Assigment .Apa seven . All instructions attached.

17

Capstone Project Change Proposal

Andy Curbelo

Grand Canyon University

Applied Evidence-Based Project and Practicum

Professor: Leslie Greenberg

March 19, 2024

Background of Clinical Problem

Medical centers around the world now know how important it is to provide care that is sensitive to different cultures and languages as a smart way to improve patient care and the quality of life for patients. Even though that is known, there are still a lot of things that health care institutions, like the site place of practice, have to deal with when it comes to skill growth. Different types of patients create a wide range of healthcare problems that have a big effect on the system that delivers care. Because of globalization and movement, people from different cultures now have to deal with each other. As a result, they speak different languages, have different views, and have different values. In the healthcare field, different levels of results can be caused by the quality of care offered without taking the above factors into account.

People who are bad at telling the difference between language and culture have small problems, but those problems change people's culture in big ways, which can have bad results. Patients from international and ethnographic backgrounds may have trouble communicating with healthcare workers, misunderstand what they are saying, and not believe them. This can make it hard for the patient to decide if the care they are receiving is good. In addition to these differences, the standard of care will get better, but mistakes may still happen, and patients will have bad health results. Because we know that all of these problems need to be fixed right away, our final project is to plan and carry out a thorough training program for nurse staff on culture and linguistic competence. We tried to close the gap in health disparities and improve the quality of health care by focusing on the nurses' ability to deal with cultural differences and their knowledge of and understanding of the things that make it hard for a diverse group of patients to get health care.

In order to reach this goal, we are thinking about how to help nurses see and respect how each patient is different, how to change the way they talk to and treat patients based on cultural differences, and how to show compassion by keeping patients' needs and wants in mind. By building a culture of competence in the healthcare field, we hope to improve patient happiness, lower healthcare problems, and eventually reach health equality for people from different ethnic backgrounds. It is important to fix the clinical problem of nurses not being culturally and linguistically competent in order to create a healthcare system that meets the needs of a diverse patient population. This is not only a necessary step to take, but it is also an important part of fairness, inclusion, and providing high-quality healthcare. Along with the other work that has been going on, our final project is meant to add to the goals of cultural literacy and better care delivery in different hospital situations.

Clinical Problem Statement

The clinical problem at our practicum site revolves around the inadequate integration of cultural and language competencies into nursing practice, leading to disparities in healthcare outcomes and diminished patient satisfaction among linguistically and culturally diverse patient populations.

Purpose of the Change Proposal

The main goal of this associate in nursing is to have a big impact on nursing practice by doing trials on how to diagnose specific clinical problems and by creating a full training program for culture and language competence. The plan aims to give nurses the skills, information, and insights they need to speak and care for people from a wide range of cultures in a way that is culturally competent. Its goal is to improve the quality of care. Getting good results for patients, making sure they are happy, and making sure everyone has access to the healthcare system are all important parts of the main project. Targeted teaching and training are thought to be possible with this method. This is how the plan aims to create a more welcoming and patient-centered care setting that values and respects the different language and cultural backgrounds of people who need medical care.

PICOT Question

Population: Nursing staff

Intervention: Cultural and language competency training program

Comparison: Standard nursing practice without cultural and language competency training

Outcome: Improved patient outcomes, increased patient satisfaction, and reduced healthcare disparities

Timeframe: Within one year of program implementation.

In nursing staff, does the implementation of a cultural and language competency training program, compared to standard nursing practice without such training, lead to improved patient outcomes, increased patient satisfaction, and reduced healthcare disparities within one year of program implementation?

Literature Search Strategy Employed

The PubMed, CINAHL, and PsycINFO databases were used to look for books in a planned way through computer databases. It was "cultural competence," "language competency," "nursing practice," and "patient outcomes" that were used as buzzwords. Only papers written in the last five years were shown when these terms were used. Studies include looking at how cultural and linguistic competence affects nurse care and how well patients do, as well as pieces that talk about how to be more culturally competent in healthcare settings.

Synthesis of Literature Review

In order to provide the best care possible to a range of patient groups, cultural competence is a crucial attribute in the healthcare industry, and especially for nursing personnel. The newest review of the literature talks about training programs for nurses that use a variety of methods and approaches. These include educational programs and studies that use qualitative methods to find out what nurses themselves think about cultural competence. A program that teaches nurses everything they need to know about their job is one way to help them become more competent. In 2022, Červeny et al. did a brief review of papers that were released between 2011 and the beginning of 2021 and were about improving the cultural literacy of nurses who work in clinical practice. The training was mostly about a few basic tactics, such as programs, led exposure, and events that boost confidence. These results make it clear that nurses need to go through organized training in order to be able to help people from other countries.

Fadaeinia et al. (2022) looked at the online cultural care training program and tested how culturally competent and effective the graduate nursing students were. Students who participated in the tech-driven educational program systems did much better on tests of cultural skills. This suggests that technology-enhanced ICT platforms could be used to help students learn about other cultures. This study showed that creative educational programs on cultural awareness are useful. It also showed that these programs are useful for connecting and reaching nursing students online.

Studies on hair quality have also looked at how nurses feel about cultural competency training, which shows how this program affects clinical practice. Kaihlanen et al. (2019) used nurses in seminal commission studies to learn more about cultural competence. It was found that nurses valued cultural competence training because it helped them understand difference in their work and have a better understanding of their varied patient group. Despite this, some of the students were not sure where they would use these cultural competence skills in their work. The focus of this study is on the idea that cultural competence trainings not only help people learn facts, but also help them learn how to use those facts in real life. In addition, the newest academic study shows that teaching cultural literacy is linked to better care for people provided by professional nurses. With Lin and Hsu's study design method from 2020, the benefits of cultural competence classes are not controlled randomly while nurses are being tested. It turned out that the training program made a big difference in how well nurses understood other cultures and how well they could connect with others. This made them do better than people who didn't do the training. It shows that training classes for clinical nurses to improve their cultural competence are a good idea based on science 1.

Cultural literacy is also important for nurses who work in urgent care clinical offices, not just for nursing students. In 2023, Osmancevic and others did a cross-sectional study to compare the levels of cultural competence among nursing students and qualified nurses working in intensive care. Data showed that students didn't know how to deal with different cultures. Because of this gap in training, nurses who work now might not know how to do this in the future. If you teach cultural literacy as part of clinical education or make it a requirement for ongoing nursing education classes and courses, this study says that nurses will be better prepared to work with a wide range of patients. According to the part of the literature study that looks at how the different pieces fit together, nursing should have programs to teach and practice cultural literacy. These classes are an important part of nurses' training because they help them understand, appreciate, and use cultural variety better, which in turn improves the care they give to patients and their own feelings about nursing. The problems with this method, like how to use it in real life and the fact that nurses have different levels of cultural literacy, still need more research. In the last stage, the nursing staff and other healthcare workers need to be on hand to adopt new ways of being culturally competent and to make sure that healthcare practices and service are fair for everyone.

Applicable Change or Nursing Theory Utilized

The Transtheoretical Model of Behavior Change is used to plan and carry out training programs for nurse practice culture and language competence. The TTM method, created by Prochaska and DiClemente in the late 1970s, is a structured way to find changes in health behaviors. This makes it useful for our program to help medical staff become more culturally and linguistically competent. The main theme shows how changing stance is the basis for growth in behavior modification. First, pre-thought, then contemplation, then planning, then action, and finally upkeep. We can be sure that the healing model we use in this training program works for every nurse and takes into account the different stages at which they are ready to make changes. In the pre-contemplation phase, nurses who are culturally competent might not know how important it is to be sensitive to different cultures in nursing. At this point, learning materials and engaging events that aim to boost knowledge and enthusiasm can be used.

Having performing self-efficacy, or being sure that you can do certain things, is also important for changing behavior. Language hurdles, lack of time, or resistance to change can make it hard for nursing staff to use their cultural and verbal skills. Our training gives nurses the skills and information to deal with these problems and easily use cultural competence principles by getting rid of obstacles and boosting self-efficacy through skill-building, role-playing, and positive feedback. Nevertheless, they devise strategies to alter behavior at different stages. Some of these are training and improving decision-making and self-determination. There will also be a focus on social support and thanks. These strategies may be used in our program for training people in language and culture through long classes, discussions based on real-life situations, hands-on training, and group mentoring. Behavior change can be kept up over time with the help of group tracking, reflecting practice sessions, and performance-based evaluations. The cycle TTM method shows that people go through clear stages more than once before they change how they act, which is the best way to get inspired. So, our execution strategy will help nurses get through the shift phase by keeping an eye on their work on a daily basis, giving those chances to keep learning new skills, and using feedback loops to find problems.

Proposed Implementation Plan with Outcome Measures

The cultural and language skills program had to be put into place in a number of steps in order to work well with nursing practice. Well-thought-out training courses will be made based on language, nurse education, science study, and culture knowledge. There should be cultural understanding, non-native conversation, and the outlook of major cultural ideas and habits in these modules. The goal is to teach nurses the language and cultural skills they need to talk to people from other backgrounds in a good way.

During delivery, there will also be more involvement from stakeholders. The training course will be made and evaluated by patients from different backgrounds, managers, nurse staff, and culture liaisons. Their cultural feedback will help make sure the program is current, culturally suitable, and meets the needs of both patients and staff. If the training program needs to be changed, follow-up tests with a few nurses will show. This step will find any problems and set a date for big changes based on what the participants say. If it goes well, the nurse team will make regular plans for the training trial run. It will be possible for students to learn in real life, online, and through engaging group projects and live meetings. Throughout implementation, the training's effect on nurse practice and patient care will be checked on a regular basis. An end measure would be an increase in the cultural and language sensitivity of nurse staff, self-reported confidence in connecting to people from different cultures, patient happiness across cultures, and fewer differences in access to healthcare between groups. Cultural and language skill training will be used in nursing by putting key success factors into action and keeping an eye on them. So, outcomes, patient happiness, and quality of life should all get better, and healthcare disparities between patients of different languages and cultures should go down.

Plan for Evaluating the Proposed Nursing Intervention

A lot of different methods will be used to test the planned nursing solution and see how well it works and how it changes nursing practice and patient care. Nurse staff will be tested before and after training to see how much they know and understand about ethnic and language variety. These standard ratings will show how much the training program has improved. By comparing scores from before and after the training, we can tell if the program helped the cultural and language skills of the nurse staff.Nurses will be asked to rate how confident they are in their ability to interact with patients from a range of linguistic and cultural backgrounds. These polls will be done on a daily basis to find out how confident people are and to see how the training program has changed nursing practice in the long run.

Patient feedback surveys will be used to track how satisfied patients from a range of culture and language backgrounds are. These surveys will be used to find out how satisfied patients are with their care, how nurses deal with patients, and how culturally sensitive the nurses are. By looking at trends in patient feedback scores, you can figure out how the program changed the patients' experience and happiness. Healthcare result measures will also be used to see how well the program does at getting rid of healthcare disparities between patient groups. Before and after the training, healthcare results like treatment adherence, return rates, and health outcomes will be compared between patient groups that are culturally and ethnically different. Any drop in healthcare inequality would show that the program improved health equality and patient results. Ongoing reviews are needed to make sure that training programs are sustainable and effective. Program changes will be based on ongoing data collection, review of result measures, and feedback from stakeholders. By keeping a feedback loop open and keeping an eye on key markers, we can find places to improve and make sure the training program stays relevant to the needs of both nurses and patients.

Identification of Potential Barriers to Plan Implementation and Discussion of Overcoming Them

The nursing staff culture and language skills training program may face many challenges. Old-school nurses may oppose change, which is a major issue. Because they're fearful of the unknown, don't think the program will work, or don't want to modify their routines, people may resist change. Clarify the training program's aim to avoid this issue. Including nursing staff in the development process, prioritizing cultural and linguistic competency training, and openly discussing challenges helps lessen opposition and improve buy-in. Access to money, time, and people may also make adoption difficult. A well-planned and executed training program requires adequate money for instruments, personnel for training programs, and time for nursing staff. Assist from institution executives and campaigning for program financing can assist overcome this challenge. Partnering with language translators or cultural liaisons may potentially boost program effectiveness by using existing resources.

Culture variations between patients and nurses, particularly cultural knowledge and comprehension, may also hinder implementation. Cultural competency training must be tailored to nursing staff and patients' backgrounds and experiences to be successful. Make sure training tools are culturally sensitive, program material covers multiple perspectives, and the healthcare environment fosters respect and inclusiveness to overcome this challenge. Scheduling and staff access concerns might make it difficult to prepare class instruction and ensure all nurses can attend. Being flexible with training dates, providing in-person and online sessions, and rewarding attendance might help solve this challenge. Participating in the planning process and asking nurses for their preferred schedule will assist ensure that all staff can attend training programs.

References

Červený, M., Kratochvílová, I., Hellerová, V., & Tóthová, V. (2022). Methods of increasing cultural competence in nurses working in clinical practice: A scoping review of literature 2011–2021. Frontiers in Psychology, 13(1). https://doi.org/10.3389/fpsyg.2022.936181

Fadaeinia, M. M., Miri, S., Azizzadeh Forouzi, M., Roy, C., & Farokhzadian, J. (2022). Improving Cultural Competence and Self-Efficacy Among Postgraduate Nursing Students: Results of an Online Cultural Care Training Program. Journal of Transcultural Nursing, 104365962211019. https://doi.org/10.1177/10436596221101925

Kaihlanen, A.-M., Hietapakka, L., & Heponiemi, T. (2019). Increasing Cultural awareness: Qualitative Study of Nurses’ Perceptions about Cultural Competence Training. BMC Nursing, 18(1), 1–9. https://doi.org/10.1186/s12912-019-0363-x

Lin, M.-H., & Hsu, H.-C. (2020). Effects of a cultural competence education programme on clinical nurses: A randomised controlled trial. Nurse Education Today, 88, 104385. https://doi.org/10.1016/j.nedt.2020.104385

Osmancevic, S., Großschädl, F., & Lohrmann, C. (2023). Cultural competence among nursing students and nurses working in acute care settings: a cross-sectional study. BMC Health Services Research, 23(1). https://doi.org/10.1186/s12913-023-09103-5

Zajac, S., Woods, A., Tannenbaum, S., Salas, E., & Holladay, C. L. (2021). Overcoming Challenges to Teamwork in Healthcare: a Team Effectiveness Framework and Evidence-Based Guidance. Frontiers in Communication, 6(1). Frontiersin. https://doi.org/10.3389/fcomm.2021.606445

Appendix

NRS-465: Capstone Change Project Evaluation Plan

Part I: Evaluation Plan

Project Objective (Goal)	Measurable Project Outcome	What data will be collected to measure this outcome?	What tool will be used to collect the data?	Who will be responsible for collecting data?
1.Increase cultural and language competency among nursing staff	Nursing staff demonstrate a 25% improvement in awareness of cultural and linguistic diversity post-training compared to pre-training	Pre- and post-training assessments measuring awareness of cultural and linguistic diversity	Assessment questionnaire/survey	Project coordinator/team leader
2. Increase nursing staff confidence and capacity to interact with culturally and linguistically diverse patients	Nursing staff report a 20% improvement in confidence and capacity to interact with diverse patients six months post-training	Survey administered to nursing staff six months after training completion. Sample Questions On a scale of 1 to 10, how confident do you feel in your ability to communicate effectively with patients from culturally and linguistically diverse backgrounds? 1: Not confident at all 10: Extremely confident How comfortable do you feel when interacting with patients who speak a language other than English? Very uncomfortable Somewhat uncomfortable Neutral Somewhat comfortable Very comfortable Have you noticed any changes in your communication skills since participating in the cultural and language competency training program? Yes No If yes, please describe the specific areas where you have noticed improvement in your communication skills. How frequently do you encounter challenges related to cultural or language differences when providing patient care? Very frequently Frequently Occasionally Rarely Never How well do you feel equipped to address cultural or language barriers that arise during patient interactions? Not equipped at all Somewhat equipped Moderately equipped Well equipped Very well equipped Do you feel that the cultural and language competency training program adequately prepared you to navigate diverse patient interactions? Yes, completely Yes, to some extent No, not really No, not at all Overall, how satisfied are you with your ability to provide care to patients from diverse backgrounds after completing the cultural and language competency training program? Very dissatisfied Dissatisfied Neutral Satisfied Very satisfied	Self-report questionnaire/survey	Project coordinator/team leader
3. Improve patient satisfaction levels from culturally and linguistically diverse groups	Patient satisfaction scores increase by 15% within one year of implementing the training program	Patient feedback surveys conducted periodically after program implementation How satisfied are you with the communication between yourself and the nursing staff during your recent healthcare interactions? Very dissatisfied Dissatisfied Neutral Satisfied Very satisfied Did you feel that the nursing staff demonstrated sensitivity and respect for your cultural background and language preferences during your recent healthcare experiences? Not at all Somewhat Moderately Very much Absolutely How likely are you to recommend this healthcare facility to a friend or family member, based on your recent experiences with the nursing staff's cultural and language competency? Very unlikely Unlikely Neutral Likely Very likely	Patient satisfaction survey	Patient liaison/feedback coordinator
4. Reduce reported differences in treatment outcomes among patients from varied cultural and linguistic backgrounds	Reported disparities in treatment outcomes decrease by 10% within one year of program implementation	Comparison of healthcare outcome metrics before and one year after program implementation	Healthcare outcome metrics analysis	Project evaluator/data analyst

Part II: Communication Plan

How will the data collected be communicated to the team?

Communication of data collected to the team will be done through regular progress reports and meetings. Moreover, these reports will contain an elaborate analysis on the collected data by giving prominence to patterns, achievements, hardships as well as areas for growth. Furthermore, a dashboard or a tool for visualizing data would be deployed in order to display key metrics in graphical form so that they are easily comprehended by members of a group. The tool will ensure transparent and decisions can be taken based on the information shared throughout the project’s implementation and evaluation (Sharma, 2020).