Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare

Abstract

Objectives The objective of this review was to evaluate evidence on the structures and processes that support development of effective culturally competent practices and a healthy work environment. Culturally competent practices are a congruent set of workforce behaviours, management practices and institutional policies within a practice setting resulting in an organisational environment that is inclusive of cultural and other forms of diversity. Inclusion criteria This review included quantitative and qualitative evidence, with a particular emphasis on identifying systematic reviews and randomised controlled trials. For quantitative evidence, other controlled, and descriptive designs were also included. For qualitative evidence, all methodologies were considered. Participants were staff, patients, and systems or policies that were involved or affected by concepts of cultural competence in the nursing workforce in a healthcare environment. Types of interventions included any strategy that had a cultural competence component, which influenced the work environment, and/or patient and nursing staff in the environment. The types of outcomes of interest to this review included nursing staff outcomes, patient outcomes, organisational outcomes and systems level outcomes. Search strategy The search sought both published and unpublished literature written in the English language. A comprehensive three-step search strategy was used, first to identify appropriate key words, second to combine all optimal key words into a comprehensive search strategy for each database and finally to review the reference lists of all included reviews and research reports. The databases searched were CINAHL, Medline, Current Contents, the Database of Abstracts of Reviews of Effectiveness, The Cochrane Library, PsycINFO, Embase, Sociological Abstracts, Econ lit, ABI/Inform, ERIC and PubMed. The search for unpublished literature used Dissertation Abstracts International. Methodological quality Methodological quality was independently established by two reviewers, using standardised techniques from the Joanna Briggs Institute (JBI) System for the Unified Management, Assessment and Review of Information (SUMARI) package. Discussion with a third reviewer was initiated where a low level of agreement was identified for a particular paper. Following inclusion, data extraction was conducted using standardised data extraction tools from the JBI SUMARI suite for quantitative and qualitative research. Data synthesis was performed using the JBI Qualitative Assessment and Review Instrument and JBI Narrative, Opinion and Text Assessment and Review Instrument software to aggregate findings by identifying commonalities across texts. Quantitative data were presented in narrative summary, as statistical pooling was not appropriate with the included studies. Results Of the 659 identified papers, 45 were selected for full paper retrieval, and 19 were considered to meet the inclusion criteria for this review. The results identified a number of processes that w...

Interventions to improve cultural competency in healthcare: a systematic review of reviews

“…Searching yielded a total of 6,830 titles, of which 19 met the inclusion criteria and were extracted for analysis (Table 1) [3-8,13-25]. The main reasons for exclusion were: articles were commentary or opinion pieces, articles were of primary studies, review articles examined cultural competency assessment tools and review articles but did not include any studies with interventions.…”

“…Existing reviews have examined cultural competency and related concepts within health care settings such as nursing [3] and mental health [4] as well as within health care systems [5]. Some reviews have focused on either provider outcomes [6] or patient/client outcomes [7] while others have examined specific health conditions such as diabetes [8].…”

Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings

“…Desired professional practice such as prescribing, and adherence to recommended guidelines improved significantly (RR: 1.52, 95% CI: 1.27, 1.82) with the interventions tailored to address identified barriers to change [36]. Appropriate and competent linguistic services, and intercultural staff training and education were identified as the key components for a culturally competent workforce [37]. There was limited evidence for the impact of physical healthcare environment involving ambience, architectural or interior design features however it has reported improved staff mood and reduced unscheduled absenteeism [38].…”

Cultural Competence Education for Rural Clinic Nurses: A Comparison of Methods

“…The Culture Matters discussion guides were developed by the primary author to accompany the Culture Matters DVDs. Because the California Endowment (2003) and Pearson et al (2007) recommended that educational materials be evaluated by representatives of the cultural community, a focus group of eight members of the Hispanic/ Latino community viewed the Culture Matters Hispanic/ Latino DVD with the discussion guides, and a focus group of six members of the Somali community viewed the Somali Culture Matters DVD with the discussion guides to ensure face validity. Both cultural groups verified the accuracy of the material in the discussion guides.…”