State of the Evidence, Making Sense of the Data: Culturally Competent Nursing Practices in Pennsylvania

Substantial evidence suggests vulnerable and traditionally under-represented racial and ethnic patients experience poorer clinical outcomes compared to the general population in the United States. The differences in the incidence, prevalence, mortality and burden of disease and other adverse health conditions that exist among specific population groups in the United States is reported as health and healthcare disparities (Fink, 2009; Hebert, Sisk, & Howell, 2008). The etiologies of health and healthcare disparities are complex and multifactorial. It includes but is not limited to environmental, systemic, and organizational level factors, along with social-cultural, patient, family, and provider-level factors (Baillie & Matiti, 2013; Betancourt, Corbett, & Bondaryk, 2014; Padela & Punekar, 2009; Purnell et al., 2016). Cultural competence is identified as a strategy to mitigate health and healthcare disparities, improve patient outcomes through increased healthcare access and full engagement of patients and families in their health and healthcare. Culturally competent clinicians appreciate the uniqueness of each patient within the context of their illness, communicate respectfully, build trust, and maintain therapeutic relationships that promote optimal health outcomes.

 Healthcare organizations play a vital role in facilitating cultural competence by providing resources, infrastructures, and policy that promotes cultural competency. This project was undertaken to determine opportunities for enhancing cultural competence practices by registered nurses in the state of Pennsylvania. Goals of this project include ascertaining opportunities for improve competent cultural practices among registered nurses in the state of Pennsylvania (PA) and to develop education and training to address identified gaps. Specifically, the objective of this project was to determine the level of cultural competence education/training, sources and availability of cultural competence information, access to cultural competence resources and extent to which culturally competent care is currently provided by RNs across the state of PA. A statewide survey of Registered Nurses in the state of PA was conducted from September 15, 2014, through March 31, 2015. The project asked for information about the respondents’ socio-demographic characteristics, sources of availability of cultural competency information, self-reported levels of cultural competency preparedness and education, and level of culturally competent care provided by the RNs. Findings were summarized using descriptive statistics including means, frequencies, and percentages.

Results: A total of 1209 RN responses were received from survey participants. The majority of the respondents were females (92%), Caucasian (85%) and baccalaureate prepared (80%). The percentage of nurses who indicated speaking English as the primary and only language was 85%. Two out of every three participants came from a Magnet designated hospital. Just over half the respondents (57%) indicated receiving formal education in the area of cultural competency, while every three out of four nurses received cultural competency education as part of their professional development. 91% saw cultural competency as essential or crucial to their career performance, yet reported lack of time, resources and incentives surrounding cultural competency performance as significant barriers in being able to provide culturally competent care. Despite availability of language interpreters, 22% indicated they never use language interpreters, while another 31% only use it a few times a year. Two out of four RNs expressed their work did not provide cultural competency teams to help with patients, while 36% of the staff was unsure where to find such resources.

Discussion/Conclusion: While just over half of survey participants reported receiving formal education and training regarding cultural competency, participants reported a strong desire to provide culturally competent healthcare services. Registered Nurses underscored cultural competency as an essential skill to their professional performance, but on the same token, reported lack of time, resources and incentives as sources of significant barriers to providing culturally competent care. The need for additional and ongoing education and training for nurses to enhance culturally competent services was evident, as well as healthcare organizations’ responsibility to provide necessary resources to facilitate cultural competence. The findings of the survey were used to guide statewide educational interventions to address gaps and bolster RNs’ cultural competence practices across the state of Pennsylvania.