Cultural Competence in Hospice Care: Addressing the Needs of Staff and Volunteers

This is a community project developed and implemented to address an identified health need.  The authors, six students from Nevada State College [NSC], attended their clinical rotation in the hospice community; four of which were at Nathan Adelson Hospice [NAH] at the Swenson and Tenaya locations, while the other two were at Creekside Hospice [CSH].  To complete this project, the authors used the community-focused nursing process model to identify and address the health need for cultural competency in grievance teaching among hospice staff and volunteers.  By addressing this need, the authors intend to enhance the staff and volunteers’ knowledge in order to enhance the patients and families’ experiences while in hospice.  The community-focused nursing process involves the following six phases: (a) define the community and establish a contract/partnership; (b) perform a needs assessment; (c) form a nursing diagnosis of the problem; (d) plan interventions; (e) implement interventions; and (f) evaluate interventions (Stanhope & Lancaster, 2014).  

In following with the nursing process, the authors performed a background search on both facilities, which included information about the health need, hospice agencies, and the target population’s demographics and statistics.  After getting both facilities’ buy-in and partnership on the project, a needs assessment was then performed by defining the target population and gathering data about the community.  The data collection involved different methods such as gathering hospice materials, performing direct observations and interviews, as well as creating a survey for the staff and volunteers.  When first speaking to the Directors of Education at both hospices, the proposed need was teaching about loss and grief, and how to intervene when a person is grieving.  After interpreting and analyzing the collected data, the authors found a gap in the population’s knowledge and a need for cultural competency in respect to grieving.  After this gap was identified, a literature review was conducted using evidence-based practices [EBP] to support the need for cultural competency in hospice care.  Based on the needs assessment, analysis, and literature review, the authors generated a community nursing diagnosis of risk of ineffective community role performance among hospice staff and volunteers related to knowledge deficit and lack of education, and inadequate role competency in regards to cultural competence.  

A teaching plan was then created to educate the hospice staff and volunteers at NAH and CSH about how to be culturally competent in regards to loss and grief.  The content topics included education about grief, culture, the process of cultural competency, and the expressions, beliefs and rituals of different culture groups in regards to death and dying.  This teaching plan consisted of SMART goals and objectives to be met, and were based on Campinha-Bacote’s (2002) model of developing cultural competency.  The presentation at CSH was scheduled on November 3, 2014, while the NAH presentation was scheduled at the Swenson location on November 7, 2014.  A pretest was given before the teaching was implemented, and then a posttest was given after the teaching to evaluate whether the teaching was effective and the objectives were met.  Data from both CSH and NAH were then compiled, analyzed and evaluated.

The evaluation showed that the SMART goals and objectives were met for CSH; but NAH did not meet all the SMART goals and objectives.  The majority of the staff at CSH and NAH (96% and 93% respectively) felt that the presentation was “very” effective in improving cultural awareness and sensitivity, and that they were likely to apply this information in their practice.  The students received excellent feedback and comments from the staff about how well the presentation went and that they liked the materials provided.  Based on the some of the feedback and comments that the students received from the attendees, directors, staff and volunteers, the authors came up with recommendations to improve their performance.