Abstract: the overall aim of this thesis is to explore, analyze and clarify how cultural competence is understood. This is explored from the perspective of nurses, nursing students, nurse educators, and nurse researchers in relation to the swedish care context. The field of transcultural nursing and cultural competence was founded in the united states in the 1950s in response to an increased awareness of cultural diversity arising from immigration. In sweden an interest in transcultural nursing and cultural competence has emerged only recently and therefore knowledge in this area is quite sparse. In study i, an instrument for measuring cultural competence was translated, adapted and evaluated for use in sweden. By following guidelines in the literature, this process was carefully laid out and the content and internal structure of the instrument was evaluated.

The findings indicated that the instrument did not meet appropriate validity and reliability levels, and the evaluation of the content indicated a weak relation between the instrument and the constructs. In study ii, the aim was to analyze the core components found in the descriptions of the most frequently cited theoretical frameworks of cultural competence. Nine theoretical frameworks of cultural competence were analyzed using a documentary analysis method. The findings revealed four themes that characterized cultural competence: an awareness of diversity among human beings an ability to care for individuals nonjudgmental openness for all individuals and enhancing cultural competence as a longterm continuous process. In study i, the aim was to identify the core components of cultural competence from a swedish perspective. The first round was conducted with qualitative interviews and was followed by three rounds with questionnaires.

In total, consensus was reached on 118 core components that were grouped into five categories, with 17 associated subcategories. These categories are: cultural sensitivity cultural understanding cultural encounter understanding of health, ill health and healthcare and social and cultural context. In the final study, study iv, qualitative interviews were conducted with 10 nursing students, five with an immigrant background and five with a swedish background, to explore their experiences of communication in cross cultural care encounters.

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Four themes were identified: conceptualizing cross cultural care encounters difficulties in communication strategies employed and factors influencing communication. The synthesis of the findings from the four studies is illustrated in figure 1 as the common patterns in the constituent elements of cultural competence in the swedish context, which are identified as: the nurse s cultural awareness, personal beliefs and values cultural assessment and cross cultural communication. The thesis concludes that transcultural nursing and cultural competence is about nurses being able to take the patient s cultural background, beliefs, values and traditions into consideration in nursing care.

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Cultural competence should not only be employed when caring for immigrants or ethnic minority groups, but also in encounters with all patients. Showing result 1 5 of 44 swedish dissertations containing the words cultural competence. During the past decade, research on competence development and cross cultural organisation has been acknowledged both in academic circles and by industrial organisations.

Cross cultural organisations that have emerged through globalisation are a manifestation of the growing economic interdependence among countries. Karolinska institutet, department of neurobiology, care sciences and society

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by harper, mary g.. The threefold purpose of this research is to identify the essential antecedents of cultural competence as identified by international nurse researchers, to compare the content of the extant cultural competence instruments to these antecedents and to potentially identify gaps in their conceptualization. A secondary aim of this research is to initiate validation of harper rsquo s model of ethical multiculturalism. The model of ethical multiculturalism depicts the attributes of ethical multiculturalism as the fulcrum of a balance between two ethical philosophies of fundamentalism and relativism. The attributes of moral reasoning, beneficence/nonmaleficence, respect for persons and communities, and cultural competence form the pyramidal fulcrum. The antecedents form the base of the pyramid and include cultural awareness, culture knowledge, cultural sensitivity, cultural encounters, cultural skill and understanding of ethical principles.

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An on line delphi method was conducted with 35 international nurse researchers identified through published research, university directories, and professional organizations. Following the delphi rounds, sixteen members of the expert panel participated in an on line focus group to validate results of the delphi and discuss cultural competence in the international arena. Consensual thematic analysis of the focus group transcripts resulted in six themes: chimerical, contact, contextual, collaboration, connections, and considering impact.

The transcultural self efficacy tool tset contained the most antecedents identified by the expert panel. Cultural competence is a process, not an outcome, and must be considered from the perspective of the recipient of care or research participant. The model of ethical multiculturalism is revised to include cultural desire as an antecedent.

Nurses must understand the impact of globalization on individual health and care delivery. Further testing of cultural competence instruments is needed to determine the correlation of self efficacy with behavior, self assessment with client assessment, and cultural competence with client outcomes. In education, research is needed to determine the most effective methods of teaching cultural competence. In practice, nurses must be prepared to provide language assistance as needed, recruitment and hiring of minorities must be increased, and minority thresholds must be used to determine cultural knowledge content for organizations.

Identify four 4 guidelines the registered professional nurse may use to enhance the ability to provide culturally competent nursing care. Provide one example the culturally competent nurse applies to each of the four 4 selected guidelines. At least one example must address care of patient s not occurring in an acute care hospital.