Increasing Cultural Competence in Nursing
As America’s patient base becomes increasingly multicultural, nurses must become more adept at addressing patients’ cultural, informational and linguistic needs, along with improving patients’ access to care and preventive services.
“The boundaries are melting,” said Beverly Malone, PhD, RN, FAAN, CEO of the National League for Nursing (NLN) in New York. “You don’t have to go abroad to have a global community, and that’s what nursing is waking up to.”
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Changing Patient Demographics
America’s demographics are changing, and NLN is involved with various global and diversity initiatives to assist with cultural competency. They have also developed a Faculty Preparation for Global Experiences Toolkit for instructors who take students abroad.
“We have to prepare nurses not just for the U.S. but for the world,” Malone said.
The Institute of Medicine’s The Future of Nursing report called for more diversity in the nursing workforce, and the Affordable Care Act aims to advance health equality for racially and ethnically diverse populations. That effort will require culturally competent nurses.
The newly insured patients will need primary care, and there are not enough physicians to care for them, creating opportunities for advanced practice nurses to fill the gap, particularly in underserved areas, explained Courtney Lyder, ND, ScD(Hon), FAAN, dean of the UCLA School of Nursing and assistant director of the UCLA Health System.
“Nurses go where the needs are greatest,” he said. “And patients feel more comfortable when they see a physician or nurse practitioner of their same background.”
Disproportionate Representation in The Nursing Workforce
But the nursing workforce is disproportionately white. The 2010 U.S. Census found 16.3 percent of the country’s population identified as Hispanic or Latino, yet the 2012 Bureau of Labor Statistic’s Current Population Survey found of the 2.875 million nurses in the United States, 6.1 percent were Hispanic. The country is 12.6 percent black or African American, but the nursing workforce is only 9.9 percent black.
The efforts to develop a more diverse and culturally competent nursing workforce often begin with nursing educators. Universities are growing their international programs to better prepare future generations of nurses.
“Nursing’s academic leaders recognize a strong connection between a culturally diverse nursing workforce and the ability to provide high quality, culturally competent patient care,” said Geraldine “Polly” Bednash, former chief executive officer of the American Association of Colleges of Nursing (AACN), which has developed cultural competencies for baccalaureate and graduate education, including toolkits to facilitate implementation.
“Though nursing has made great strides in recruiting and graduating more nurses from diverse backgrounds, much more must be done to ensure that new nurses and those in the workforce are prepared, able to provide culturally sensitive and population responsive care,” she said.
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UCLA Advancing Cultural Competence in Nursing
UCLA School of Nursing has taken cultural competency to heart. It is the most ethnically diverse school on the UCLA campus, with 55 percent of students from minority backgrounds. In part, that has evolved as top-flight candidates seek to attend a school with minority faculty and leadership. The school accepts about 2 percent of qualified applicants and does not set minority quotas.
“We see diversity as a strength,” Lyder said. “We are more diverse than we were in 1980 or 1960, and we know from research that patients and families like seeing and feel comfortable with a nurse who looks like them.” He added that Los Angeles enjoys a very diverse population.
“Our students have to be global nurses and to appreciate and respect culture,” he said. “Culture may impact how you deliver care or how people receive care.”
Nurses learn to tailor interventions to the needs of individual patients. Faculty study some of the city’s diverse residents, such as researching breast cancer in Korean-American women and prostate cancer risk in Latino men.
The UCLA nursing school has agreements with organizations in other countries, including China, Australia, Korea and the Philippines, and engages in cooperative academic and research studies. This bolsters UCLA students’ cultural competency, said Adey Nyamathi, PhD, ANP, FAAN, associate dean for international research and scholarly activity at UCLA.
“Having that person sitting among you is so powerful, because students will come and ask them about how these issues are experienced in their country,” Nyamathi said. UCLA’s nursing curriculum incorporates global content, and students can enjoy opportunities to study abroad.
“Students are craving cultural competency,” Nyamathi noted. “We must embrace it and ensure it’s integrated.”
UCLA also has reached out and partnered with Charles R. Drew University of Medicine and Science School of Nursing on three bridge projects, allowing students in the historically black college’s master’s-degree program to transition into UCLA’s doctoral program.
“Nurses need to be solving some of the problems that ail our society,” Lyder said. “We’re not creating future nurses [just] for California, but for the globe.”
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