Foundations of Transcultural Nursing

NRSE 4570 RUBRIC: M1 A2 WA: CULTURAL DIVERSITY AND ITS INFLUENCE ON NURSING PRACTICE (40 pts) Criteria Introduction Key Requirement 1 Key Requirement 2 Body Key Requirement 3 Conclusion Last updated: 06/07/2017 Accomplished 7 to 7 Points  Clearly states the purpose of the paper.  Provides a comprehensive overview of topic or questions.  Engages the reader.  Organized and has easy follow. 7 to 7 Points  Identify all eight reasons why transcultural nursing is a necessary specialty, according to Madeleine Leininger.  Identifies each and demonstrates critical thinking. 7 to 7 Points  Describe the meaning of culture in student’s own words.  Relates its relationship to the field of nursing.  Evidence of critical thinking. 6 to 6 Points  Describes three ways that culturally sensitive care is provided in student’s own words  Demonstrates critical thinking. 7 to 7 Points  Summarizes paper and reflects on what the reader has learned from the paper.  Demonstrates persuasive thought and is well organized. Levels of Achievement Needs Improvement 2 to 6 Points  Overview is provided, but key points/ideas are missing.  Purpose statement is not clear.  Does not engage the reader.  Somewhat disorganized but still comprehensible 3 to 6 Points  Identifies the eight reasons but does not demonstrate critical thinking OR  Identifies fewer than eight reasons 3 to 6 Points  Brief definition of culture/only defines per a textbook definition  Does not relate the relationship of culture to the field of nursing.  Lacks critical thinking. 3 to 5 Points  Brief mention of three ways that you provide culturally

 Sensitive care  No critical thinking  Only 1 paragraph. 2 to 6 Points  Merely summarizes the introduction or contains new ideas not present in the paper contents.  Somewhat disorganized but still comprehensible © 2017 School of Nursing – Ohio University Not Acceptable 0 to 1 Points  Does not provide an overview of the paper or is absent.  No purpose statement. 0 to 2 Points  Identifies fewer than half of the reasons set forth by Leininger  No critical thinking, difficult to follow writer’s train of thought 0 to 2 Points  Writer is disorganized  Brief definition  No relation of culture to nursing 0 to 2 Points  Lists three ways that culturally sensitive care is provided  Writer is disorganized  Difficult to follow train of thought. 0 to 1 Points  Simply restates the introduction or is absent.  Disorganized to the point of distraction. Page 1 of 2 NRSE 4570 RUBRIC: M1 A2 WA: CULTURAL DIVERSITY AND ITS INFLUENCE ON NURSING PRACTICE (40 pts) Criteria Stylistics Accomplished 6 to 6 Points  APA Citations are appropriate.  Formatted correctly.  Reference page is complete and correctly formatted.  At least 4 references provided: Two (2) references from required course materials and two (2) peer-reviewed references. *References not older than five years.  More than 600 words excluding title and reference pages. Levels of Achievement Needs Improvement 3 to 5 Points  APA Citations are appropriate and formatted correctly.  Reference page is formatted correctly.  References are not professional or is not formatted correctly.  Missing 1 professional reference.  At least 600 words or more excluding title and reference p ages. Not Acceptable 0 to 2 Points  No citations are used or citations are made but not formatted correctly Foundations of Transcultural Nursing

 Reference page is missing.  Less than 600 words excluding title and reference pages. Peer-reviewed references include professional journals (i.e. Nursing Education Perspectives, Journal of Professional Nursing, etc. –), professional organizations (NLN, CDC, AACN, ADA, etc.) applicable to population and practice area, along with clinical practice guidelines (CPGs – National Guideline Clearinghouse). References not acceptable (not inclusive) are UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance recommendations, & secondary clinical databases. *All references must be no older than five years (unless making a specific point using a seminal piece of information) Note: You will have three (3) attempts to submit a written assignment, only the final attempt will be graded. For each attempt you will receive a SafeAssign originality report. This will give you a chance to correct the assignment based on the SafeAssign score. Click here to view instructions on how to interpret SafeAssign originality report. Last updated: 06/07/2017 © 2017 School of Nursing – Ohio University Page 2 of 2 bs_bs_banner Journal for Specialists in Pediatric Nursing E D I TO R I A L The influence of culture on nursing practice and research Search terms Culture, diversity, cultural sensitivity, cultural humility, cultural competence. doi: 10.1111/jspn.12058 Any nurse practicing at the bedside or conducting research with patients or students is keenly aware of the influence of culture on such practice. Culture shapes each one of us as an individual and as a nurse; similarly, it also shapes our patients and our research participants. The purpose of this editorial is to review briefly our shared understanding of what we mean by culture and to increase each one’s awareness of how culture is more than just a person’s country of origin, language, or self-declaration of ethnicity. The word culture comes from the Latin cultura, which means “a cultivating, agriculture” (Online Etymology Dictionary, 2013). Many English words are derived from this same Latin term. Most of us are familiar with cultivating or tilling the soil in our gardens, and we know the importance of agriculture in providing nutritious foods for our animal companions and ourselves. It is helpful to keep this original meaning in mind as we approach the other people we meet as nurses, faculty, and researchers. Each individual has come from an environment that provided the nutrients that influenced the unique development of that person. The social culture in which the individual was raised has transmitted information, ideas, beliefs, values, religious customs, and traditions that have strongly influenced how that person views and interacts with the world. All of us share some aspects of culture, and we are really members of multiple cultures. Nursing, as a profession, has a culture into which we are socialized as students. Our work setting has another culture to which we learn to adapt. Each of these cultures has an effect on how we dress, how we speak and write, how we express our feelings, and what we eat. Throughout our nursing education, we have been apprised of the differences in major cultural or ethnic groups. We learn about the cultural influences of people born and raised in various countries. We understand that their cultures have influenced their behavior, in general, and their health behaviors, in particular. Journal for Specialists in Pediatric Nursing 19 (2014) 1–2 © 2014, Wiley Periodicals, Inc. In nursing, we have focused on the concept of cultural competence. More recently, the American Association of Colleges of Nursing (AACN, 2008) has included the term cultural humility in its glossary as an outcome of nursing education and suggests that it may be a better term than cultural competence in nursing education. Cultural humility includes “lifelong commitment to self-evaluation and selfcritique, . . . and developing mutually beneficial and advocacy partnerships with communities on behalf of individuals and defined populations” (AACN, 2008, p. 36). Attaining cultural humility means providing nursing care that begins with a sensitivity or openness to the cultural influences that shaped the other. It begins with awareness of cultural influences that may have much in common with our own, or that may be drastically different. One hallmark of American culture is mandatory kindergarten through Grade 12 education for all our children. The original purpose of this mandate was to ensure a citizenry who could read and write, but another advantage of this mandate was that it has served as a major socializing institution for the children of native citizens and immigrants alike. A closer look at this institution provides a unique view of culture. It is through going to school that American children learn how to use the English language, what kinds of food and attire are “in,” how to celebrate national holidays and birthdays, and in some early grades, how to enjoy music and physical activity. Children learn how to get along together, to make decisions, and to solve problems. But ask any child who has experienced the change from elementary to middle school and then middle school to high school, or has had to change school districts because her or his parents moved, about the differences in school cultures, and you will get an earful. Foundations of Transcultural Nursing

Although developmental transitions from elementary to middle and from middle to high school are anticipated, major transitions that occur in schools when a child’s family relocates across the country can be 1 Editorial sources of confusion and trauma. The culture of elementary school in the middle of Chicago is vastly different from the culture of the school in a small town in Montana, Arizona, or Kentucky. Parents may be unaware of the drastic shifts in culture that come not only with a major move to a new house and neighborhood but also to a new school system for children of any age. Similarly, school, community, and hospital and clinic-based nurses may be unaware that children who move, however infrequently, may experience “culture shock” when exposed to new foods, new ways of using a common language, and new ways of expected dress and interacting with others. Unfortunately, we have very little research evidence about such experiences. We also have little research in some areas where cultural sensitivity is paramount: end-of-life, prenatal expectations, and working with immigrant and refugee populations. Keeping cultural awareness and humility in the foreground rather than in the background of our daily activities as nurse clinicians, educators, and researchers is not a given. It takes the intention to consistently meet the other with a perspective of openness to respect and honor cultural differences. Pediatric nurses who rise to the challenge of becoming culturally competent and remaining so need to realize that this essential competency applies not only to being sensitive to persons who are racially or ethnically different from themselves but to the children they encounter who may have recently moved from one location to another. Because cultural sensitivity begins with self-awareness, it may be 2 L. Rew helpful to reflect on your own experiences with the various cultures to which you were exposed as you transitioned from preschool, to elementary, to middle, to high school, and to college. How did these social institutions alter your beliefs, affect what you wore, how you used language, and how you solved problems and interacted with other people? Perhaps you had the experience of moving from one part of the country to another or the experience of going to the same school from Grade 1 to Grade 12 with the same 20 kids. Perhaps you had easy transitions from elementary to middle to high school or maybe some of those changes still bring back unpleasant memories. On your next coffee break at work, share some of your school culture experiences with a peer or two. You will have a greater appreciation of the diversity of social institutions and you will have taken another step on the path to applying culturally sensitive principles in your area of nursing practice. Lynn Rew, EdD, RN, AHN-BC, FAAN Associate Editor ellerew@mail.utexas.edu References American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: American Association of Colleges of Nursing. Online Etymology Dictionary. (2013). Culture. Retrieved from http://www.etymonline.com Journal for Specialists in Pediatric Nursing 19 (2014) 1–2 © 2014, Wiley Periodicals, Inc. J Immigrant Minority Health (2012) 14:175–182 DOI 10.1007/s10903-010-9403-z ORIGINAL PAPER Assessing Cultural Perspectives on Healthcare Quality Ann D. Bagchi • Raquel af Ursin • Alicia Leonard Published online: 14 October 2010  Springer Science+Business Media, LLC 2010 Abstract This study explores cultural differences in perceptions of quality of care and examines whether existing surveys, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS) questionnaires, adequately capture conceptions of healthcare quality among members of racial/ethnic minority groups. Eight focus groups with African Americans, Asian Indians, Latinos, and whites were organized into two 45-minute segments. In one segment, participants rated the quality of care depicted in a video; in the other they discussed the concept of ‘‘healthcare quality.’’ Foundations of Transcultural Nursing

We found that members of racial/ethnic minority groups are more likely than whites to identify cultural competency and providing a holistic approach to care as important to healthcare quality. Neither of these concepts is currently included in the core CAHPS questionnaire. The CAHPS and other quality surveys may not accurately capture concepts of healthcare quality that members of racial/ethnic minority groups deem most important. Keywords CAHPS
Race/ethnicity
Quality
Cultural competency Background The Consumer Assessment of Healthcare Providers and Systems (CAHPS) project was initiated in 1995 by the A. D. Bagchi (&) Research Division, Mathematica Policy Research, 600 Alexander Park, Princeton, NJ 08540, USA e-mail: abagchi@mathematica-mpr.com R. af Ursin
A. Leonard Survey Division, Mathematica Policy Research, Princeton, NJ, USA Agency for Healthcare Research and Quality (AHRQ) to create a standardized set of surveys to describe patients’ perspectives on the quality of their health plans. The CAHPS surveys have since become a cornerstone for evaluations of healthcare quality across health plans and settings [1]. However, as Morales et al. note, ‘‘Most existing consumer surveys were developed for a target population consisting of persons who are employed, insured, acculturated, English-proficient, well-educated, and of moderate to high socio-economic status.’’ [2] Research shows that a variety of patient characteristics (such as marital status, socioeconomic circumstances, and cultural background) are associated with differences in perceptions of healthcare quality and should be taken into consideration when interpreting quality ratings [3, 4]. Although the CAHPS surveys have been adapted over the years to represent better the needs and preferences of a variety of groups [5–12], little research has been done to examine whether the measures included in the CAHPS adequately capture those aspects of healthcare encounters that racial and ethnic minority group members consider the most essential for rating the quality of care they receive [13–18]. The present study used qualitative methods to explore cultural differences in perceptions of healthcare quality across four racial/ethnic groups and was designed to answer the following research questions: (1) How do patients define quality with respect to interactions with physicians and other staff members during office visits?; (2) Are there differences across racial/ethnic groups in the factors considered important to healthcare quality?; (3) Do the CAHPS surveys capture aspects of care that affect the perceptions of healthcare quality among members of racial/ ethnic minority groups?; and (4) How can consumer surveys be adapted to account better for racial/ethnic differences in assessments of healthcare quality? 123 176 J Immigrant Minority Health (2012) 14:175–182 Conceptual Framework Data Collection The conceptual model guiding the study is a modification of Donabedian’s framework, which describes ‘‘quality assessment’’ (that is, the measurement of healthcare quality) in terms of care structure (facilities and equipment), processes (activities involved in diagnosis and treatment), and outcomes (changes in individuals brought about by the care they receive) [19]. Figure 1, adapted from Sofaer and Firminger, presents our model for understanding patients’ assessment of care at a given point in time and takes into account the ways that patients’ expectations and experiences (for example, characteristics, cultural norms, knowledge of care processes, and health care needs) interact to shape their perceptions of the care they receive [20]. The focus groups were organized into two 45-minute segments: in Segment 1, we showed a video depicting a healthcare encounter between a white, male physician and an elderly, Asian (non-Indian), female patient. We used the same video (‘‘A Somatic Complaint,’’ from Kaiser Permanente’s Cultural Issues in the Clinical Setting video series) for each group in order to ensure that all participants viewed exactly the same encounter. Foundations of Transcultural Nursing

To ensure consistency and because the video was in English, we recruited only English-speaking participants. Participants were asked to rate the quality of care depicted in the video based on questions adapted from the CAHPS and other health quality surveys. In Segment 2, the focus group moderator led a more general discussion of how participants think about quality in healthcare. To address the potential for response bias, we alternated the order of the segments across the two focus groups within a given racial/ethnic group. Data analyses revealed no differences in response patterns based on segment order. Methods Participant Recruitment Measures We conducted eight 90-minute focus groups with adults (18 or older), with two focus groups for each of the following racial/ethnic groups: African Americans, Latinos, Asian Indians (hereafter ‘‘Indians’’), and whites. For each focus group, we recruited 15 participants (for a potential total sample of 120), assuming that 10–12 would actually attend each discussion. We used three sources to recruit participants: cold calls using lists of telephone numbers from areas with high concentrations of the specific target populations (as identified using Census tract data), flyers posted in train stations and supermarkets in the same targeted areas, and an ad on Craigslist.org. Sixty-eight percent of participants were recruited through the Craigslist ad, 21% via the flyers, and the remaining 11% through cold calls. Patient Characteristics Patient‘s perception of the encounter Research staff took notes during the focus group sessions and kept audio recordings which were transcribed into text documents and analyzed using Atlas.ti, a software program for the analysis of qualitative data. After reviewing notes, the two senior members of the study team (AB and RA) developed a list of themes related to healthcare quality that could be identified as arising from each of three sources: (1) the core CAHPS Clinical and Group Survey instrument, (2) supplemental CAHPS questionnaire items, and (3) discussions among focus group participants. Foundations of Transcultural Nursing

They then met to compare lists and create a final, consolidated list of key topics from the focus group discussions. We employed a hierarchy to assign a source to each concept; items mentioned in the core CAHPS questionnaire were attributed to that source even if they were mentioned in the supplemental surveys or by focus group participants. Those topics not included in the core CAHPS but included in the supplemental surveys were attributed to the supplement, even if discussed in the focus groups. A topic was assigned to the focus group category only if it was not included in either the core or supplemental CAHPS items. The hierarch … Foundations of Transcultural Nursing