Parent perspectives from a neonatal intensive care unit: a missing piece of the culturally congruent care puzzle.

The majority of existing theoretical models and tools of culturally competent and congruent care have been developed from the health care provider perspective. Recently, the Culturally Congruent Care Puzzle proposed a model in the form of a three-dimensional puzzle with a provider level and a client level that interact to create the outcome level, which is culturally congruent care. However, the constructs that comprise the client, or patient, level, have not yet been clearly articulated. This study explored parent (client/patient) perceptions of culturally congruent care within a tertiary neonatal intensive care unit based on interviews with culturally diverse families with hospitalized infants (n = 21). The findings identified four primary constructs in the client/patient level: (a) a provider-client relationship of caring and trust, (b) respectful and appropriate communication, (c) culturally responsive and accessible social and spiritual supports, and (d) a welcoming and flexible organizational environment. These four interconnecting pieces are infused with the sociopolitical history and dynamics of culture, ethnicity, immigration, and colonization that clients/patients bring to their experience of health and health care. These elements of the client/patient level also interact with the provider level in various ways.