Document Type


Degree Name



Oregon Health & Science University


This study was centrally concerned with two concepts: culture and cultural competence as they relate to the education of healthcare professionals. The goal of this study was to examine the current state of cultural competence and contribute to its conceptual development in order to guide curricula in healthcare education. To accomplish this, a critical examination of the central tenets of cultural competence was made with recommendations for integration of cultural competence into healthcare education. Findings from this study contend that conceptualizing, teaching, and learning cultural competence as a finite body of knowledge is both superficial and inadequate for the sweeping social and demographic changes occurring today. Furthermore, a focus on cultural "traits" obscures the interlocking systems and oppressive relations that establish and maintain systems of imbalanced power and therefore health disparities between and among groups within the U.S. and worldwide. This study explored cultural competence through interviews with 20 multidisciplinary cultural and cultural competence experts from the U.S. and abroad. Multidisciplinary data were thought to yield richer findings than any one discipline alone and therefore could generate a more comprehensive and innovative approach to integrating cultural competence in healthcare education in the future. Awareness, engagement, and application were central themes that applied, albeit differently, across four domains of cultural competence: intrapersonal, interpersonal, system/organization, and global. Awareness in all domains stressed understanding context (of self, others, and systems) as a key element in developing cultural competence. Engagement highlighted development of intellectual, attitudinal, and behavioral flexibility, skillful communication, empathy, and building high-quality relationships. Application emphasized building personal capacity, whole body communication, conflict negotiation, and responsiveness to client, family, and community needs and priorities. Recommendations for integrating cultural competence into healthcare education included faculty development, spiraling curriculum with an iterative revisiting and deepening of the complexity of the cultural competence content, experiential learning paired with facilitated reflection, and building a critical mass of cultural competence within a healthcare education setting through the support of leadership and infrastructure.




School of Nursing



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