Competency Assessment and Action Plan, Coursework Example

Demographics and Organizational Assessment

Communities throughout the United States possess considerable challenges with respect to managing cardiovascular disease and minimizing related risks. Organizations working with patients must develop and integrate strategies to improve outcomes for this patient population and must recognize the issues that prevail within different patient populations. For veterans, cardiovascular disease is particularly challenging and requires an effective approach to address concerns that impact this population as they balance their military service with other objectives. Cardiovascular health is of critical importance in preserving the health of veterans throughout the United States; therefore, the Veterans Administration Health System has established key priorities to assist with reducing the risks associated with cardiovascular disease for veterans.

Cardiovascular disease risk within the veteran population is high, particularly in veterans over the age of 40 (Vimalananda et.al, 2013). An in-depth study of over two million VA patients conducted by researchers at the VA demonstrated that cardiovascular risk is a critical concern, as there is an increased risk of hypertension, diabetes, obesity, and hyperlipidemia for this patient population (Vimalananda et.al, 2013). Therefore, it is necessary to address these findings and to develop strategic objectives that will accommodate this population group in an effective manner (Vimalananda et.al, 2013). A thorough evaluation of these risk factors and their prevalence with veterans is essential to the discovery of directives that will have a positive impact on patient outcomes over the long term (Vimalanada et.al, 2013).

In recent years, studies have demonstrated that the prevalence of Post-Traumatic Stress Disorder (PTSD) has been influential in the diagnosis of cardiovascular disease for an ever-increasing group of veterans (Seaman, 2013). It is known that “PTSD sufferers are known to often have raised levels of stress hormones and other chemicals signaling overactivation in the fight-or-flight pathways of the nervous system” (Seaman, 2013). As a result, there is a greater association between PTSD and heart disease for many veterans, which must be addressed more closely in future studies, particularly in relation to stress (Seaman, 2013).  This is one of several strategic approaches to cardiovascular disease that must be considered by the Veterans Administration on a widespread basis in an effort to produce effective patient outcomes for this population (Seaman, 2013).

The Veterans Administration recognizes the critical nature of cardiovascular disease risk within its veteran population (Goldberg). In particular, veterans possess a greater likelihood to be diagnosed with cardiovascular disease as they age, as lower levels of physical activity, diabetes, hypertension, and weight gain are likely to occur (Goldberg). As a result, the VA has established the following: “The clinical translation exercise and weight loss program in the VA – Managing Obesity for Veterans Everywhere (MOVE!) improves exercise capacity, functional performance and body composition to reduce diabetes and CVD risk” (Goldberg, p. 1-2). The health of veterans facing cardiovascular disease is of primary concern because this condition impacts their lives and wellbeing in dramatic ways (Goldberg). It is necessary to consider these issues and to address the potential risks associated with cardiovascular disease through expanded programmatic efforts to improve outcomes for veterans (Goldberg).The application of interventions to reduce cardiovascular risk and to improve the health of veterans must continue to be explored throughout the VA health system in an effort to achieve optimal health and wellbeing for veterans (Goldberg).

The Veterans Administration has taken a number of important steps to address the concerns related to cultural competence as related to veterans. Those who have given service to the military are particularly vulnerable to patient care and treatment and may demonstrate sensitivity to these alternatives, depending on the circumstances (Meyer, 2012). As the veterans population becomes increasingly prominent in the United States, it is necessary for the VA to consider its own role and its responsibility to provide veterans with care that is both culturally competent and responsible (Meyer, 2012).With the increased focus on the military and on veterans in recent years, it is more important than ever to address some of these challenges and to take the steps that are required to ensure that patient care in the Veterans Administration addresses the most prevalent concerns and its of the highest possible quality (Meyer, 2012). These efforts also support the ongoing ability to develop appropriate initiatives and strategies to improve the health of veterans, and in particular, cardiovascular health (Meyer, 2012).

The Veterans Administration has expanded its knowledge with this process; however, the ability to educate healthcare professionals working with veterans requires additional support and guidance from key individuals who are experts in the area of PTSD and other psychological concerns (Meyer, 2012). These efforts require a greater understanding of the breadth of military service and its impact on veterans and their families from the physical, psychological, social, and emotional perspectives (Meyer, 2012). The Veterans Administration must explore additional opportunities not only to educate its veteran patients, but also its staff members in treating health-related conditions, including cardiovascular disease, using the appropriate methods that are available to promote educational alternatives and action planning activities (Meyer, 2012). In this context, there is a great necessity to address the status of culturally competent care and treatment and to consider other alternatives to improve veteran patient outcomes that recognize the culture of veterans and the specific needs that they require (Meyer, 2012). It is anticipated that a culturally aware and appropriate action plan will play an essential role in supporting veterans and their health concerns in a manner that is consistent with their beliefs and expectations regarding care and treatment (Meyer, 2012).

Literature Review

A wide body of literature has evolved in recent years that addresses the need for culturally competent and appropriate care for veterans. It is important to consider the research that has been performed in this area and to demonstrate that there is a clear commitment to providing veterans with culturally competent care at all times. The contributions made by experts and professionals within the Veterans Administration and throughout healthcare practice play a role in supporting positive outcomes for veterans who may find it difficult to obtain and accept care from these providers.  Therefore, trends regarding these objectives and other challenges must be considered by exploring various literature resources in order to accomplish these objectives in the desired manner.

From a nursing-based perspective, there are critical challenges associated with the development of culturally competent procedures for patient care and treatment. The American Association of Colleges of Nursing (AACN) has summarized the primary objectives related to culturally competent education, including a toolkit that supports expanded knowledge regarding a variety of cultural competencies (2008).For example, some of the most important competencies include the use of existing data to promote cultural competence in patient care, developmental exercises to promote this agenda, and the advancement of healthcare objectives for populations that are considered to be vulnerable (AACN, 2008).Expert knowledge in these areas will lead to greater outcomes for these population groups, including veterans, many of whom possess challenges that are difficult to identify from a non-veteran perspective (AACN, 2008). The toolkit also considers the following: “The most important aspect in developing cultural competence is understanding the interrelatedness of cultural concepts. It is suggested that these definitions be used as a first step toward understanding the complex and dynamic nature of culture” (AACN, 2008, p. 2). This perspective supports the ongoing development of educational tools and frameworks to provide nurses and other healthcare professionals with culturally competent education and guidance to treat their patients with respect and understanding (AACN, 2008).

In addressing these concerns, the National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care have been designed to support the necessity for culturally responsible healthcare at all times (The Office of Minority Health, 2013).These standards include the ability to provide expert leadership and guidance in this area, training as needed to speak additional languages to better communicate with patients, and develop relationships with patients that are grounded in cultural awareness and diversity (The Office of Minority Health, 2013). When conflicts or other concerns arise, these standards establish the tone for overcoming these obstacles and in supporting the objectives that are necessary to achieve culturally competent care at all times (The Office of Minority Health, 2013). These efforts are particularly relevant for veterans requiring healthcare and treatment, as they possess a unique set of challenges that are different from other populations. The ability to apply CLAS Standards to veterans is of critical importance in supporting this population and the physical, psychological, social, and emotional needs that they face in their daily lives after military service (The Office of Minority Health, 2013).These contributions made by employees in the Veterans Administration system are instrumental in advancing the desired healthcare outcomes for veteran patients, many of whom possess unique cultural identities and circumstances (The Office of Minority Health, 2013).

The Transcultural Nursing Society has also established its own set of standards in order to promote culturally competent care at all times (2010). It is known that “Cultural standards exist within political, economic, and social systems. Many health organizations throughout the world have defined care for their specific populations from the perspective of these systems. The variation among standards and the context within which standards are practiced precludes a single set that fits all cultures” (Transcultural Nursing Society, 2010, p. 2). Due to the complex nature of cultural competence in healthcare practice, it is essential to identify the different approaches that are necessary to ensure that patient care for vulnerable population groups is optimized, such as the care provided to veterans (Transcultural Nursing Society, 2010). This group requires a special level of attention and understanding due to the stress associated with military service and related experiences. However, cultural identifiers and standardized approaches are also applicable to this population group (Transcultural Nursing Society, 2010).

Expanding knowledge regarding cultural competence requires a greater understanding of the key assumptions, challenges, and limitations that are posed on nurses and other professionals when working with patients. Therefore, methods of measuring cultural competence must be considered in order to accomplish the desired objectives and to facilitate supportive outcomes for patients (Loftin et.al, 2013). In this capacity, a variety of instruments must be considered that will support the measurement of cultural competence, including those that capture self-awareness and self-recognition of cultural competence (Loftin et.al, 2013). However, no single instrument is ideal for measuring these conditions, and several options must be evaluated when attempting to make these measurements (Loftin et.al, 2013).Since cultural diversity is so relevant in today’s healthcare environments, it is more important than ever to establish an effective understanding of the elements that play a role in becoming culturally competent professionals (Loftin et.al, 2013). These alternatives have an important impact on the delivery of patient care, particularly when cultural diversity is evident (Loftin et.al, 2013).

Culturally competent care and treatment must adhere to one or more models in an effort to achieve success in this area (Campinha-Bacote, 2002). The most appropriate approach utilizes a set of common beliefs and principles in an effort to produce consistency in working with individual patients from diverse cultures (Campinha-Bacote, 2002). In addition, this model reflects upon the challenging nature and scope of cultural diversity and awareness to enhance quality of care and treatment over time (Campinha-Bacote, 2002). This includes knowledge, encounters, and desire as key components of cultural competency for nurses and other healthcare providers (Campinha-Bacote, 2002). These efforts are important because they reflect a capacity to expand upon existing experiences and apply said knowledge to future encounters and experiences with patients (Campinha-Bacote, 2002).

The ability to provide patients with consistently high quality of care and the level of attention that is required to expand knowledge supports the development of different perspectives to manage cultural competence more effectively (Medscape Nurses, 2005). In expanding upon the Campinha-Bacote model of cultural competence even further, it is believed that this model is “a volcano. At the base, there must be a true desire to be culturally competent. Once this desire is developed, it wells up and finally erupts, pervading all decisions made as a healthcare provider” (Medscape Nurses, 2005). Therefore, it is important to identify the constructs that play a role in supporting patient outcomes and in facilitating growth within the realm of nursing that contributes to positive outcomes for culturally diverse patients, such as veterans (Medscape Nurses, 2005).

Cultural competence in nursing practice also conveys the importance of different perspectives and approaches to accommodate nursing knowledge and expertise in this area (Crenshaw et.al, 2011). Therefore, education must address the key principles of cultural competence as a means of evaluating existing practice methods in order to ensure that cultural competence is achieved (Crenshaw et.al, 2011). In addition, tools that support the measurement of cultural competence play a critical role in addressing weaknesses in education regarding cultural competence, as well as the opportunities that are available to influence these practices in a favorable manner (Echeverri et.al, 2010).

An educational approach to cultural competence must include the support of language proficiency within healthcare education (Wright et.al, 2010). These contributions are important contributors in teaching students to speak other languages, listen intently, and understand what others are expressing through language (Wright et.al, 2010). This strategy supports the ongoing development of cultural and language proficiency that will have a positive impact on patients who represent different cultures and who require specific types of communication that are non-traditional (Wright et.al, 2010). In a similar context, it is important to identify the constructs that are available to address the social nature of cultural competency, including mutual respect and social justice within the healthcare setting (Douglas et.al, 2011). These standards must support the creation of an environment that is based upon strong communication skills, diversity awareness, values and beliefs, and patient advocacy, amongst other principles (Douglas et.al, 2011). Each of these indicators represents a means of expanding cultural competence so that patient care is optimized at all times, regardless of culture or language differences (Douglas et.al, 2011). These standards establish the tone for meaningful and appropriate conversations with patients and their families in healthcare settings at all times (Douglas et.al, 2011).

Action Plan Analysis

Planning a course of action to accommodate the ever-increasing needs of cultural competence demonstrates the importance of perspectives that are likely to address the most important challenges associated with culturally competent care. Therefore, nurses must demonstrate critical thinking skills in the development of an action plan that will support cultural competence (Feng et.al, 2010). In any healthcare environment, including the Veterans Administration Health System, it is of critical importance to think about issues with a critical eye and examine the potential solutions that support cultural awareness and diversity (Feng et.al, 2010). The chosen action plan must work cooperatively with other objectives so that veterans are provided with effective leadership and guidance in patient care and treatment that also recognizes cultural differences and needs (Purnell et.al, 2011). An action plan for cultural competence requires a collaborative approach in order to develop new strategies that will improve veteran patient outcomes (Purnell et.al, 2011).

The chosen action plan must consider the role that nurses play in achieving cultural competence in healthcare environments. Veterans face their own unique set of concerns and issues for which specific strategies must evolve. The chosen action plan must recognize that this group of patients deserves the focus and attention that is required to address their health concerns in a constructive manner (Campinha-Bacote, 2011). As a result, cultural competence issues must be evaluated in the context of their influence on nurse communication with patients to facilitate positive health and wellbeing for veterans (Campinha-Bacote, 2011). The action plan must consider the approaches that are likely to be effective in educating nurses working with veterans so that the cultural needs of experienced military veterans are addressed appropriately at all times (Campinha-Bacote, 2011). This strategy must also be concerned with the recognition of core values and principles that are likely to be common among veterans, such as a strict work ethic and a strong-willed approach to life and the task at hand (Campinha-Bacote, 2011). From this perspective, it is important that nurses possess the skills and education that are required to ensure that veterans are treated with the respect and are given the level of attention that they deserve, given the service that they have provided to their country (Campinha-Bacote, 2011).

The chosen action plan should consistently address cultural competence so that nurses possess the education that is required to adhere to nationally recognized standards in this area. At the same time, nurses should also exercise patients in providing care and with themselves as cultural competence requires time and effort to achieve the desired results (Taylor and Alfred, 2010). From this perspective, nurses must also demonstrate their willingness to be effective listeners and communicators with their patients by recognizing their own limitations and working proactively to overcome them with expanded training and guidance (Taylor and Alfred, 2010). Nurses must learn from each other and take the initiative to understand the needs of their patients and to recognize where changes and greater cultural awareness must be addressed at a higher level (Taylor and Alfred, 2010).

The proposed action plan must utilize existing tools that are useful in measuring cultural competence within the Veterans Administration Health System. Some of the possible options include the following: 1) The Transcultural Self-Efficacy Tool and 2) The Cultural Competence Clinical Evaluation Tool (Jeffreys, 2010). These and other tools are available to nursing leaders and other field experts to measure current levels of cultural competence in order to determine where additional education and goal-setting is required (Jeffreys, 2010). These tools should be used at regular intervals to measure the level of cultural competence that nurses possess within the system so that their veteran patients will be provided with culturally sensitive care and treatment (Jeffreys, 2010).

For experienced nurses working with veterans, there is always room for growth in the area of cultural competence. Many nurses do not believe that their own knowledge of different types of cultures is sufficient, or they do not believe that this should be a primary concern (Fulbright Sumpter and Brooks Carthon, 2011). However, there is considerable benefit to education and expanded knowledge in this area, as it supports the professional growth and maturity of nurses (Fulbright Sumpter and Brooks Carthon, 2011). These efforts are applicable to the veteran patient population because nurses must recognize the difficulties associated with military service and should be aware of the issues that they might encounter when treating these patients, including Post-Traumatic Stress Disorder and other related concerns (Fulbright Sumpter and Brooks Carthon, 2011). In the evaluation of cardiovascular disease, it is of particular importance to address cultural competence in order to improve outcomes for veterans who are at a high risk for this condition (Fulbright Sumpter and Brooks Carthon, 2011).

The proposed action plan must also consider the ethical framework that surrounds cultural competence, as nurses must be trained effectively to provide culturally competent care that is also ethically responsible (Woods, 2010). In this context, veterans face a number of social challenges throughout their lives that should be considered during care and treatment, as these may interfere with quality of care and health-related outcomes (Woods, 2010). Nurses must recognize that their actions may be largely instrumental in providing support to veterans who struggle in a social setting (Woods, 2010). However, nurses might not recognize the extent of these concerns if they do not recognize the limitations associated with cultural competence (Woods, 2010). These concerns are particularly important because they reflect upon the ability of nurses to exercise knowledge of veteran struggles with socialization and integration into their surrounding communities (Woods, 2010).

Finally, the use of existing programmatic examples plays an important role in shaping cultural competence for nurses working with special and vulnerable patient populations, such as veterans. In this context, recognizing that veterans possess their own set of unique challenges and struggles may assist nurses in determining how to best provide care for this population. In using prior examples, action planning must consider past successes and failures in this area in order to determine which strategy might be useful or applicable to the chosen environment (McDougle et.al, 2010). These contributions are essential to the discovery of new methods and approaches to involve patients in their care through open lines of communication so that cultural competence is explored in depth (McDougle et.al, 2010). By observing existing examples of action plans and educational strategies, healthcare organizations such as the Veterans Administration Health System will recognize where weaknesses prevail and where additional insight is required in order to accomplish high quality patient care (McDougle et.al, 2010). This process also has a significant influence on recognizing cultural diversity and the type of culture that veterans are likely to represent (McDougle et.al, 2010). These efforts are useful in formulating an action plan that is detail-oriented, appropriate, ethically responsible, and measurable so that the population in need is provided with maximum support (McDougle et.al, 2010). These contributions are particularly significant because they establish the tone for growth and opportunity within healthcare practice that exercises cultural awareness, sensitivity, and expanded communication with those patients who are the most vulnerable and those that are in need of greater assistance and support, such as veterans who have experienced traumatic events during their time of service (McDougle et.al, 2010).

Findings and Recommendations

Based upon the needs of the veterans population with respect to culturally competent care, it is important to first identify where weaknesses prevail within a given workplace environment. It is believed that many of the issues that veterans face are based upon their highly individual and often traumatic experiences, many of which nurses are not able to grasp or understand. Therefore, nurses who exercise cultural sensitivity and also take the time to address these concerns by asking the appropriate questions are likely to learn from their patients. These experiences will support the ongoing development of new nursing-based perspectives that will lead to lasting and meaningful relationships between veterans and their caregivers. There are a number of issues to consider within the Veterans Administration that possess unique ramifications for this highly vulnerable population group. Therefore, it is strongly recommended that nurses and other healthcare providers working with veterans should obtain education that is tailored to veterans so that professionals will recognize the primary concerns that veterans face. It is expected that these alternatives will serve as the framework for an enhanced approach to patient care and treatment for veterans that is grounded in cultural awareness and sensitivity.

The unique and challenging nature of the veteran population is well known throughout society. However, the extent of these challenges is largely unclear and unexplored, due to lack of funding and resources, as well as limited interest in the recovery of this population group after their time of service. This period is often very traumatic and must be well understood from a nursing perspective so that culturally responsible and appropriate care is provided to patients at all times without delays or confusion. It is anticipated that these efforts will also enhance communication between veterans and their caregivers in a favorable manner. However, nurses without the appropriate training and education are likely to fall behind their colleagues and may delay or prohibit optimal quality of care for their patients. These concerns are particularly useful because they evaluate the areas where gaps in knowledge and education exist so that these gaps might be prevented in the future. Nurses with the desired level of training and education in cultural competence will also possess greater confidence in working with veterans and with the government-sponsored system as a whole.

It is recommended that the Veterans Administration Healthcare System continue to identify areas where training and education are weak in the area of cultural competence. This is best achieved through the evaluation of specific measures or markers for cultural competence and how nurses respond to these objectives. When nurses respond well to cultural competence and are aware of this practice, they are more likely to be effective and successful in treating their patients in the desired manner. Nurses must recognize that patients, especially veterans, have a unique set of concerns that are often difficult to manage, yet their willingness to collaborate with these patients to improve their health is of primary concern. Veterans should be treated with respect and concern for their welfare at all times, and nurses should represent this population with a high level of support and encouragement. In spending time with members of the veteran population, it is more important than ever to recognize the different concerns that prevail in their lives after they have left military service. These experiences are often traumatic and very stressful; therefore, nurses should recognize that their ability to be sensitive to these issues is essential for patient wellbeing.

In evaluating the work that has been performed in the Veterans Administration, the organization has come a long way in developing its internal controls and strategies to support patients facing a variety of risks, including cardiovascular concerns. However, there is always room for growth, and the organization possesses a great opportunity to explore new mandates to exercise culturally competent and responsible care for all veteran patients. It is of primary concern that this organization work collaboratively with its patients so that they possess all possible means of recovery and support for their health needs. Nurses must actively contribute to this process through a plan of action that considers the key obstacles that veterans face in managing their healthcare needs. Nurses must be provided with an organized and appropriate plan of action so that patients are treated with respect and encouragement throughout all phases of patient care. This also supports the development of strategic growth and recognition that veterans possess a unique set of needs that are very different from the rest of the population. These efforts are instrumental in facilitating the desired outcomes so that veterans obtain the care and treatment that they need to promote greater health and wellbeing.

Finally, it is recommended that in the course of action to develop a strategy for veterans, there must be an appropriate mechanism in place that will support positive outcomes and the ability to recognize where weaknesses prevail. When these weaknesses are identified, it is possible to better understand the elements that may distinguish veterans from other population groups. The greater the recognition of these needs from a nursing perspective, there is a greater opportunity to provide optimal quality of care and treatment. These contributions are important and meaningful in supporting patients who require specific types of care and treatment, particularly when they possess cardiovascular health risks, so that these risks are minimized and supported by the appropriate nursing-based objectives. The manner in which nurses obtain and secure knowledge in this area of study will have a significant impact on long-term care of the veteran population within the Veterans Administration system. This knowledge will support ongoing efforts to provide these patients with specific care and treatment that is appropriate for their needs over time.

Conclusion

The veterans population possesses a challenging set of requirements and circumstances that require nurses to demonstrate effective knowledge an, nd understanding of the conditions that surround their health status. The Veterans Administration has come a long way in recognizing its weaknesses in educating nurses and other healthcare providers to offer culturally competent patient care. However, this process is ongoing and requires continuous learning and a commitment by nurses to adhere to nationally recognized standards of care and treatment. In this capacity, nurses must be effective promoters of culturally competent care through their actions and their focus on the best interests of their veteran patients. Therefore, strategic action planning is required to ensure that these needs are met in the desired manner.

It is important for nurses working with veterans to adhere to culturally competent standards and to obtain knowledge as necessary to fill in their own knowledge gaps and to be recognized for their contributions to this type of practice setting. When these objectives are met, then it is possible for veterans to experience greater comfort and understanding of the care that is provided to them. In these settings, nurses are responsible for maximizing the level of care and treatment that is offered to ensure mutual respect and trust between nurse and patient. In addition, action planning is a key contributor to the development of new perspectives and opportunities to achieve greater growth and understanding of the key elements of care and treatment for veterans. Therefore, cultural competence is an essential component of standard nursing practice and should continue to be explored to obtain additional knowledge, understanding, and acceptance of different cultures to provide ethically appropriate and responsible care to all patients, particularly veterans with a history of unique and often traumatic experiences.

Reflection

In exploring the different dimensions of cultural competence, this group of exercises and assignments has been very valuable in recognizing the importance of this topic and why it matters within different population groups. Based upon observation and personal experience, it appears that there is insufficient knowledge regarding the type of care and treatment that veteran patients require throughout their lives. In these cases, nurses are not likely to fully comprehend the stress and demands of military service, as well as the traumatic events that are often experienced or witnessed. However, upon exposure to these elements, it is likely that there will be a greater understanding of these needs that will be effective contributors to nursing practice in this area.

Upon further reflection of cultural competence, it is also important to recognize that there are significant gaps in knowledge and a lack of understanding of the different elements that contribute to effective outcomes for veterans. In many instances, these individuals are poorly misunderstood and are not treated with the level of respect and admiration that they deserve. In cases where Post-Traumatic Stress Disorder or other health challenges have been identified, these concerns are often poorly managed out of fear or lack of knowledge by nurses and other healthcare providers. Therefore, it is more important than ever to demonstrate that nurses must take the time and effort that is necessary to reflect upon these circumstances and to determine how to best move forward to obtain knowledge and to be culturally competent in working with and treating veterans. This process requires many different components of knowledge and a greater understanding of the elements that are likely to be most effective in addressing the needs of veterans on a comprehensive basis.

Cultural competence in nursing practice has become increasingly relevant in the treatment of all patient populations, due in large part to the expanded level of diversity that exists throughout the United States. As a result, it is important to identify these concerns and to overcome gaps in knowledge through the expansion of knowledge on a personal level. It is necessary to look within and to recognize where stereotypes or lack of knowledge exist so that patient care is not discriminatory or inappropriate, particularly for veterans who require a unique level of care and treatment. When nurses perform self-reflection in this manner, they are likely to recognize areas where improvements might be made so that future efforts are consistent and focused on providing culturally responsible and competent patient care.

It is expected that through training and knowledge of the efforts required to expand cultural competence, nurses will also recognize where additional support or guidance is necessary to ensure that patient care is not compromised. Veterans possess a set of experiences that are not only unique, but that also warrant significant respect and admiration. Nurses must exercise sensitivity and appropriate behaviors when treating these patients so that their unique contributions in protecting society and their military service are sufficiently recognized. These efforts will be effective in enabling nurses to enhance their own knowledge of different cultures, to recognize the benefits of cultural diversity, and to address the concerns that many patients face as they seek treatment. The preservation of health must serve as a key priority in these cases and should also demonstrate the ability to exercise the appropriate behaviors and approaches to patient care. From a personal perspective, these priorities are critical in nursing practice because they convey the importance of different attitudes and beliefs regarding healthcare for all persons, regardless of their cultural backgrounds. These priorities must serve as a key focus for the continued development of veterans healthcare practice and treatment.

References

American Association of Colleges of Nursing (2008). Tool kit of resources for cultural competent education for baccalaureate nurses. Retrieved from http://www.aacn.nche.edu/education-resources/toolkit.pdf

Camphina-Bacote, J. (2011). Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. The Online Journal of Issues in Nursing, 16(2), retrieved from

http://gm6.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No2-May-2011/Delivering-Patient-Centered-Care-in-the-Midst-of-a-Cultural-Conflict.aspx

Camphinha-Bacote, J. (2002). The process of cultural competence in the delivery of Healthcare services: a model of care. Journal of Transcultural Nursing, 13, 181-184.

Crenshaw, K., Shewchuk, R.M., Qu, H., Staton, L.J., Bigby, J.A., Houston, T.K., Allison, J., and Estrada, C.A. (2011). What should we include in a cultural competence curriculum? An emerging formative evaluation process to foster curriculum development. Academic  Medicine, 86(3), 333-341.

Douglas, M.K., Pierce, J.U., Rosenkoetter, M., Pacquiao, D., Callister, L.C., Hattar-Pollara, M., Lauderdale, J., Milstead, J., Nardi, D., and Purnell, L. (2011). Standards of practice for culturally competent nursing care: 2011 update. Journal of Transcultural Nursing, 22(4), 317-333.

Echeverri, M., Brookover, C., and Kennedy, K. (2010). Nine constructs of cultural competence for curriculum development. American Journal of Pharmaceutical Education, 74(10), 181.

Feng, R.C., Chen, M.J., Chen, M.C., and Pai, Y.C. (2010). Critical thinking competence and disposition of clinical nurses in a medical center. Journal of Nursing Research, 18(2), 77-87.

Fulbright Sumpter, D., and Brooks Carthon, J.M. (2011). Lost in translation: student perceptions of cultural competence in undergraduate and graduate nursing curricula. Journal of  Professional Nursing, 27(1), 43-49.

Goldberg, A.P. Department of Veterans Affairs: risk factors for cardiovascular diseases. Retrieved from http://www.aging.senate.gov/award/vet2.pdf

Hobbs, K. (2008). Reflections on the culture of veterans. Journal of the American Association of  Occupational Health Nurses, 56(8), 337-341.

Jeffreys, M.R. (2010). The cultural competence education resource toolkit. New York: Springer Publishing Company.

Kirmayer, L.J. (2012). Rethinking cultural competence. Transcultural Psychiatry, 49(2), 149-164.

 Loftin, C., Hartin, V., Branson, M., and Reyes, H. (2013). Measures of cultural competence in nurses: an integrative review. The Scientific World Journal, retrieved from http://www.hindawi.com/journals/tswj/2013/289101/

McDougle, L., Ukockis, G., and Adamshick, L. (2010). Evaluation of a new cultural competency training program: CARE Columbus. Journal of the American Medical Association, 102(9), 756-760.

Medscape Nurses (2005). Cultural competence: an integral part of holistic nursing practice. Retrieved from http://www.medscape.com/viewarticle/513607

Meyer, E. (2012). Developing military cultural competency in health care providers. Academic Medicine, 87(1), 3.

Office of Minority Health (2013). The national CLAS standards. Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=15

Purnell, L., Davidhizar, R.E., Giger, J.N., Strickland, O.L., Fishman, D., and Allison, D.M.  2011). A guide to developing a culturally competent organization. Journal of  Transcultural Nursing, 22(1), 7-14.

Seaman, A.M. (2013). PTSD tied to raised heart disease risk. Retrieved from http://www.reuters.com/article/2013/06/28/us-ptsd-tied-to-raised-heart-disease-idUSBRE95R12Z20130628

Taylor, R.A., and Alfred, M.V. (2010). Nurses’ perceptions of the organizational supports needed for the delivery of culturally competent care. Western Journal of Nursing Research, 32(5), 591-609.

Transcultural Nursing Society (2010). Standards of practice for culturally competent nursing care. Retrieved from http://www.tcns.org/files/Standards_of_Practice_for_Culturally_Compt_Nsg_Care-Revised_.pdf

Vimalananda, V.G., Miller, D.R., Christiansen, C.L., Wang, W., Tremblay, P., and Fincke, B.G. (2013). Cardiovascular disease risk factors among women veterans at VA medical facilities. Journal of General Internal Medicine, 28(Suppl 2), S517-S523.

Woods, M. (2010). Cultural safety and the socioethical nurse. Nursing Ethics, 17(6), 715-725.

Wright, B.D., Geissler, E.M., and Cowell, C.E. (2010). Achieving linguistic proficiency and cross-cultural competence in the health professions: an intensive content model. Global Business Languages, 2(8), retrieved from http://docs.lib.purdue.edu/gbl/vol2/iss1/8/