" (a Manager's Guide to Cultural Competence Education for Health Care Professionals, nd) Cultural competence is a development process as no individual "becomes culturally competent overnight or with one or two hours of training." (a Manager's Guide to Cultural Competence Education for Health Care Professionals, nd) Cultural competence training is stated to involve "attitude changes and the examining of personal biases and stereotypes as an initial step to acquiring the skills and competencies necessary for quality cross-cultural care." (a Manager's Guide to Cultural Competence Education for Health Care Professionals, nd)
The Kaiser Family Foundation (2003) states in the work entitled: "Compendium of Cultural Competence Initiatives in Health Care" that cultural competency faces challenges which include: (1) the lack of agreement on the terms, definitions and core approaches; (2) limited research on impact and effectiveness; (3) a misperception that the activities are focused exclusively on people of color, rather than also on diverse population groups that, for example, arise from religious affiliation, class, or sexual orientation; and (4) absence of a financing funding source considered sufficient to implement new initiatives. (United States Department of Justice, 2000)
The work of Bacal, Jansen, and Smith (2006) entitled: "Developing Cultural Competency in Accordance with the Health Practitioners Competence Assurance Act" states that the differences in cultural:
body language, how to show (dis)respect, modesty and privacy concerns, expressions of (dis)agreement, and what constitutes courtesy, it is easy when dealing with someone from another culture to unwittingly give offence or to unintentionally make someone feel awkward, uncomfortable, or confused. In a medical set-ting, patients are often already un-certain, intimidated, and/or apprehensive, so anything that worsens, rather than improves, these feelings tends to create additional barriers between the doctor and patient.10Numerous studies, reviewed by Levinson, demonstrate that patient outcomes improve when patients' cultural, emotional, and personal concerns are considered along with their medical condition." (Bacal, Jansen, and smith, 2006)
IV. EMERGING STANDARDS of CARE
It is clear from the literature reviewed in this study that 'Emerging Standards' of 'culturally competent care' are developing rapidly among healthcare professionals and that best practices are being identified and acknowledged widely among professional nursing staff which includes proper training provisions to equip staff with the necessary levels of competence in negotiation cultural factors known to influence access to healthcare by ethnically diverse patients.
SUMMARY & CONCLUSION
This work has examined the issue of culturally competent provision of care for those in the nursing and other healthcare services professions and has identified various aspects of culturally competent care and the characteristics of culturally competent care among health care organizations and professionals. The standards that are emerging as 'best practice' standards of care are those gained through trial and experience, research study and their findings, and the experiential provision of health care by nursing professionals as accounted for in these various studies and accompanying reports. There is a general consensus among health care professionals and professional nursing staff of the primary requirements of delivering culturally competent care and this consensus has been related as well in this study. As noted in this study culturally competent care is a developmental process that is ongoing in nature and that never actually stops developing since culturally competent care is an ongoing enabler of access to effective healthcare by those among ethnically and racially diverse populations that comprise the patient base for health care organizations and professionals in their daily practice.
Foley, R. And Wurmser, T.A. (2004) Culture Diversity/a Mobile Workforce Command Creative Leadership, New Partnerships, and Innovative Approaches to Integration. Nursing Administration Quarterly, Vol. 28 (2) April/May 2004.
Cultural Competency in Medicine (2008) American Medical Student Association. AMSA Foundation 2008.
Racial and Ethnic Disparities in Health Care: A Position Paper of the American College of Physicians. 3 Aug 2004. Vol. 141 Issue 3. Annals of Internal Medicine. Online available at http://www.annals.org/cgi/content/full/141/3/226
Like, Robert C. (nd) Cultural Competency Training: Best and Promising Practices. Center for Healthy Families and Cultural Diversity. Department of Family Medicine UMDNJ - Robert Wood Johnson Medical School.
Manager's Guide to Cultural Competence Education for Health Care Professionals () Online available at (http://188.8.131.52/search?q=cache:m8H4v3gJG30J:www.calendow.org/uploadedfiles/managers_guide_cultural_competence (1).pdf+nursing:+cultural+competency,+emerging+standards+of+care&hl=en&ct=clnk&cd=7&gl=us
Executive Order 13166 (2000) Improving Access to Services for Persons With Limited English Proficiency. United States Department of Justice. 11 Aug 2000. Civil Rights Division. Online available at http://www.usdoj.gov/crt/cor/Pubs/eolep.php
Bacal, Kira, Jansen, Peter, and Smith, Kathleena (2005) Developing Cultural Competency in Accordance with the Health Practitioners Competence Assurance Act. Maori and Pacific Island Health.Vol. 3 No. 4 October 2006. Online available at http://184.108.40.206/search?q=cache:eGo -- lTdopQJ:www.mauriora.co.nz/file/Bacal_Oct_06.pdf+nursing:+cultural+competency,+emerging+standards+of+care&hl=en&ct=clnk&cd=11&gl=us