1. 1 Enhancing the Integration of Cultural Competence In a MSN Curriculum Nan Leslie, PhD, WHNP-BC; Susan McCrone PhD, PMHCNS-BC; Cynthia Persily, PhD, RN, FAAN; Alvita Nathaniel, PhD, FNP-BC 1

2. 2 The authors wish to thank the Health Resources and Services Administration (HRSA) for support of this project (Grant #: 1D09HP09085-01-00)

3. The Need for Cultural Competence in the Curriculum Our health care system has begun to acknowledge the diversity of the population that it serves. There has been an increasing emphasis on nursing education that emphasizes the cultural competence of those who deliver care (Office of Minority Health, 1999; Stith & Nelson, 2003). To eliminate health disparities, curricula need to incorporate a deeper understanding of the multicultural context in which care is delivered. 3

4. The Construct of Cultural Competence A complex interactive process of developing cultural awareness, knowledge, and skill acquisition in the delivery of optimal levels of health care within the context of multicultural clinical organizational, and community situations. (Campinha-Bacote, 2002;Gilbert, 2003; Purnell, 2002) 4

5. 5 Our Shrinking World Population is increasing and land/person is becoming less 5

6. Expanding a Rural Perspective to a Global Perspective 6

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9. 9 Demographics of WV (USA) Population1,818,470 (299,398,484) Female51.0% (50.7%) White94.9%(80.1%) Black3.3%(12.8%) Am Indian 0.2%(1.0%) – Alaska Native Asian0.6%(4.4%) Hawaiian &0%(0.2%) – Other pacific Islanders 9

10. Demographics of WV (USA) 2 or more races0.9%(1.6%) Hispanic/Latino0.9%(14.8%) White non-Hispanic94.1%(66.4%) Living in same house in 1955 and 2000 (persons 5 yrs. & older)63.3%(54.1%) US Census Bureau 2008 10

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12. 12 An Evolving WVU SON Graduate Curriculum Original MSN Program1970s MSN-FNP1995 PhD 2000 MSN Revised2005 PNP2003 NNP2004 DNP2007 WHNP & GNP2008 BSN to DNP2010 12

13. 13 Fostering Sensitivity and Awareness of Cultural Differences and Needs Concepts of ethnicity and culture are threaded throughout the curriculum – Developed from NONPF guidelines – But… – Is this satisfactory to prepare practitioners to intervene in health disparities by fostering sensitivity and awareness of patients’ cultural differences?

14. 14 Focal Areas That Would Strengthen Cultural Competence Strengthen cultural competence in the curriculum Develop web based cultural competence modules for APN preceptors in clinical settings outside the University 14

15. 15 HRSA Objective(s) 3 of the 4 objectives in our HRSA grant emphasize the preparation of health professionals, Advanced Practice Nurses, who will deliver culturally competent care

16. 16 HRSA Support to Promote Culturally Competent Care Funded Consultant – Provided tool for the assessment of faculty knowledge of cultural competence – Suggested tools for the process of curriculum assessment and enhancement – Assisted in the development of an outline for modular development

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18. The Process A convenience sample of 35 nursing faculty were involved in the project. A pre-post test design was used to evaluate the impact of a 3 hour educational program provided by the consultant on faculty cultural competence. 18

19. 19 Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals – Revised (IAPCC_R © ) [Campinha-Bacote, 2002] 25 - item Likert scale Measures five cultural constructs: – Desire – Awareness – Knowledge – Skill – Encounters

20. Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals – Revised (IAPCC_R) [Campinha-Bacote, 2002 © ] Tool has been used nationally and internationally. Construct, content, and face validity have been established. Cronbach alpha reliabilities ranged from.72 to.87 in national samples Cronbach alpha reliability in this study was – Pretest 0.899Post test 0.871 20

21. 21 Findings

22. 22 Analyses A paired t-test was used to analyze the pre- and post test scores. Sample mean on the pretest was 71.2 and on the posttest 78.8 (p. <.001). There was a significant difference (p. < 0.05) on 12 of the 25 items from pretest to posttest.

23. Item Scores Significantly Changed from Pretest to Posttest On the items from the five subscales of the assessment tools, scores improved differently indicating more deficits in some areas than in others. – Awareness 3/5 60% – Knowledge 2/5 40% – Skill 4/5 80% – Encounters 1/5 20% – Desire 2/5 40% 23

24. Level of Cultural Competence Culturally Proficient 91-100 Culturally Competent 75-90 Culturally Aware 51-74 Culturally Incompetent 25-50 Based upon these levels, at the completion of the educational session among the faculty attendees: 26% were culturally aware 66% were culturally competent 8% were culturally proficient 24

25. Module Development Undertaken by a task force of faculty to create modules for continuing education for preceptors and students entering our DNP program without a background in cultural competence Utilized the Campinha-Bacote Model 25

26. Cultural Awareness/Attitudes Module 1 – Self assessment – prejudices/ biases – Exploration of one’s own cultural background – Importance in health care – Models/ Initial resources 26

27. Cultural Knowledge/Cultural Encounters Module 2 – Bio-cultural ecology/pathophysiology/assessment Module 3 – Ethnic pharmacology Module 4 – Institutional and organizational issues in cultural competency 27

28. Cultural Knowledge/Cultural Encounters Module 5 – Health literacy/ linguistic competence Module 6 – Ethical issues in culturally competent care 28

29. Cultural Skills Module 7 – Culturally competent care toolkits Module 8 – Culturally competent education toolki ts 29

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