DiversityNursing Blog

by Jennifer Etienne and Anna Diane
Boston College William F. Connell School of Nursing

Our names are Jennifer Etienne and Anna Diane, and we are currently senior nursing students at Boston College. This past January, Boston College’s Connell School of Nursing sponsored a nursing service trip to Leogane, Haiti as a part of the community health clinical requirement. This service trip included Boston College (BC) nursing students, nurse practitioners and registered nurses. We held mobile clinics for ten days and saw over 1100 patients. Over the course of our trip, we encountered many patients who we will never forget.

We were amazed by the beauty and kindness of the Haitian people despite all the myriad challenges of their daily lives. We saw many of the common medical conditions that we see in the U.S., such as hypertension, GERD, and diabetes. Due to the area’s extreme poverty, most of our patients had not received health care in years- if at all. A typical day consisted of waking up at 6 a.m., eating breakfast, and packing up a truck with all of the medications and supplies that we had restocked and repacked the night before. We worked with the resources that were available in the community. We set up the clinic with a triage station, consultation, and pharmacy that were situated in the home of one of the individuals within the community. We were fortunate to have a Haitian dentist participate in our clinic as well. Generous neighbors were kind enough to donate chairs and tables for use in our clinics. The women’s privacy room for pelvic exams was constructed from two sheets and a cement wall on a slab of pavement, and the dentist did his work in a reclining lawn chair. In spite of these challenging conditions, our clinics were very successful with the individuals within the community, as exemplified by their gratitude.

The truth is that the people in Haiti receive little healthcare and basic problems often become major health concerns, which is very frustrating to us as future health care providers. This experience illustrated the importance of preventative health care measures. Preventative health care measures, such as providing health education, not only empowered the people, but also gave us a chance to interact with our patients. For example, we crafted and brought cycle beads, which we handed out to the women who we saw in our clinics. These beads help women with family planning as an alternative to birth control contraceptives because many Haitian women do not have the choice to take birth control or access to contraceptives.
It was clear that education was the most important aspect of health promotion and health prevention in Haiti, because it gave the Haitian people a sense of autonomy. For example, simple measures such as demonstrating to Haitians how to properly carry a bucket of water by evenly distributing their weight could help prevent future back problems. We realized, however, that in order to educate the Haitian people on preventative measures, we had to consider what resources were available to them. For instance, teaching a group of Haitian families how to reduce their risk of hypertension would be difficult since measuring cups and nutritional labels are not always available to them. However we could overcome the issue by demonstrating the healthy amount of salt used to prepare meals by using the tip of one’s pinky as an alternative measuring device. Such measures could help to reduce the risk of hypertension in Haitian families and significantly improve overall health. We believe that the use of primary prevention can help to prevent illness in Haiti and empower the people to make their own healthy choices.
Even though we treated more than eleven hundred patients, the realization that the majority of Haitians still lack access to basic health resources was overwhelming. Despite this sad reality, the people we met and the patients we treated assured us that our work was appreciated and worthwhile. Treating this population was an extremely moving experience. We were able to immediately see the difference that we were making, whether it be through treating a baby with scabies or rehydrating a child, the patients were enormously appreciative. This trip has forever changed how we view the care that we will provide as future nurses. We are more aware of the issues that affect Haitians, such as a pervasive lack of health education and the need for more culturally sensitive health care providers. This experience has further motivated us, because as minorities, we recognize our important role in communicating, advocating, and initiating preventative programs to help improve the care and quality of health of minorities. We hope to apply our nursing skills, education, and experiences to help decrease health disparities both within the U.S. and other countries.

Thank you for allowing us to share about our experience in Haiti. We strongly encourage others to consider doing nursing work abroad. In addition to helping those in need of care, such trips endow nurses with truly invaluable perspective into the issues that face the world of health care. With hope, the insights that nurses gain through these types of trips will benefit their patients for years to come.

Originally published by the University of Phoenix

1. Join a nursing society.

"Nursing societies provide a wide variety of ways to stay on the cutting edge of our profession," says Kerrie Downing, RN, MSN, campus college chair of the nursing program at the University of Phoenix Minneapolis/St. Paul Campus. Nursing societies can be large and national in scope, such as the American Nurses Association, or small, as regional associations and specialty societies are. These organizations often offer their members access to publications, online discussion boards and a host of other services, which can include career advice, conferences, conflict resolution, even political advocacy.

"It's always great to have someone else within the profession to connect with, and not just be limited by the people in your workplace," Downing says.

2. Volunteer in your profession.

"I advise nurses to get involved in their [profession's] self-governance," says Juanito C. Torres Jr., MSN, a registered nurse who manages the nursing simulation lab at the University of Phoenix Hawaii Campus. This can include unit practice councils at the hospitals where nurses work, or research committees sponsored by nursing societies, among other opportunities. "Nurses need to get involved in these types of committees to be aware of the latest developments and promote best practices," Torres says. Nurses can even get involved in political action; changes in national policy on seat belt laws and public smoking bans, for instance, owe their enactment in large part to nurses.

3. Attend conferences often.

Conferences offer plenty of opportunities to stay current, whether it's an opportunity to network or hear lectures by leading voices in the profession. "If you've been working in the same area for more than two to three years, your skills are probably stale and you need to get up to speed," says Margi Schultz, RN, PhD, who obtained her BSN and MSN degrees from University of Phoenix and is currently a nurse educator. "Conferences offer you a way to get the latest information so you can keep your nursing practice based on the best available evidence."

4. Read nursing journals.

Torres says that top nursing journals such as American Journal of Nursing and Evidence-Based Nursing publish the latest research. Many hospitals subscribe to these and other journals, and societies frequently make them available at a discount to their members.

5. Step out of your comfort zone.

Shultz recommends that nurses shake up their routines a bit in order to gain new skills. "Go to classes, obtain advanced certifications, maybe shadow a nurse in another specialty," she says. "There's no reason to get bored with the same old thing."

The news that some employers have asked for direct access to the Facebook accounts -- including user names and passwords -- of people applying for jobs at their firms has set off a firestorm of controversy.

The reports have raised questions about whether the practice is illegal and if such a policy could expose those employers to potential discrimination lawsuits. The dust-up has even triggered calls by some in Congress for a federal investigation into the practice.

But those recent events only highlight a new reality: The identity that individuals create in the world of social media is quickly becoming an important factor in hiring decisions and in people's broader professional lives.

"The questions around employer access to social network log-ins reflect a broader debate in society about a host of digital privacy issues," says Andrea Matwyshyn, a Wharton professor of legal studies and business ethics. "This is a new concern -- the degree to which employers can gain access to all role identities through one virtual space. There is no parallel to that in the real world."

While the reaction to the practice has been swift and intense, it's hard to predict if it will become a lasting trend.

But, Matwyshyn says, she began hearing about employers requesting access to the Facebook accounts of potential hires as far back as 2008. To date, however, she says, there is no good data on how widespread the practice has become.

The fact that it exists at all is not entirely unexpected: According to Matwyshyn, a number of studies show that most employers look at candidates' online profiles when making hiring decisions, noting a 2011 survey by social-media monitoring service Reppler that found that 91 percent of recruiters report using social-networking sites to evaluate job applicants.

But checking out a publicly available profile on Facebook -- or even asking a job candidate to "friend" someone in human resources at a company where they are applying for a position -- is worlds apart from gaining unfettered access to someone's account through a password.

"If you can take Facebook passwords, what about Gmail passwords?" asks Stuart Soffer, a non-residential fellow at The Center for Internet and Society at Stanford Law School and managing director of IPriori, an intellectual-property consulting firm.

If left unchecked, Soffer says, the practice could expand beyond human resource departments evaluating potential employees.

"What about allowing Facebook access to insurers so they can see what you are saying about your health?" he says. "They could use it as a basis for judging the risk of insuring you."

The request for access to log-in information also raises some serious legal questions.

Clearly concerned about the legal and business implications of privacy breaches, Facebook has come out against the practice, stating that sharing or soliciting a Facebook password is a violation of the company's statement of rights and responsibilities.

"We don't think employers should be asking prospective employees to provide their passwords because we don't think it's the right thing to do," Facebook Chief Privacy Officer Erin Egan says. "But it also may cause problems for the employers that they are not anticipating."

Matwyshyn says employers could be essentially asking job candidates to violate their contract with Facebook if they ask for passwords, creating "an untenable conflict between contract law and employers' perceptions of their own interest in vetting candidates."

In addition, if a Facebook account includes information on an applicant's race or age, for example, that could potentially expose the employer to claims of discriminatory hiring practices. According to Matwyshyn, it is legally hazy whether accessing someone's Facebook account where that information is available is akin to asking it in the interview.

"Arguments can be made that this is a back-door method to gaining information that the prospective employer wouldn't otherwise have access to," she says.

Meanwhile, the issue is getting the attention of Congress. Senate Democrats Charles Schumer and Richard Blumenthal, from New York and Connecticut respectively, have asked the Justice Department and the Equal Employment Opportunity Commission to look into the practice.

But even if it is eventually prohibited or otherwise curbed through legal or legislative channels, Wharton management professor Nancy Rothbard predicts that the use of social media in hiring decisions will continue to be a flashpoint in the years ahead.

"The core of the problem is the blending of personal and professional lives," Rothbard says. "We are still in the infancy of trying to understand how to deal with all this."

Opening the Window -- and Closing a Door?

Just how far employers can legally go to check out job candidates online may not be clear -- but why they are looking for new methods of evaluating applicants is easy to understand, says Wharton management professor Adam Grant.

Research, he says, has shown that the typical job interview is a poor tool for predicting which candidates will succeed. If that does not work, companies need to find something that does.

"Applicants are very motivated to put their best foot forward in an interview," Grant says. "It is very difficult to spot the people who will represent an organization well. But on Facebook, you can see the applicant making day-to-day decisions -- it is a window into how an individual is likely to act."

In fact, recent research has provided evidence that online profiles can be very revealing about specific personality traits.

A paper published recently in the Journal of Applied Social Psychology entitled, "Social Networking Websites, Personality Ratings, and the Organizational Context: More Than Meets the Eye," studied 518 undergraduate students and their Facebook profiles.

The researchers found that the Facebook profiles were a good predictor of the so-called "big five personality traits:" conscientiousness, agreeableness, extroversion, emotional stability and openness. And for a subset of the group where the researchers were able to contact supervisors at companies that had hired those students, there was a correlation between scores on two personality traits -- emotional stability and agreeableness -- and job performance. (SeeHREOnline^TM story here.)

"There is strong evidence that social networking is a valid way of assessing someone's personality," says Donald Kluemper, a professor of management at the Northern Illinois University College of Business and a co-author of the study.

But he says that does not mean there is evidence that an unstructured perusal of a Facebook account will result in better hiring decisions.

"Until a method is validated in a number of ways, including a study of adverse impacts and the legal issues, I wouldn't recommend companies rely on social-networking profiles," Kluemper says.

Now, the use of social-media information is far from fine-tuned, with recruiters typically checking out social media to get a general sense of the person applying for a job or to hunt for any red flags. But it is possible the use of that information could become more sophisticated.

"People are mining that data right now for other purposes, including targeting ads to the right people," says Shawndra Hill, a Wharton operations and information management professor. "It is not out of the realm of possibility to focus that on other outcomes, like how good a match someone is for a job or whether there is a high likelihood they might do something illegal."

While the value of that data may be apparent, it remains to be seen how social media should ultimately fit into some aspects of professional life.

Take the less-controversial practice of managers' friending their colleagues through Facebook. Rothbard says this practice creates numerous potential headaches. Two years ago, she and some colleagues did a series of interviews with 20 people at a variety of levels and in a number of different industries, and found that people were often unnerved friending either bosses or subordinates.

"People felt very uncomfortable with crossing the private and professional boundary when it came to the hierarchy [within an organization]," Rothbard says. "They talked about friending their bosses with similar discomfort and language as they did when they spoke about friending their moms."

Interestingly, Rothbard adds, the rules for social networking in the workplace may differ based on gender.

She led a study of 400 students in which participants were shown Facebook profiles, told that the person was either a boss, a peer or a subordinate, and then asked to rate the individuals based on how likely they were to accept that person's friend request.

The findings: Female bosses with bare-bones profiles were less likely to be accepted than those who revealed more personal information, while the opposite pattern held for male bosses.

"Women who have limited profiles are more likely to be shunned than the women who have a more active presence," Rothbard says. "People see them as cold. But male bosses who reveal less information are more likely to be accepted than those who reveal a lot of information."

The increased scrutiny of people's virtual lives may change the way individuals operate in the social-networking realm.

According to Rothbard, there are essentially four ways of dealing with privacy issues. There are those who control their list of friends carefully, rejecting friend requests from people with whom they don't want to share personal information. Then, there are those who accept virtually all requests, but are very careful about what they post, limiting that content to very safe, less revealing information.

There is also a hybrid approach in which people use privacy settings to share some information with close friends and less-sensitive material with others. And, finally, there is the "let it all hang out" crowd -- those who are comfortable sharing all their information with a large group of close (and not so close) friends.

Grant predicts more people will opt for the more-controlled, filtered approach as they realize their social-media profiles are being scrutinized by potential employers.

"As employers gain this information, so do candidates," Grant points out. "So candidates may use Facebook more carefully and remove the cues that are so valuable [to employers]."

Soffer agrees people will become much more careful about their social-media personas.

"There are ways around this," Soffer says of the unwanted exposure of social-media behavior. "One thing that could happen is people will start having two Facebook accounts." One will be for close friends; the other, a more sanitized version for employers.

But there is always the potential that something posted for viewing by a small group of close friends on Facebook could get out into larger circulation. And for that reason, some argue, the risks of being active in the social-media space outweigh the benefits.

"If you are a CEO, or aspire to be a CEO or director of a public company, I think it makes sense to refrain from social networking," says Dennis Carey, vice chairman at Korn/Ferry International. "There are other ways to communicate with employees and the outside world through properly controlled channels. Some of the messages that are conveyed can be misconstrued or taken out of context by a third party."

The fear of a photo or comment made long ago coming back to haunt you is hardly unfounded. Because sites such as Facebook have been around less than a decade, it is not certain how long someone's social-networking history will remain accessible.

"It is unclear how long the information persists," Hill says. "Firms have different privacy policies, and often privacy policies change over time. While there are policies that allow for deleting data you no longer want on the site, it is hard to guarantee that this information won't live on a database somewhere."

The controversy worries some fans of the social-media revolution.

"I worry that there is already a sense right now that our participation online may come back to haunt us," says Chris Ridder, co-founder of the law firm Ridder, Costa & Johnstone and a non-residential fellow at The Center for Internet and Society at Stanford Law School.

"It inhibits our ability to express ourselves," he says. "If we can only express public relations-like statements, it takes away a good bit of the utility of the Internet. I think it would be a shame if we were to lose the playful aspect of this new technology."

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How would you feel if someone asked for your account information to Facebook or Twitter in an interview? What if your boss did it? Do you think this is a privacy violation? Should there be legislation on this? Let us know in the comments; we want to hear from you!

Nurses are as diverse as the patients they treat.

But that diversity will become grayer for the next few years as more middle-age people are going into nursing as a second career.

That trend can be seen in the class that will graduate May 18 from Heartland Community College's two-year nursing program in Normal. Students graduate with an associate's degree in nursing and then may take the registered nurse licensing exam.

Non-traditional students — those who don't begin college right after high school — are the norm in Heartland's nursing program. But, in this class, none of the 40 students is a traditional student.

“I was pretty surprised when I started,” said second-year nursing student John Cook, 47, of Normal. “There was virtually no one right out of high school. I remember thinking that I'd be the oldest one in there by far and that's not the case.

“It's a huge cross-section of people with bachelor's degrees in other fields, including a lot of moms.”

Students begin clinical rotations at area hospitals and long-term care facilities during their first semester, said professor of nursing Barb McLaughlin-Olson. For every hour that they are in the classroom, in the lab and at clinical sites, they are expected to spend three hours on course work.

The nursing-as-a-second-career trend has been in place for several years, said Deb Smith, vice president and chief nursing officer of OSF St. Joseph Medical Center, Bloomington.

Some people who pursue nursing as a second career take advantage of accelerated, one-year nursing programs for people who already have a bachelor's degree, Smith said. For example, Illinois State University's Mennonite College of Nursing in Normal has an accelerated bachelor of science in nursing program.

Laurie Round, vice president of patient care services and chief nursing executive at Advocate BroMenn Medical Center in Normal, said the recession has driven some people from their original careers into nursing. Both ISU-Mennonite and Illinois Wesleyan University's School of Nursing in Bloomington reported an increase in enrollment last fall.

There is a demand for nurses because nurses work in hospitals, doctors' offices, businesses, insurance companies, long-term care facilities and churches. But second-career nurses also are drawn to the field for altruistic reasons, Smith and Round said.

“They want to do something that's meaningful,” Round said. “They want to touch peoples' lives.”

Middle-age adults going into nursing need to learn a career quickly and need to keep their energy level up.

Some middle-age adults are challenged by all the technology involved with patient care, Round and Smith said.

But the maturity and experience of second-career nurses generally makes up for any challenges.

“I love the energy, the intensity, the maturity and the decision-making skills that they bring to the field,” Round said. “These people are choosing nursing while raising a family and working at the same time and that shows perseverance, commitment and discipline.”

Second-career nurses not only come in with the experience of previous employment and raising a family. They also have social skills and because they are close in age to nurses already in the field — the average age of nurses is 47 — they fit in with other nurses quickly, Smith said.

McLaughlin-Olson said, “They can use their life experiences to help them become better nurses. Because they've lived through life's challenges, they've learned how to critically think when issues come up, and they have empathy and can relate to people having problems.”

But Smith and Round also are impressed with traditional nursing students, who graduate to enter nursing in their early 20s. They are intelligent, energetic and learn quickly, they said.

For that reason, both Round and Smith said middle-age, second-career nurses are not necessarily the new face of nursing.

“I see a great mix across generations,” Round said.

Adds Smith: “It's good to have people entering nursing with a variety of life experiences. That further enriches our profession.”

Adapated from a WBUR radio series. Links to Audio can be found below.

America's nursing shortage has been compared to a perfect storm gathering in intensity. In just over a decade nearly 80 million baby boomers will be in or reaching retirement, their medical needs placing an immense strain on our health care system. Nurses themselves will be leaving the profession and a younger generation of nurses will not be trained in enough numbers to fill the growing needs of hospitals and patients.

In "Nursing a Shortage: Inside Out," WBUR Special correspondent Rachel Gotbaum reports on how the shortage has come about and why it matters for nurses, hospitals and patients alike. She takes us into hospitals where the longest running nursing shortage in history is already impacting care. She reports on the roots of the problem that encompass not just the changing career choices for young women, the out-dated image of nursing but also the serious difficulties faced by nursing schools trying to find nurse-educators.

Nurses explain the effect of the shortage on their care of patients and how it is influencing their commitment to the profession and whether they stay or leave. Hospital administrators describe what they need to do to recruit and retain nurses in this competitive market , and Gotbaum reports on the growing tensions over whether mandating nurse-patient ratios is an answer to the problem or an impediment.

There have been shortages of nurses in this country since the 1960's but they have always resolved themselves fairly quickly. This nursing shortage began in 1998. Although it has been slightly alleviated it is expected to get worse when considering the increased retirement rates expected in coming years.

80 million baby boomers are slated to retire in the next decade and they will need a lot more medical care. At the same time many experienced nurses will be leaving the profession. The shortage began after managed care ushered in an era of cost cutting in the early 1990s. Nurses were replaced by lesser skilled workers. In Massachusetts 27 percent of hospital nurses were laid off, the largest number in the country. The profession became unattractive to women who began to have many other career choices. But as nurses left the workforce, studies showed that patient care suffered. One study published in the Journal of the American Medical Association found that patients whose nurse cares for 8 or more people have a 30 percent greater chance of dying than if their nurse cares for four patients. The same nurses are also more likely to be burnt out and dissatisfied with their jobs.

As hospitals started experiencing acute shortages of nurses, they responded by raising salaries and offering bonuses to nurses to enter the profession. Media campaigns were launched to extol the attractions of nursing. By 2003 185 thousand registered nurses entered this nation's hospital workforce. But even with this huge influx of nurses the shortage in 2007 still existed, and as demand for nurses increases many agree the gap will steadily grow. The number of registered nurses increased from approximately 2.5 million in 2007 to under 2.7 million in 2011. Despite this increase, some states are fighting about whether to mandate nurse-to-patient ratios. The number of new nurses is influenced by a large number of external factors so pinpointing the cause is difficult, but the significance of the increase is more important. Although 200,000 sounds like a lot of nurses, this is only an 8% increase. Just as important as the number of nurses is the number of patients which rose almost 10% from 2007 to 2008 alone according to the National Healthcare Cost and Utilization Project.

Audio Links Click Here

(from CNN)

The number of interracial couples in the United States has reached an all-time high, with one in every 10 American opposite-sex married couples saying they're of mixed races, according to the most recent Census data released Wednesday.

In 2000, that figure was about 7%.

The rate of interracial partnerships also is much higher among the unmarried, the 2010 Census showed.

About 18% of opposite-sex unmarried couples and 21% of same-sex unmarried partners identify themselves as interracial.

The term interracial, as it pertains to the study, is defined as members of a couple identifying as of different races or ethnicities.

Analysts suggest the new figures could reflect U.S. population shifts, broader social acceptance of such unions and a more widespread willingness among those polled to be classified as mixed race.

"Identifying as an interracial couple shifts over time," census spokeswoman Rose Kreider said.

Among interracial opposite-sex married couples, non-Hispanics and Hispanics are by far the most frequent combination, making up about 45% of such partnerships, Kreider said.

The second most represented group are those in which at least one person identifies as multiracial, while the third are marriages between whites and Asians.

Marriages between blacks and whites are the fourth most frequent group among married opposite-sex interracial couples.

Having professional translators in the emergency room for non-English-speaking patients might help limit potentially dangerous miscommunication, a new study suggests.

But it hadn't been clear how well professional interpreters perform against amateurs, such as an English-speaking family member, or against no translator at all.

The current findings, reported in the Annals of Emergency Medicine, are based on 57 families seen in either of two Massachusetts pediatric ERs. All were primarily Spanish-speaking.
The research team audiotaped the families' interactions with their ER doctor. Twenty families had help from a professional interpreter and 27 had a non-professional. Ten had no translation help.

It's not clear why some families had no professional interpreter. In some cases, Flores said, there may have been no one available immediately. Or the doctor might not have requested an interpreter.

The findings suggest that professionals can help avoid potentially dangerous miscommunication between patients and doctors, according to Flores and his colleagues.
In one example from their study, an amateur interpreter -- a family friend -- told the doctor that the child was not on any medications and had no drug allergies. But the friend had not actually asked the mother whether that was true.

Cost questions

There are still plenty of questions regarding professional interpreters, according to Flores.
For one, he said studies are needed to compare the effectiveness of in-person professional translators versus phone and video translation services.

There are also questions about what type of translation help families and doctors prefer, and what's most cost-effective. Federal law may require many hospitals to offer interpreters, but it does not compel the government or private insurance to pay for them. Right now, some U.S. states require reimbursement, but the majority do not. So in most states, Flores told Reuters Health, "the hospitals and clinics, and ultimately the taxpayers (because of uncompensated/charity care), are left covering the costs." But the cost-per-patient can be kept down. One study found that when a group of California hospitals banded together to offer translators by phone and video, the cost per patient was $25.

As for national costs, Flores pointed to a 2002 report from the White House Office of Management and Budget. It estimated that it would cost the U.S. $268 million per year to offer interpreter services at hospitals and outpatient doctor and dentist visits.

Another issue is training -- including the question of how much is enough. In the current study, errors were least common when interpreters had 100 hours of training or more: two percent of their translation slips had the potential for doing kids harm. There are numerous training programs for medical interpreters nationwide. But few of them provide at least 100 hours of training, Flores noted.

As for hospitals, it seems that most do not offer their own training programs. And even when they do, the hours vary substantially, Flores said. Based on these findings, he and his colleagues write, requiring 100-plus hours of training "might have a major impact" on preventing translation errors -- and any consequences for patients' health.

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Have you ever used a translator as a nurse or as a patient? How did it go? What is the ideal training program?

By definition...

Cultural competency is having specific cognitive and affective skills that are essential for building culturally relevant relationships between providers and patients. Obtaining cultural competency is an ongoing, lifetime process, not an endpoint. Becoming culturally competent requires continuous self-evaluation, skill development, and knowledge building about culturally diverse groups.

Healthcare disparities are inequalities in healthcare access, quality, and/or outcomes between groups. In the United States, these inequalities may be due to differences in care-seeking behaviors, cultural beliefs, health practices, linguistic barriers, degree of trust in healthcare providers, geographical access to care, insurance status, or ability to pay. Factors influencing these disparities include education, housing, nutrition, biological factors, economics, and sociopolitical power.

Models

Several models of cultural competency exist. In a model called The Process of Cultural Competence in the Delivery of Healthcare Services, by Campinha-Bacote, nurses are directed to ask themselves questions based on the five constructs-awareness, skill, knowledge, encounters, and desire (ASKED)-to determine their own cultural competency. According to this model, nurses need an awareness of their own cultural biases and prejudices, cultural knowledge, and assessment and communication skills. Nurses also need to be motivated to have encounters with culturally diverse groups. In its most recent form, this model suggests that these encounters are the pivotal key constructs in the process of developing cultural competency.

The Giger and Davidhizar Transcultural Assessment Model identifies six cultural phenomena nurses and other healthcare providers assess in their patients: biological variations, environmental control, time, social organization, space, and communication.

Staff should select a model that best fits your specific work setting and patient population.

Beware stereotypes

Taking it all in

You can gain helpful information by performing a cultural assessment and using a broad definition of culture that reflects the differences in healthcare besides race and ethnicity. These definitions include age, gender, disability, sexual orientation, immigration status, employment status, socioeconomic status, culture, and religion.

To avoid stereotyping, keep in mind that individuals within a particular group can vary in many respects. For example, among older adults, certain characteristics may be typical but some older adults may demonstrate attributes that differ from the group. Many believe that all older people resist the use of modern technology; however, many people who are elderly enjoy using smartphones, tablets, electronic readers, and other devices. These intracultural differences are important to consider; having group knowledge never justifies predicting behaviors of any individual members. As part of a cultural assessment, determine the specific values, beliefs, attitudes, and health needs of each patient. See Performing a cultural assessment for an example using the Giger and Davidhizar Transcultural Assessment Model.

In the United States, the healthcare system is a cultural entity with its own norms and values. Yet nurses may overlook a facility's institutional culture when they consider the impact culture has on patients' healthcare access and outcomes. Both organizational and hospital unit culture play a role in determining the quality of care a patient receives. When you can determine what interpersonal or institutional barriers exist within a particular institution, clinic, or community setting, you're better able to assist your patients in overcoming them to achieve better healthcare outcomes.

Goals and Considerations of cultural competency

How do you know whether you're providing culturally competent care? Some believe that they've reached the goal of cultural competency as they gain new knowledge or skills, or have encounters with culturally diverse groups. But while providers may meet goals, there is always room for improvement. Helpful questions and considerations when determining cultural competency include:

* What does being culturally competent mean to me and the patients I serve?

* Which cultural competency model and/or assessment tool is most useful to me, given my patient population?

* As I gain cultural knowledge and skills, how can I use that knowledge to improve my patients' healthcare outcomes and assist in reducing healthcare disparities for underserved populations?

* Did the patient demonstrate an understanding of what I was trying to convey or teach?

* What can I do to improve the quality of care I deliver to members of this group?

Title: Confident Voices: The Nurses' Guide to Improving Communication & Creating Positive Workplaces

Author: Beth Boynton, RN MS

Amazon Review:

“Confident Voices is a "must read" for every nurse who has had conversations with peers, supervisors, physicians and health care providers that have ended badly or wanted a different outcome. Confident Voices is designed to negotiate health care in the 21st Century and for communicating in a way that leaves everyone feeling included and honored in the process of day-to-day discussions in getting the job done. Beth Boynton's book provides the nurse with conversation tools to navigate difficult situations and provides support and feedback to reframe the situation so all involved win. I appreciate all the work Beth Boynton did in writing this book and the necessity of clear, concise communications in this difficult period we are all facing in the health care today.”

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Have you read Confident Voices? What did you think of it? Has it helped you communicate at work?

Are you a nurse who uses an iPhone? The iPhone is especially useful for nurses who are mobile, as this tool can help you stay in touch with medical teams and patients’ needs. Additionally, many new apps have been developed for the iPhone that fit a nurse’s lifestyle and professional requirements. Why carry 15 tools around with you when one will do the work for them all? Many of the iPhone apps listed below are not open source or free. And, many require wireless networks to operate. But, when you consider the cost of the tools you might need to simulate these apps, the app may be worth the investment.

The apps below are linked either to download sites or reviews with a link to the download site. They are listed in alphabetical order, a methodology that shows we don’t favor one app over another.

1. A.D.A.M. Symptom Navigator: If patients are using this app, maybe you should, too – easily find out what to do about any symptoms. Learn self care, when to go to the doctor, and when it is an emergency.
2. Bishop’s Score Calc: This obstetric calculator is used to calculate Bishop’s Score, a score used to assess probability of impending delivery as well as expected success rate if labor is induced. Expectant parents may also find this of use in aiding their obstetrician in determining whether induction of labor is reasonable.
3. Bio Dictionary: Bio Dictionary covers most of general biological terms. Two methods are offered for searching, and terms and their explanations are audible!
4. Cockcroft: Calculate the estimated clearance of creatinine (eCcr) with the creatinine serum rate (in mg/dL or in micromol/L). Weight can be either in kilogram or in pounds.
5. Epocrates Rx: One of the few free iPhone apps, Epocrates Rx includes a drug guide, formulary information and drug interaction checker. This product also includes continual free updates and medical news. Plus, this app resides on your device so you can look for information without wireless connections.
6. Eponyms for the iPhone: Downloadable through the iTunes store and courtesy of Pascal Pfiffner, this app brings the beautiful eponym database from Andrew J. Yee to your iPhone or iPod touch.
7. Glucose Charter: Glucose-Charter is a blood glucose, insulin and medication recording app for any iPhone. Patients can self-monitor, nurses can use it to check patients.
8. iAnesthesia: Case Logs: iAnesthesia: Case Logs allows all anesthesia providers to easily create, manage and backup case logs quickly in the operating room, leaving you with more free time when not at work.
9. iChart: Keep track of patients through this personal medical assistant. It stores everything from patient data to charts and lists of medications in a streamlined, organized fashion.
10. In Case of Emergency (ICE): You may not always practice in a hospital setting. If not, this app can provide you with all the information you need to contact emergency services in your location.
11. iRx: iRx is a pharmaceutical reference tool to get FDA information on specific drugs. This application is currently in beta status, but is fully functional.
12. Lab Tests: This laboratory test database is broken up into categories including, Blood Bank, Clinical Chemistry, Coagulation, Hematology, Serology, Immunology, Tumor Markers, Urinalysis and Therapeutic Drugs. Reference ranges and notes on the clinical significance of the test are given when indicated.
13. Medical Reference: Why memorize medical terminology when you can look it up on your iPhone?
14. Mediquations: Mediquations for the iPhone and iPod Touch brings over 201 common medical calculations and scoring tools to your fingertips with the simplicity and elegance you expect out of an iPhone application.
15. MIM Radiology: The MIM iPhone Application provides multi-planar reconstruction of data sets from modalities including CT, PET, MRI and SPECT, as well as multi-modality image fusion.
16. Mosby’s iTerms Flash Cards for Medical Terminology: Mosby’s iTerms Flash Cards for Medical Terminology, the premier study guide for mastering the prefixes, suffixes, combining forms, and abbreviations used to build medical terms, is now available for the iPhone and iPod touch.
17. NCLEX-RN Medications: Nursing students can cram for their NCLEX exam with this app that will help you study medications and conditions.
18. Netter’s Anatomy Flash Cards: Using outstanding anatomical illustrations from Netter’s hugely popular Atlas of Human Anatomy (4th Edition), Netter’s Anatomy Flash Cards allows you to carry the bestselling reference for human anatomy on your iPhone or iPod touch.
19. Netter’s Musculoskeletal Flash Cards: Master the musculoskeletal anatomy and pathology you need to know with 210 flash cards.
20. Netter’s Neuroscience Flash Cards: Enhance your understanding of key neuroscience concepts with Netter’s Neuroscience Flash Cards for iPhone and iPod touch.
21. Nursing Central: Nursing Central is the complete mobile solution for nursing produced by Unbound Medicine. The app includes premier disease, drug and test information by and for nurses.
22. Pocket First Aid Guide: Do you panic when caring for several people at once? Get a grip with this iPhone app. This is a first-aid guide for your iPhone that will help you treat anything from beestings to burns to eye injuries while you are within range of the Internet.
23. ReachMD: The ReachMD CME iPhone application is an easy-to-use and fully accredited Continuing Medical Education tool that gives healthcare practitioners a convenient way to earn free CME credits through their iPhone or iTouch.
24. ScribbleDoc: If you can’t read the good doctor’s writing, perhaps this app can help. Use your iPhone to scan the problem and ScribbleDoc should convert the image to text.
25. Skyscape Medical Resources: Available from the iTunes Apps Store, this app offers Outlines in Clinical Medicine, Archimedes – Medical Calculator, RxDrugs: Drug Dosing Tool and MedAlert for free with their download.