Influence of Organizational Factors on Clinical Cultural Competence
Notice bibliographique
Résumé
This qualitative research used a case study method to study clinical cultural competence at one hospital located in a large city in Canada. The study explored the overarching central question: how does the organizational and practice environment influence the understanding and enactment of clinical cultural competence in an organization embarking on a deliberate process of organizational and practice change? Interviews with clinicians, administrators and organizational diversity consultants (N=40), along with field notes and a review of selected documents were used to: (a) examine clinical cultural competence from the clinicians' perspective; and (b) describe key factors and processes within the practice environment that support or limit the provision of such care. The research was situated within a theoretical framework for practice development proposed by Kitson, Harvey McCormack (1998) that identifies practice development to be a function of three key variables: evidence, context and facilitation. The philosophical stance of critical realism was used to analyze the findings. Results indicate that despite a significant organizational commitment to diversity, cultural competence in clinical care was largely limited to awareness and lacking in application in practice. Cultural competence was described in terms of adding a layer of cultural understanding to clinical care; however, this was accompanied by a feeling of inadequacy with respect to cultural issues. This study further revealed an overlap and a need to differentiate between cultural competence and client-centered care. The overall organizational approach was one of mandated change and included the development of various initiatives such as diversity policy and mandatory training for all staff. However, these initiatives were experienced both positively and negatively; indicating a need to examine not just what resources exists in an organization, but also how they are experienced. Although leadership was evident in the form of organizational commitment, it was not translated into care. The findings suggest a reconsideration of two of the most frequently recommended strategies--diversity training and enhancing workforce diversity. In addition, the findings also suggest enhancements to practice development framework to address complex phenomenon such as clinical cultural competence. These are further discussed in the dissertation report.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».