In approaching the discussion of cultural competence in nursing education, I would like to begin by introducing a spiritual construct that I call "cultural desire" (Campinha-Bacote, in press). Cultural desire is defined as nurses' motivation to "want to" engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skulful, and seeking cultural encounters. It stands in contrast to the feeling of "having to" participate in this process. This desire should be genuine and authentic and must come from nurses' aspiration, not desperation. As eloquently stated by Napoleon Hill, "The starting point of all achievement is desire" (Cyber Nation International, Inc., 1999). If we are to make great strides and achievements in the area of cultural competence in nursing education, we must begin by addressing our own level of cultural desire.
Cultural desire includes a passion for and commitment to the process of cultural competence and will inspire us to examine uncomfortable subjects, such as racism. Barbee (2002) rightly stated that when the subject is racism, there is dialectical tension. However, we can no longer avoid the reality of racism in health care. The American Nurses Association's Position Statement on Discrimination and Racism in Health Care (2002) states that, "Discrimination and racism continue to be a part of the fabric and tradition of American society and have adversely affected minority populations, the health care system in general, and the profession of nursing" (Summary section). In addition, a recent congressionally mandated report from the Institute of Medicine (IOM) reveals that a large body of research supports the findings that racial and ethnic minorities in the United States receive lower quality health care than the White population, even when insurance status, income, age, and severity of condition are comparable (Smedley, Stith, & Nelson, 2002). Examples of health care disparities found in the IOM report (Smedley et al., 2002) include that minorities are:
* Less likely to be given appropriate cardiac medications or undergo bypass surgery.
* Less likely to receive kidney dialysis or transplants.
* Less likely to receive appropriate cancer diagnostic tests and treatments.
* Less likely to receive the most sophisticated treatments for HIV infections.
* More likely to receive some less desirable procedures, such as lower limb amputations for diabetes and other conditions.
Although many sources may contribute to the disparities mentioned above, evidence currently suggests that racism on the part of health care professionals also may contribute to differences in care. In this issue of the Journal of Nursing Education, Hassouneh-Phillips and Beckett's article, "An Education in Racism," directly confronts this issue by examining the experiences of 9 women of color in nursing doctoral programs. Cultural desire also will compel us to continue to ask the question, "What constitutes cultural content in nursing education and how do we measure it? Byrne, Weddle, Davis, and McGinnis' article, The Byrne Guide for Inclusionary Cultural Content," provides nurse educators with guidelines to evaluate and create instructional materials, while Rew, Cookston, Khosropour, and Martinez's article, "Measuring Cultural Awareness in Nursing Students," provides a reliable way to measure outcomes of cultural awareness.
It is desire that creates our future (Allender, 1999). If we want to create a future of ensuring cultural competence in nursing education, it must be driven by cultural desire. It is the fuel necessary to draw nurse educators into their personal journeys toward cultural competence. However, we must remember that Napoleon Hill also stated, "Weak desires bring weak results" (Cyber Nation International, Inc., 1999). It is my hope that these thought-provoking articles will serve to stimulate and strengthen our level of cultural desire.
- Allender, B. (1999). The healing path. Colorado Springs: WaterBrook Press.
- American Nurses Association. (2002). Position statement on discrimination and racism in health care. Retrieved December 28, 2002, from http://www.nursingworld.org/readroom/ position/ethics/etdisrac.htm
- Barbee, E. (2002). Racism and mental health. Journal of the American Psychiatric Nurses Association, 8, 194-199.
- Campinha-Bacote, J. (in press). Cultural desire: The development of a spiritual construct of cultural competence. Journal of Christian Nursing.
- Cyber Nation International, Inc. (1999). Quotes to inspire you: Napoleon Hill. Retrieved March 26, 2003, from http://www.cyber-nation.com/victory/quotations/authors/ quotes_hill_napoleon.html
- Smedley, B., Stith, A., & Nelson, A. (2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academic Press.