There is an urgency to the development of culturally competent care.This urgency is due to increasing diversity, increasing disclosure of identities, care delivery moving to home, and increasing inequity in access to health care. The development of a knowledgebase for culturally competent care is constrained by substantive and methological issues, such as the limited view of culture as a unit analysis and limitations in designs and methods that could capture the intergrative nature of participants' experiences. Therefore, I propose that components of foundational knowledge in nursing may include, but should not be limited to, populations and their cultures; culture-specific nursing phenomena; and responses to diversity, marginalization, vulnerability, and transitions. To develop culturally competent knowledge, researchers, theoreticians, and reviewers are urged to address eight criteria to ensure rigor and credibility in scholarship: contextuality, relevance, communication styles awareness of identity and power differentials, disclosure, reciprocation, empowerment, and time.
Professor, Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California.
This article is based on a keynote speech given at the 11th research conference "Toward Culturally Competent Health Care," Rutgers State University, Alpha Tau Chapter of Sigma Theta Tau, Princeton, NJ, March 30, 1995. The author acknowledges the thoughtful reviews of an earlier version from Joanne Hall, PhD, RN, Jeanne De Joseph, PhD, FANN, Pat Stevens, PhD, RN, and Juliene Lipson, PhD, FAAN. The arguments provided in this manuscript have been greatly enhanced by their recommendations.