This study examined doulas' perspectives on how cultural and community perceptions influence immigrant women's birth and perinatal care. Doulas saw their role as cultural brokers and advocates as helping immigrant women navigate the healthcare system and make informed choices. However, cultural and language barriers, lack of respect for cultural practices, and stereotyping sometimes disadvantaged immigrant women. Community doula programs aimed to address this by providing interpretation and advocating for culturally appropriate care.
Advancing the field of cultural competency by providing the first structural competency certificate program in the country. Online, on-demand and FREE, including free continuing education credits. Live trainings coming soon. Give me a call!
2018-04-18 المؤتمر العلمي الثاني للمعهد القومي لعلوم المسنين جامعة بني سويف بعنوان" التحديات والمستجدات العالمية في رعاية المسنين"
http://www.bsu.edu.eg/ShowConfDetails.aspx?conf_id=217
Introduction to Culture and Health - May 26 2016jayembee
This presentation presents information about the national CLAS Standards, defines culture, and explores the intersections of culture and health. Medical mistrust and its impact on health seeking behaviors is also examined.
Another student reply react adding some extra imformation relate to .docxYASHU40
Another student reply react adding some extra imformation relate to this post.
Please start the post with Hello Vanessa. dont use hello student ,
Biological variations and nursing care of childbearing women
There are a number of cultural beliefs and practices which nurses may encounter when dealing with women’s health. Cultural beliefs and practices are continuously evolving making it necessary for nurses to acknowledge the various cultures and explore the meaning of childbearing (Deger, 2017).Some of these issues are directly linked to biological variations in women for example menstruation. Most women who undergo menstruation often have the potential of bearing children. Research has shown that menstruation is often associated with physical discomfort, increased emotionality and restricted social and physical activities. In some cultures, and religions, women who are menstruating are viewed as ritually impure and are not allowed to participate in religious ceremonies.
These negative attitudes towards menstruation are likely to influence adjustment to the emergence of maturity, femininity and sexuality. Nurses that work with women therefore have to be aware that culture, religion and society are crucial factors in the development of attitudes towards menstruation.
Similarly, childbirth is one of life’s most significant events and the perinatal period is accompanied by many culturally shaped beliefs. Nurses need to realise areas where there may be differences between traditional cultural practices and the current western practices (Deger, 2017). It is helpful to assess what being pregnant means to an expectant mother. Moreover, some women view pain as a necessary part of the birth process and satisfaction with the birth experience is often associated with the sense of fulfilment. Nurses are thus enabled to become culturally sensitive when they understand that responses to pain differ according to cultural norms. Nurses can therefore learn how to properly support and comfort the women and coaching the people accompanying the labouring mother so that culturally competent care can be exercised.
Culturally competent care for Hispanic women
Research has shown that Hispanic women experience higher rates of perinatal death varying by country of origin. Little research currently exists on the experiences of such women meaning that nurses have no guidance with regards to caring for this vulnerable population (Sobel, 2016).
It is important to first consider the risk factors for perinatal loss among these people. Hispanic women have been shown to have a number of factors that lead to loss for example, there is a higher teen birth ratio, more births to unmarried mothers and twice the likelihood of receiving late care or no care at all. There are a number of ways in which members of the Hispanic community mourn their loss. Many Hispanic families believe in the spiritual and psychological continuity with the dead which takes the form of a con.
Another student reply react adding some extra imformation relate to .docxSHIVA101531
Another student reply react adding some extra imformation relate to this post.
Please start the post with Hello Vanessa. dont use hello student ,
Biological variations and nursing care of childbearing women
There are a number of cultural beliefs and practices which nurses may encounter when dealing with women’s health. Cultural beliefs and practices are continuously evolving making it necessary for nurses to acknowledge the various cultures and explore the meaning of childbearing (Deger, 2017).Some of these issues are directly linked to biological variations in women for example menstruation. Most women who undergo menstruation often have the potential of bearing children. Research has shown that menstruation is often associated with physical discomfort, increased emotionality and restricted social and physical activities. In some cultures, and religions, women who are menstruating are viewed as ritually impure and are not allowed to participate in religious ceremonies.
These negative attitudes towards menstruation are likely to influence adjustment to the emergence of maturity, femininity and sexuality. Nurses that work with women therefore have to be aware that culture, religion and society are crucial factors in the development of attitudes towards menstruation.
Similarly, childbirth is one of life’s most significant events and the perinatal period is accompanied by many culturally shaped beliefs. Nurses need to realise areas where there may be differences between traditional cultural practices and the current western practices (Deger, 2017). It is helpful to assess what being pregnant means to an expectant mother. Moreover, some women view pain as a necessary part of the birth process and satisfaction with the birth experience is often associated with the sense of fulfilment. Nurses are thus enabled to become culturally sensitive when they understand that responses to pain differ according to cultural norms. Nurses can therefore learn how to properly support and comfort the women and coaching the people accompanying the labouring mother so that culturally competent care can be exercised.
Culturally competent care for Hispanic women
Research has shown that Hispanic women experience higher rates of perinatal death varying by country of origin. Little research currently exists on the experiences of such women meaning that nurses have no guidance with regards to caring for this vulnerable population (Sobel, 2016).
It is important to first consider the risk factors for perinatal loss among these people. Hispanic women have been shown to have a number of factors that lead to loss for example, there is a higher teen birth ratio, more births to unmarried mothers and twice the likelihood of receiving late care or no care at all. There are a number of ways in which members of the Hispanic community mourn their loss. Many Hispanic families believe in the spiritual and psychological continuity with the dead which takes the form of a con.
Advancing the field of cultural competency by providing the first structural competency certificate program in the country. Online, on-demand and FREE, including free continuing education credits. Live trainings coming soon. Give me a call!
2018-04-18 المؤتمر العلمي الثاني للمعهد القومي لعلوم المسنين جامعة بني سويف بعنوان" التحديات والمستجدات العالمية في رعاية المسنين"
http://www.bsu.edu.eg/ShowConfDetails.aspx?conf_id=217
Introduction to Culture and Health - May 26 2016jayembee
This presentation presents information about the national CLAS Standards, defines culture, and explores the intersections of culture and health. Medical mistrust and its impact on health seeking behaviors is also examined.
Another student reply react adding some extra imformation relate to .docxYASHU40
Another student reply react adding some extra imformation relate to this post.
Please start the post with Hello Vanessa. dont use hello student ,
Biological variations and nursing care of childbearing women
There are a number of cultural beliefs and practices which nurses may encounter when dealing with women’s health. Cultural beliefs and practices are continuously evolving making it necessary for nurses to acknowledge the various cultures and explore the meaning of childbearing (Deger, 2017).Some of these issues are directly linked to biological variations in women for example menstruation. Most women who undergo menstruation often have the potential of bearing children. Research has shown that menstruation is often associated with physical discomfort, increased emotionality and restricted social and physical activities. In some cultures, and religions, women who are menstruating are viewed as ritually impure and are not allowed to participate in religious ceremonies.
These negative attitudes towards menstruation are likely to influence adjustment to the emergence of maturity, femininity and sexuality. Nurses that work with women therefore have to be aware that culture, religion and society are crucial factors in the development of attitudes towards menstruation.
Similarly, childbirth is one of life’s most significant events and the perinatal period is accompanied by many culturally shaped beliefs. Nurses need to realise areas where there may be differences between traditional cultural practices and the current western practices (Deger, 2017). It is helpful to assess what being pregnant means to an expectant mother. Moreover, some women view pain as a necessary part of the birth process and satisfaction with the birth experience is often associated with the sense of fulfilment. Nurses are thus enabled to become culturally sensitive when they understand that responses to pain differ according to cultural norms. Nurses can therefore learn how to properly support and comfort the women and coaching the people accompanying the labouring mother so that culturally competent care can be exercised.
Culturally competent care for Hispanic women
Research has shown that Hispanic women experience higher rates of perinatal death varying by country of origin. Little research currently exists on the experiences of such women meaning that nurses have no guidance with regards to caring for this vulnerable population (Sobel, 2016).
It is important to first consider the risk factors for perinatal loss among these people. Hispanic women have been shown to have a number of factors that lead to loss for example, there is a higher teen birth ratio, more births to unmarried mothers and twice the likelihood of receiving late care or no care at all. There are a number of ways in which members of the Hispanic community mourn their loss. Many Hispanic families believe in the spiritual and psychological continuity with the dead which takes the form of a con.
Another student reply react adding some extra imformation relate to .docxSHIVA101531
Another student reply react adding some extra imformation relate to this post.
Please start the post with Hello Vanessa. dont use hello student ,
Biological variations and nursing care of childbearing women
There are a number of cultural beliefs and practices which nurses may encounter when dealing with women’s health. Cultural beliefs and practices are continuously evolving making it necessary for nurses to acknowledge the various cultures and explore the meaning of childbearing (Deger, 2017).Some of these issues are directly linked to biological variations in women for example menstruation. Most women who undergo menstruation often have the potential of bearing children. Research has shown that menstruation is often associated with physical discomfort, increased emotionality and restricted social and physical activities. In some cultures, and religions, women who are menstruating are viewed as ritually impure and are not allowed to participate in religious ceremonies.
These negative attitudes towards menstruation are likely to influence adjustment to the emergence of maturity, femininity and sexuality. Nurses that work with women therefore have to be aware that culture, religion and society are crucial factors in the development of attitudes towards menstruation.
Similarly, childbirth is one of life’s most significant events and the perinatal period is accompanied by many culturally shaped beliefs. Nurses need to realise areas where there may be differences between traditional cultural practices and the current western practices (Deger, 2017). It is helpful to assess what being pregnant means to an expectant mother. Moreover, some women view pain as a necessary part of the birth process and satisfaction with the birth experience is often associated with the sense of fulfilment. Nurses are thus enabled to become culturally sensitive when they understand that responses to pain differ according to cultural norms. Nurses can therefore learn how to properly support and comfort the women and coaching the people accompanying the labouring mother so that culturally competent care can be exercised.
Culturally competent care for Hispanic women
Research has shown that Hispanic women experience higher rates of perinatal death varying by country of origin. Little research currently exists on the experiences of such women meaning that nurses have no guidance with regards to caring for this vulnerable population (Sobel, 2016).
It is important to first consider the risk factors for perinatal loss among these people. Hispanic women have been shown to have a number of factors that lead to loss for example, there is a higher teen birth ratio, more births to unmarried mothers and twice the likelihood of receiving late care or no care at all. There are a number of ways in which members of the Hispanic community mourn their loss. Many Hispanic families believe in the spiritual and psychological continuity with the dead which takes the form of a con.
Comment 1Community health nurses can apply the strategies of cul.docxdivinapavey
Comment 1
Community health nurses can apply the strategies of cultural competence by being culturally aware. Nurses should start by assessing the patient to determine the person’s knowledge and beliefs before providing care. This will give the nurse insight as to how to proceed with education and treatment.
An example of a nurse practicing cultural preservation would to acknowledge the use of traditional healers within the Hispanic community. Latinos term illnesses as either “hot” or “cold” and treat such illnesses with herbs or other measures, such as massage on the affected area or steam baths. The treatment of such illnesses is termed cultural accommodation and should be encouraged if these forms of treatment have been proven harmless. An example of cultural repatterning would be for the nurse to work with the patient to change a person’s behavior(s) that would be harmful to him/her. Cultural brokering is recognized as connecting differing cultural backgrounds so that a change in behavior can be made to produce a successful outcome. Barriers to applying any of these strategies is a lack of understanding on the nurse’s part and recognizing that family plays a major role in influencing behavior. For example, research shows that Latino adolescents that battle substance abuse are more successful with their treatment and have better outcomes with family support. This is due to, in part, because Hispanic families rely on the entire family (aunts, uncles, cousins, grandparents, etc.) as a unified support system (Burrow-Sanchez). However, some barriers to Latinos obtaining treatment could be a lack of access to needed healthcare/treatment, language barriers, etc.
Therefore, it is very important for nurses to be culturally aware and practice patience and understanding while maintaining respect when it comes to providing care for people that come from different cultures.
Comment 2
A community health nurse has a great challenge in applying cultural competence because they see and treat such a variety of culturally different people. It is key for the community health nurse to assess their own beliefs and be aware that they may greatly vary from the people in their care. Being open minded and setting aside personal biases while implementing the four strategies of cultural competence is needed to achieve success (Maurer & Smith, 2013).
Midwives work in facilities, but also work in the community as well assisting with birthing in homes. Cultural preservation can be seen by only using a female midwife in the home birth of a Muslim baby as well as respecting that the father will most likely not be present for the birth. Cultural accommodation example would be to allow a mother soon after giving birth to eat a ratb, which is a type of date. This is thought to help promote excellent breast milk for the baby. Cultural repatterning would be discussing that the tradition of placing khakhe shafaa, a type of mud, in the infant’s mouth after birt ...
(1) citation reference 150 words CultureHmong CultureC.docxmadlynplamondon
(1) citation reference 150 words
Culture
Hmong Culture
Considerations
In beginning the interview, a consideration to remember is that eye contact is considered rude to Hmong People and that tone of voice and body language are very important; taking too loudly, placing too much emphasis on words, or talking excessively with hands and arm movements can result in noncompliance (Carteret, 2012). As this patient is young and assumed to be mainstream with Western culture, she will likely be understanding and forgiving of eye contact, tone, and body language but interactions with older family members will require care.
Gender of the nurse might play a role in some assessments, it is important to ask if a male nurse has permission to touch the abdomen or auscultate the lungs, heart, or abdomen. Questions pertaining to sex should be private and held with a nurse who is the same gender as the patient, it is of note that questions or examinations regarding sexual health can be misinterpreted as judgment of promiscuity, resulting in refusal, so sex must be addressed with much explanation and rationale without judgment (Carteret, 2012). As infection can be related to sex or sexual contact, this should be addressed with this patient.
The patient’s language preference for the interview is also important. The patient is a young adult and in college, however, her preference might be Hmong, or the language typically spoken at home. Another consideration is, does the patient want anyone else present for her interview/assessment? Hmong People have a family structure that is patriarchal, meaning, the father generally very involved in decision making and can, ultimately have the final say on a topic or treatment; the mother is caregiver and may wish to be present to help take care of the patient. Hmong Elders also play a large role in decision making, with a Grandfather that might want to talk directly with the doctor and make decisions over the wishes of the patient or patient’s father (Carteret, 2012).
Hmong Culture has roots in animism, which is the belief that objects, places, animals, people, etc. all have spirits and bodies that maintain a natural balance (Duffy, J., Harmon, R., Ranard, D.A., Thao, B., & Yang, K. (2004). The fever in this patient could be related to an imbalance in her spirit, an inhabitation by another sprit that is making her ill, disapproval of recent behavior by dead ancestors, or a curse (Carteret, 2012). The family might elect to have a religious healer, or Shaman visit to perform holistic medicine on the patient, some of this medicine might cause burns or pinch marks with coining or skin pinching being common practices for illness (Khuu, Yee, & Zhou, 2017). An understanding of Western medicine might not be present, the patient or family may ask for dosages of antibiotics for infection or acetaminophen of fever to be increase or decrease based on how they feel; it is important to explain that medications are dosed on scientifi.
Please reply to this discussion post. 2 paragraphs. 2 References. AP.docxleahlegrand
Please reply to this discussion post. 2 paragraphs. 2 References. APA.
As an Advanced Practice Registered Nurse (APRN) who plans to reside in such a culturally diverse city such as Miami, Fl it is extremely important that we are not just familiarized and conscientious of our own values, beliefs, culture, and self-concept, but that we are aware cognizant of others’ cultures, beliefs and values and how they could potentially impact not just the patient’s overall health, but the interventions we plan to implement to improve their health. As the percentage of patients with type 2 diabetes and the epidemic of obesity on the continual rise in Hispanics and African Americans, it is imperative that we as providers understand the factors contributing to these alarming numbers. Clinical trials have demonstrated that understanding the factors contributing to these health concerns and providing culturally tailored interventions can be efficient and effective (Joo & Liu, 2021).
Research conducted demonstrated the positive impact of several culturally tailored interventions on type 2 diabetes and these included open discussions of cultural beliefs about diabetes and their treatments, employing use of their native language, integrating cultural dietary preferences, and encouraging family participation and support (Joo & Liu, 2021). With respect to obesity, research has been conducted to examine culturally influenced interventions geared towards family genetics, behaviors, and the environment by using e-health as an opportunity to deliver interactive, culturally diverse, tailored information, however this was found to be largely dependent on literacy levels (Gustafson et al., 2010). Hispanic and African Americans who were surveyed prior to and after using the web, for example, to search health related information stated that the information available was not in lay-mans terms, difficult to comprehend, and interactive databases that contained simulated health care workers delivered the information much too quickly for them (Gustafson et al., 2010).
Mitrani (2010) references that culturally tailored interventions requires providers have an understanding of common root causes of disorders and culturally related factors that influence such disorders- a linkage must be established. As the daughter of Cuban immigrants, most family gatherings are centered around food and family dinners are quite the norm. Even though each member of the family is of a different educational circumstance or literacy level, generation, or of native language, the food preferences remain consistent: lechon (pig), white rice, black beans, and yuca (cassava). As children we are told to eat everything served on our plates. The portions are relatively large. It is important in this instance to understand that our support system and how we are raised can be of significant impact on our nutritional values, beliefs, and our overall health. It is of particular importance then that when ...
Cultural Competence and PovertyExploring Play Therapists’ AOllieShoresna
Cultural Competence and Poverty:
Exploring Play Therapists’ Attitudes
Lauren Chase and Kristie Opiola
Department of Counseling, University of North Carolina at Charlotte
This article reports the findings of a survey that investigated attitudes toward poverty
among play therapists (N � 390) and its relation to demographic information. Multi-
variate analyses of variance (MANOVA) were used to measure the relationship
between play therapists’ demographics and their attitudes toward poverty, specifically
their structural, personal deficiency, and stigma scores. Results indicated that both
region and age resulted in differing views on poverty. Participants living in the
Northeast held stronger structural views of poverty than participants in the South.
Similarly, participants in the 50 –59 and 60 plus age groups disagreed to strongly
disagree with a personal explanation toward poverty than participants in the 30 –39 age
group. The importance of play therapists’ examining their attitudes toward poverty and
the direct impact on their work is discussed. Finally, implications of the results,
including overall findings, are explained.
Keywords: play therapy, attitudes of poverty, cultural competence
Culturally competent training is an element
of credentialing requirements that ensures men-
tal health providers offer adequate and respon-
sive care to diverse populations. Although the
mental health field has embedded cultural com-
petence in their standards and guidelines, there
are discrepancies in the way the profession as-
sesses and measures competence (Sue et al.,
1996). Researchers have investigated attitudes
toward poverty in the helping professions
(Levin & Schwartz-Tayri, 2017; Noone et al.,
2012; van Heerde & Hudson, 2010; & Wit-
tenauer et al., 2015), but no study has focused
on play therapists’ attitudes toward poverty.
The purpose of this study is to fill a gap in the
literature regarding play therapist’s attitudes to-
ward poverty because awareness and knowl-
edge are key elements to implement culturally
responsive services and skills with diverse chil-
dren in a variety of settings.
Cultural Competence
Cultural competence is an important compo-
nent of professional practice, and practitioners
are expected to develop skills and understand-
ing pertaining to diverse clientele. Researchers
define cultural competence as the set of beliefs,
knowledge, and skills mental health providers
possess in order to deliver effective interven-
tions and services to members of various cul-
tures (Gilbert et al., 2007; Sue, 2006). The New
Freedom Commission on Mental Health (2003)
recognized disparities in mental health delivery
and viewed the lack of cultural competence for
minority populations as a persistent problem.
Culturally competent health care is essential to
providing effective care to all populations. To
aid practitioners in their ability to increase their
cultural competence, leading professional men-
tal health associations have published ...
On the Margins of Health Care Provision: Delivering at Home in Harare, Zimbabwepaperpublications3
Abstract: This paper analyses the phenomenon of home deliveries by pregnant women in an urban setting in Zimbabwe. It argues that, though home deliveries are commonly practiced in the rural areas, they have now found their way into and are even proliferating in the urban areas. Social cultural values, religious belief and economic status/resources determine women’s place of birth. Whilst government policies expounded through the Ministry of Health (MoH) programs and policies denounce home deliveries, the frail health care system characterized by mass exodus of qualified personnel, in availability of drugs and understaffing of healthcare centres do little to lure pregnant women to deliver in hospitals. Furthermore, the high levels of poverty among the populace entail that people cannot afford either public or private hospital services; and thus resort to home-based healthcare and subsequently home deliveries. The paper explores the factors fuelling home deliveries and the challenges associated with this practice in Harare, Zimbabwe.
Low birth weight infants and preterm births are some of the leading .docxssuser47f0be
Low birth weight infants and preterm births are some of the leading factors that contribute significantly to morbidity and infant mortality (Loftin, Habli, Snyder, Cormier, Lewis & DeFranco, 2010). The authors further state that different ethnic and cultural groups experience the problem at different levels, often due to differences in socioeconomic factors, varying behaviors during pregnancy among the different cultures, and varying sociodemographic profiles. Cultural differences during pregnancy (such as approaches to education and health) are major contributors to the differences that the different ethnic and racial groups experience. This problem affects the black communities (and minority communities) more when compared to the white population.
Extremely low birth weight babies has an extremely negative impact on families and communities because such babies often require specialized care, which is often quite costly for many families. Babies born with extremely low birth weights often spend extended periods of time on specialized care because they need ongoing care and constant monitoring, and they often struggle to survive because they have premature vital organs such as the lung and the heart. These make such babies to become quite vulnerable to diseases (such as chronic lung disease, cerebral palsy, and hyperactivity disorder), and may cause financial and emotional stress in families. Such situations also require communities to invest a lot in specialized equipments and health experts, which is quite costly. Low birth weight babies may require special education arrangements, vision/hearing treatment, speech therapy, and physical therapy (The Urban Child Institute, 2017).
According to March of Dimes Foundation, the annual cost related with premature birth in the U.S. is $26.2 billion.
Considering the high cost involved in dealing with cases of low birth weight babies, it is critical that professional health organizations develop viable and sustainable solutions to address the problem. Such health programs/initiatives often provide great relief for families and communities because they provide specialized care at affordable costs. More importantly, they provide timely interventions for both prevention and treatment of such health complications. The Florida's Healthy Start is such an initiative in my community that helps to address the needs of preterm infants and their families. This initiative started in 1991, and it aims at providing universal risk screening for all pregnant women and infants in Florida (FloridaHealth, n.d). The aim is to determine those at risk of developing health complications and providing necessary interventions.
The Healthy Start initiative provides vital services and adequately meets the needs of the Florida population. Through this initiative, the community has been able to save the lives of many pregnant women and premature infants, thereby significantly lowering the infant mortality rates. This initiative n ...
Running head CULTURAL INCOMPETENCE IN NURSING .docxjoellemurphey
Running head: CULTURAL INCOMPETENCE IN NURSING
CULTURAL INCOMPETENCE IN NURSING12
Literature Review: Cultural Incompetence in Nursing
Bettina Vargas
Kaplan University
Literature Review: Cultural Incompetence in NursingComment by Tracy Towne: Use citations to support yoru statements so the reader knows it is not just your opinion
In healthcare, cultural incompetence impedes the delivery of quality care at the global, national and healthcare organizational level. In the United States, the minority disproportionate access of healthcare is mainly due to cultural incompetence in nursing and so are the increasing health issues they face, such as high rates of diseases and deaths. At the practicum site, Coral Gables Nursing and Rehabilitation, the effect of cultural incompetence in reference to the delivering poor quality care to a culturally diverse patient population is evident. With this in mind, the focus of this literature review is to provide insight on the trends of cultural incompetence, explore theories used to examine cultural incompetence, gaps in the pre-existing literature and solutions to cultural incompetence. This will help to contextual cultural incompetence and find lasting solutions for eradicating cultural incompetence and prioritizing cultural competence.
Trends
Cultural incompetence in nursing finds its roots in the nursing education and training. According to Bednarz, Schim, & Doorenbos (2010), as the general population records increased diversity, so do the nursing classroom where the minorities are enrolling in nursing education at a higher rate. This increases the need to focus on diversity in nursing education to nurture cultural competent nursing professionals. However, cultural incompetence among the teaching staff in terms of the inability to counter diversity barriers make it difficult to teach a diverse classroom and impart students with cultural competence. These barriers emerge from values and common attitudes held by nursing education and culture such as avoiding unwanted discrimination and the Golden Rule, which is “do unto others as you would have them do unto you” (para. 9). As Hassouneh (2013) indicate, the effect of such barriers, is “unconscious incompetence” as well intentioned faculties are unable to recognize realities, including the fact that each student is unique and deserves unique treatment, thus generating more barriers towards instilling students with cultural competence. The nursing education and training lacks uniformity in accommodating the needs of diverse students. Lack of efficiency in cross-cultural communication, both in written and spoken form aggravates this. Besides, nursing education has no profound way of bringing the different cultures, jargon and professional languages that the students and the faculty possess together to create coherence and increasingly enable the nurses and the faculty to understand each other. The effect is a learning environme ...
Student PaperCultural Competency in Baccalaureate Nursing .docxdeanmtaylor1545
Student Paper
Cultural Competency in Baccalaureate Nursing Education: A Conceptual Analysis
Deborah Byrne, RN, MSN, La Salle University, Villanova University
Abstract
The ability to deliver culturally competent nursing care is an expected competency of
undergraduate nursing education programs. The American Association of Colleges of Nursing
(AACN) and the National League for Nursing (NLN) have developed toolkits that provide nurse
educators with models and teaching strategies to facilitate student learning in cultural
competency. However, the concept of cultural competency varies as does the best method for
integrating and evaluating cultural competency in undergraduate nursing curriculum. With the
growing number of diverse clients, it is imperative that nursing students deliver culturally
competent care. This article explores the current view of the concept of cultural competency from
the standpoint of nursing education and the methods used to evaluate cultural competency in
undergraduate nursing education programs.
Keywords: cultural competency, simulation,
undergraduate nursing education, cultural
awareness, cultural humility
Background and Significance
Health care is increasingly complex, diverse,
and growing in the United States. The United
States Census Bureau (2009) predicts that the
U.S. population of non-European Caucasians will
be equivalent to Caucasian Americans by 2050.
According to Healthy People 2020, there are
significant health disparities among minority
groups. A fundamental goal of Healthy People
2020 is to eliminate health disparities for all
groups (U.S. Department of Health and Human
Services [USDHHS]). The need for culturally
competent health care is essential to reduce
health disparities and ensure positive health
outcomes.
The National League for Nursing (NLN) and
American Association of Colleges of Nursing
(AACN) include culturally appropriate care in their
accreditation standards and have developed
toolkits for nurse educators to assist with
incorporating cultural competency in
undergraduate nursing curricula (NLN, 2009;
AACN, 2008). There is, however, no consensus in
the literature regarding effective ways to teach
cultural competency to undergraduate
baccalaureate nursing students. Most nursing
programs in the United States include the concept
and skill of cultural competency as a program
outcome and attempt to integrate cultural
competency into their curricula. Attempts at
integration have been reported as inadequate in
developing culturally competent nurses (Brennan
& Cotter, 2008). As the diversity of the population
increases, so too must the cultural competency of
nurses in practice. It is imperative that
undergraduate nursing students develop cultural
competency knowledge, awareness, and skills
while experiencing didactic courses, clinical, and
simulation experiences.
Culture is integral to how people view death,
birth, illness, and health (Delgado et al., 2013).
For individuals to seek health care, .
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
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Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
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Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
Jpe23 1 ptr-a5_025-032
1. Culture and Community Perceptions | Kang 25
Influence of Culture and Community
Perceptions on Birth and Perinatal Care
of Immigrant Women: Doulas’ Perspective
Hye-Kyung Kang, MA, MSW, PhD
ABSTRACT
A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influ-
ence of cultural and community beliefs on immigrant women’s birth and perinatal care, as well as their
own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that
doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural
brokers, and emotional and social support. Also, doulas share a consistent set of professional values, includ-
ing empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not
always recognize these values as culturally based. More emphasis on cultural self-awareness in doula train-
ing, expanding community doula programs, and more integration of doula services in health-care settings
are recommended.
The Journal of Perinatal Education, 23(1), 25–32, http://dx.doi.org/10.1891/1058-1243.23.1.25
Keywords: doulas, culture, community, immigrant women, cultural self-awareness
The aim of this study is to describe the influence
of cultural and community perceptions on birth
and perinatal care of immigrant women from the
perspectives of doulas who practice in Washington
State. Doulas are trained and experienced women
who provide continuous physical, emotional, and
informational support to mothers before, dur-
ing, and after birth (Gentry, Nolte, Gonzalez,
Pearson & Ivey, 2010). Researchers have found that
doula support influenced positive birth outcomes,
including decreased need for medical technological
interventions or pain medications (Hodnett, Gates,
Hofmey, & Sakala, 2013), lower rates of birth com-
plications or having a low birth weight newborn
(Gruber, Cupito, & Dobson, 2013), and less likeli-
hood of lower newborn Apgar scores (Hodnett et al.,
2013; Sauls, 2002). Doula support is also associated
with decreased maternal stress (Wen, Korfmacher,
Hans, & Henson, 2010), more breastfeeding,
greater self-esteem, confidence in mothering, and a
decreased likelihood of postpartum depression and
anxiety (Abramson, Breedlove, & Isaacs, 2005).
Doula support may be particularly pertinent for
perinatal immigrant women, especially those who
are limited-English speakers or those with limited
resources. As immigrant mothers account for 23%
of all births in the United States (Livingston & Cohn,
2012), birth and perinatal care for these women are
2. 26 The Journal of Perinatal Education | Winter 2014, Volume 23, Number 1
cultural brokers and advocates throughout these
processes as they help immigrant women navigate
through the complex process of health-care decision
making and by providing social and emotional sup-
port (Small et al., 2002).
The role of culture is critical in terms of birth and
perinatal care for immigrant mothers when consider-
ing the role of doulas as cultural brokers and advo-
cates; however, it must be considered in a complex
and contextual manner. Although many health-care
providers recognize the importance of culture when
working with immigrants, one common pitfall is
essentialization (Takeuchi & Gage, 2003). When
providers assign limited and generalized cultural
understanding and meanings to an identified ethnic
group, they gloss over the intricate within-group di-
versity as well as the complex social and historical
contexts within which those cultural meanings may
exist. Another pitfall is creating a dichotomy wherein
the immigrant “culture” is studied and scrutinized,
whereas the practitioners’ cultural beliefs, values, and
practices remain unexamined and normalized (Davis-
Floyd & Sargent, 1997). In addition, cultural values
and perceptions that caregivers/resource brokers hold
are important to examine because they may serve as
a lens through which clients’ needs are interpreted;
there are times when the caregiver thinks she or he
understands but may have misinterpreted because of
her/his own unexamined cultural filters. For example,
Brookes, Summers, Thornburg, Ispa, and Lane (2006)
found that Early Head Start program home visitors
in their study negatively interpreted when moth-
ers wanted to focus on their own needs instead of
parenting or child development during home visits.
Rather than interpreting such behavior as healthy self-
care, which is a necessary part of effective parenting,
some home visitors viewed it as selfishness.
Thus, it is important to understand how doulas
think about culture, community perceptions, and
childbirth and perinatal care because these per-
ceptions influence their understanding of what the
immigrant mother is trying to convey to them as well
as whether or not they will advocate for immigrant
women who seek help and support during such
vulnerable times such as childbirth and perinatal
periods. This study helps to illuminate not only the
doulas’ perceptions about childbirth and perina-
tal care and the impact of cultural and community
beliefs on pregnant women’s health-care decisions
but also their own cultural beliefs and values that
affect their ability to work in intercultural settings.
important issues. Although immigrant women are
an extremely diverse population and research on
their birth outcomes is highly equivocal (Ceballos
& Palloni, 2010; Cervantes, Keith, & Wyshak, 1999;
Cripe, O’Brien, Gelaye, & Williams, 2011; Janevic,
Savitz, & Janevic, 2011; Johnson, Reed, Hitti, &
Batra, 2005; Madan et al., 2006; Qin & Gould, 2010;
Urquia et al., 2010), navigating an unfamiliar and
complicated U.S. health-care system may nonethe-
less leave many immigrant mothers overwhelmed,
vulnerable, and less able to access necessary re-
sources during a particularly stressful time such as
pregnancy and birth (Schoroeder & Bell, 2005). For
example, in a study about the birthing and perina-
tal experiences of immigrant Filipina, Vietnamese,
and Turkish women in Australia, Small, Yelland,
Lumley, Brown, and Liamputtong (2002) found
that these participants reported less satisfaction with
the caregiver attitudes, provision of information
and explanations, participation in decision making,
and continuity of care they received than did non-
immigrant Australian women. Olayemi, Morhason-
Bello, Adedokun, and Ojengbede’s (2009) study
with African women of various ethnic backgrounds
found that pregnant women who shared their care-
givers’ ethnicity experienced the labor as less pain-
ful and that having trained doulas who gave social
and emotional support helped reduce the mother’s
experience of pain. In a U.S. study, Dundek (2006)
reported that cesarean surgery rates were lower
among Somali refugee/immigrant women who were
attended by a doula at birth than among their coun-
terparts who did not have a doula. Hazard, Callister,
Birkhead, and Nichols (2009) reported positive out-
comes from the Hispanic Labor Friends Initiative, a
Utah project through which Hispanic women from
local communities who were mothers and trained
for labor support and translation provided perina-
tal support to pregnant Hispanic immigrant women
across care settings. As these studies indicate, doulas
who practice in a culturally sensitive manner may
help improve the childbirth and perinatal care ex-
perience of immigrant women (Callister, Corbett,
Reed, Tomao, & Thornton, 2010) by acting as
The role of culture is critical in terms of birth and perinatal care
for immigrant mothers when considering the role of doulas as
cultural brokers and advocates; however, it must be considered in a
complex and contextual manner.
3. Culture and Community Perceptions | Kang 27
health-care procedures (and whether they are elec-
tive or not), and pre- and postpartum care plans.
They also often linked mothers’ ability to make
informed choices to a sense of empowerment. Thus,
participants regarded actively encouraging their
clients to ask for information, discussing options
with them, and advocating for access to informa-
tion when needed as an essential part of their work
as doulas.
Participants believed that having care providers
(such as doctors, midwives, nurses, and doulas) who
demonstrate their support and respect for mothers’
individual childbirth experiences was essential.
This involved listening to mothers (or mothers and
their partners when appropriate), communicating
with them about their choices, and honoring their
wishes and cultural practices. Support and respect
were especially important when the birth did not go
as the woman hoped (e.g., needing a cesarean sur-
gery when the woman planned for a “natural” birth)
or when women’s cultural practices (e.g., having
multiple family members in the birthing room) did
not correspond with their care providers’ expecta-
tions. Because doulas are involved throughout the
prenatal period as well as the birth, they have an in-
timate knowledge of individual women’s birthing
plans and preferences; therefore, they are able to
provide consistent care and support to women
in a way that is different from other health-care
providers. Participants emphasized that birth was
the time when women were both highly vulnerable
and courageous; many immigrant women chose to
have a birth doula because they wanted someone
to “be there for them,”“support them when they are
fearful,” and “speak for them when they can’t.”
Participants indicated a strong preference for nat-
ural birth by which they often meant birth that did
not involve medications (e.g., epidural) or medical
technological interventions (e.g., cesarean surgery);
for a subset of participants, natural birth meant
nonhospital birth. Although some participants felt
that natural birth was paramount to a good birth be-
cause of the possible adverse effects of medications
and medical procedures, others felt that as long as
the mother felt supported throughout her birth-
ing process and both the mother and the baby were
healthy, medical technological interventions, if nec-
essary, did not take away from having a good birth
experience. Despite this difference, participants gen-
erally advocated for natural birth whenever possible
and often educated women about this option.
METHODS
This qualitative study used a key informant inter-
view method to understand phenomena from the
point of view of participants and their particular
social and institutional contexts (Strauss & Corbin,
1990). The author obtained a human subjects review
approval from her institution for the study and was
aided by two major childbirth service organizations
in the Pacific Northwest to recruit professional
doulas who practiced in Washington State. The
in-person interviews were audio taped and later
transcribed. Data were analyzed using conventional
content analysis (Hsieh & Shannon, 2005). Peer
debriefing, negative case analysis and consultation
with a knowledgeable insider (in lieu of member
checks1
) were used to foster trustworthiness of the
interpretation of data (Lincoln & Guba, 1985).
Eleven participants, whose individual experi-
ences as a professional doula ranged from 1 to
7.5 years, were interviewed for this study. Seven
participants self-identified as White, European, or
Caucasian; three as Black or African American; and
one as mixed race. Eight participants were U.S. born,
and three were immigrants from Peru, Somalia, and,
Venezuela, respectively. In addition to English, six
spoke Spanish, one Somali, two French, and one
both Japanese and Chinese. All but one participant
worked with clients who were immigrant women of
color from Asia, Southeast Asia, Africa, South Amer-
ica, Middle East, and Mexico.2
An average of 40% of
their clients were immigrant women of color, and
45.5% were nonimmigrant White women. Most im-
migrant doulas spent most of their time working
with women of their own ethnic and/or linguistic
backgrounds.
RESULTS
The “Good” Childbirth and Perinatal Care
Three factors were identified by all of the partici-
pants as important in their consideration of “good”
birth and perinatal care: mothers being able to make
informed choices, mothers feeling supported and
respected by care providers, and natural (nonmedi-
cated/nonintervention) childbirth. These factors
linked directly to what they saw as their work as
doulas.
Participants emphasized that pregnant women’s
ability to make decisions about their birth and peri-
natal care depended heavily on having sufficient
information about their options regarding health-
care providers, types and places of birth, possible
4. 28 The Journal of Perinatal Education | Winter 2014, Volume 23, Number 1
explanations from health-care providers, which may
be based on cultural beliefs about medical authority,
further disadvantaged them. Another complicating
issue was the fact that many health-care providers
worked under pressure from a heavy patient load
and a tight schedule, which barred them from taking
sufficient time to assure that all the options were fully
explained, interpreted, and understood. If doulas
were not available to help them to sift through this
complex and at times contradictory information,
women would have been greatly disadvantaged.
Participants spoke about language barriers as
a major factor that hindered immigrant women
from getting the best services. Even though the
state required interpreter services, it was often
difficult to find reliable and culturally appropri-
ate (such as female) interpreters. Language differ-
ences could become acutely problematic if women
needed unexpected procedures or if the health-
care provider needed to make an urgent decision
during birth because sometimes they had to rely on
phone-based interpretation services, which could be
stressful and confusing for the mother and for the
health-care team.
Participants expressed a strong concern over
the lack of respect for low-income and/or lim-
ited English–speaking immigrant women’s cul-
tural preferences during birth at some hospitals.
Although some health-care providers were respect-
ful, other providers disregarded women’s cultur-
ally based wishes (e.g., a woman having her body
covered for cultural reasons) even though there was
no apparent health-care reason not to honor them
simply because doing so would necessitate provid-
ers altering their “standard” practices. Participants
also found it deeply troubling when some health-
care workers treated immigrant women and their
families as if they were “charity cases” that did not
deserve the best services based on racial/ethnic/class
stereotypes or when health-care providers imposed
their own cultural beliefs and values on women and
their partners (e.g., pressuring and shaming male
partners into being present in the birthing room
when women did not want them there for religious
and cultural reasons). Because of these reasons,
participants felt that community doula programs,
which offered no-cost doula services to low-income
immigrant women, were essential in offsetting
some of these disadvantages because they helped
women gain much-needed information, access, and
advocacy.
Culture and Community Perceptions
Participants identified a prominent source of com-
munity perceptions for immigrant women as other
women in their families or social networks. Com-
munity narratives about childbirth and perinatal
care, shared among these networks and reproduced
across generations, not only constructed a commu-
nity’s perception of good birth and perinatal practice
but also shaped the cultural meaning-making,that is,
how a woman understood her childbirth experience
and how she felt about herself as a mother. Also, cul-
tural meanings about childbirth and perinatal care
practices were not uniform, reflecting the internal
diversity based on class status, generational differ-
ences, and other factors, within any given ethnicity-
or national origin–based community. For example,
within the same immigrant community, good birth
could mean a natural birth or a cesarean birth,
because in their country of origin, cesarean surgery
was promoted to upper- and middle-class women
as the “modern” and “medically superior” way to
give birth, whereas lower income women who had
little access to such expensive medical technological
interventions equated “the traditional way” (giving
birth without medications or technological inter-
ventions) with a strong womanhood. Women often
interpreted their childbirth experience through the
lens of their own social network’s narratives, which
sometimes meant that they doubted their child-
birth choices or felt as if they let themselves and
other women in their family down if their childbirth
experience did not match the narrative. Similarly,
immigrant women who were raised in the United
States sometimes felt conflicted when the traditional
perinatal care practices that their mothers or grand-
mothers insisted on were at odds with their health-
care providers’ recommendations.
The Confluence of Cultural and Language
Differences and Economic Resources
The confluence of cultural and language differences
and lack of economic resources greatly diminished
low-income immigrant women’s access to the best
care and treatment. Participants who worked with
such clients observed that they were often given
significantly less information about their birth and
perinatal care and that their care options seemed
to be delimited by their health insurance (e.g.,
Medicaid) coverage rather than by their individual
health needs. The fact that many immigrant women
were not used to asking questions of or demanding
5. Culture and Community Perceptions | Kang 29
March 9, 2009). It was not clear from the interviews
how doulas might deal with such situations because,
by and large, they have not interrogated these pro-
fessional values as culturally specific values.
The cultural and community perceptions of the
birth community were often contrasted with those of
the “medical culture,” with which doulas expressed
a complex relationship. On the one hand, doulas
shared with health-care providers many professional
values, such as scientific and evidence-based prac-
tice, and had good working relationships based on
mutual respect and care for pregnant women.On the
other hand, doulas were often viewed as “outsiders”
by some health-care providers, especially those who
were skeptical of non-Western health-care practices.
This outsider status was highly frustrating to doulas
because it undermined their ability to advocate for
their clients.
DISCUSSION AND IMPLICATIONS
The aim of this article is not to broadly generalize
the findings but rather to describe the influence of
cultural and community perceptions on birth and
perinatal care of immigrant women from the per-
spectives of doulas in one state. In addition, as the
author, I am mindful of the influence of my own
sociocultural locations (a bilingual immigrant
woman of color who is a health-care outsider but
has worked extensively with immigrant women as a
social worker) on my interpretation of the data. For
example, on the one hand, as a social worker, I hold
similar professional values as those identified by
doulas in this study (such as client self-determina-
tion and respect for cultural diversity); on the other
hand, my exposure to poststructural theories and
social justice education sensitized me to the pos-
sible perils of grand narratives and normative dis-
courses. Holding these potentially conflicting ideas
may influence the ways in which I interpret the par-
ticipants’ values and beliefs. Similarly, as a bilingual
immigrant woman of color, I may over-identify with
the experiences of immigrant mothers of color who
are navigating a complex U.S. health-care system,
which can result in a paradoxical danger of erasing
important within-group differences. Being aware
of these and many other threats to interpretation, I
have used several methods to foster trustworthiness
of my analysis, such as peer debriefing, negative case
analysis, and consultation with a knowledgeable
insider (Lincoln & Guba, 1985). Thus, following
discussion and implications are offered within such
Doulas’ Own Culture and Community Perceptions
Most of the White participants had difficulty articu-
lating their own cultural beliefs or values regarding
birth and perinatal practice and did not believe that
they influenced their perceptions. A subset of White
participants identified their culture as “Western”
and reflected that they usually did not think about
their own culture unless they encountered clients
whose cultural practices were very different from
their own. This is consistent with the phenomenon
where people in the mainstream often do not see the
need to examine their own perceptions because such
perceptions are reinforced constantly by society
and thus seem “normal” and beyond interrogation
(Miller & Garran, 2008). Participants of color (of
which three of whom were also immigrants) more
readily identified what they considered their ethnic-
ity-based cultural beliefs and values and how they
influenced their perceptions. It is likely that their
lived experiences sensitized them to cultural differ-
ences and their consequences. However, all partici-
pants explicitly stated that they did not impose their
own cultural values or beliefs on their clients and
that they supported their clients’ cultural values and
beliefs “without judgment.”
Most participants identified the “birth commu-
nity,” including doulas and midwives, as the com-
munity whose perceptions influenced them the
most. Although they identified a remarkably similar
set of community values (informed choice, empow-
erment, nonjudgmental support for women’s cul-
tural practices, scientific/evidence-based practice,
and “natural birth”), some did not see these as cul-
turally based, whereas others thought they could be
considered a cultural influence (a “birth culture”).
What complicates this picture is that some of
the doulas’ professional values may be in conflict
with one another in certain situations. For example,
the value of nonjudgmental support for women’s
cultural practices can be in conflict with the value
of scientific/evidence-based practice when work-
ing with women whose cultural practices may be
at odds with what doulas consider to be evidence-
based practice. Similarly, most nonimmigrant
doulas consistently conceptualized birth and peri-
natal care decisions as individual women’s choices
and often linked such decision making to a sense
of empowerment. This may be at odds with some
women’s cultural practice wherein informed birth
and perinatal care decisions include her family’s
opinions (S. Capestany, personal communication,
6. 30 The Journal of Perinatal Education | Winter 2014, Volume 23, Number 1
these values and beliefs were so naturalized within
the doula community (or the birth community)
that it seemed difficult for some doulas to recognize
them as culturally specific beliefs and values. This
phenomenon elucidates how difficult it is to rec-
ognize the specificity of values and beliefs that one
inhabits unless they are contrasted with another
set of values and beliefs, which is particularly chal-
lenging for those whose values are echoed by main-
stream culture (Miller & Garran, 2008).
Cultural self-awareness is paramount to inter-
cultural practice because being keenly aware of the
influence of one’s cultural values and beliefs can
help practitioners avoid privileging them over other
values and beliefs and become more conscious of the
dynamics of power in intercultural practice (Hays,
2008). Without cultural self-awareness, doulas can
inadvertently become gatekeepers, advocating for
the practices that are consistent with their values and
beliefs and trying to influence women to change their
beliefs or practices when they are not. An impor-
tant implication for doulas and other perinatal care
providers is that the cultural competence training
should start with reflecting on their own professional
and personal beliefs and values and how these values
influence their perceptions and practices, which is
consistent with Small et al.’s (2002) findings. Without
this grounding, learning about other people’s cultural
beliefs and practices,as important as they are,still will
be interpreted through a very specific, unrecognized,
and unexamined lens (Davis-Floyd & Sargent, 1997),
which can lead to essentialization and “othering” of
diverse realities (Takeuchi & Gage, 2003).
Despite these challenges, doulas fill an impor-
tant role with pregnant immigrant women; their
advocacy can greatly aid women in gaining access
to information and effective care, and their emo-
tional and social support can significantly improve
women’s emotional experience during childbirth
and perinatal periods. For example, Hodnett et al.’s
(2013) international review of 23 trials indicated
that women who had continuous labor support
(such as doula support) were more likely to give
birth without medical technological interventions
and less likely to need pain medications or have
babies with lower Apgar scores. In addition, these
researchers found that mothers who had continuous
support also expressed more satisfaction with their
childbirth experience.
Given that doulas, as a profession, are at times
considered health-care outsiders, it is more likely
contexts as a reflection on and a synthesis of the les-
sons from this study.
This study highlights the compounding impact
of economic resources and cultural differences on
immigrant women’s birth and perinatal care. While
language and cultural differences hindered immi-
grant women’s full access to care, limited economic
resources exacerbated the problem because their op-
tions were delimited by the confines of the public in-
surance coverage. Similarly, inadequate resources at
the hospitals and clinics made it difficult for health-
care providers to offer effective interpreters or suffi-
cient time during perinatal appointments.A possible
implication for perinatal care is that providing cul-
turally appropriate and supportive services requires
resource advocacy both on the client level (including
families as well as individuals) and on the systemic
level. Perinatal educators may consider including
systems advocacy as part of the training for doulas
and other perinatal care providers.
Another consideration for perinatal education is
the need for increasing the number of trained bicul-
tural and bilingual doulas from immigrant commu-
nities and for expanding community doula services
for immigrant women. Lack of resources, informa-
tion, or cultural resonance may prevent many im-
migrant women from accessing doula service and its
many advantages. This study echoed prior research
(Hazard et al.,2009) findings that having doulas who
not only shared the primary language of the women
and had understanding of their cultural beliefs and
practices but also were skilled at navigating the U.S.
health-care system was highly effective in aiding
immigrant women to feel supported and to gain
access to information and resources. Given the high
birth rates among immigrant women, the number
of community doulas and the availability of their
services should grow accordingly to meet the needs
of this potentially vulnerable population.
The participants’narratives about good birth and
perinatal care demonstrate that there is a consistent
set of beliefs and values that doulas hold, which
reflect their professional orientation. However,
Doulas fill an important role with pregnant immigrant women; their
advocacy can greatly aid women in gaining access to information
and effective care, and their emotional and social support can
significantly improve women’s emotional experience during
childbirth and perinatal periods.
7. Culture and Community Perceptions | Kang 31
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that they are more sensitive to such status and its
negative consequences than other health-care pro-
viders (such as doctors) who are more socialized and
centralized into the health-care system. This experi-
ence and sensitivity may help doulas be more effec-
tive mediators and brokers for pregnant immigrant
women. Furthermore, such services can be highly
beneficial to health-care providers when working
with immigrant women whose cultural practices and
languages are unfamiliar to them. Therefore, more
integration of doula services in health-care settings
and an expansion of culturally relevant community
doula programs are recommended.
ACKNOWLEDGMENTS
The author is grateful to Sheila Capestany, execu-
tive director, Open Arms Perinatal Services, Seattle,
Washington, and Annie Kennedy, director, Simkin
Center for Allied Birth Vocations at Bastyr Univer-
sity, Seattle, Washington, for their generous con-
sultation on and assistance with this research. This
study was funded by the Clinical Research Institute
grant, endowed to the Smith College School for
Social Work by the Brown Foundation.
NOTES
1. Although Lincoln and Guba (1985) recommend
member checks as an avenue for ensuring trust-
worthiness of the analysis of data, respect for the
participants’ time commitment and busy sched-
ules barred the author from asking for more time
from them for member checks. In lieu of mem-
ber checks, the author consulted with a knowl-
edgeable insider, who was a doula with extensive
intercultural clinical experience and was very
familiar with the local perinatal care practices
and politics, during the data analysis phase. The
consultant’s feedback was incorporated into the
analysis of data.
2. The national backgrounds of immigrant cli-
ents included Ethiopia, China, Mexico, Somalia,
Honduras, Peru, Colombia,Algeria, Gambia,Viet-
nam, Chad, Iraq, Jamaica, Fiji, India, El Salvador,
Nicaragua,Venezuela, Laos, Burma, and Eritrea.
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