DiversityNursing Blog

By Carolina Madrid

August 31, 2012

We tend to categorize every ethnic community outside of  Whites as a minority or diverse population group, but there’s a gray area that we’re failing to pay close attention to: the bicultural and multiracial population. It was the fastest-growing youth group in the country in the last decade, increasing almost 50 percent to 4.2 million, according to Census 2010.

As our nation’s population becomes more diverse, the bicultural population will continue growing and the segregated communications approaches that have worked in the past will not work with this audience any longer. Use the guide below as an overview to understanding biculturalism and how you can think about it in an upcoming campaign.

A cultural tug of war

Being bicultural, multicultural or multiracial means that you have ties to different cultures. It can mean that you grew up in the United States with roots in another country or that you have parents from distinct ethnic backgrounds. Either way, there’s usually a sense of being pulled in two different directions while trying to maintain both or assimilate into another.  Why does this matter? Because someone who you thought was a Hispanic, Spanish-speaking person may not be receptive to messaging that speaks solely to Latinos.

Inglés or Spanish?

The language preference of bicultural individuals varies.  Younger populations who went to school in the United States tend to prefer English, while older populations will favor their native language.  There’s also the second-generation population who doesn’t prefer one or the other. The language you use will largely depend on the demographic.

What am I?

The degree to which individuals associate themselves with a given cultural background also varies. Just as there are those who believe in maintaining a sense of heritage, there are those who don’t want to stay in touch with their roots and prefer to assimilate into only one culture. This is why it’s important to stay away from explicit cultural messaging that would isolate or turn off the bicultural or multiracial population.

Univision or CNN?

Just because someone speaks Spanish doesn’t mean he or she watches Univision, the nation’s largest Spanish-language network. In fact, he or she will likely prefer to watch English-language TV. Still, on CNN, there is an opportunity to reach the bicultural population with messaging about the Hispanic or Asian population.

Fusion nation

Fusion cuisine is a perfect example of the adaptation and merging of two different cultures. You appreciate the base flavor of the dish, while adding in contemporary ingredients and spices for a blend that’s the best of both worlds. Don’t be afraid to also use this approach in your communications programs, using a mix of messages.

Contextual decision-making

How you communicate with a bicultural population will also depend on the message that you’re trying to convey. Different scenarios will call for the incorporation of cultural messaging, while other times, this might seem forced. But what is certain is that early awareness and the ability to use it wisely will reap the rewards of a genuine connection.

From thestarpress.com By Michelle Kinsey

MUNCIE — Indiana University Health Ball Memorial Hospital wants to make sure that every person who walks through their doors gets equal treatment.

That commitment has landed the hospital at the top of a list, as the first in the state to be designated as lesbian, gay, bisexual, transgender (LGBT) friendly by the Human Rights Campaign, the nation’s largest LGBT civil rights organization.

The news came in the form of the HRC’s annual Healthcare Equality Index for 2012, which looks at how equitably healthcare facilities in the United States treat their lesbian, gay, bisexual and transgender patients and employees.

IU Health BMH was one of 234 nationwide — but the only one in the state — recognized as a “Leader in LGBT Healthcare Equality,” meeting all four core policy categories — patient non-discrimination; employment non-discrimination; equal visitation for same-sex partners and parents, and training in LGBT patient-centered care.

“We are proud of the recognition,” said IU Health BMH President and CEO Mike Haley. “It’s the result of a lot of hard work.”

That work began two years ago, after a transgender patient claimed she was mistreated in the hospital’s emergency room.

Transsexual Erin Vaught claimed she was called “it” and “he-she” and eventually denied treatment when she went to the ER on July 18, 2010, for a lung condition that was causing her to cough up blood.

Complaints were filed days later by Indiana Equality and Indiana Transgender Rights Advocacy Alliance and the incident went viral, with the hospital receiving criticism nationwide, and beyond.

Ball Memorial Hospital released a statement saying the hospital was conducting an internal review.

The result?

“We failed to meet their needs,” Haley said. “We acknowledged that openly.”

Then they went a step further.

“It’s one thing to apologize,” he said. “It’s another to say, ‘And furthermore, I want this hospital to be considered as a place anyone would want to go if they needed a hospital.’”

Haley issued a challenge to all physicians, employees and volunteers to meet every HRC key indicator.

Ann McGuire, vice president of human resources for IU Health BMH, led the hospital’s efforts. Members of the LGBT community were asked to help.

Jessica Wilch, board member and past president of Indiana Equality, an LGBT rights group, said she was a “believer in what (IU Health BMH was) trying to do” from the first meeting.

“When this went viral, my concern was that BMH would take the stand that this was an isolated incident and just pacify the process,” Wilch said. “Instead they saw it as a teachable moment.”

New policies were drafted and training was developed.

In addition to hospital leaders, anyone a patient would come in contact with was involved in the training, McGuire said, adding that it was about more than just a tutorial. It was about “eye-opening” conversations.

Wilch agreed, saying that face-to-face conversations with the LGBT community were essential.

“We could talk freely about the things we have encountered and then come up with ways, together, to handle it differently,” she said.

Overall, the HRC reports the number of American hospitals striving to treat lesbian, gay, bisexual, and transgender (LGBT) patients equally and respectfully is on the rise.

This year’s survey found a 40 percent increase in rated facilities.

Last year, IU Health BMH was short a few policy additions for the leadership HRC designation, but was still recognized for its efforts.

Wilch said she was not surprised the hospital “hit all of the marks” this year.

“They have become, essentially, one of the leading hospitals in the country, because it really started with them,” she said. “They were the ones who reached out to us and said ‘How can we make this better? How can we do the right thing?’”

Haley said he believed the training and policies developed at IU Health BMH will be used “across IU Health.”

IU Health BMH has also set out to look at other ways to expand their “best practices” when it comes to diversity, McGuire said. The hospital has been hosting Palettes of Diversity events, which have celebrated not only the LGBT community, but other cultures.

“We are making sure we are hard-wiring an environment recognizing and supporting diversity for all who come here,” Haley said.

McGuire agreed.

“It’s about relationships and dignity and respect,” she said. “It is uniqueness that each of us brings that makes us stronger as a community.”

And, McGuire would tell you, as a hospital.

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?

by Claire Theriot Mestepey

Whether you are interviewing a person with a disability for a job or meeting them for the first time at a party, here are some simple tips that will put you both at ease. It’s so important to remember that no matter what the disability is, whether blindness, deafness or wheelchair-users, they are people. Once you overcome preconceived notions about their outer appearance, it will pave the way to better communications, understanding, and acceptance.

1. When you first meet, always offer to shake hands. Most of us will offer the most controlled limb; it might even be a foot. For instance, because of my cerebral palsy, my left arm’s natural state is folded up, hand sitting on my shoulder. So if I had to extend my left arm to shake yours, it would take 13 minutes. But I can shake your right hand with little or no effort. Let the person with the disability take the lead, but do offer a friendly handshake. I think the first handshake sets the tone of how open one will be in the relationship. In other words, opened hand, opened heart.

2. Often people want to speak louder when they are addressing me. I am not deaf, but even if I was, how would shouting help us communicate better? Always try to talk in a normal tone. I do believe that disability etiquette is a two-way street and if the person with the disability would like you to speak louder they should just ask.

3. Most people are good Samaritans at heart; they like to help. As a woman with cerebral palsy I appreciate immensely when people offer assistance. Sometimes I accept with a nod and a thank you. Other times I don’t want help. I’m extremely independent and if I know the task is doable, however difficult it may seem, I like accomplishing it. On rare occasions overzealous Samaritans try to help, despite my pleas not to. I know people are just trying to help, but it borders on being disrespectful and can sometimes put the person with a disability on defense.

These are just three common disability etiquette tips. Upon reflection, these suggestions works for anyone, disabled or not. Many people want to learn disability etiquette, which is quite admirable. Taking the time to know someone, though, is more important than any etiquette training. Moving beyond stereotypes and learning each person’s limitations (because we all have them) and abilities are essential to understanding what an individual can offer your organization.

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Have you ever felt unsure of what to do meeting someone with disabilities? How did you handle the situation?

Have you ever tried any of Ms. Mestepey's suggestions? Did it help? Do you have additional behaviors you find helpful?

In addition to being a Career Job Board for student Nurses up to CNO's, we are an Information Resource. We hope you find this "Focus on Diversity" story particularly interesting...

Pat Magrath, National Sales Director at DiversityNursing.com recently sat down with Dr. Earlene Avalon, PhD, MPH, Director of Nursing Diversity Initiatives; and Eva Gómez, MSN, RN, CPN, Staff Development Specialist at Children's Hospital Boston to discuss the Nursing Career Lattice Program, Diversity and Cultural Competence, and their roles at Children's Hospital Boston.

Dr. Avalon has overseen The Nursing Career Lattice Program (NCLP) at Children's Hospital Boston since the Program started in 2009. The NCLP is an initiative designed to increase the racial and ethnic diversity of Children's nursing staff. Through a generous grant, the NCLP was designed to "address the local shortage of nurses of color as well as to create a workforce that better reflects our patient population's multi-ethnic and multi-racial makeup. The Lattice Program looks for potential nursing students among our current employees-including Clinical Assistants, Surgical Technicians, Administrative Assistants and Food Service staff." The NCLP provides the services and support employees need to complete their education in various nursing schools throughout the Boston area.  

Dr. Avalon states, "It is important to note that I am not a nurse by training. My training is in public health and workforce development in healthcare. I have always been interested in ways that we can increase diversity at the provider level (e.g. nursing) and how that impacts patient satisfaction and outcomes."   

Dr. Avalon suggests "workforce development programs are a win-win for both the employee and the hospital. In particular, given the significant impact that nurses have on the lives of our patients and their families, we are committed to continuously growing a nursing workforce that is able to successfully meet the needs of our changing patient population."

"Our work focuses on looking within our own four walls and developing our employees to their fullest potential," says Dr. Avalon. "One of my responsibilities, and truly one of the best aspects of my job, is the opportunity to sit down with an employee and discuss their aspirations and any challenges they face in pursuit of a career in nursing.  For many, they were forced to put their dream of becoming a nurse on hold.  Oftentimes, employees express that they are the first in their family to attempt college-level courses and they do not have support systems at home. As a result, they often do not know what questions to ask or where to begin and this can negatively impact their success in college. NCLP offers support to our employees that allows them to realize that they are not alone in this process."  

The program provides employees with one-on-one mentoring, professional development, academic counseling and the financial support needed to successfully complete nursing school. "My team helps employees to create a semester-by-semester plan that will enable them to pursue their dream of becoming a nurse - even if it is on a part-time basis." Dr. Avalon continues "We also support our employees by providing them with an experienced nurse as a mentor and the opportunity to shadow a nurse in order to have a better understanding of the profession."

NCLP is not just an academic resource; they help each employee with tutoring, selecting pre-nursing coursework as well as creating a plan to help balance the demands associated with school, transportation, family and work. NCLP enables Children's Hospital Boston to create a strong multicultural workforce that provides the best family-centered care to their patients and community.

Five years ago Ms. Gomez came on board as a Staff Development Specialist to focus the work on Cultural Competence and Diversity. She states, "Among my many roles, I lead the Multi-Cultural Nurses' Forum, the Student Career Opportunities Outreach Program and I provide Cultural Diversity Awareness training to staff throughout the hospital."

I asked Ms. Gomez why Healthcare Institutions should have someone like her on their staff. She responded, "Cultural competence and diversity are two essential ingredients in delivering care for all patients and should be assets that are recognized, valued and embraced at every level of any hospital or healthcare institution. Awareness, advocacy and education are essential components of successful diversity and cultural competence initiatives. Having someone in this role can help hospitals remain on track by carrying out the activities that drive these initiatives. This effort will ultimately lead us into providing care for all of our patients in a culturally appropriate and meaningful way."

She also states, "The work of diversity is ongoing and evolving. In 5-10 years, we will probably have grown and improved the diversity within the nursing profession. However, I expect we will continue to work so our efforts don't become stagnant and we need to sustain the positive changes achieved thus far. The future is hopeful, but it will require time, dedication and work from all of us."

Working together with other Children's Hospital Boston employees, Dr. Avalon and Ms. Gomez have:

• Organized and coordinated The Multi-Cultural Nurses' Forum, which included their first-ever night session. This session was held at 2am in order to better meet the needs of their night nurses. The hospital's CNO and Senior Vice President, Eileen Sporing attended the meeting in order to have a one-on-one conversation with the night time nursing staff who are part of the forum.
• Brought diverse high school students into the nursing profession through their Student Career Opportunities Outreach Program.
• Created a successful nursing mentoring program.

The Peer Advisor Program, which pairs upper-class students with first-year students to help them get acclimated to and thrive at U.Va., became her extended family. Students in the program came to rely on her like a mother away from home.

On the occasion of her retirement, Terry sat down for an interview with UVa Today's Anne Bromley and talked about the philosophy behind the Peer Advisor Program and her roles at the University.

…

UVa Today: Did you feel like you were creating something new here at U.Va., changing its history?

Terry: I didn’t think of it so consciously at that time. I thought of it more as exposing more people, more children, more students about possibilities about college. 

The great thing about those sessions is that not only were we talking with high school juniors and seniors, but the families were there. I remember creating a series of leaflets for children. We called it "Steps to College." In it we were suggesting things for them to think about for that particular year. 

It makes me feel very proud, being in the Office of Admission for almost 10 years, from 1980 to 1989, and seeing the numbers of black students increase. When I look at the alumni who come back, many of them were students in high school when I met them. That makes me feel older, but it also makes me feel proud because of the things that they are doing. 

Those days at admissions laid the foundation in terms of this work for the Peer Advisor Program. 

I often tell the story of my second year in admissions when the vice president for student affairs, Ernie Ern, invited me and others to a meeting he was holding of black students. The thing that touched me the most was a young man, and I remember his words: "U.Va. has done everything to get me here, but now that I’m here, nobody seems to care." I never forgot that, because here was a student who had been recruited and who had come, but who was experiencing what I’ll call disappointment, experiencing isolation.

When I left that meeting, I went back to my office and I sat down and I looked at the black student admissions committee that I had organized. One of the things I immediately thought is, I'm going to add a subcommittee to check on students we had had contact with. I assigned members of the committee to the different residence halls, and they picked up where we left off – after two or three weeks, we were gone – but the students were there to check on the welfare of other students, and that was one of the forerunners of the Peer Advisor Program.

I found, probably about a year or two ago, a note that I had written Jean Rayburn, who at the time was dean of admission. She had sent out a note to the staff to ask if any of us had any ideas about ways of retaining students. I actually wrote – and I have it hand-written because we didn't have the computers then – several things, and one of them was what I called a "Big Brother, Big Sister program." I smiled when I read it because number one, I had forgotten about it; number two, when I read it, it was exactly the kinds of things I have done with the Peer Advisor Program. 

UVa Today: How did you come over to the Office of African-American Affairs?

Terry: I applied for the position because I wanted to have more time with my children. Did that happen? No. Looking at this office and that it had developed this program that I'd actually proposed, this was something I was excited about. It was the program that attracted me. 

Everybody makes sacrifices, and when I look at U.Va. and some of the sacrifices, it's not just been me, it's been my family. 

Shawna, when she was real little, she thought every person who was a teenager or a young adult was a peer adviser. I remember being in church one Sunday and U.Va. students talking to me. Shawna got antsy because she'd been good, she had sat through service, and she beckoned me and said, "Mommy, Mommy, can't we go home? Can't you stop talking to all these peer advisers?" 

I think in our household, it almost has been that I have three children as opposed to two – the Peer Advisor Program is actually the same age as my son, 24. So they have grown up around peer advisers. I'd have peer advisers over for dinner, we would do things together, so it's just been that other presence in our house.

…

UVa Today: Have people asked you, "Shouldn't every first-year student have this kind of program?" Are there things that are specific issues or challenges to black students, or has that changed over time?

Terry: The latter part hasn't changed. I have peer advisers do mid-year interviews. We have questions about the disappointments you have experienced, the joys you've had; what is the best academic experience you've had, what is the worst? I do find that students still talk about, sadly, some racial insensitivity. If one asks, "Is this program still needed?", it is still needed, though this program is not about separating, it's about providing support. 

Should every student have a peer adviser? I think every student should. The way I have always seen it is every student has a peer adviser through the role of residence life. I think the difference is peer advisers don't have to manage an environment within a dorm setting, so I know peer advisers don't have to enforce rules. With [resident advisers], there are certain rules they have to enforce. RAs are on call 24 hours; so, too, are peer advisers. 

Where I see the difference is, if there is some racial insensitivity – it's not to say that an RA cannot address that at all, an RA can – I have additional support here. If I have experienced something, then I can be of more assistance, perhaps, than someone who may not have experienced it. 

… 

— By Anne Bromley