Diversity and cultural competence in health care : a systems approach


    • Dreachslin, Janice L.
    • Gilbert, M. Jean
    • Malone, Beverly


Diversity and cultural competence in health care : a systems approach

Janice L. Dreachslin, M. Jean Gilbert, Beverly Malone

Jossey-Bass, c2013

  • : pbk

大学図書館所蔵 件 / 4



Includes bibliographical references and index



Major changes are occurring in the United States population and the nation's health care institutions and delivery systems. Significant disparities in health status exist across population groups. But the health care enterprise, with all its integrated and disparate parts, has been slow to respond. Written by three nationally known scholars and experts, Diversity and Cultural Competence in Health Care: A Systems Approach is designed to provide health care students and professionals with a clear understanding of foundations, philosophies, and processes that strengthen diversity management, inclusion, and culturally competent care delivery. Focusing on current practice and health care policy, including the recently passed Patient Protection and Affordable Care Act of 2010 (ACA), this textbook integrates strategic diversity management, self-reflective leadership, and the personal change process with culturally and linguistically appropriate care into a cohesive systems-oriented approach for health care professionals. The essentials of cultural competence and diversity management covered in this text will be helpful to a wide variety of students because they encompass principles and practices that can be realistically incorporated into the ongoing work of any health care field or organization. Each chapter contains learning objectives, summary, key terms, and review questions and activities designed to allow students to understand and explore concepts and practices identified throughout the text.


Figures and Tables ix Preface xi Acknowledgments xv The Authors xvii PART ONE THE DIVERSITY IMPERATIVE 1 Chapter 1 Systems Approach to Cultural Competence 3 Dimensions of Diversity 7 Health Care Diversity Challenges 19 Health Care Disparities in the United States 20 Changing the US Health Care System 21 Systems Approach in the Health Care Delivery Organization 26 The Importance of Leadership 27 Summary 28 Review Questions and Activities 29 Chapter 2 Systematic Attention to Health Care Disparities 35 What Are Health Care Disparities? 36 Race and Ethnic Disparities in Health Status 37 Disparities Across Other Diversity Dimensions: Gender, Sexual Orientation, the Elderly 49 Stakeholder Attention to Health Care Disparities 56 Systematic Strategies for Reducing Health Care Disparities 60 Summary 65 Review Questions and Activities 66 Chapter 3 Workforce Demographics 75 Trends in the US Labor Force 76 Diversity and the Health Professions 81 Drivers of Disparities in the Health Professions 83 Checklist of Recommended Organizational-Level Actions 90 Workforce Diversity Challenges 96 Summary 100 Review Questions and Activities 101 PART TWO THE DEVELOPMENT OF CULTURAL COMPETENCE 105 Chapter 4 Foundations for Cultural Competence in Health Care 107 What Is Cultural Competence in Health Care? 109 Long Journey Toward Cultural Competence 119 Cultural Competence and the Health Care Provider Organization 126 Cultural Competence and the Multicultural Health Care Workforce 133 Summary 138 Review Questions and Activities 139 Chapter 5 Hallmarks of Cultural Competence in Health Care Professionals 143 Personal Journey of Cultural Competence 145 Framework for Role Development 153 Journey of Self-Discovery 156 Summary 167 Review Questions and Activities 168 Chapter 6 Training for Knowledge and Skills in Culturally Competent Care for Diverse Populations 171 Eight Principles for Knowledge and Skills Training 173 Cultural Competence Knowledge and Skills for Administrators and Directors 177 Cultural Competence Training for Health Care Professionals in Direct Patient Care 183 Cultural Competence Training for Support Staff 207 The Role of Assessment in Cultural Competence Training 208 Summary 211 Review Questions and Activities 212 PART THREE CULTURAL COMPETENCE AND HEALTH CARE DELIVERY 219 Chapter 7 Cultural Competence in Health Care Encounters 221 Models from Transcultural Nursing 225 Giger-Davidhizar Transcultural Assessment Model (GDTAM) 238 Being Culturally Responsive 251 Summary 253 Review Questions and Activities 254 Chapter 8 Language Access Services and Crosscultural Communication 259 Language Use in the United States 261 Language Differences in Health Care Encounters 262 Attitudes Toward Limited-English Speakers 266 Changing Responses to Language Barriers in Health Care 268 An Expanding Profession: The Health Care Interpreter 278 Translation in Written Health Care Communication 284 Communication Is More Than Words 286 Summary 290 Review Questions and Activities 291 Chapter 9 Group Identity Development and Health Care Delivery 299 Research Highlights 301 Minority Status Group Identity Development 305 Majority Status Group Identity Development 313 Using the Models 325 Summary 328 Review Questions and Activities 329 PART FOUR CULTURAL COMPETENCE AND THE HEALTH CARE ORGANIZATION 333 Chapter 10 The Centrality of Organizational Behavior 335 The Science of Organizational Behavior 338 Organizations as Contexts for Behavior 339 OB Research Highlights 341 Can Culturally Competent Health Care Professionals Go It Alone ? 350 Summary 356 Review Questions and Activities 357 Chapter 11 The Business Case and Best Demonstrated Practices 361 Evolution of the Business Case 363 The Business Case for Cultural Competence in Health Care 364 Workforce, HRM, and the Business Case 373 Best Demonstrated Practices 376 Assessment and the Systems Approach 386 Benchmarking 389 Role of Metrics in the Systems Approach 390 Summary 397 Review Questions and Activities 399 Chapter 12 The Future of Diversity and Cultural Competence in Health Care 405 Trends That Support Widespread Adoption of the Systems Approach 406 The Sustainability Movement and the Systems Approach 419 Change Management and Force Field Analysis: Tools to Envision and Shape the Future 420 Summary 425 Review Questions and Activities 426 Glossary 429 Index 439

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