Methods: The background literature provides the framework for this project.
Improving the quality of care to diverse populations is an important national and international concern for nursing and the total health care system. Numerous reports reveal that health care disparities and inequalities continue to persist globally. In the United States, health disparities have significant economic impacts estimated in trillions of dollars. Schoeni, Dow, Miller, and Pamuk (2011) suggest eliminating health disparities for people with less than a college education in the US would have a $1.02 trillion economic value. Beyond the financial considerations, eliminating health disparities builds health equity to allow all people access to better health care and healthier lives.
Nurses have historically been providers of care to all people. However, nursing students are often ill prepared to provide care to diverse patients. Arielli (2013) described how culturally diverse settings challenge students in emotional ways including frustration, conflict, and others. McClimens (2014) also found that nursing students expressed difficulties and challenges in meeting patient needs and concluded that students would benefit from preparatory education and training in culturally diverse settings. Recognizing how patients’ cultural diversity impacts patients’ health are important learning opportunities for advanced practice nurses.
Determining the best method to deliver cultural diversity education to health care workers has yet to be determined. Cultural diversity is extremely complex with numerous underlying facets. Thornton et al. (2016) stressed that social determinants, the conditions in which people live, work, play, worship, learn, are part of cultural diversity and are paramount in decreasing health disparities. Poverty; lack of access to health care facilities, education, employment; neighborhood conditions; exposure to violence; and other determinants are increasingly recognized to impact healthcare. Dankwa-Mullan and Perez-Stable (2016) emphasize that health disparities are a “place-based issue” where changing the conditions could make differences in health outcomes. Stone et al. (2013) described the development and testing of two training modules on cultural diversity for health care workers in England and Wales. Following testing, the researchers concluded the use of such modules was feasible and an effective way to improve participants’ knowledge and understanding of cultural diversity. However, the best way in translating knowledge and understanding into practice remains unknown. It is reported that service learning, typically an experiential education opportunity that places health professional students in communities to learn social, economic, political contexts of health can be a positive vehicle for reducing health disparities (Sabo et al., 2015). In a service learning study, Rasmor, Kooienga, Brown, and Probst (2014) found in a small sample of nurse practitioner students who participated in an immersion experience with clinical practice settings such as free clinics with uninsured and non-documented immigrant patients, revealed that students challenged their own beliefs and attitudes regarding vulnerable populations, gained insight into care of these patients, and expressed intent to volunteer at these settings. These authors recommended further study beyond focus groups used in their small sample size study. It is not known if this learning experience extended beyond students’ expressing intent to volunteer at these settings.
This study includes thirty-two advanced practice nursing students who are participating in the project. Interventions included an online learning module designed to increase cultural competent patient-centered care, working with interpreters, assessing populations, and planning services; a three-hour credit course analyzing major social determinants that affect health and their consequences; and two semesters of clinical experiences in selected underserved areas. Outcomes that are being measured include students’ knowledge of culturally diverse populations, faculty evaluations of students’ performance, students’ commitment to work in underserved areas, and employment in underserved areas after graduation.
Preliminary qualitative data have revealed students’ awareness of different cultures, knowledge that health has many different meanings to different individuals, importance of taking an extra few minutes to listen to patient’s stories provides a much better picture of their health and concerns and helps patients and their families engage in the best possible treatment and outcomes. Both qualitative and quantitative data are being analyzed and results will be presented.
Conclusion: The findings of this study is important to advanced nurse practitioners and their culturally diverse patients.