A
Successful Partnership to Help Reduce Health Disparities at Kaiser
Permanente: The Institute for Culturally Competent Care and the Kaiser
Permanente School of Anesthesia |
to
pdf >>
By
Nilda
Chong, MD, MPH, DrPH; Sassoon M Elisha, CRNA, MS, EdD
Maria Maglalang, RN, MN, NP; Karen Koh, MPH, DrPHi
Abstract
An
innovative partnership with the Kaiser Permanente (KP) Institute
for Culturally Competent Care (ICCC) has enabled the KP School of
Anesthesia (KPSA) to become one of the first nurse anesthetist programs
in the western United States to incorporate a formal cultural competence
curriculum into its educational program. Housed administratively
in the California State University system since 1981, KPSA is a
fully accredited, 24-month program that educates registered nurses
to become certified registered nurse anesthetists (CRNAs). The collaboration
between the ICCC and KPSA represents a unique opportunity to enhance
the care student nurse anesthetists provide in ten Southern California
KP hospitals. In addition to serving KP patient populations, students
travel to 12 affiliated hospitals in urban and rural areas. The
partnership also benefits KP: Upon graduation, 80% to 90% of the
student nurse anesthetists in each graduating class join the diverse
KP workforce. This article describes the genesis, evolution, and
potential impact of this ongoing collaboration to reduce health
disparities.
The Need for
Cultural Competency Curricula at the Kaiser Permanente School of Anesthesia
The patient
population in the Kaiser Permanente (KP) Southern California Region
comprises approximately 100 distinct cultural groups. The major ethnic
communities in the area include African American, Armenian American,
Central American, Chinese American, East Indian American, Filipino
American, Mexican American, Jewish American, Japanese American, Korean
American, and Vietnamese American. Aware of the diversity in the patient
population in Southern California, the faculty at the KP School of
Anesthesia (KPSA) concluded that principles of culturally competent
care should be incorporated into the didactic curriculum to enhance
students' opportunities to deliver high-quality care and establish
effective cross-cultural communication with patients.
To reach
this educational goal, KPSA enlisted the participation and support
of KP's Institute for Culturally Competent Care (ICCC). ICCC provides
consultation and develops tools, training, and educational resources
for clinicians to develop and enhance their cultural competency in
order to increase their patients' compliance with treatment and positively
impact the health outcomes of patients during the clinical encounter.
The KPSA
faculty envisioned cultural competency training as enhancing student
nurse anesthetists' ability to provide holistic, high-quality anesthesia
care and to exhibit awareness, knowledge, understanding, and respect
regarding cultural differences and similarities during the perioperative
period. The faculty decided that the scope of the training would frame
"culture" as encompassing racial, ethnic, religious, and
social issues, thereby modeling the definition proposed by the US
Department of Health and Human Services Office of Minority Health.1
Three
cornerstones guided the collaborative planning process undertaken
by ICCC and KPSA. First, the changing demographic profile of the United
States requires health care staff to have a basic understanding of
conceptual issues regarding cross-cultural communication and basic
knowledge of health beliefs and practices of culturally diverse populations.
Second, cultural competence can enhance clinicians' opportunities
to deliver high-quality care to patients from diverse cultural backgrounds.
Finally, the collaboration represented a strategic opportunity to
help decrease racial and ethnic health disparities.
Developing
and Implementing Culturally Competent Curricula at KPSA
Theoretical
and practical aspects of patient care are incorporated into every
accredited nursing educational program in the US. From human anatomy
and physiology to pharmacology and pathophysiology, a major goal of
nurse anesthesia education is to provide students with a solid theoretical
foundation. Of critical importance is integration of theoretical concepts
into clinical practice, which has been the focus of nursing education.
Distinct educational opportunities for cultural competency knowledge
and skills acquisition have not traditionally been formally integrated
into nursing education curricula.
The KPSA
cultural competency curriculum consists of four modules and was developed
from the 16-hour cultural competence training curriculum created for
KP health care clinicians by ICCC. Through collaboration with the
KP Distance Learning Program, the KPSA curriculum was customized for
integration into the existing KPSA nurse anesthesia program. Because
application to clinical practice is a key component in developing
cultural skills, the four modules are interwoven throughout the nurse
anesthesia curriculum. This methodology allows students ample time
to apply and practice the module concepts during clinical rotations.
At the conclusion of the four-module training sessions, student nurse
anesthetists become formally certified in culturally competent care.
During
the first semester of each academic year, the Institute staff deliver
Module 1: Introduction to Diversity and Culturally Competent
Care and Module 2: Cultural Awareness. Through facilitated
class discussions and learning exercises, students learn how to recognize
and deal with the biases and preconceptions they have formed throughout
their childhood and adulthood experiences.
Building
upon the first two modules, KP content experts present Module 3:
Cultural Knowledge to the students in the second semester. This
module focuses on cultural beliefs, health practices, and nuances
of specific social and cultural groups and includes information on
African Americans, Latinos, Asian and Pacific Islander populations,
LGBT (lesbian, gay, bisexual, and transgender) populations, and persons
with disabilities. ICCC's Provider Handbook Series on Culturally
Competent Care 2-6 serves as a major resource for the
students: Each handbook is devoted to a specific sociocultural group.
Students who complete Module 3 are assigned to select a patient
whose culture differs from their own and to record clinical encounters
that occur during the clinical rotations; this serves as preparation
for the case presentation each student is expected to conduct at the
conclusion of the nurse anesthesia program.
During
the last semester, students participate in Module 4: Cultural Skills,
a highly interactive module that focuses on cross-cultural communication.
A major component of this module is the individual student case
presentation and discussion with peers.
Successes
and Challenges
An obvious
challenge encountered when implementing the cultural competency curriculum
has been students' uneasiness with discussing cultural values different
from their own. Some resistance to change has been encountered in
the form of some students questioning the need for cultural competency
when their jobs involved "minimal interaction with patients"
and "putting people to sleep for a living." On the successful
side, many students value the utility of the cultural knowledge and
skills gained as well as appreciate the insight gained from identifying
their own biases and preconceptions around diversity issues.
The KPSA
cultural competence program continues to evolve. Since 2004, for example,
students have received didactic training sessions on culture and expressions
of fear and pain, leading students to understand that these cultural
differences exist not only among patients but also among health care
providers. In addition, more specificity has been added to the cultural
competency training curriculum, such as how to work with interpreters.
The partnership
between KPSA and ICCC reflects leadership in delivering health care
that is both evidence-based and built on understanding the health
beliefs and practices of our culturally diverse membership. Training
programs such as the four-module training curriculum in culturally
competent care can facilitate development of cultural awareness, knowledge,
and skills for the lifelong journey toward cultural competence. Most
importantly, the KPSA-ICCC partnership reaffirms KP's commitment to
help reduce health disparities.
Acknowledgment
The Medical Editing Service of The Permanente Medical Group
Physician Education and Development Department provided editorial
assistance.
References
- US
Department of Health and Human Services, Office of Minority Health.
National standards for culturally and linguistically appropriate
services in health care: final report [monograph on the Internet].
Washington (DC): US Department of Health and Human Services, Office
of Minority Health; 2001 [cited 2005 Dec 22]. Available from: www.omhrc.gov/omh/programs/2pgprograms/finalreport.pdf.
- Kaiser
Permanente National Diversity Council; Kaiser Permanente National
Diversity Department. A provider's handbook on culturally competent
care: African American population [monograph on the Intranet]. 2nd
ed. [Oakland (CA)]: Kaiser Permanente; 2003 [cited 2005 Dec 22].
Available from: http://diversity.kp.org/docs/pdf/providers_handbook_african_american.pdf.
- Kaiser
Permanente National Diversity Council; Kaiser Permanente National
Diversity Department. A provider's handbook on culturally competent
care: Asian and Pacific Islander population [monograph on the Intranet].
2nd ed. [Oakland (CA)]: Kaiser Permanente; 2003 [cited 2005 Dec
22]. Available from: http://diversity.kp.org/docs/pdf/providers_handbook_asian_pacific_islander.pdf.
- Kaiser
Permanente National Diversity Council; Kaiser Permanente National
Diversity Department. A provider's handbook on culturally competent
care: Latino population [monograph on the Intranet]. 2nd ed. [Oakland
(CA)]: Kaiser Permanente; 2001 [cited 2005 Dec 22]. Available from:
http://diversity.kp.org/docs/pdf/latino_handbook2ed.pdf.
- Kaiser
Permanente National Diversity Council; Kaiser Permanente National
Diversity Department. A provider's handbook on culturally competent
care: lesbian, gay, bisexual and transgender population [monograph
on the Intranet]. 2nd ed. [Oakland (CA)]: Kaiser Permanente; 2004
[cited 2005 Dec 22]. Available from: http://diversity.kp.org/docs/pdf/handbook_lgbt.pdf.
- Kaiser
Foundation Rehabilitation Center; Kaiser Permanente National Diversity
Council; Kaiser Permanente National Diversity Department [monograph
on the Intranet]. A provider's handbook on culturally competent
care: individuals with disabilities. [Oakland (CA)]: Kaiser Permanente;
2004 [cited 2005 Dec 22]. Available from: http://diversity.kp.org/docs/pdf/disability_handbook_final.pdf.
