Cultural competence in Slovenian hospital nutrition
A qualitative descriptive study
DOI:
https://doi.org/10.14528/snr.2022.56.2.3149Keywords:
cultural competence, hospital nutrition, dietary adaptation, diversity, culture, adaptation, nutrition, challenges, developmentAbstract
Introduction: Adherence to dietary restrictions and principles related to the cultural background of patients is important in hospital nutrition, as nutrition has an impact on health outcomes, as well as on the length and cost of hospitalisation. This approach requires organisational and individual cultural competence. The purpose of the study was to explore the perspective of those responsible for hospital nutrition on cultural competence, assess whether hospital nutrition is adapted to patients' cultural background and identify the challenges in this area.
Methods: A qualitative research using semi-structured interviews was conducted. We interviewed 14 food service managers and nutritionists from eight Slovenian hospitals. The data were analysed using a deductive content analysis within Atlas.ti software.
Results: The respondents were aware of the diversity of the patients and the importance of adapting the diet to the cultural background, although the concept of cultural competence is unfamiliar. There are limitations in adapting diets. Knowledge on cultural aspects of nutrition is scarce and training in this area is almost unavailable. Other challenges such as organisational, technological and communication challenges hinder the development of cultural competence.
Discussion and conclusion: Similar challenges to ours are also faced abroad. Although, according to the respondents, patients have many possibilities to adapt their diet, it would be difficult to claim that cultural competence exists, as this concept encompasses other skills as well. Further research, educational opportunities on the cultural aspects of nutrition and awareness of the importance of nutritional services at all levels in the healthcare system are needed to further develop cultural competence in this area.
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Alpers, L. M. (2019). Hospital food: When nurses' and ethnic minority patients' understanding of Islamic dietary needs differ. Nursing open, 6(4), 1455–1463. https://doi.org/10.1002/nop2.343 PMid:31660173; PMCid:PMC6805268
Bakaloudi, D. R., Halloran, A., Rippin, H. L., Oikonomidou, A. C., Dardavesis, T. I., Williams, J. ... Chourdakis, M. (2021). Intake and adequacy of the vegan diet. A systematic review of the evidence. Clinical Nutrition, 40(5), 3503–3521. https://doi.org/10.1016/j.clnu.2020.11.035 PMid:33341313
Beck, A. M., Balkn, U. N., Fürst, P., Hasunen, K., Jones, L., Keller, U. ... Ovesen, L. (2001). Food and nutritional care in hospitals: How to prevent undernutrition report and guidelines from the Council of Europe. Clinical Nutrition, 20(5), 455–460. https://doi.org/10.1054/clnu.2001.0494 PMid:11534942
Beck, A. M., Balknas, U., Camilo, M., Furst, P., Gentile, M., Hasunen, K. ... Ovesen, L. A. R. S. (2002). Practices in relation to nutritional care and support–report from the Council of Europe. Clinical Nutrition, 21(4), 351–354. https://doi.org/10.1054/clnu.2002.0555 PMid:12211176
Bond, P. (2013). A hospital nutrition improvement programme. Nursing Times, 109(39), 22–24. Retrieved June 14, 2021 from https://cdn.ps.emap.com/wp-content/uploads/sites/3/2013/09/021013-A-hospital-nutrition-improvement-programme.pdf.
Bradshaw, C., Atkinson, S., & Doody, O. (2017). Employing a qualitative description approach in health care research. Global qualitative nursing research, 4, 1–8. https://doi.org/10.1177/2333393617742282 PMid:29204457; PMCid:PMC5703087
Campinha- Bacote, J. (2003). The process of cultural competence in the delivery of healthcare services: A culturally competent model of care. Cincinnati: Transcultural Care Associates. https://doi.org/10.1177/10459602013003003 PMid:12113146
Cardenas, D., Correia, M. I. T. D., Ochoa, J. B., Hardy, G., Rodriguez-Ventimilla, D., Bermúdez, C. E. ... Barazzoni, R. (2021). Clinical nutrition and human rights: An international position paper. Clinical Nutrition, 36, 534–544. https://doi.org/10.1016/j.clnu.2021.02.039 PMid:34023070
Carolan, M. (2022). The sociology of food and agriculture (3rd ed.). London: Routledge. https://doi.org/10.4324/9781003133780
Council of Europe, Committee of Ministers. (2003). Resolution ResAP(2003)3 on food and nutritional care in hospitals. Nutrition & Food Science, 34 (2). https://doi.org/10.1108/nfs.2004.01734bab.003
Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed. Retrieved April 2, 2021 from https://files.eric.ed.gov/fulltext/ED330171.pdf
Cuerda, C., Muscaritoli, M., Donini, L. M., Baqué, P., Barazzoni, R., Gaudio, E. ... Van Gossum, A. (2019). Nutrition education in medical schools (NEMS). An ESPEN position paper. Clinical Nutrition, 38(3), 969–974. https://doi.org/10.1016/j.clnu.2019.02.001 PMid:30772092
Curry, K. R. (2000). Multicultural competence in dietetics and nutrition. Journal of the Academy of Nutrition and Dietetics, 100(10), 1142–1143. https://doi.org/10.1016/S0002-8223(00)00335-7
Doyle, L., McCabe, C., Keogh, B., Brady, A., & McCann, M. (2020). An overview of the qualitative descriptive design within nursing research. Journal of research in nursing: JRN, 25(5), 443–455. https://doi.org/10.1177/1744987119880234
Edelstein, S. (2010). Food, cuisine, and cultural competency for culinary, hospitality, and nutrition professionals. Sudbury: Jones & Bartlett Publishers.
Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x PMid:18352969
European Ageing Network. (2021). Promoting well-nutrition in elderly care. Tabor: European Ageing Network. Retrieved May 30, 2022 from https://european-nutrition.org/good-practices/ean-guideline-promoting-well-nutrition-in-elderly-care/
Galletta, A. (2013). Mastering the semi-structured interview and beyond: From research design to analysis and publication. New York: NYU Press. https://doi.org/10.18574/nyu/9780814732939.001.0001
Goody, C. M., & Drago, L. (2009). Using cultural competence constructs to understand food practices and provide diabetes care and education. Diabetes Spectrum, 22(1), 43–47. https://doi.org/10.2337/diaspect.22.1.43
Goriup, J. (2016). Multicultural society and nursing. In B. M. Kaučič, B. Filej & B. Dobrowolska et al. (Eds.), Multicultural society and aging: Challenges for nursing in Europe: Selected chapters (pp. 4–14). Celje: Visoka zdravstvena šola.
Greenebaum, J. (2012). Veganism, identity and the quest for authenticity. Food, Culture & Society, 15(1), 129–144. https://doi.org/10.2752/175174412X13190510222101
Handtke, O., Schilgen, B., & Mösko, M. (2019). Culturally competent healthcare: A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision. PloS ONE, 14(7), Article e0219971. https://doi.org/10.1371/journal.pone.0219971 PMid:31361783; PMCid:PMC6667133
Helman, C. G., 2007. Culture, health and illness. London: Hodder Arnold. https://doi.org/10.1201/b13281
Hofstede, G. (2011). Dimensionalizing cultures: The Hofstede model in context. Online readings in psychology and culture, 2(1), 2307–0919. https://doi.org/10.9707/2307-0919.1014
Holloway, I. & Galvin, K. (2016). Qualitative research in nursing and healthcare. West Sussex: John Wiley & Sons.
Jager, M., den Boeft, A., Leij-Halfwerk, S., van Der Sande, R., & van den Muijsenbergh, M. (2020). Cultural competency in dietetic diabetes care: A qualitative study of the dietician's perspective. Health Expectations, 23(3), 540–548. https://doi.org/10.1111/hex.13019 PMid:32045075; PMCid:PMC7321725
Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: A systematic scoping review. BMC Health Services Research, 18(1), 1–15. https://doi.org/10.1186/s12913-018-3001-5 PMid:29609614; PMCid:PMC5879833
Jongen, C., McCalman, J., Bainbridge, R., & Clifford, A. (2018). Cultural competence in health: a review of the evidence. Singapore: Springer.
Kim, H., Sefcik, J. S., & Bradway, C. (2017). Characteristics of Qualitative Descriptive Studies: A Systematic Review. Research in nursing & health, 40(1), 23–42. https://doi.org/10.1002/nur.21768
Kittler, P., Sucher, K. P., & Nelms, M. (2017). Food and Culture. Belmont: Cengage Learning.
Kodeks etike v zdravstveni negi in oskrbi Slovenije. (2014). Ljubljana: Zbornica zdravstvene in babiške nege Slovenije – Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije. Retrieved from https://www.zbornica-zveza.si/sites/default/files/doc_attachments/kodeks_ etike_v_zdravstveni_negi_in_oskrbi_slovenije_marec_2014.pdf
Lipovec Čebron, U. (2019). Medkulturni (in drugi) nesporazumi v zdravstvu. In N. K. Pokorn & U. Lipovec (Eds), Večjezično zdravje: komunikacijske strategije in večkulturni stiki s tujejezičnimi bolniki v slovenskem zdravstvenem sistemu (pp. 78–91). Ljubljana: Znanstvena založba Filozofske fakultete.
Moffat, T., & Prowse, T. (2010). Human diet and nutrition in biocultural perspective: Past meets present. Oxford: Berghahn Books.
Ng, E., & Wai, C. (2021). Towards a definition of anti-oppressive dietetic practice in Canada. Critical Dietetics, 5(2), 10–14. https://doi.org/10.32920/cd.v5i2.1407
Pokorn, N. (2019). Reševanje jezikovnih ovir v slovenskem zdravstvu: analiza stanja. In N. K. Pokorn & U. Lipovec (Eds), Večjezično zdravje: komunikacijske strategije in večkulturni stiki s tujejezičnimi bolniki v slovenskem zdravstvenem sistemu (pp. 31–47). Ljubljana: Znanstvena založba Filozofske fakultete.
Pope, C., Ziebland, S., & Mays, N. (2000). Analysing qualitative data. BMJ 320(7227), 114–116. https://doi.org/10.1136/bmj.320.7227.114 PMid:10625273; PMCid:PMC1117368
Poulain, J. P. (2017). The sociology of food: eating and the place of food in society. London: Bloomsbury Publishing.
Prosen, M. (2018). Developing cross-cultural competences: opportunity for ensuring health and healthcare equality and equity. Obzornik zdravstvene nege, 52(2), 76–80. https://doi.org/10.14528/snr.2018.52.2.262
Reddy, S., & Anitha, M. (2015). Culture and its influence on nutrition and oral health. Biomedical & Pharmacology Journal, 8(Special Oct), 613–620. https://dx.doi.org/10.13005/bpj/757
Seeleman, C., Suurmond, J., & Stronks, K. (2009). Cultural competence: A conceptual framework for teaching and learning. Medical Education, 43(3), 229–237. https://doi.org/10.1111/j.1365-2923.2008.03269.x PMid:19250349
Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International journal of Nursing Studies, 99, Article 103386. https://doi.org/10.1016/j.ijnurstu.2019.103386
Špindler, N., Cilar Budler, L., Klanjšek, P. ., & Kegl, B. (2021). Vpliv izbirčnosti v prehrani na prehranjenost otrok. Obzornik zdravstvene nege, 55(4), 237–242. https://doi.org/10.14528/snr.2021.55.4.3070
Tan, H. S. G., Fischer, A. R. H., Tinchan, P., Stieger, M., Steenbekkers, L. P. A., & van Trijp, H. C. M. (2015). Insects as food: Exploring cultural exposure and individual experience as determinants of acceptance. Food Quality and Preference, 42, 78–89. https://doi.org/10.1016/J.FOODQUAL.2015.01.013
Tappenden, K. A., Quatrara, B., Parkhurst, M. L., Malone, A. M., Fanjiang, G., & Ziegler, T. R. (2013). Critical role of nutrition in improving quality of care: An interdisciplinary call to action to address adult hospital malnutrition. Journal of the Academy of Nutrition and Dietetics, 113(9), 1219–1237. https://doi.org/10.1016/j.jand.2013.05.015 PMid:23871528
UNESCO. (2009). Investing in Cultural Diversity and Intercultural Dialogue: UNESCO World Report. Paris: UNESCO Publishing. Retrieved from http://unesdoc.unesco.org/images/0018/001852/185202e.pdf
Waldstein, A. (2018). Food, Anthropology of. The International Encyclopedia of Anthropology, 1–9. https://doi.org/10.1002/9781118924396
Wall-Bassett, E., & Harris, N. (2017). Promoting cultural competency: A nutrition education model for preparing dietetic students and training paraprofessionals in an international setting. Global Journal of Health Science, 9(7), 108–116. https://doi.org/10.5539/gjhs.v9n7p108 PMid:15156839
World Medical Association. (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 PMid:24141714
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