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Mary Mescher Benbenek PhD RN CNP
Linda Lindeke PhD RN CNP FAAN
School of Nursing
University of Minnesota
EMBRACING A GLOBAL FRAMEWORK: INTEGRATING THE NEW AACN CULTURAL COMPETENCY STANDARDS INTO NURSE PRACTITIONER EDUCATION
Or put another way:
Embracing a Global Framework: Integrating the new AACN Cultural Competency Standards and CULTURAL HUMILITY into Nurse Practitioner Education
Practitioner Education
Grant Support Acknowledgement
Addressing Health Disparities through DNP Preparation (PI Sandra Edwardson, PhD RN FAAN) is funded by a 3‐year grant from the U.S. Department of Health and Human Services
Department of Health and Human Services, Health Resources and Services Administration (HRSA) D09HP14823.
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Acknowledgements
• We would like to acknowledge our colleagues in the School of Nursing, the School’s Diversity and Inclusivity Committee and our students
• Additionally, we credit the University of Additionally we credit the University of
Minnesota Center for Spirituality and Healing for research and education in integrative/complementary therapies (Director Mary Jo Kreitzer PhD RN)
Introduction: Setting the Stage for Multiculturalism
311,591,917 U.S. population 2011
– 79 ethnicities
– 40 language categories spoken in the home
– 2010 census: individuals allowed to list more than 1 race
– Shifting age demographics
Age
Percentage
Under 5 years
6.5
5‐17 years
17.4
18‐44 years
37.2
45‐64 years
25.7
65 years and older
12.8
U.S.Census Bureau. The 2012 Statistical Abstract
Culturally Unique Health Care Beliefs
• Eastern Medicine
• Traditional Chinese Medicine • Herbal Therapies
• Cupping and Coining 2
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Considerations in Providing Culturally Appropriate Health Care
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Gender, defined in multiple ways
Disability and functional status
Geography, access to services
Socioeconomic status
Age and developmental capacity
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Interaction customs and approaches
Preventative health and health promotion benefit
Health/language literacy
Our own assumptions as providers (i.e. rye contact)
Religious beliefs, customs and requirements
Trust Cultural Competence
• “Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to ork effecti el in cross
those professions to work effectively in cross‐
cultural situations”. (Cross 1989)
• Cultural competence is defined for our purposes as the attitudes, knowledge, and skills necessary for providing quality care to diverse populations (The California Endowment, 2003).
Cultural Humility
• Focuses on self‐reflection and self‐critique of personal values and beliefs
• Acknowledges values and beliefs of other cultures
• Builds on uniqueness of cultures
• Creates mutually beneficial care model for APRN and patients, families, communities
• Requires us to examine our assumptions, suspend judgment and ask questions 3
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Stages of Cultural Competence
Cultural Proficiency
Cultural humility?
Cultural Competence
Cultural Pre‐
Competence
Cultural Blindness
Cultural Incapacity
Cultural Destructiveness
Adapted from The National Center for Cultural Competence, Georgetown University 2005
Why Cultural Competence in Graduate Education?
• Develop a socially and empirically derived understanding of complex causes of disparities • Implement culturally competent nursing care • Address social justice • Advocate for patients and policies that advance health d
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care • Develop competency in collaboration with patients, key persons, agencies, and various stakeholders, • Modify attitude and transform personally
• Contribute to culturally competent scholarship •
American Association of Colleges of Nursing 2009
AACN Cultural Competencies
• Competency 1: Apply knowledge of social and cultural factors that affect nursing and health care across multiple contexts.
• Competency 2: Use relevant data sources and best evidence in providing culturally competent care.
• Competency 3: Promote achievement of safe and quality Competency 3: Promote achievement of safe and quality
outcomes of care for diverse populations.
• Competency 4: Advocate for social justice, including commitment to the health of vulnerable populations and the elimination of health disparities.
• Competency 5: Participate in continuous cultural competence development
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American Association of Colleges of Nursing 2009
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Integration of Cultural Competency/Humility into APRN DNP Education
• Self‐reflection
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Paul Gorski multicultural pavilion (1995‐2012)
Exploration of own culture and beliefs
Discovery of bias (quiz)
Concept mapping
• Scenarios with facilitated student discussion
– Worlds Apart 1 video (link)
– Worlds Apart 2 video (link)
– Book, journal discussions (all‐school book reading: The Immortal Life of Henrietta Lacks)
Case Study Discussion
• Characteristics of Case Studies
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Across the lifespan
Multiple cultures
Chronic disease management
Preventative screening issues
Preventative screening issues
Immunizations • Integrated into DNP core courses: Holistic Health Assessment, Assessment and Management of Health, Clinical Pharmacotherapeutics, APRN clinical courses and seminars, Family Theory, Ethics, Health Policy, Leadership
Cross‐Cultural Experiences
• Interpreter panel discussion
• Diverse clinical experiences
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Socio‐economic
Rural Urban
Ethnic/community clinics
School‐based clinics • Interdisciplinary student‐run clinic experiences
– Family Practice
– Integrative Health
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Characteristics of Culturally Competent Students
Value diversity
Practice with cultural humility
Conduct self‐assessment
Manage the dynamics of difference
Manage the dynamics of difference
Acquire and institutionalize cultural knowledge
• Adapt to diversity and the cultural contexts of communities they serve •
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Adapted from National Center for Cultural Competence
Outcome Evaluation
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Observed Standardized Clinical Encounter (OSCE)
Simulation and role play
Clinical portfolio
Cli i l ti t t
Clinical patient outcomes
Practicum evaluation
Self‐reflection/journaling/surveys
Community engagement clinical hours Scholarship (papers, assignments, DNP projects)
Challenges to Integrating Cultural Competence
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Developing stereotypes
Time constraints within the clinic setting
Limited language abilities
Lack of cultural actors for OSCEs
Lack of cultural role models among faculty
Continuum: Stages of Cultural Competence
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Patient Diversity
Cultural backgrounds
Socioeconomic backgrounds
Age
Gender
Health beliefs
APRN Educational Needs
AACN Cultural Competencies
Education
Clinical Practice
Case Studies
Investigation
Surveys
Clinical Experiences
Cultural Competence
Scholarship
Writing
Research
Presentations
Policy Formation
Service Involvement
Professional Associations
Cultural Humility
Patient Outcomes
Diminished health disparities
Enhanced patient adherence
Improved satisfaction
Resources
• AACN Toolkit http://www.aacn.nche.edu/education‐resources/cultural‐
competency
• Camphina –Bacote model http://www.transculturalcare.net/
• Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989). Towards A Culturally Competent System of Care, Volume I. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center.
Gilbert M J (2003) Principles and Recommended Standards for Cultural
• Gilbert. M. J. (2003). Principles and Recommended Standards for Cultural Competence Education of Health Care Professionals. The California Endowment. http://www.calendow.org/uploadedFiles/principles_standards_cultural_c
ompetence.pdf
• National Center for Cultural Competence http://nccc.georgetown.edu/
• Cultural humility http://info.kp.org/communitybenefit/assets/pdf/our_work/global/Cultura
l_Humility_article.pdf
Celebrate the richness of multiculturalism!
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