This article describes initial testing of an instrument designed to provide evidence of cultural competence among health care providers and staff. The Cultural Competence Assessment (CCA) instrument was based on a model describing cultural competence components (fact, knowledge, attitude, and behavior). Content and face validity were confirmed through expert panel review, subject feedback, and field-testing. The CCA was administered to an interdisciplinary health care team in a community hospice setting. Preliminary findings suggest that the CCA performed well. Internal consistency reliability for the scale was 0.92. Construct validity by factor analysis demonstrated that 25 items had loadings above 0.42. Construct validity was supported with a significant correlation to the widely used Inventory for Assessing the Process of Cultural Competence among Health care Professionals (IAPCC). Validity also was supported by significant differences between individuals with different educational levels and prior diversity training. The CCA is a promising tool to measure cultural competence in populations with a wide range of educational levels and backgrounds.

This article presents the 3-D puzzle model of culturally congruent care, defines the levels and constructs employed by this model, presents some assumptions, and lays out some basic propositions as a foundation for further work. There are many extant frameworks and theories of culture and cultural competence in nursing and health care; the model presented here draws heavily from prior work and is an attempt to present a synthesis of concepts and processes in a new way. The ideas presented here build particularly on pioneering work in transcultural nursing by Leininger. Leininger's work specifically focuses on the use of qualitative methods to understand the ways in which culture influences nursing care from an emic, or insider, perspective. The 3-D puzzle model extends Leininger's work to include concrete articulations of constructs relevant to design and implementation of intervention strategies for teaching and measuring competency among nurses and other providers.

The purpose of this study was to discover perceptions, experiences, and patterns of health care behavior among Arab Americans in an urban Midwestern area of the United States and then to discover perceptions and experiences of health care providers related to culturally competent care. The goal of the study was to generate findings that would provide the basis for implementing system-wide changes to include culturally competent care. A qualitative focus group methodology was used to discover the care patterns and perceptions of Arab Americans and the local health care providers. The nurse researchers conducted 10 focus groups. Six themes were identified, including the unique caring behaviors of Arab families, the complexity of the health care system to Arab Americans, communication gaps, the diversity of perceptions of cultural competency, obstacles to accessibility of care, and workforce diversity issues.

need to educate nurses to deliver culturally competent care for an increasingly diverse patient population, regardless of geographic location. (3)(4) This need served as the primary impetus for this work. Cultural standards exist within political, economic, and social systems, and that many health organizations throughout the world have defined care for their specific populations from the perspective of these systems. The variation among standards and the context within which standards are practiced may preclude a single set that fits all cultures.

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