DiversityNursing Blog

Cultural respect is vital to reduce health disparities and improve access to high-quality healthcare that is responsive to patients’ needs, according to the National Institutes of Health (NIH). Nurses must respond to changing patient demographics to provide culturally sensitive care. This need is strikingly evident in critical care units.

“As an emergency room nurse in a small rural hospital, I was present when an elderly Native American man was brought to the emergency room by his wife, sons, and daughters,” Deborah Flowers says in Critical Care Nurse. “He had a history of 2 previous myocardial infarctions, and his current clinical findings suggested he was having another. During the patient’s assessment, he calmly informed the emergency room staff and physician that, other than coming to the hospital, he was following the ‘old ways’ of dying. He had ‘made peace with God and was ready to die’ and ‘wanted his family with him.’”

“The emergency room physician ordered intravenous fluids, a dopamine infusion, a Foley catheter, and transfer to the intensive care unit of a regional hospital 3 hours away. The patient died 2 weeks and 2 code blues later, and was intubated and receiving mechanical ventilation for most of that time. No family members were present when he died except for his wife. The rest of his family members were unable to afford the cost of traveling to a healthcare facility that far from home. This man’s cultural values and preferences in relation to dying were disregarded.”

In contrast, promoting culturally competent nursing care helps nurses function effectively with other professionals and understand the needs of groups accessing health information and healthcare.

Examining Culturally Competent Nursing Care

Definitions

Cultural competence can be defined as “developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds; demonstrating knowledge and understanding of the client’s culture; accepting and respecting cultural differences; adapting care to be congruent with the client’s culture,” according to Larry Purnell in his book Transcultural Health Care: A Culturally Competent Approach (1998).

Another definition states that cultural competence “describes how to best meet the needs of an increasingly diverse patient population and how to effectively advocate for them,” says Barbara L. Nichols, former CEO of the Commission on Graduates of Foreign Nursing Schools, in NSNA Imprint.

Explanations of culturally competent nursing care focus on recognizing a patient’s individual needs, including language, customs, beliefs and perspectives. Cultural sensitivity is foundational to all nurses. “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person,” states the American Nurses Association’s Code of Ethics for Nurses.

Relevance

More than one-third (37 percent) of the U.S. population consists of individuals from ethnic and racial minority groups, and by 2043, minority groups will become the majority, according to research from the American Association of Colleges of Nursing. However, nurses from minority backgrounds represent 19 percent of the registered nursing (RN) workforce. Men account for 9.6 percent of the RN workforce.

There is a “challenge presented by the health care needs of a growing number of diverse racial and ethnic communities and linguistic groups, each with its own cultural traits and health challenges,” the NIH says. Nurses and other healthcare providers must account for these differences through cultural respect to support positive health outcomes and provide accuracy in medical research.

“The development of cultural competence in the nursing practice first requires us to have an awareness of the fact that many belief systems exist,” says Lanette Anderson, executive director of the West Virginia State Board of Examiners for Licensed Practical Nurses. “The beliefs that others have about medical care in this country, and sometimes their aversion to it, may be difficult for us to understand. We must remember that we don’t need to understand these beliefs completely, but we do need to respect them.”

Developing Cultural Competence

Framework for Delivering Culturally Competent Services

Campinha-Bacote and Munoz (2001) proposed a five-component model for developing cultural competence in The Case Manager.

1. Cultural awareness involves self-examination of in-depth exploration of one’s cultural and professional background. This component begins with insight into one’s cultural healthcare beliefs and values. A cultural awareness assessment tool can be used to assess a person’s level of cultural awareness.
2. Cultural knowledge involves seeking and obtaining an information base on different cultural and ethnic groups. This component is expanded by accessing information offered through sources such as journal articles, seminars, textbooks, internet resources, workshop presentations and university courses.
3. Cultural skill involves the nurse’s ability to collect relevant cultural data regarding the patient’s presenting problem and accurately perform a culturally specific assessment. The Giger and Davidhizar model offers a framework for assessing cultural, racial and ethnic differences in patients.
4. Cultural encounter is defined as the process that encourages nurses to directly engage in cross-cultural interactions with patients from culturally diverse backgrounds. Nurses increase cultural competence by directly interacting with patients from different cultural backgrounds. This is an ongoing process; developing cultural competence cannot be mastered.
5. Cultural desire refers to the motivation to become culturally aware and to seek cultural encounters. This component involves the willingness to be open to others, to accept and respect cultural differences and to be willing to learn from others.

Tips

Nurses should explain healthcare jargon to patients whose native language is not English, according to Monster contributing writer Megan Malugani. A breast cancer awareness program for U.S. immigrants demonstrated that women were too shy to say they didn’t understood certain terms. Some assumed that Medicare and Medicaid were forms of cancer.

Many people from other cultures seek herbal remedies from traditional healers — and they can be harmful or interact poorly with Western medicine. Nurses should ask patients about any alternative approaches to healing they are using. Another example of cultural sensitivity involves nurses understanding the roles of men and women in the patient’s society. “In some cultures, the oldest male is the decision-maker for the rest of the family, even with regards to treatment decisions,” Anderson says.

The most important way for nurses to achieve cultural competency and promote respect, according to Anderson, is to gain the patient’s trust for a stronger nurse-patient relationship. This requires sensitivity and effective verbal and non-verbal communication.

Pitfalls

Nurses should never make assumptions or judgments about other individuals or their beliefs. Instead, nurses can ask questions about cultural practices in a professional and thoughtful manner.

Common pitfalls to avoid involve stereotyping and labeling patients, according to Flowers.

• Nurses should avoid unintentionally stereotyping a patient into a specific cultural or ethnic group based on characteristics like outward appearance, race, country of origin or stated religious preference. Stereotyping refers to an “oversimplified conception, opinion, or belief about some aspect of an individual or group of people,” she says. Additionally, many subcultures and variations can exist within a cultural or ethnic group. For instance, the term Asian-American includes cultures such as Chinese, Japanese, Taiwanese, Filipino, Korean and Vietnamese, and within these cultures, there are variations in geographic region, religion, language, family structure and more.
• Nurses should be careful about labeling patients. For instance, citizens in the United States may refer to themselves as Americans, but that term can also apply to individuals from Central and South America. Flowers recommends referring to a person from the United States as a U.S. citizen.

Responding to Higher Standards in Nursing

More hospitals across the United States now require that nurses have a bachelor’s degree. Rising educational standards are emphasized to increase the quality of care that patients receive. Alvernia University’s online RN to BSN Completion Program is designed to improve patient outcomes and help nurses meet each patient’s needs, including those unique to the patient’s cultural background. The degree program takes place in a convenient online learning environment that accommodates students’ work and personal schedules.

The RN to BSN Completion Program includes a class — NUR 318 Developing Cultural Competency & Global Awareness — which offers students “an opportunity to begin their lifelong journey to becoming culturally engaged.” This course has existed at Alvernia University for more than a decade, and demonstrates how Alvernia is leading the way in preparing culturally competent nurses.

If you’re a parent, you know how daunting those first few months are, not to mention exhausting. Many of you work with new mothers in the maternity ward, doctor’s office, etc. Wouldn’t it be helpful to offer more education about SIDS and how to care for a newborn?
 
The Baby Box Co, Cooper University Hospital and several other facilities in NJ have teamed up to save infant lives in New Jersey. It's quite an interesting idea this baby box, and because it's educational, the hope is it will increase safety for newborns. Sounds like a wonderful and welcome idea for new mothers and fathers. We hope it will spread across the U.S. and reduce infant mortality.

A statewide safe-sleeping campaign featuring free cardboard "Baby Boxes" rolled out Thursday at Cooper University Hospital, part of the newest effort to reduce the number of infants dying from Sudden Unexpected Infant Death Syndrome (or SUIDS).

New Jersey is the first state where all expecting and new parents can receive mattress-lined boxes and infant care supplies from The Baby Box Co. after completing an online parenting education program through its website, babyboxuniversity.com.

Finland introduced baby boxes, along with prenatal care and parenting education, as a way to decrease its infant mortality rate, from 65 deaths per 1,000 births in 1938, to 1.3 deaths per 1,000 births in 2013, according to the World Health Organization.

That country's work inspired Jennifer Clary and Michelle Vick to launch The Baby Box Co. in the United States. According to its website, Baby Boxes serve families in 52 countries.

"I think we have a very special product, but it's only special because of the way we distribute it," Clary, the CEO, said. "Early parenting education is linked to infant mortality reduction. That's what we focus on."

The New Jersey program expects to distribute about 105,000 boxes this year. In South Jersey, the boxes will be distributed by Cooper University Health Care and Southern New Jersey Perinatal Cooperative, among others. Parents also can choose to have the box delivered to their home.

Made from sturdy cardboard, the boxes can be used as a bed for the baby until 5 or 6 months of age. The supplies include diapers, wipes, a onesie, breastfeeding supplies and other items, valued at $150.

The program was introduced by New Jersey's Child Fatality & Near Fatality Review Board, using a grant from the Centers for Disease Control. The review board examines deaths and near-deaths of children to identify causes and ways to prevent future deaths.

While unsafe sleeping practices don't account for every case of SUIDS, parental education can help eliminate preventable deaths, said Dr. Kathryn McCans, an emergency department physician at Cooper who also leads the review board.

"Unsafe sleep is a significant cause of SUIDS in our state and likely in every state," McCans said. "Based on national data, New Jersey fares pretty well, as far as the rate of SUIDS death, but our rate is still high enough that it results in 50 to 60 deaths a year that seem to have at least unsafe sleep associated with it, even if it wasn't the full cause."

Factors associated with safer sleep include a firm mattress and a bare crib with no blankets, pillows, bumpers or stuffed animals in it; no smoking or substance use during or after pregnancy or by anyone in the household; exclusive breastfeeding during the first six months of life or any amount of breastfeeding possible.

"This program, at its core, is about getting education out to parents in a form that younger parents really love," McCans said.

Cooper doctors and health experts in New Jersey helped the company create educational videos for expectant parents on topics like installing car seats, safe sleeping practices, breastfeeding resources and support, and fatherhood engagement.

Two Camden families were the first to receive their boxes Thursday. Dolores Peterson popped her 5-week-old daughter into a cardboard box lined with a mattress, as cameras recorded little Ariabella Espada's reaction.

Peterson, a first-time mother, said she plans to tell her mothers group about the program.

"I'm going to let every mother know to sign up and get a box," Peterson said, so their babies can sleep safely, too.

To receive a free box, New Jersey parents can register for free online at babyboxuniversity.com. After watching a 10-15 minute program and taking a short quiz, parents can choose how to receive their box.

All nurses work to improve health outcomes and help monitor and manage disease. But community health nurses work in traditional public health settings and focus on the overall health of an entire community or multiple communities. Community health nursing is also known as public health nursing.

Roles and Responsibilities

“Nurses in community health work with diverse partners and providers to address complex challenges in the community,” Phyllis Meadows, PhD, RN, writes in the American Journal of Nursing. “Nowhere is this more evident than in current efforts to identify, reach, and treat people living with HIV and AIDS and in efforts to help the elderly effectively manage their chronic health problems and remain at home.”

Working with diverse populations requires cultural competency to “understand invisible factors in the community that promote health and prevent disease, such as assets, values, strengths, and special characteristics of the communities,” Pamela Kulbok, DNSc, RN, and others say in The Online Journal of Issues and Nursing. Community health nurses develop strategies and interventions that target entire population groups, families or individuals. Regardless of the practice setting, they focus on preventing illnesses, injuries or disabilities and promoting good health.

Responsibilities can include providing primary care, health education and care management to individuals and families in the community. Community health nurses can provide input to programs that address public health problems, develop public policy for health promotion and disease prevention, and evaluate health trends to help determine intervention priorities.

The Public Health Security and Bioterrorism Response Act of 2002 added a new dimension to the profession and “catapulted community health nursing to the center of emergency response plans,” according to Meadows. “Community health nurses, especially those in public health settings, are now considered first responders—a role that traditionally belonged to law enforcement and emergency response professionals. In the event of a public health threat, community health nurses will organize and administer immediate care.”

Practice Settings and Education

A strength of community health nurses is their adaptability. They provide care in patients’ homes, at organized events and at agencies and institutions that serve people with specific health needs.

Settings include community health clinics, community nursing centers, schools, churches, housing developments, local and state health departments, neighborhood centers, homeless shelters and work sites. Vulnerable and high-risk populations are often the focus of care, which includes homeless individuals, the elderly, teen mothers, pregnant women, smokers, infants and those at risk for a specific disease.

Nurses wishing to pursue a career in community health nursing typically need a bachelor’s degree and clinical experience. Those with advanced degrees can pursue teaching and research opportunities.

Making a Difference in the Community

Community health nurses merge their clinical knowledge with community involvement and outreach efforts to respond to health problems and promote overall health. They rely on critical thinking, advocacy and analytical abilities to provide dynamic and adaptive care that impacts the community.

Alvernia University’s online RN to BSN Completion Program takes a community-first approach to developing nursing skills. Courses such as Health Restoration in the Aging Population and Health Promotion in Families and Communities focus on health restoration and promotion in the community, which is ideal for students wanting to pursue a career as a community or public health nurse. The program takes place in an online learning environment that can accommodate students’ work and personal schedules.

Click here to access Alvernia University’s online RN to BSN completion program.

Washington DC area philanthropists Joanne and Bill Conway have committed to a $5 million gift to support our CNL program, funding the education of more than 110 new nurses over five years, beginning in 2018. The Conways, who gave a similar gift to UVA Nursing in 2013 are, with this transformative gift, renewing their pledge to encourage a broader diversity in the students who enroll in this program.

• Applicants must be Virginia residents, and have a FAFSA on file
• They should have experience with a vulnerable population, and a commitment to service 
• They should have exposure to healthcare in some way – through work, volunteering, personal/family experience
• They should be able to communicate well and must commit to providing 50 volunteer hours each year of funding on top of their clinical hours either in a rural, underserved or their home communities
• They must present on their work to the School of Nursing community during the course of their academic career.

All Conway Scholars (entering this summer `17, to graduate in 2019) receive a year-long grant for tuition and related expenses ($24k over the year). The new gift, which will begin funding students in 2018

A new cervical cancer study found that women with hysterectomies weren't accounted for in the previous study of cervical cancer death rates. The new evidence shows the death rate is 10.1 per 100,000 black women and 4.7 per 100,000 white women.  

This new evidence also shows a major racial disparity in cervical cancer in the US. Cervical cancer is highly preventable in the US thanks to screenings and HPV vaccines. But clearly this study shows that women need better access to those screenings and other preventative measures. 

The new findings add to the current understanding of cervical cancer's impact on different communities, said Dr. John Farley, a practicing gynecologic oncologist and professor at Creighton University School of Medicine at St. Joseph's Hospital and Medical Center in Arizona.

 

"It lets us know that there is substantial work to do to investigate and alleviate the racial minority disparity in cervical cancer in the US," said Farley, who was not involved in the study, but co-authored an editorial about the new findings in the journal Cancer on Monday.

 

"Those who get cancer, many times, do not have access to screening," he said. 

 

Even though cervical cancer mortality rates are higher than previously thought, Farley said that he thinks the current screening recommendations for cervical cancer are still adequate. However, he added, more women should have access to screenings and other preventive measures.

 

Rositch said, "It may be that some women are not obtaining screening according to our current guidelines, not necessarily that guideline-based care is insufficient."

 

How to prevent and screen for cervical cancer

The American Cancer Society recommends that women begin cervical cancer screenings at age 21 by having a pap test every three years. Then, beginning at 30, women should have a pap test combined with a HPV test every five years. 

 

Symptoms of cervical cancer tend to not appear until the cancer has advanced, which is why screening and HPV vaccinations are urged. 

 

"We have a vaccine which can eliminate cervical cancer, like polio, that is currently available and only 40% of girls age 13 to 17 have been vaccinated," Farley, co-author of the editorial, said. "This is an epic failure of our health care system in taking care of women in general, and minorities specifically."

 

Women over 65 might not need to continue screening if they don't have a history of cervical cancer or negative pap test results, according to the American Congress of Obstetricians and Gynecologists.

 

Each year, about 38,793 new cases of cancer are found in parts of the body where HPV is often found. The virus not only has been linked to cervical cancer, but also cancers of the vulva, vagina, penis, anus or throat. 

 

A study that published in the journal JAMA Oncologylast week found that among a group of 1,868 men in the United States, about 45% had genital HPV infections and only about 10% had been vaccinated.

 

"Male HPV vaccination may have a greater effect on HPV transmission and cancer prevention in men and women than previously estimated," the researchers wrote in that study.

 

If you’re looking for an update on legislative measures for Nurses, please read this article. Some information is by state, such as legislation in CA to prevent workplace violence which is referred to as “a regulation landmark and a model for other states and the country. It requires every health care provider to develop a comprehensive workplace violence prevention plan.”

There is also national legislation such as the ban on powdered surgical gloves across the country that goes in to effect today. What are your thoughts about the legislation noted below?

Although 2016 brought some legislative disappointments-such as Congress's failure to pass Title VIII legislation, which is designed to reauthorize, update and improve nurse workforce programs-several states moved forward with an array of legislation and regulations that will affect nursing practice this year.

Here's a sampling of what's new for nurses in 2017:

1. Combatting workplace violence, starting in California

California Occupational Safety and Health Standards Board approved regulations to prevent workplace violence in health care settings. The legislation (SB 1299) passed in 2014 and was sponsored by the California Nurses Association/National Nurses United (CNA/NNU).

Bonnie Castillo, RN, director of health and safety for CNA/NNU called the legislation a regulation landmark and a model for other states and the country. It requires every health care provider to develop a comprehensive workplace violence prevention plan. The plans must assess threats and risk of physical and verbal attacks and how to mitigate the risk. Nurses and other health care workers must be involved in the planning.

The rules require hands-on training, competency validation and engineering controls, such as alarms. The regulation includes the entire health facility campus, including parking garages. The regulations require internal incident logs and reporting to Cal/OSHA, even if no injury occurred. And there is a provision to disallow retaliation if the nurse or other worker reports or calls in law enforcement.

"The intent is to ensure all hospitals are safe and therapeutic," Castillo said. "The incidence of violence has increased."

The union will meet with representatives of the Occupational Safety and Health Administration in January about making these regulations national. NNU plans to advocate for passage of similar legislation in other states, and legislation to protect nurses in other settings, such as schools or retail clinics.

"Every state needs this," Castillo said. "Nurses cannot provide a level of care their patients need if they are unsafe. If the nurse is at risk, everybody is at risk."

2. Oregon's nurse staffing law takes effect

The Oregon Legislature passed nurse-staffing legislation in 2014 and all aspects of the law have taken effect as of January 1, 2017. It requires that hospitals create nurse staffing committees comprised of direct-care nurses and nurse managers to develop and approve staffing plans for their hospitals. The law also sets limits on mandatory overtime, creates a mediation process to resolve disagreements and requires regular audits by the Oregon Health Authority.

3. Multistate nurse licensing and the Enhanced NLC

The Nurse Licensure Compact (NLC), launched in 2000, allows nurses to have one multistate nursing license and practice in their home state and other compact states. Twenty-five states currently participate in the original compact, which streamlines the licensing process for many travel nurses.

In 2015, the National Council of State Boards of Nursing (NCSBN) developed an Enhanced Nurse Licensure Compact, which lets nurses provide telehealth nursing services or respond to emergencies in fellow compact states without an additional license. The enhanced compact will come into effect when 26 states pass it or on December 31, 2018.

South Dakota became the first state to pass the Enhanced NLC in 2016. Nine additional states have followed, and the NCSBN expects several more states to approve the new compact in 2017.

Contact American Mobile for help expediting the nurse licensing process, in compact and non-compact states.

4. Changes to nurse continuing education          

Washington State has changed its continuing education requirements to include that nurses complete a mandatory 6 hours of continuing education in suicide assessment, treatment and management.

Florida is considering a requirement that all nurses and other health care professionals complete a 2-hour continuing education course about human trafficking and domestic violence every third biennial relicensure or recertification. For nurses, the course must be approved by the Board of Nursing.

5. State scope of practice laws for nurse practitioners

State regulations about how much autonomy nurse practitioners have in their practice are constantly changing. This State Practice Environment map from the American Association of Nurse Practitioners (AANP) can help you keep up on the latest news. Find travel NP jobs with our partner, Staff Care.

6. National ban on powdered surgical gloves

The U.S. Food and Drug Administration is banning the use of powdered gloves during surgeries, in patient examination gloves and absorbable powder for lubricating a surgeon's glove. The agency said that these products "present an unreasonable and substantial risk of illness or injury and that the risk cannot be corrected or eliminated by labeling or a change in labeling." The ban takes effect January 18, 2017.

Magnet certification. You’ve heard the term, but do you really know what it means and how difficult it is to achieve Magnet status? Did you know that only 6% of all US hospitals are Magnet recognized? To work at a Magnet hospital brings pride to their Nurses because it’s something they’ve worked hard to achieve.

If you’d like to know what it’s like to work at a Magnet recognized hospital, please read this article written by a Magnet Nurse.