The Road to Cultural Competency

Are We There Yet?Dr. Victoria Haynes

Associate Professor of Nursing

MidAmerica Nazarene University

vmhaynes@mnu.edu

What is Cultural Competency?

“Cultural competency is a broad concept used to describe a variety of interventions that aim to improve the accessibility and effectiveness of health care services for people from racial/ethnic minorities”. (Troung et al, 2014)

Definitions

There is no universally agreed-upon definition of what is cultural competency

Definitions in Nursing

• 1. “Cultural competency is defined as ‘the process in which the healthcare provider continuously strives to achieve the ability to work effectively within the cultural context of a client, individual, family or community” (Kardong-Edgren, S. et al)

• 2. “Cultural competence is defined as a set of skills and behaviors that enable a nurse to work effectively within the cultural context of a client/patient” (Troung et al, 2014)

• 3. Cultural competence is “the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural and linguistic needs” (Pearson et al , 2007)

Other Terms Used

Cultural Awareness• Cultural awareness is the recognition

of one’s own attitudes and assumptions toward similarities and differences in others, acknowledging racism, bias, and stereotyping (Mareno & Hart 2014).

Cultural Sensitivity• "the knowledge and interpersonal

skills that allow providers to understand, appreciate, and work with individuals from cultures other than their own. It involves an awareness and acceptance of cultural differences, self awareness, knowledge of a patient's culture, and adaptation of skills“ (ACOG,2011)

Can we ever become culturally competent?

Acquiring “cultural competence” is deceptively viewed as achievable: “One is competent in interacting with patients from diverse backgrounds much in the same way as one is competent in performing a physical exam or reading an EKG” (Beach et al., 2005, p. 356; Betancourt, Green, Carrillo, &Ananeh-Firempong, 2003).

Do you agree?

Cultural Diversity Activity

.

CULTURAL SCAVENGER HUNTChat with the people in the room.  Find people who have had the following experience.  Have them sign their name or initials in the appropriate blank.  Try to talk to everyone in the room. __________  1.   Knows a folk dance.__________  2.   Has been to an American Indian pow wow.__________  3.   Has cooked or eaten ethnic food in the last week.__________  4.   Can say, “hello” (or similar greeting) in four different languages.__________  5.   Has sat under a palm tree.__________  6.   Has attended a religious service of a religion other than their own.__________  7.   Has attended a Kwanzaa celebration, or knows what Kwanzaa is.__________  8.   Has relatives or ancestors who came through Ellis Island.__________  9.   Plays a musical instrument.__________  10. Has had to utilize crutches, a wheelchair, a cane, or has worn a cast__________  11. Can name four different kinds of breads from other cultures.__________  12. Has seen a Spike Lee movie.__________  13. Is bilingual, or has relatives who speak a language other than English.__________  14. Knows some American sign language.__________  15. Has studied a foreign language.

Nursing Workforce Diversity Facts

• Minorities constitute one third of the US population and are expected to increase to 54% by 2050 (Passel & Cohn, 2008; US Census Bureau, 2010).

• Despite these population trends, more than 80% of licensed registered nurses in the United States are non-Hispanic whites, highlighting the underrepresentation of Hispanic, black, American Indian, and Alaska native nurses (US Department of Health and Human Services, 2010).

• The Sullivan Commission (2004) found that only about 10% of nurse faculty in the United States represent racial and ethnic minorities.

Health Disparities Defined

Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” (Healthy People 2020, 2015)

Health Disparities

• Access to Care

• Blacks had worse access to care than Whites for about half of access measures.

• Hispanics had worse access to care than Whites for two-thirds of access measures.

• Asians and American Indians and Alaska Natives had worse access to care than Whites for about one-third of access measures.

AHRQ 2014 National Health Care Quality and Disparities Report.

• Quality Measures

• Blacks received worse care than Whites for about one-third of quality measures.

• Hispanics, American Indians and Alaska Natives, and Asians received worse care than Whites for some quality measures and better care for some measures.

Health Disparities

Of all the forms of inequality, injustice in health care is the most shocking and inhumane. Martin Luther King, Jr.

• A US survey of Hispanics found that 25% of Puerto Ricans had 3 or more CVD risk factors

• Advanced stage breast cancer diagnosis ha increased in black women since 2000-2007 but decreased in white women

• The rate of AIDS diagnosis in men ages 13-24 rose by 116% in blacks compared to 50% in whites. It also rose by 35% in Hispanics

• (Jacobson, 2014)

Strategies to Improve Health Disparities

• Increasing diversity in the health care work force

• Recruitment of diverse providers

• Cultural competency training

• Healthy People 2020

• Aims to address health disparities and achieve health equity

• Affordable Care Act

• Improving health care access

• Provisions to improve workforce diversity, eliminate disparities, and cultural competency education

Strategies to Improve Cultural Competency

• What does you current employer do to improve culturally competency?

• Is it mandatory?

• How often?

• Have you noticed any differences ?

What can we do to improve ?

• Provider education-CEUs, seminars, workshops

• Nursing education curriculum

• Cultural self assessment

• Mission trips

• Mandatory annual training

• Cultural events

Trends

Is it getting better?

Is it getting worse?

Current Events/Issues• Cultural diversity and the

police

• Immigration reform/control

• Diverse President

Personal Experiences

• Have you ever worked or cared for a culturally diverse patient or coworker?

• Have you ever encountered any ethical dilemmas related to someone's cultural preferences?

• Have you been on a mission trip to a culturally diverse area?

• Were you raised around culturally diverse people?

Things to Remember

• No single set of guidelines for culturally competent care can apply to all cultures.

• Cultural competence is a lifelong learning process

• Self awareness is the first step. Understanding one’s own cultural values and beliefs as well as the culture of others is essential

• A diverse workforce is needed to provide culturally competent care and help decrease health disparities

References

AHRQ (2014). National Health Care Quality and Disparities Report. Retrieved from: http://www.ahrq.gov/research/findings/nhqrdr/nhqdr14/2014nhqdr.pdf

American College of Obstetricians and Gynecologists (2011). Cultural sensitivity and awareness in the delivery of health care. Committee Opinion No. 493. Obstet Gynecol 117:1258.

Beach MC, Price EG, Gary TL, Robinson K, Gozu A, Palacio A, Smarth C, Jenckes M, Feuerstein C, Bass EB, Powe NR, & Cooper LA: (2005) Cultural competence: A systematic review of health care provider educational interventions. Med Care, 43, 356–373.

Betancourt, J. R. (2003). Cross-cultural medical education: Conceptual approaches and frameworks for evaluation. Academic Medicine, 78(6), 560–569.

Douglas, M., Rosenkoetter, M.,Pacquiao, D., Callister, L., Hattar-Pollara, M., Lauderdale, J., Milstead, J.,Nardi D., & Purnell L. (2014) Guidelines for Implementing Culturally Competent Nursing Care. Journal of Transcultural Nursing 25 (2) 109-121.

Jacobson, J.(2013). From disparity to equity. American Journal of Nursing. 113 (4) pp 21-23.

Kardong-Edgren, S., & Campinha-Bacote, J. (2008) Cultural competency of graduating US Bachelor of Science nursing students. Contemporary Nurse: A Journal for the Australian Nursing Profession. (28), 37-44.

ReferencesMareno, N., & Hart, P.(2014) Cultural competency among nurses with undergraduate and

graduate degrees: implication for nursing education. Nursing Education Perspectives. 35(2), 83-88.

Passel, J. S., & Cohn, D. (2008). U.S. population projections: 2005-2050. Washington, DC: Pew Research Center. Retrieved from http://www.pewhispanic.org/files/reports/85.pdf\

Pearson A, Srivastava R, Craig D, Tucker D, Grinspun D, Bajnok I, Griffin P, Long L, Porritt K, & Han T, Gi AA. (2007)/ Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare. International Journal of Evidence Based Healthcare, 5, 54–91.

Sullivan Commission. (2004). Missing persons: Minorities in the health professions. A report of the Sullivan commission on diversity in the healthcare workforce. Retrieved from www.amsa.org/AMSA/Libraries/Committee_Docs/Sullivan_Commission.sflb.ashx

Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Services Research. 14 (1) 1-31.

US Census Bureau. (2010). 2010 census data. Retrieved from www.census.gov/2010census/data/

Questions ???.