Systemic, organization, and healthcare provider and individual barriers for diverse populations result in health disparities and dissatisfaction with healthcare experiences. Racial and ethnic minorities may view their healthcare encounters negatively when not receiving nursing care inclusive of their cultural needs. Nurses can adapt the healthcare delivery system to meet the unique needs of this population by adopting culturally sensitive care initiatives. The purpose is to identify the relationship between the intercultural development of nurses and racial and ethnic minority patients’ satisfaction with nursing care and to test the acceptability of recommended transcultural behaviors and concepts necessary for interculturally sensitive nursing care.
Methods:
Guided by Madeleine Leininger’s Culture Care Theory, the study is a mixed-method research design requiring the use of three separate instruments – the Intercultural Development Inventory®, the Hospital Consumer Assessment of Healthcare Providers and Systems, and Leininger’s Sunrise Enabler to Discover Cultural Care. The Intercultural Development Inventory, LLC (IDI®) is a theory-based, psychometric test measuring cultural competence across a monoculture to intercultural mindset continuum. Supported by the Center for Medicare & Medicaid Services for value-based care, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is used to gauge minority patient satisfaction. The Leininger’s Sunrise Enabler is a research tool used to understand how to apply cultural based theory to nursing care and interventions. The design is to determine how a Central Kentucky healthcare delivery system can utilize the psychometric results of the Intercultural Development Inventory to evolve patient-centered care, to include culturally sensitive interventions and guidelines aimed to improve patient satisfaction while combating care disparities for racial and ethnic minorities.
Results:
The data collection of HCAHPS data consisted of 36 pre- and 37 post-intervention surveys from ethnic and racial minority patients. Comparative analysis of the pre- and post-intervention HCAHPS scores show modest patient satisfaction improvements in the overall nurse communication domain of 2.1%. For the nursing communication domain question, “During this hospital stay, how often did nurses treat you with courtesy and respect?” there is a 9% score increase.
The fifteen nursing staff participants received two documents as a result of completing the IDI - their score profile along the five-point Intercultural Development Continuum (IDCTM) with orientation distinction, and their Individual Development Plan. The initial and final report of the group’s intercultural competence is at a central point on IDCTM, which is Minimization of cultural differences. The nurses perceived themselves at one level above Minimization at the Acceptance point on IDCTM. On the IDI, the nurse perceived orientation increased by 6.39 percentile points and their developmental orientation by 12.87.
The interrelationship and positive study outcomes indicate a causal relationship between nurse cultural competency level and the degree of racial and ethnic minority patient satisfaction with their healthcare experiences.
Conclusion:
The study determines how a hospital can utilize the psychometric results from the Intercultural Development Inventory® to evolve health care using culturally sensitive nursing care to provided patient-centered interventions necessary in improving patient satisfaction for racial and ethnic minorities.