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Keywords: cultural competence, healthcare, curriculum, learning and teaching
BACKGROUND
The concept of cultural competence has been a focus of many countries in an attempt to address healthcare inequalities. A variety of literature about cultural competence has been produced (Truong et al. 2014; Clifford et al. 2015), particularly in the education and health disciplines.
Historically the literature indicates that a number of definitions have emerged from a variety of disciplines. Health discipline definitions share key elements (Betancourt 2002; Goode 1995). These elements include but are not limited to: valuing diversity, being self-reflective, being conscious of the dynamics of cross-cultural interactions, institutionalising the importance of cultural knowledge, and making adaptations to health service delivery that reflect cultural understanding (Humphery 2000; Ranzijn et al. 2008).
Contemporary Australian models of cultural competence in nursing are increasingly adopting the New Zealand approach to culturally safe practice where clinicians understanding power differentials is at the forefront (Australian Institute of Health and Welfare, 2019). Carberry (1998), a foundational author and writing from an Australian nursing perspective, suggests competency alone is dangerously insufficient. She contests the way to being culturally safe through the nurses' competence in delivery of cultural care is foundationally flawed through the power imbalance between nurse and client.
The mere fact that individuals can be excluded from health professional expert knowledge and 'othered' (p. 10) suggests that models need to move beyond safety. Increasingly we are seeing a values based approach being explored in the literature aligning with Carberry's foundational thinking.
Education of Australian professionals in cultural competence is believed to be paramount (Hunt et al. 2015). More recent research in Australia has indicated that cultural competence training has resulted in preparedness to work with Aboriginal people (Paul et al. 2006; McRae, 2008; Hunt et al. 2015; Biles, 2017), understanding of health challenges (Mooney et al. 2005; Biles, 2017)and improved relationships between Indigenous Australians and non-Indigenous Australians, all of which can enhance access to mainstream service care (Si et al. 2006).
The onus of cultural competence is largely directed to educators providing learning opportunities to prepare health professionals for delivering their services in culturally appropriate ways rather than on individual leadership of health professionals.
Further, Australian understanding in cultural competence is largely directed towards Indigenous Australian cultural competence.
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