Cultural Compliance Education in an Ambulatory Surgery Center

Michelle Lane, RN

University of San Francisco 

               Cultural Compliance Education in an Ambulatory Surgery Center

     The motivation behind this educational plan is derived from an observed educational gap regarding cultural compliance existing in my facility. The purpose of it is to remind the PACU staff that nurses are not only mandated by the Code of Ethics for Nurses, but are ethically responsible, to provide non-discriminatory care to all patients they encounter (ANA, 2015). Title VI of the Culturally and Linguistically Appropriate Services Standard 1 (DHHS, 2001) states that “Healthcare organizations should ensure that patients/consumers receive from all staff members, effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language” (p.49).

Learning Needs Assessment

     My learning needs assessment was completed by observation. Ventura County has a Hispanic/Latino population of 42% (U.S. Census Bureau, 2014). My ambulatory surgery center (ASC) utilizes discharge instructions printed in English as well as a Spanish-speaking medical assistant or patient family member to interpret instructions for the patient. This means that a patient cannot refer to their instructions at home unless they have an English speaking/reading person in the house. In addition, a lack of cultural understanding can lead to inferior medical care and poor follow up care. According to Elizabeth Higginbotham, RN, JD (2003), “A language barrier not only threatens your ability to deliver high-quality patient care, it poses a significant legal risk, as well” (para.1). Further, in my opinion, many nurses make culturally inappropriate comments based on a patient’s response to pain. The nurses may lack understanding that the Latino culture has certain beliefs about health and illness that affect the way they view the healthcare system and the way they express themselves when ill. Maier-Lorentz (2008) states “hospitals and other health care facilities should offer nurses frequent in-service programs on cultural competency in order to increase their level of confidence and knowledge of transcultural skills” (p.42).

Educational Goal

     My goal in this education plan is that the PACU nurses will display cultural compliance in the care and discharge of all Hispanic/Latino patients.

Learning Objectives

     My objectives are that After a 30 minute group session using PowerPoint, supplemental handouts, and discussion:

1. The PACU nurses will be able to recall and discuss in their own words, at least three Latino cultural beliefs about health and illness (cognitive).
2. The PACU nurses will be able to demonstrate four steps toward cultural sensitivity by participating in a role playing session (psychomotor).
3. The PACU nurses will be able to express at least one value to providing culturally competent care (affective).

     My objectives were chosen using the ABCD method because I find that it helps me to break the objectives apart and identify the desired skill that I am after and, as Bastable (2008) notes, it is an easy way to remember the four elements that are included in a behavioral objective.

Evidence in Support of Educational Plan

      Because audiences have diverse learning styles, most students will be able to learn effectively if they are provided a combination of visual, auditory, reading/writing, and kinesthetic activities (Lujan & DiCarlo, 2006).  Bastable (2008) states “the cognitive, affective, social, and psychomotor domains of the learner can be influenced by the educator, who can act as a motivational facilitator or blocker” (p.204). Bryan, Kreuter and Brownson (2008) identified five key principles of adult learning. The principles are:

1. Adults need to know why they are learning. 2. Adults are motivated to learn by the need to solve problems. 3. Adults’ previous experience must be respected and built upon.

4. Adults need learning approaches that match their background and diversity and

 5. Adults need to be actively involved in the learning process. These needs are addressed by having specific objectives, a specific problem to address, relating material to what the learner already knows, contextualizing content in a variety of ways, and providing a participatory learning environment (Bryan et al., 2008).

Implementation Plan

    Our group will meet together for a 30-minute session in a private room to avoid distraction. After students fill out a brief pre-test to determine previous knowledge, I will begin the instruction by utilizing media via a computer PowerPoint presentation. I will provide supplemental handouts to present the information. The PowerPoint portions will encompass the lecture and provide charts and pictures, all of which will address the visual and auditory learners. The printed handouts will address the learners who prefer reading/writing. After the lecture/PowerPoint portion of the session I will have the students participate in a role-playing activity that includes real life examples of cultural care situations. We will conclude with a discussion about the topic and material. The role-play and discussion will address the kinesthetic learners and will promote working as a group.  

Evaluation

     To determine if my educational program has created a change in nurse behavior, evaluation of the outcome of my teaching will initially take place after the education portion of our session. Based on my objectives the nurses will verbalize understanding of three Latino beliefs regarding health and illness, as well as the value of providing culturally competent care. The nurses will also demonstrate, in a role-play session, that they can correctly address or respond, with cultural sensitivity, to a situation involving a Latino, Spanish-speaking patient. Initially the nurses will be integrating new values or attitudes but assessment for effective, ongoing change will be done by observation and completion of a rating sheet with closed ended questions which will ask to what extent the nurse has used the information they learned regarding cultural compliancy. This will be done at intervals of three, six and twelve months. Bastable, 2008 states, “ outcome evaluation should include measuring nurses’ knowledge or behavior sometime after they have returned to the unit…to determine whether a change has really taken place” (p. 566). Krueger (2001) states, “Most changes in behavior actually require some time to accomplish, and you wont be able to get an accurate measurement of change while at the meeting. Therefore, it is usually best to delay the measurement until after sufficient time has passed for participants to actually make the desired change” (p.10).

I believe that nurses having the appropriate discharge tools and an understanding of cultural differences can and will improve patient experiences and outcomes. Nurses can promote safe, high-quality care by following in the footsteps of Florence Nightingale who was the “ultimate educator” (Bastable, 2008, p.5) as she taught not only the patients about the importance of nutrition, fresh air and exercise, but sought to educate physicians, nurses and other healthcare personnel as well.

References

American Nurses Association. (2015). Code of ethics for nurses. Retrieved from

http://www.nursingworld.org/codeofethics

Bastable, S. (2008). Nurse as educator: Principles of teaching and learning for nursing practice. Sudbury, MA: Jones and Bartlett

Bryan, R., Kreuter, M., & Brownson, R. (2009).  Integrating adult learning principles into training for public health practice. Health Promotion Practice (10) 4, 557-563.

Retrieved from http://hpp.sagepub.com/content/10/4/557.long

Higginbotham, E. (2003). Legally speaking: How to overcome a language barrier. RN. 66-67.

Retrieved from http://www.modernmedicine.com/modern-medicine/content/legally-speaking-how-overcome-language-barrier

Krueger, R. (2001). Guide for measuring outcomes at the meeting and after the meeting. University of Minnesota Extension Service, St. Paul, MN. Retrieved from http://www.tc.umn.edu/~rkrueger/evaluation_mo.pdf

Lujan, H., & DiCarlo, S. (2006).  First-year medical students prefer multiple learning styles. Advances in Physiology Education. (30) 1, 13-16.

Retrieved from http://advan.physiology.org/content/30/1/13.long

Maier-Lorentz, M. (2008). Transcultural nursing: It’s importance in nursing practice. Journal of Cultural Diversity 15 (1), 42.  Retrieved from http://0-web.a.ebscohost.com.ignacio.usfca.edu/ehost/pdfviewer/pdfviewer?sid=55e9d65e-ddd3-4daf-b32b-778293a97db6%40sessionmgr4005&vid=1&hid=4206

US Census Bureau. (2014). Quick Facts Ventura County.

Retrieved from https://www.census.gov/quickfacts/table/PST045214/06111

U.S. Department of Health and Human Services (DHHS). (2001). National standards for culturally and linguistically appropriate services in healthcare: Executive summary. Retrieved from http://minorityhealth.hhs.gov/assets/pdf/checked/executive.pdf

Appendix A