medical practitioner and public health medicine expertise across Australia and NZ.
This experience has been at the forefront of the development of cultural competency and cultural safety approaches within NZ. The analysis has been informed by the framework of van Ryn and colleagues [ 27 ] which frames health provider behaviour within a broader context of societal racism.
This review and analysis has been conducted from an Indigenous research positioning that draws from Kaupapa Māori theoretical and research approaches. Therefore, the positioning used to undertake this work aligns to effective Kaupapa Māori research practice that has been described by Curtis as: transformative; beneficial to Māori; under Māori control; informed by Māori knowledge; aligned with a structural determinants approach to critique issues of power, privilege and racism and promote social justice; non-victim-blaming and rejecting of cultural-deficit theories; emancipatory and supportive of decolonisation; accepting of diverse Māori realities and medical literature review service of cultural essentialism; an exemplar of excellence; and free to dream [ 28 ], medical literature review service.
The literature review searched international journal databases and the grey literature. No year limits were applied to the original searching. Databases searched included: Medline, Psychinfo, Cochrane SR, ERIC, CINAHL, Scopus, Proquest, Google Scholar, EbscoHost and grey literature.
A total of 59 articles published between and were used to inform this review. Articles reviewed were sourced from the USA, Medical literature review service, Australia, NZ, Taiwan and Sweden Additional file 1 Table S1. In addition to clarifying concepts of cultural competence and cultural safety, a clearer understanding is required of how best to train and monitor for cultural safety within health workforce contexts.
An assessment of the availability and effectiveness of tools and strategies to enhance cultural safety is beyond the scope of this review, but is the subject of a subsequent review in process.
Cultural competency is a broad concept that has various definitions drawing from multiple frameworks. Overall, this concept has varying interpretations within and between countries see Table 1 for specific examples. Introduced in the s, cultural competency has been described as a recognised approach to improving the provision of healthcare to ethnic minority groups with the aim of reducing ethnic health disparities [ 31 ].
One of the earliest [ 49 ] and most commonly cited definitions of cultural competency is sourced from a report authored by Cross and colleagues in the United States of America [ 29 ] p. Cultural competence is a set of congruent behaviours, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations. Cross et al. attitudes, policies, and practices that are destructive to cultures and consequently to the individuals within the culture such as cultural genocide to the most positive end of cultural proficiency e.
agencies that hold culture in high esteem, who seek to add to the knowledge base of culturally competent practice by conducting research and developing new therapeutic approaches based on culture, medical literature review service. Other points along this continuum include: cultural incapacitycultural blindness and cultural pre-competence Table 1.
By the time that cultural competency became to be better understood in the late s, there had been substantial growth in the number of definitions, conceptual frameworks and related terms [ 31505152 ]. Table 1 provides a summary of the multiple, interchangeable, terms such as: cultural awareness ; cultural sensitivity ; cultural humility ; cultural security ; cultural respect ; cultural adaptation ; and transcultural competence or effectiveness.
Unfortunately, this rapid growth in terminology and theoretical positioning sfurther confused by variations in policy uptake across the health sector, reduced the potential for a common, shared understanding of what cultural medical literature review service represents and therefore what interventions are required. Table 2 outlines the various definitions of cultural competency from the literature.
the ability of individuals to establish effective interpersonal and working relationships that supersede cultural differences medical literature review service recognizing the importance of social and cultural influences on patients, considering how these factors interact, and devising interventions that take these issues into account [ 53 ] p.
Some positionings for cultural competency have been critiqued for promoting the notion that health-care professionals should strive to or even can master a certain level of functioning, knowledge and understanding of Indigenous culture [ 61 ]. Cultural competency is not an abdominal exam. It is not a static requirement to be checked off some list but is something beyond the somewhat rigid categories of knowledge, skills, and attitudes p, medical literature review service.
By the early s, governmental policies and cultural competency experts [ 5054 ] had begun to articulate cultural competency in terms of both individual and organizational interventions, and describe it with a broader, systems-level focus, e. Moreover, some commentators began to articulate the importance of critical reflection to cultural competency.
For example, Garneau and Medical literature review service [ 55 ] align themselves more closely to the notion of cultural safety when they describe cultural competency as:. a complex know-act grounded in critical reflection and action, which the health care professional draws upon to provide culturally safe, congruent, and effective care in partnership with individuals, families, and communities living health experiences, and which takes into account the social and political dimensions of care [ 55 ] p.
There is a large body of work, developed over many years, describing the nuances of the two terms [ 34363843medical literature review service, 4649596263646566676869 ]. Similar to cultural competency, medical literature review service, this concept has varying interpretations within and between countries.
Table 3 summarises the definitions and use of cultural safety from the literature. Cultural safety foregrounds power differentials within society, the requirement for health professionals to reflect on interpersonal power differences their own and that of the patientand how the transfer of power within multiple contexts can facilitate appropriate care for Indigenous people and arguably for all patients [ 32 ]. The term cultural safety first medical literature review service first proposed by Dr.
Irihapeti Ramsden and Māori nurses in the s [ 74 ], and in the Nursing Council of New Zealand made cultural safety a requirement for nursing and midwifery education [ 32 ]. Cultural safety was described as providing:. Cultural safety is about acknowledging medical literature review service barriers to clinical effectiveness arising from the inherent power imbalance between provider and patient [ 65 ].
This concept rejects the notion that health providers should focus on learning cultural customs of different ethnic groups. Instead, cultural safety seeks to achieve better care through being aware of difference, decolonising, considering power relationships, implementing reflective practice, and by allowing the patient to determine whether a clinical encounter is safe [ 3265 ].
Cultural safety requires health practitioners to examine themselves and the potential impact of their own culture on clinical interactions. This requires health providers to question their own biases, attitudes, assumptions, stereotypes and prejudices that may be contributing to a lower quality of healthcare for some patients. There is debate over whether cultural safety reflects an end point along a continuum of cultural competency development, or, whether cultural safety requires a paradigm shift associated with a transformational jump in cultural awareness.
Irihapeti Ramsden [ 75 ] originally described the process towards achieving cultural safety in nursing and midwifery practice as a step-wise progression from cultural awareness through to cultural sensitivity and on to cultural safety.
However, Ramsden was clear that the terms cultural awareness and cultural sensitivity were separate concepts and that they were not interchangeable with cultural safety.
where the movement from cultural competence to cultural safety is not merely another step on a linear continuum, but rather a more dramatic change of approach. This conceptualization of cultural safety represents a more radical, politicized understanding of cultural consideration, effectively rejecting the more limited culturally competent approach for one based not on knowledge but rather on power [ 63 ].
There are a number of reasons why this approach can be harmful and undermine progress on reducing health inequities. The consequences for persons who experience othering include alienation, marginalization, decreased opportunities, internalized oppression, and exclusion [ 77 ].
To foster safe and effective health care interactions, those in power must actively seek to unmask othering practices [ 78 ]. This type of cultural essentialism not only leads to health care providers making erroneous assumptions about individual patients which may undermine the provision of good quality care [ 3153586364 ], but also reinforces a racialised, binary discourse, used to repeatedly dislocate and destabilise Indigenous identity formations [ 80 ]. By ignoring power, medical literature review service, narrow approaches to cultural competency perpetuate deficit discourses that place responsibility for problems with the affected individuals or communities [ 81 ], overlooking the role of the health professional, the health care system and broader medical literature review service structures, medical literature review service.
Inequities in access to the social determinants of health have their foundations in colonial histories and subsequent imbalances in power that have consistently benefited some over others.
Health equity simply cannot be achieved without acknowledging and addressing differential power, medical literature review service, in the medical literature review service interaction, medical literature review service, and in the broader health system and social structures including in decision making and resource allocation [ 82 ]. An approach to cultural competency that focuses on acquiring medical literature review service, skills and attitudes is problematic because it suggests that competency can be fully achieved through this static process [ 58 ].
Literature Review, The Principles to Medical Research and Publication, Part I
, time: 22:38The importance of Literature Review in Research Writing | Elsevier Blog
Apr 19, · The studies under review show that obesity is responsible for a large fraction of costs, both for health care systems and for society. Heterogeneity is a major limitation among the COI literature in general and the COO literature in particular, which hinders a Nov 21, · Oral Surgery, Oral Medicine, Oral Pathology Oral Radiology is required reading for practitioners in the fields of oral surgery, oral medicine, oral pathology, oral radiology or advanced general practice blogger.com is the only major dental journal that provides a practical and complete overview of the medical and surgical techniques of dental practice in four areas Nov 14, · A key difference between the concepts of cultural competency and cultural safety is the notion of ‘power’. There is a large body of work, developed over many years, describing the nuances of the two terms [34, 36, 38, 43, 46, 49, 59, 62,63,64,65,66,67,68,69].Similar to cultural competency, this concept has varying interpretations within and between countries
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