Patient Centeredness, Cultural Competence and Healthcare Quality

Portland VA Medical Center, Portland, OR 97239, USA.
Journal of the National Medical Association (Impact Factor: 0.96). 12/2008; 100(11):1275-85.
Source: PubMed


Cultural competence and patient centeredness are approaches to improving healthcare quality that have been promoted extensively in recent years. In this paper, we explore the historical evolution of both cultural competence and patient centeredness. In doing so, we demonstrate that early conceptual models of cultural competence and patient centeredness focused on how healthcare providers and patients might interact at the interpersonal level and that later conceptual models were expanded to consider how patients might be treated by the healthcare system as a whole. We then compare conceptual models for both cultural competence and patient centeredness at both the interpersonal and healthcare system levels to demonstrate similarities and differences. We conclude that, although the concepts have had different histories and foci, many of the core features of cultural competence and patient centeredness are the same. Each approach holds promise for improving the quality of healthcare for individual patients, communities and populations.

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Available from: Lisa A Cooper, Nov 21, 2014
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    • "Empathy is a key mediator of prejudice reduction (Pettigrew & Tropp 2008) and changes in attitudes have been demonstrated following educational programmes focusing on empathy towards specific groups. This is noteworthy as health professionals often show less empathy and more prejudice towards CALD patients (Somnath Saha & Cooper 2008). Pain is an area of particular concern with studies indicating that the pain of CALD patients is often undertreated (Drwecki et al. 2011). "
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    ABSTRACT: To determine the effect of immersive 3D cultural simulation on nursing students' empathy towards culturally and linguistically diverse patients. Accelerated globalisation has seen a significant increase in cultural diversity in most regions of the world over the past forty years. Clinical encounters that do not acknowledge cultural factors contribute to adverse patient outcomes and health care inequities for culturally and linguistically diverse people. Cultural empathy is an antecedent to cultural competence. Thus, appropriate educational strategies are needed to enhance nursing students' cultural empathy and the capacity to deliver culturally competent care. A one-group pretest, post-test design was used for this study. The simulation exposed students to an unfolding scene in a hospital ward of a developing county. A convenience sample of second-year undergraduate nursing students (n = 460) from a semi-metropolitan university in Australia were recruited for the study. Characteristics of the sample were summarised using descriptive statistics. T-tests were performed to analyse the differences between pre- and post simulation empathy scores using an eight item modified version of the Kiersma-Chen Empathy Scale. Students' empathy towards culturally and linguistically diverse patients significantly improved after exposure to the 3D simulation experience. The mean scores for the Perspective Taking and Valuing Affective Empathy subscales also increased significantly postsimulation. The immersive 3D simulation had a positive impact on nursing students' empathy levels in regards to culturally and linguistically diverse groups. Research with other cohorts and in other contexts is required to further explore the impact of this educational approach. Immersive cultural simulation experiences offer opportunities to enhance the cultural empathy of nursing students. This may in turn have a positive impact on their cultural competence and consequently the quality of care they provide to culturally and linguistically diverse patients. © 2015 John Wiley & Sons Ltd.
    Journal of Clinical Nursing 07/2015; 24(19). DOI:10.1111/jocn.12893 · 1.26 Impact Factor
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    • "The ideas of patient-centeredness dates back to the late 1960s. Central to patientcentered care is that patients are regarded as unique and it contains a specific approach to how health care workers should communicate with patients (Saha et al., 2008). Mead and Bower (2000) found five dimensions influencing the patient-centeredness ; professional context, doctor factors, patient factors, consultation-level and " shapers " . "

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    • "An element of shared decision-making and an essential component of patient-centred care is effective communication and information sharing [21]. Researchers have also discussed how patient-centred approaches can alleviate disparities in care based on ethnicity, race and socioeconomic status [22], [23]. Other components of patient-centred care frameworks include continuity of care [22] and structural factors such as the availability of resources and time [24]. "
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    ABSTRACT: Interactions between patients and service providers frequently influence uptake of prevention of mother-to-child transmission (PMTCT) HIV services in sub-Saharan Africa, but this process has not been examined in depth. This study explores how patient-provider relations influence PMTCT service use in four government facilities in Kisesa, Tanzania. Qualitative data were collected in 2012 through participatory group activities with community members (3 male, 3 female groups), in-depth interviews with 21 women who delivered recently (16 HIV-positive), 9 health providers, and observations in antenatal clinics. Data were transcribed, translated into English and analysed with NVIVO9 using an adapted theoretical model of patient-centred care. Three themes emerged: decision-making processes, trust, and features of care. There were few examples of shared decision-making, with a power imbalance in favour of providers, although they offered substantial psycho-social support. Unclear communication by providers, and patients not asking questions, resulted in missed services. Omission of pre-HIV test counselling was often noted, influencing women's ability to opt-out of HIV testing. Trust in providers was limited by confidentiality concerns, and some HIV-positive women were anxious about referrals to other facilities after establishing trust in their original provider. Good care was recounted by some women, but many (HIV-positive and negative) described disrespectful staff including discrimination of HIV-positive patients and scolding, particularly during delivery; exacerbated by lack of materials (gloves, sheets) and associated costs, which frustrated staff. Experienced or anticipated negative staff behaviour influenced adherence to subsequent PMTCT components. Findings revealed a pivotal role for patient-provider relations in PMTCT service use. Disrespectful treatment and lack of informed consent for HIV testing require urgent attention by PMTCT programme managers. Strategies should address staff behaviour, emphasizing ethical standards and communication, and empower patients to seek information about available services. Optimising provider-patient relations can improve uptake of maternal health services more broadly, and ART adherence.
    PLoS ONE 09/2014; 9(9):e106325. DOI:10.1371/journal.pone.0106325 · 3.23 Impact Factor
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