Accounting for culture in patient focused care

Cultural competence is represented as a quantifiable set of individual attitudes along with communication and practice skills that enable staff to work effectively with patients and families from various backgrounds.  Many organizations including ours have programs developed to better prepare staff to meet the expectations of cultural competency in hospital settings.  However, what is often lacking is the structural piece of promoting this competency on a daily basis. We have found that leaving it up to the individual nurse to question patients creates major variation in how patients are assessed and how they are acturally .  We would like to share with you how we have structured our cultural assessment piece within our nursing assessment.  Often nursing assessments have little structure with regard to questions around culture.  We have introduced Arthur Kleinman’s questions specifically to identify patients with cultural needs.  Arthur Kleinman is a contemporary physician and anthropologist who has conducted extensive research on the impact of culture and perception of health.  He currently teaches at Harvard Medical School.  We have applied his methodology as a means to foster a clinical climate which is sensitive to the diversity of our patient populations and to assist us in gathering firsthand knowledge from patients on their explanation for the cause, severity, treatment needs and prognosis of their illness or injury.  We know that the perceptions and practices of patients will directly affect their health care behaviors.  We have developed and applied the assessment slightly different among our varied patient populations.  We will review feedback received from staff and how we evolved the process to better meet the needs of both patients and nursing staff.  Lastly we will demonstrate how you too can develop this assessment and care planning process though your electronic medical record system.  We operationalize the nursing process in practice everyday and in every patient care unit.  Horizon Expert Documentation System (HED), a McKesson product, is our automated documentation system.  Being culturally competent can be difficult for even the most conscientious nurse.  Instituting a standardized assessment has helped our nurses meet this demand within our healthcare system.

Presentation Plan

1. Introduction

• Cultural mix at Wyoming Medical Center
• History of our electronic documentation system

• History of our cultural assessment

2. The Nursing Process in Culturally Skilled Care

• Arthur Kleinman’s background
• Kleinman’s Cultural Assessment
• Nursing Diagnoses
• Developing appropriate patient-centered goals
• Evidence-based interventions

3.Evaluation

• How are we doing
• Case study #1
• Case study #2
• What comes next