Toward an inclusive digital health system for sexual and gender minorities in Canada

Most digital health systems (DHS) are unable to capture gender, sex, and sexual orientation (GSSO) data beyond a single binary attribute with female and male options. This binary system discourages access to preventative screening and gender-affirming care for sexual and gender minority (SGM) people. We conducted this 1-year multi-method project and cocreated an action plan to modernize GSSO information practices in Canadian DHS. The proposed actions are to: (1) Envisage an equity- and SGM-oriented health system; (2) Engage communities and organizations to modernize GSSO information practices in DHS; (3) Establish an inclusive GSSO terminology; (4) Enable DHS to collect, use, exchange, and reuse standardized GSSO data; (5) Integrate GSSO data collection and use within organizations; (6) Educate staff to provide culturally competent care and inform patients on the need for GSSO data; and (7) Establish a central hub to coordinate efforts.

Awareness of Nurses Regarding Culturally Competent Care in Hospitals of Punjab: Cross Sectional Study

Background: Nursing profession is one of the professions which is continuously developing and uniformly acclimatizing to not only new medical treatments and expansions but also adapting the socio-cultural norms and expectations. Aim: To analyze the level of nurses’ awareness regarding culturally competent care in three selected hospitals of Punjab. Study design: Cross-sectional study. Methodology: Study setting was public hospitals of Punjab-Pakistan after ethical review committee’s (ERC) approval. Data was collected from nurses (n=133) by using self-administered questionnaire that was adapted from cultural awareness assessment tool. They were selected from three hospitals through non-probability convenient sampling technique. Statistical analysis: Data was analyzed by using SPSS version-20. To summarize the results, mean ± SD, frequencies, percentages and graphs were used. Results: Overall average score of cultural competence was 24.31 ± 3.457 which was on the lower side. Scores of Muzaffar Garh nurses was statistically significantly higher than both hospitals (p-value <0.001). This variation is due to years of experience (4-6 years) of nurses in Muzaffar Garh. Perhaps, comparatively long period of experience made them aware of the cultural practices of the people. Conclusion: We concluded that frequent and long-term interaction of nurses with patient which may help nurses in developing understanding of client’s culture because novice nurses are not able to understand point of view of the patients with diverse culture as they are not prepared to deal with the problems of cultural diversity. Keywords: Nursing Profession, Cultural Norms, Trans-cultural Nursing Care and Awareness.

Home Health Nurses’ Journey Toward Culture-Sensitive/Patient-Centered Skills: A Grounded Theory Study

Introduction. Home health patients, who are members of minority and vulnerable groups, suffer disparate outcomes. Patient-centered care (PCC) and culturally-competent care (CCC) aim to facilitate high-quality, equitable care. How home health nurses incorporate PCC and CCC principles into their assessment and care-planning practices has not been -investigated. This study answers the question, “ What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?” Methods. Home health nurses (n= 20) were recruited into this grounded theory study from agencies around the United States via flyers, websites, and contacts. We conducted in-depth recorded interviews using a semi-structured interview guide to ask questions about nurses’ assessment and care-planning practices, their understanding of CCC and PCC principles, and facilitators/barriers to CCC and PCC practice. Results. Participants primarily gained their CCC and PCC assessment and care-planning skills through a “seat of your pants,” trial-and-error process, with little educational or agency assistance. They combined caring, diverse patient experiences, and critical, creative self-reflection on their experiences to gradually learn helpful, though not optimal, CCC and PCC strategies. However, they reported numerous barriers that discouraged or distressed them in their quest to deliver culturally-competent and patient-centered care. Only a few nurses demonstrated the resilience to overcome these challenges creatively and happily. Conclusion. If we accept that patient-centered care and culturally competent care are key elements of high-quality, equitable care, this grounded theory may help home healthcare clinicians, administrators, educators, and policy-makers identify impact points for enhancing CS/PC practices.

A Narrative Study of the Experiences of Providing Culturally Competent Care by Frontline Staff Caring for Older Ukrainian Immigrants in a Mono-culture Long-term Care Facility

Frontline healthcare providers are increasingly called to demonstrate respect for clients’preferences by providing culturally competent care as part of person-centered approaches. Review of literature, however, shows culturally competent care practices have been poorly integrated into healthcare. Among Canada’s population, care of older Ukrainian immigrants has received limited consideration. This narrative study explored experiences of two Ukrainian nurses providing culturally competent care in Ukrainian long-term care homes in the Greater Toronto Area. Textual and photographic data were analyzed via categorical-content and visual analysis approaches in keeping with narrative methodology. Three levels of data analysis were completed: emergent theme analysis, comparative theme analysis, and metaphoric representative analysis. Major themes include honoring the client, home is where the varenyky are served, the culturally competent nurse as the doorway to culturally competent care, and cultural insight as the solid foundation. Study implications are for organizational practice, policy and research.

A Narrative Study of the Experiences of Providing Culturally Competent Care by Frontline Staff Caring for Older Ukrainian Immigrants in a Mono-culture Long-term Care Facility

Frontline healthcare providers are increasingly called to demonstrate respect for clients’preferences by providing culturally competent care as part of person-centered approaches. Review of literature, however, shows culturally competent care practices have been poorly integrated into healthcare. Among Canada’s population, care of older Ukrainian immigrants has received limited consideration. This narrative study explored experiences of two Ukrainian nurses providing culturally competent care in Ukrainian long-term care homes in the Greater Toronto Area. Textual and photographic data were analyzed via categorical-content and visual analysis approaches in keeping with narrative methodology. Three levels of data analysis were completed: emergent theme analysis, comparative theme analysis, and metaphoric representative analysis. Major themes include honoring the client, home is where the varenyky are served, the culturally competent nurse as the doorway to culturally competent care, and cultural insight as the solid foundation. Study implications are for organizational practice, policy and research.

Ethical and culturally competent care of transgender patients: A scoping review

Background: Transgender individuals experience discrimination, stigmatization, and unethical and insensitive attitudes in healthcare settings. Therefore, healthcare professionals must be knowledgeable about the ways to deliver ethical and culturally competent care. Ethical considerations: No formal ethical approval was required. Aim: To synthesize the literature and identify gaps about approaches to the provision of ethical and culturally competent care to transgender populations. Design: A Scoping Review Literature Search: Literature was searched within CINAHL, Science Direct, PubMed, Google Scholar, EMBASE, and Scopus databases using indexed keywords such as “transgender,” “gender non-conforming,” “ethically sensitive care,” and “culturally sensitive care.” In total, 30 articles, which included transgender patients and their families and nurses, doctors, and health professionals who provided care to transgender patients, were selected for review. Data were extracted and synthesized using tabular and narrative summaries and thematic synthesis. Findings: Of 30 articles, 23 were discussion papers, 5 research articles, and 1 each case study and an integrative review. This indicates an apparent dearth of literature about ethical and culturally sensitive care of transgender individuals. The review identified that healthcare professionals should educate themselves about sensitive issues, become more self-aware, put transgender individual in charge during care interactions, and adhere to the principles of advocacy, confidentiality, autonomy, respect, and disclosure. Conclusions: The review identified broad approaches for the provision of ethical and culturally competent care. The identified approaches could be used as the baseline, and further research is warranted to develop and assess organizational and individual-level approaches.