The Patient's Charter identifies the need for nurses to respect patients' rights to influence their care, and contemporary nursing practice advocates that nurses work in partnership with patients. Hence nurses are encouraged to share their power and facilitate empowerment in their patients by giving them information and support. However, the literature indicates that nurses are not very successful in making patients feel empowered to make informed decisions. This study, conducted in 1998, provides some answers as to why this may be the case. The aim of the study was to explore and describe nurses' and patients' views regarding partnership in care in hospital. Using the grounded theory approach, participants were drawn from four hospitals in Western Australia. A purposive sample of 33 nurses and 32 patients were interviewed in-depth. Participant observation was also conducted and field notes were written. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings showed that nurses viewed involving patients in care as requiring them to give patients information and to share their decision-making powers with them. With the exception of a few, the majority of nurses were unwilling to share their decision-making powers. This created a situation of power imbalance with subsequent little patient input. Factors identified included nurses' beliefs that they "know best", the view that patients lacked medical knowledge and the perceived need for nurses to hold onto their power and maintain control. If nurses and patients are to work as partners, it is important that nurses make every effort to equalize the power imbalance. One way to do this is for nurses to share and give information to patients readily and to be open in their communication with them.

This study aims to conduct a concept analysis on cultural competence in community healthcare. Clarification of the concept of cultural competence is needed to enable clarity in the definition and operation, research and theory development to assist healthcare providers to better understand this evolving concept. Rodgers' evolutionary concept analysis method was used to clarify the concept's context, surrogate terms, antecedents, attributes and consequences and to determine implications for further research. Articles from 2004 to 2015 were sought from Medline, PubMed, CINAHL and Scopus using the terms "cultural competency" AND "health," "cultural competence" OR "cultural safety" OR "cultural knowledge" OR "cultural awareness" OR cultural sensitivity OR "cultural skill" AND "Health." Articles with antecedents, attributes and consequences of cultural competence in community health were included. The 26 articles selected included nursing (n = 8), health (n = 8), psychology (n = 2), social work (n = 1), mental health (n = 3), medicine (n = 3) and occupational therapy (n = 1). Findings identify cultural openness, awareness, desire, knowledge and sensitivity and encounter as antecedents of cultural competence. Defining attributes are respecting and tailoring care aligned with clients' values, needs, practices and expectations, providing equitable and ethical care, and understanding. Consequences of cultural competence are satisfaction with care, the perception of quality healthcare, better adherence to treatments, effective interaction and improved health outcomes. An interesting finding is that the antecedents and attributes of cultural competence appear to represent a superficial level of understanding, sometimes only manifested through the need for social desirability. What is reported as critical in sustaining competence is the carers' capacity for a higher level of moral reasoning attainable through formal education in cultural and ethics knowledge. Our conceptual analysis incorporates moral reasoning in the definition of cultural competence. Further research to underpin moral reasoning with antecedents, attributes and consequences could enhance its clarity and promote a sustainable enactment of cultural competence.

With 28% of Australia's population having a culturally and linguistically diverse (CALD) background, the health system faces an increasing challenge to provide accessible and culturally competent health care. The view that all CALD communities are homogenous and solutions can be developed for the entire nation is detrimental. Despite available health services, CALD communities are reluctant to use them due to cultural differences, perceived racism and misunderstandings leading to the existing health disparities. Therefore, gathering data from four prominent CALD communities, such as the Sudanese, Afghani, Pacific Islander and Burmese communities in Logan, Queensland, about how they perceive and use health services can provide insightful information towards development of a service model that will better suit these CALD communities. The objective of the study was to examine the extent to which four prominent CALD communities (Sudanese, Afghani, Pacific Islander and Burmese) access and use health services in Logan, Queensland. Six focus group interviews using interpreters were conducted in English with Sudanese, Afghani, Pacific Islander and Burmese people. The results indicated that even long-standing CALD communities, such as the Pacific Islander people, were unfamiliar with health services and experienced difficulties accessing appropriate health care. Most wanted doctors to use traditional healing methods alongside orthodox medicine, but did not feel respected for their beliefs. Language difficulties impeded communication with health professionals who were hindered by ineffective use of interpreters. In conclusion, a clear role for bilingual community-based navigators was identified by CALD participants to address concerns about the health system, and to improve accessibility and health service usage.

Culturally and linguistically diverse (CALD) communities in Australia experience both significant health disparities and a lack of access to services. Consequently, there have been calls for culturally appropriate services for people with chronic disease in CALD populations. This paper presents a systematic review of the literature on the effectiveness of culturally appropriate interventions to manage or prevent chronic disease in CALD communities. Evidence was sought from randomized controlled trials and controlled studies that examined strategies for promoting cultural competence in health service delivery to CALD communities. The outcomes examined included changes in consumer health behaviours, utilisation/satisfaction with the service, and the cultural competence of health‐care providers. Of the 202 studies that were identified only 24 met the inclusion criteria. The five categories of intervention that were identified included: (1) the use of community‐based bi‐lingual health workers; (2) providing cultural competency training for health workers; (3) using interpreter service for CALD people; (4) using multimedia and culturally sensitive videos to promote health for CALD people and (5) establishing community point‐of‐care services for CALD people with chronic disease. The review supported the use of trained bi‐lingual health workers, who are culturally competent, as a major consideration in the development of an appropriate health service model for CALD communities.