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Critique1.pptxCultural competence: evidence based project
Marissa
Why Cultural competence?
It is a standard of care for nursing staff and ancillary staff.
Builds patient rapport.
Allows for staff to be more competent and confident in their care.
Staff within Steward Health Care reported being uncomfortable with addressing culture needs.
50% of nursing staff reported interest in specialized culture training.
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Evidence Based practice is strongly linked to positive patient outcomes, therefore it is an essential skill to practicing health care professionals (Milner, 2018). In regard to culturally competent and spiritually competent nursing care, 40% of nurses felt uncomfortable in addressing patient’s needs. Consequently 70% believed that culturally and spiritually based nursing care influences better patient outcomes. These survey categories were utilized to gather data on if there was a significant need for change. In addition, 50% of nurses that were surveyed said that they would engage in specialized training regarding cultural and spiritual competence. This evaluates readiness for change and growth amongst the nursing staff.
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Facilitating change
Assessing readiness for change.
Identifying protentional barriers.
Utilizing positive changes to encourage staff.
Setting examples through management.
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Clinical inquiry will be integrated through utilization of implementation science which is creating generalized knowledge through study designs that are powered to show a difference in the intervention being tested (Granger, 2018). When implementing changes within a facility there are always protentional barriers. In implementing specialized cultural and spiritual training for nurses’ barriers could include resistance to change, lack of comfort, lack of participation. In utilization of clinical inquiries and evidence of positive change within patient outcomes barriers will be overcome.
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Problem Description
The United States is continuing to grow more diverse through race and ethnicity.
Each culture has specific needs regarding everyday life and health care needs.
Needs can include dietary, philosophies, and traditions.
As health acre providers these needs need to be addressed and understood in order to give the best possible holistic care.
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It is projected that in the United States will continue to be more racially and ethnically diverse within the upcoming years. With that being said, it is estimated that the Hispanic population will be that if 29% by 2060. While in 2014 the Asian population accounted for 5.4% of the population but again is suspected to be growing by 2060. In addition, this will alter health care in many ways (Abrishami, 2018).
Without knowledge of these specific beliefs and many more, it is difficult for the nurse to provide proper care to their patients on a holistic level. Health care professionals, specifically nurses, are expected to demonstrate knowledge, skills, and abilities to understand customs, values, and beliefs. At the same time, they are to address the needs and barriers of their patients in order to achieve the best outcomes (Shingles, 2018). According to the Joint Commission (2014), “additional studies show that incorporating the concepts of cultural competence and patient- and family-centeredness into the care process can increase patient satisfaction and adherence with treatment”.
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PICOT Question
“As cultural, communication, mobility, and other basic patient needs go unmet, hospitals will continue to put themselves and their patients at risk for negative consequences.” (Joint Commission, 2014).
Will the nurses of Steward Healthcare have better patient outcomes when undergoing specialized culturally and spiritually based training versus no training, during the patient’s hospital stay?
On the front lines of deliverance of care, lies the nurse and patient which are ultimately the change agents. Beginning with the understanding and specialized training of the nurse, the expectations of care can be exceeded for the patient and their families.
Ultimately, patient centered care is of the upmost importance to nursing and health care, implementing continuous change to improve that care is necessary. Will the nurses of Steward Healthcare have better patient outcomes when undergoing specialized culturally and spiritually based training versus no training, during the patient’s hospital stay?
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Supportive Literature
Peer reviewed articles were obtained for the literature review of the project.
Databases included MEDLINE, CINAHL, and PubMed.
All literature retrieved was published in the last five years for the most relevant information.
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The database that was utilized for the purpose of this Evidence Based Project was that of Grand Canyon University. With that being said, GCU’s database encompasses multiple other databases in one search engine. Articles utilized for this project were drawn from CINAHL, PubMed, MEDLINE, and Science Direct. CINAHL contains many types of subject areas such as nursing biomedicine, and alternative medicines. CINAHL also houses citations from 1981 to present. Pub Med is a government run database that is available to the public and supported by the public. Finally, MEDLINE, one of the most searchable databases in medicine covers subjects in medicine, health and biomedical services. Both MEDLINE and CINAHL are among the best-known databases within healthcare, which is useful to the clinician in trying to improve patient outcomes through easily searched evidence-based practice (Melnyk, pg. 58). When having access to the GCU Library there is unlimited access to these databases and was the primary source of data gathering for the purpose of this project.
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Proposed Solution
Specialized Training Program for all Staff.
Includes online modules, face to face class time, and a post test.
Mandatory for all staff.
Counts towards 9 credit hours of continuing education for nursing staff.
The proposed solution for obtaining cultural and spiritual competence is to implement a mandatory specialized training program. The training program will be presented by the education program and will be a continuous program so that staff can sign up throughout the year to meet their mandatory education. This program is vital in providing the principal standard of care according to the US Department of Health and Human Services, “provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs” (HHS, 2018). The program will integrate both online and traditional classroom time. First off, the staff member will complete the modules provided by the U.S Department of Health and Human Services. “Culturally Competent Nursing Care: A Cornerstone of Caring is a free e-learning program from the HHS Office of Minority Health. It is accredited for up to 9 continuing education credits, at no cost, for nurses” (HSS, 2018). . The traditional classroom portion will be a discussion facilitated by the nurse educator, reviewing key points, specific demographics and associated care, followed by a formal written test.
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Expected outcomes
All staff will feel more confident in providing culturally competent care.
Greater patient rapport will be built.
Patient satisfaction surveys will obtain higher scores.
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The outcomes on quality of care should be greatly improved being that the focus on patient specifications are shifted to treating the patient as a whole. “Disparities in health care quality may result not only from cultural and other barriers between patients and health care providers but also between entire communities and health care systems” (Beach, 2016). With implementation of this program Steward can begin breaking the barrier between patients and providers allowing for the provider to give the best quality of care to the patient and the community.
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The Stetler Model
There are five phases within the model; preparation, validation, decision making, translation, and evaluation. The preparation phase includes searching, sorting, and ultimately selecting evidence. This was done through internal and external research. The internal research included a survey that evaluated the readiness for change regarding cultural and spiritual care within Steward Health Care. The External research was conducted through the Grand Canyon Library where five main articles were selected as evidence. The literature as well as the internal research revealed that there were higher patient outcomes and comfort of staff when cultural competence is applied (Melnyk, pg 279).
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Implementation Plan
Setting will be at Steward Health care in Arizona.
The project will be on going, however for the purpose of the project it will be conducted in one year’s time.
Employees will complete their online modules, attend class, and complete a post test.
The setting in which the protentional subjects will be in is the Steward Health Care Hospital in Arizona. There is no need for a consent or approval form being that the training for staff will be mandatory continuing education. The patient involvement will be that of an end of stay survey that is already in use. The amount of time needed to complete the project will be one year’s time. This will allow for nurses to complete trainings and also evaluate the progression of patient satisfaction as more nurses complete training. Being that there is an online resource that will be utilized this will be done at the staff member’s own pace and convivence, and they will be able to clock in for education hours while completing the online modules. Furthermore, the other resources that will be needed will be that of the nursing educator to develop and set up class times and a final test. There will also be instruments to help to compile the results of the patient surveys regarding their care. The implementation of the intervention will first take place by the head of each department delivering the information to their employees that further training will need to be completed. From that point, employees will also be sent information on objectives and how to begin their mandatory education. The employees will need to complete their modules online before attending the face to face class time with the nurse educator. At that time, they will schedule their class time and complete a class followed by a test.
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Data Collection
Data will be collected before and after training.
Trends will be revealed in terms of staff and patient satisfaction.
A comments section will be included so that there can be improvements made to the development of the program,
The nursing educator will collect data on multiple levels throughout one years’ time. This includes identifying how many staff members successfully completed their cultural competence training. It will also include compiling results of surveys from staff that identify whether or not they feel that the training helped them within their practice. “In addition, teachers can discern the importance they attach to improving their EBP skills” (Melnyk, pg 351). Finally, the patient surveys will be collected and evaluated for positive change.
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Budget
The main components of cost to Steward Health care is that of staff and nursing educator time.
The online training modules are free to all nurses.
The introductory e mail will be free of cost.
The program costs are minimal to the facility being that majority of the learning will take place through online modules. While staff will be compensated for they time during the online portion of learning, the time spent should be approximately 4 hours. The face to face class time will also require pay to all staff participating at their regular pay rate including the nurse educator.
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Evaluation of Process
Quarterly surveys will be conducted for the first year.
After the first year, yearly surveys will be conducted to continue quality improvement.
All staff will need to be in compliance with training.
To continue education and practice on this matter, a yearly survey can be conducted to staff who have completed the course to evaluate if more training is needed and what the frequency of this may be. (For example, surveys may continue to be positive for 2 years and then decline on the 3rd year, indicating that it’s time for a repeat course.) In an effort to keep everyone consistent in the training offered on our campus, all new hires would be responsible for completing the training modules online and then once annually there will be a classroom education for those who have not completed it yet.
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Conclusion
Evidence based practice drives nursing practice.
Cultural competent staff allows for treating patients respectfully and holistically.
Implementation of this program will allow for better patient outcomes and satisfaction.
References
Abdul-Raheem, J. (2018). CULTURAL HUMILITY IN NURSING EDUCATION. Journal Of Cultural Diversity, 25(2), 66-73. Retrieved from:https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=hch&AN=129643546&site=eds-live&scope=site
Abrishami, D. (2018). The Need for Cultural Competency in Health Care. Radiologic technology, (5). 441. Retrieved from: http://eds.b.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?vid=3&sid=b89129c9-b18a-42f9-9a24-bd99c6ae54a5%40sessionmgr104&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=RN615950930&db=edsbl
Advanogy. (2018). Learning Styles. Retrieved from: https://www.learning-styles- online.com/overview/
Alvarez, K., Marroquin, Y., Sandoval, L., & Carlson, C. (2014). Integrated Health Care Best Practices and Culturally and Linguistically Competent Care: Practitioner Perspectives. JOURNAL OF MENTAL HEALTH COUNSELING, (2). 99. Retrieved from: http://eds.b.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?vid=6&sid=b89129c9-b18a-42f9-9a24-bd99c6ae54a5%40sessionmgr104&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=RN351598462&db=edsbl
References continued
Beach. (2016) The role and Relationship of Cultural Competence and Patient-Centeredness in health Care Quality. Retrieved from: https://www.commonwealthfund.org/publications/fund-reports/2006/oct/role-and-relationship-cultural-competence-and-patient
Chen, H., Jensen, F., Measom, G., & Nichols, N. D. (2018). Evaluating Student Cultural Competence in an Associate in Science in Nursing Program. Teaching & Learning In Nursing, 13(3), 161-167. doi:10.1016/j.teln.2018.03.005. Retrieved from: http://eds.b.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?vid=12&sid=b89129c9-b18a-42f9-9a24-bd99c6ae54a5%40sessionmgr104&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=edsgcl.543731400&db=edsgao
Dodou, D. (2014)Social Desirability in the same offline, online, and paper surveys: A metanalysis. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0747563214002143
Granger, B. B. (2018). Science of Improvement Versus Science of Implementation: Integrating Both Into Clinical Inquiry. AACN Advanced Critical Care, 29(2), 208-212. doi:10.4037/aacnacc2018757
Melnyk, B. & Fineout-Overholt, E. (2015) Evidence-Based Practice in Nursing & Healthcare. A Guide to
best practice. Third Edition. Wolters Kluwer Health Philadelphia, PA.
Milner, K. (2018). Health professions faculty beliefs, confidence, use, and perceptions of organizational culture and readiness for EBP: A cross-sectional, descriptive survey.
References continued
National Center for Complementary and Integrative Health. (2013). Traditional Chinese Medicine: In Depth. Retrieved from: https://nccih.nih.gov/health/whatiscam/chinesemed.htm#key
National Hindu Students. (2016). Why do Hindus worship the Cow? Retrieved from: https://www.nhsf.org.uk/2007/05/why-do-hindus-worship-the-cow/
The Joint Commission. (2014). Advancing effective communication, cultural competence, and patients and family centered care. Retrieved from: https://www.jointcommission.org/assets/1/6/ARoadmapforHospitalsfinalversion727.pdf
Shingles, R. R. (2018). Beyond the List of Traits: Addressing and Assessing Cultural Needs of Patients in Health Care Settings. Kinesiology Review, 7(2), 173-179.
Stevens, M. (2015) Developing Intercultural Competencies: Elaborating the Personal Barriers to Change. Journal of Strategic Management Studies. Retrieved from: https://s3.amazonaws.com/academia.edu.documents/42549674/2015__Stevens__Fox-Kirk__Thompson__Fawcett__Fawcett__Developing_Intercultural_Competencies.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1535421643&Signature=3BBcUAXl4utSIv90iur2sf5Skt8%3D&response-content-disposition=inline%3B%20filename%3DDeveloping_Intercultural_Competencies_El.pdf
Steward Health Care.(2018) About Us. Retrieved from: https://www.steward.org/about-us
