OBJECTIVE: Racial and ethnic minority groups are underrepresented in chiropractic education and the profession, and are less likely than individuals identifying as White to have access to or use chiropractic care. Stakeholders with leadership positions in USA-based chiropractic colleges and organizations participated in 3 online diversity, equity, and inclusion (DEI) summit meetings to foster a deeper understanding of DEI, identify DEI objectives, and develop action steps and drive change. Summit I (51 attendees) comprised 3 presentations that provided background about DEI in chiropractic education and practice. Summit II (32 attendees), comprised 4 breakout sessions addressing organizational issues in DEI. Summit III (65 attendees) comprised 5 collaborative sessions focused on implementation of DEI objectives.
METHODS: We use aggregate data and qualitative summaries to provide a descriptive narrative. Data sources include pre/post-summit quantitative surveys, items from open-ended questionnaires, and a spreadsheet of recommendations for increasing organizational DEI.
RESULTS: Before attending Summit I, 48% rated their understanding of DEI issues as \"moderately\" or \"very\" high, compared with 74% afterward. Summit II participants suggested actions that should be taken by their institutions and the profession. Summit III participants stressed the need for DEI-supportive data, policies, and resources. They identified > 150 action steps to address DEI objectives. A listserv was established to facilitate ongoing institutional collaboration.
CONCLUSIONS: Summit participants recognized the importance of developing a diverse, culturally aware chiropractic workforce. The summits provided structure and support for stakeholders to effectively plan for and implement DEI in their organizations and institutions.

AbstractA 29-year-old female East African refugee with no formal psychiatric history and a medical history significant for HIV was admitted for failure to thrive and concern for bizarre behavior in the context of abandonment by her husband and separation from her child. After psychiatric evaluation, it was determined that she did not have the capacity to care for herself independently; adult protective services then pursued and was awarded guardianship. While admitted, the patient repeatedly refused medical treatment, had a feeding tube placed for forced nutrition and medications (though she did at one point remove this tube herself), and received two electroconvulsive therapy (ECT) treatments. Soon thereafter, the patient\'s court-appointed guardian met with the primary medical, psychiatric, and ethics teams to discuss goals of care in the setting of complex social and cultural needs. It was collectively determined that the patient\'s choices to refuse care (including nutrition, lab work, medications, and ECT) and some repeated behaviors (e.g., denial of divorce, denial of HIV, denial of need for care) could be considered culturally appropriate in the context of the acute stressors leading up to hospitalizations. All teams concluded, therefore, that the patient had the capacity to refuse these interventions and that further forced intervention would pose a greater chance of exacerbating her already-significant trauma history than improving her outcomes. Ultimately, the patient was able to be discharged into the care of her guardian, who would assist her in receiving support from members of her community who share her language and culture.

BACKGROUND:  Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants\' vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey.
OBJECTIVE:  To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants.
METHODS:  Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items.
RESULTS:  The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants\' connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth.
CONCLUSIONS:  Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities.

OBJECTIVE: There is a shortage of nurses, Aboriginal Health Practitioners, GPs and other staff in remote Australian health clinics. There is also high turnover of staff, leading to questions of \'who\' is appropriate for remote First Nations practice? The aim of this paper was to identify the characteristics of staff who are likely to work well in remote First Nations settings, from the perspectives of remote health practitioners.
METHODS: This is a qualitative study involving content analysis of interviews.
METHODS: The study is conducted in and with 11 Aboriginal Community Controlled Health Services across northern and central Australia.
METHODS: Eighty-four staff working in these clinics who spoke about staff qualities suited to remote practice.
RESULTS: Participants identified a range of qualities desirable in remote practitioners, which were grouped into three topics: (1) professional qualifications and experience, including cultural skills; (2) ways of working, including holisitic approach, resilience, competence, and being a team player, approachable, flexible and hard-working; and (3) specific community needs, namely the need for local First Nations staff, male practitioners and returning short-term staff. The combination of experiences, ways of working, and fit to both the team and community were emphasised.
CONCLUSIONS: Identifying the characteristics of staff who are likely to work well in these settings can inform recruitment strategies. This study found that a combination of professional qualifications, skills and experience as well as ways of working, individual characteristics and needs of communities are desirable for working in remote, First Nations settings.

OBJECTIVE: To examine the association between caregiver-perceived cultural sensitivity of health care providers and child health status in the United States.
METHODS: We analyzed National Survey of Children\'s Health data (n = 145,226) from 2016-2020. Using logistic regression, we determined odds of reporting a better health status by level of caregiver-perceived provider cultural sensitivity while controlling for potential confounders.
RESULTS: Children with providers perceived as more culturally sensitive by their caregivers had 2.38 times the odds (95% confidence interval: 1.73, 3.28) of enjoying a better caregiver-assessed health status compared with children whose providers were perceived as less culturally sensitive. Caregivers of BIPOC children in our sample were 1.99 times more likely (95% CI: 1.89, 2.10) to report their provider as only sometimes or never culturally sensitive.
CONCLUSIONS: Cultural sensitivity of health care providers, as perceived by caregivers, was associated with caregiver-assessed child health status in our study. This association remained significant when controlling for various sociodemographic variables. Our findings highlight the need for more research around the potential positive impact that improving provider cultural sensitivity could have on the health of children who are Black, Indigenous, or other People of Color (BIPOC).

The influx of migrants to Canada has resulted in a shift in the country\'s demographic landscape. Individuals often interpret and approach health and wellness through the lens of their cultural heritage, which has led to stereotyping behaviors and discriminatory practices, exacerbating the notion of \"Othering\". Immigrant older adults are likely to experience discrimination in a more dreadful way in the form of societal isolation and marginalization due to the collective systems of power such as ageism, ableism, and racism. This paper results from continuous thought-provoking discussions initiated by the first author (AM) in her doctoral program at the University of Western Ontario for the Philosophy of Nursing Science course, taught and facilitated by the second author (SM). After studying the course materials on \"revolutionary science\" and reflection on the process of paradigm shift introduced by Thomas Khun and engaging in critical discussions on a range of relevant philosophical concepts such as bio-power, othering, silencing and ignorance, marginalization, oppression, neoliberalism, health equity, and social justice, we have been prompted to rethink the concept of cultural competence in nursing education and healthcare practices, particularly in the context of nursing care of older adults. Therefore, in this paper, we will critique the concept of cultural competency in the context of an anti-racist and anti-oppressive lens and suggest a pivotal response to move towards an inquiry-driven approach based on cultural humility and respect in the nursing care of older adults.

Transcultural nursing is a discipline that emphasizes culturally competent care for diverse populations, recognizing the influence of culture on health beliefs, values, practices, and outcomes. It requires nurses to respect cultural differences and similarities, but faces challenges in curriculum design, faculty development, and student assessment. This paper explores transcultural nursing education\'s current state and future directions, addressing the American Association of Colleges of Nursing essentials for integrating cultural content into nursing curricula, reviewing Madeleine Leininger\'s transcultural nursing theory, diversity, equity, and inclusion concepts, and discussing the main challenges of transcultural nursing education, including lack of student diversity, training, and resources. Strategies to overcome these challenges include interprofessional collaboration, cultural immersion, and evidence-based practice. The paper concludes with how emergency department nurses should incorporate this into practice.

BACKGROUND: Changes in Polish demographic data with a growing number of culturally and linguistically diverse patients stipulate new directions in medical education to prepare future physicians to work effectively across cultures. However, little is known about Polish medical students\' willingness to gain cross-cultural knowledge and skills, desire to get engaged in interactions with patients from diverse cultural backgrounds, expectations and needs concerning cross-cultural training as well as challenges they face in the path to cultural competence.
METHODS: Therefore, in this study, we conducted and thematically analysed fifteen semi-structured interviews with medical students to broaden our understanding of medical students\' perception of cross-cultural competence enhancement.
RESULTS: The conducted thematic analysis allowed for the development of four themes, which showed that Polish medical students perceived skills and knowledge necessary to facilitate culturally congruent care as indispensable to form quality patient-doctor relations, believed that lack of cultural sensitivity may lead to dangerous stereotype formation and insufficient competence may be the source of stress and anxiety resulting in confusion and lack of confidence. Finally, numerous suggestions have been made by participants on how to improve their cross-cultural competence. Students emphasized, however, the role of medical education with active and experiential learning methods, including simulation-based training, in the process of equipping them with the knowledge and skills necessary to provide best quality care to culturally diverse patients.
CONCLUSIONS: Our analysis indicated that Polish medical students seem to hold positive attitudes towards cultural competence development and view it as an important component of physician professionalism.

BACKGROUND: Current research has identified how ethnic minority women experience poorer health outcomes during the perinatal period. In the United Kingdom, specialist perinatal mental health services provide mental health treatment for women throughout the perinatal period. Service users have previously highlighted that perinatal services are hard to access and lack cultural sensitivity, whereas healthcare professionals have described limited opportunities and resources for developing cultural competency.
OBJECTIVE: We explored the experiences of ethnic minority women with National Health Service (NHS) specialist perinatal teams and identified what culturally sensitive perinatal mental health care means to this group.
METHODS: Individual semi-structured interviews were conducted, and an interpretative phenomenological analysis framework was used to analyse the interview transcripts.
METHODS: Participants were recruited from NHS specialist perinatal teams and online via social media.
RESULTS: Six women were interviewed. Four group experiential themes central to the experiences of participants emerged: (1) strengthening community networks and peer support; (2) valuing cultural curiosity; (3) making sense of how culture, ethnicity, race and racism impact mental health; and (4) tailoring interventions to ethnic minority women and their families.
CONCLUSIONS: The findings capture how ethnic minority women experience specialist perinatal teams and offer insights into practising culturally sensitive care. Perinatal mental health professionals can support ethnic minority women by strengthening their access to community resources and peer support; being curious about their culture; helping them to make sense of how culture, ethnicity, race and mental health interact; and applying cultural and practical adaptations to interventions.
UNASSIGNED: A Lived Experience Advisory Group (LEAG) of women from ethnic minority groups contributed to the design and conduct of this study. The LEAG had lived experience of perinatal mental health conditions and accessing specialist perinatal teams. The LEAG chose to co-produce specific aspects of the research they felt fit with their skills and available time throughout five group sessions. These aspects included developing the interview topic guide, a structure for debriefing participants and advising on the social media recruitment strategy.

Although culturally appropriate care is vital to quality of care, many barriers exist to implementing culturally appropriate care in practice. Nurse leaders are in a position where they can act toward addressing some of the barriers and engage nursing staff in strategies to promote the implementation of culturally appropriate care practices on a unit. This article is an opinion piece wherein the authors illustrate leadership strategies that advocate for and nurture a practice where nursing staff are supported to apply their culturally appropriate skills in practice.