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Enhancing the Integration of Cultural Competence In a MSN Curriculum

Nan Leslie, PhD, WHNP-BC;Susan McCrone PhD, PMHCNS-BC;

Cynthia Persily, PhD, RN, FAAN; Alvita Nathaniel, PhD, FNP-BC

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The authors wish to thank the Health Resources and Services Administration (HRSA) for support of this project (Grant #: 1D09HP09085-01-00)

The Need for Cultural Competence in the Curriculum

• Our health care system has begun to acknowledge the diversity of the population that it serves.

• There has been an increasing emphasis on nursing education that emphasizes the cultural competence of those who deliver care (Office of Minority Health, 1999; Stith & Nelson, 2003).

• To eliminate health disparities, curricula need to incorporate a deeper understanding of the multicultural context in which care is delivered.

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The Construct of Cultural Competence

• A complex interactive process of developing cultural awareness, knowledge, and skill acquisition in the delivery of optimal levels of health care within the context of multicultural clinical organizational, and community situations.

(Campinha-Bacote, 2002;Gilbert, 2003; Purnell, 2002)

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Our Shrinking World Population is increasing and land/person is becoming less

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Expanding a Rural Perspective to a Global Perspective

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Expanding a Rural Perspective to a Global Perspective

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Demographics of WV (USA)

• Population 1,818,470 (299,398,484)• Female 51.0% (50.7%)• White 94.9% (80.1%)• Black 3.3% (12.8%)• Am Indian 0.2% (1.0%)

– Alaska Native• Asian 0.6% (4.4%)• Hawaiian & 0% (0.2%)

– Other pacific Islanders

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Demographics of WV (USA)

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An Evolving WVU SON Graduate Curriculum

• Original MSN Program 1970s• MSN-FNP 1995• PhD 2000• MSN Revised 2005• PNP 2003• NNP 2004• DNP 2007• WHNP & GNP 2008 • BSN to DNP 2010

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Fostering Sensitivity and Awareness of Cultural Differences and Needs

• Concepts of ethnicity and culture are threaded throughout the curriculum– Developed from NONPF guidelines

– But…

– Is this satisfactory to prepare practitioners to intervene in health disparities by fostering sensitivity and awareness of patients’ cultural differences?

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Focal Areas That Would Strengthen Cultural Competence

• Strengthen cultural competence in the curriculum

• Develop web based cultural competence modules for APN preceptors in clinical settings outside the University

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HRSA Objective(s)

• 3 of the 4 objectives in our HRSA grant emphasize the preparation of health professionals, Advanced Practice Nurses, who will deliver culturally competent care

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HRSA Support to Promote Culturally Competent Care

• Funded Consultant– Provided tool for the assessment of faculty knowledge of cultural

competence– Suggested tools for the process of curriculum assessment and

enhancement – Assisted in the development of an outline for modular development

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The Process

• A convenience sample of 35 nursing faculty were involved in the project.

• A pre-post test design was used to evaluate the impact of a 3 hour educational program provided by the consultant on faculty cultural competence.

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Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals –

Revised (IAPCC_R©) [Campinha-Bacote, 2002]

• 25 - item Likert scale

• Measures five cultural constructs:– Desire

– Awareness

– Knowledge

– Skill

– Encounters

Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals –

Revised (IAPCC_R) [Campinha-Bacote, 2002©]

• Tool has been used nationally and internationally.

• Construct, content, and face validity have been established.

• Cronbach alpha reliabilities ranged from .72 to .87 in national samples

• Cronbach alpha reliability in this study was– Pretest 0.899 Post test 0.871

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Findings

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Analyses

• A paired t-test was used to analyze the pre- and post test scores.

• Sample mean on the pretest was 71.2 and on the posttest 78.8 (p. < .001).

• There was a significant difference (p. < 0.05) on 12 of the 25 items from pretest to posttest.

Item Scores Significantly Changed from Pretest to Posttest

• On the items from the five subscales of the assessment tools, scores improved differently indicating more deficits in some areas than in others. – Awareness 3/5 60%– Knowledge 2/5 40%– Skill 4/5 80%– Encounters 1/5 20%– Desire 2/5 40%

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Level of Cultural Competence

• Culturally Proficient 91-100• Culturally Competent 75-90• Culturally Aware 51-74• Culturally Incompetent 25-50

Based upon these levels, at the completion of the educational session among the faculty attendees:

26% were culturally aware66% were culturally competent 8% were culturally proficient

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Module Development

• Undertaken by a task force of faculty to create modules for continuing education for preceptors and students entering our DNP program without a background in cultural competence

• Utilized the Campinha-Bacote Model

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Cultural Awareness/Attitudes

• Module 1– Self assessment – prejudices/ biases

– Exploration of one’s own cultural background

– Importance in health care

– Models/ Initial resources

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Cultural Knowledge/Cultural Encounters

• Module 2 – Bio-cultural ecology/pathophysiology/assessment

• Module 3– Ethnic pharmacology

• Module 4– Institutional and organizational issues in cultural

competency

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Cultural Knowledge/Cultural Encounters

• Module 5– Health literacy/ linguistic competence

• Module 6 – Ethical issues in culturally competent care

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Cultural Skills

• Module 7– Culturally competent care toolkits

• Module 8– Culturally competent education

toolkits

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