by Maegan Szalkowski -Number of replies: 0
DF #2
by Maegan Szalkowski -Number of replies: 0
Introduction
Transcultural nursing starts within one’s self, but goes far beyond the individual. After deciding if we are culturally competent people/ healthcare providers, we must look from a wider lens; is the organization we work for culturally competent? According to Boyle et al, there are nine factors that determine if an organization is providing transcultural nursing care (2024). These factors include; “Environmental context; Language and Ethnohistory; Technology; Religious/Philosophical; Social Factors; Cultural Values; Political/Legal; Economic and Education” (Boyle et al., 2024, p. 437).
Political and Legal Assessment and Recommendation
When looking at my own institution, the first factor that I feel may influence their cultural competence are political and legal factors. The power at my institution rests within the administration. The small community hospital that I work at is owned by a large medical cooperation. I have found that our policies and procedures come from this large medical company and do not always apply to our small community hospital. Those of us who work in the hospital refer to them as the “mothership”. A faraway place that we never interact with, that houses all of the rules for our facility. In order to better serve our patient population, we need to be mindful of the differences that large teaching hospitals have from small community facilities. Employees of my hospital find it hard to take initiative and spark change in our facility because everything has to go through the “mothership” first. We have suggestion boards in our break rooms and suggestion boxes where we can put ideas in anonymously. Unfortunately, I have personally put suggestions in the box and never heard another word about them. In order to make changes occur, staff need to come together and present such ideas very structurally. If we want to see change on the ground level, where patients will actually be affected by the change, we need to start from the top with upper administrators. “Hospitals are a hard organization to change. Publicly owned and operated hospitals even more so. In many countries, both managers and staff anticipate, despite constant calls for improvements in efficiency, quality, and responsiveness, that little will be different tomorrow or next year” (Edwards & Saltman, 2017, p. 1). This quote is exactly what we need to change in healthcare. One proposal I have to solving this problem would be to have individual meetings with someone from the medical cooperation. This company owns 9 hospitals that are all very different. Someone from the company should come and sit down with staff members, meaning nurses and doctors who work on the front lines, and discuss how things are going. Discuss what is working and what isn’t. Not all policies work everywhere. I think this would be a great way to initiate change and would be a step in the right direction for my institution to strive towards cultural competence.
Environmental Context Assessment and Recommendation
The second factor that I used when conducting an organizational assessment at my jobs was environmental context. The hospital is located in a low socioeconomic community, serving members of many surrounding communities as well. I would say the overall health literacy of the patient population is poor. Our hospital has a large psychiatric and detox program. This brings many members of the community that suffer from mental illness as well as drug and alcohol addiction. Certain social determinants of health effect the members of this community. The members of the community do not come from wealth, they struggle to pay for housing, many of them are homeless. This is the majority of the patient population we serve at my institution. The facility does offer social workers and case managers to every patient that needs them. They are present seven days a week. They help patients with discharge planning, getting into rehab, setting up follow up visits, home health nurses, OT/PT visits and even help them find the best ways to pay for their medication. Our social workers go above and beyond to help serve the patients in our community and provide resources for them that they can use long after discharge. A proposal I have to assisting with environmental factors at my institution would be to offer more help for mental health patients. We need to separate our mental health patients from our medical and surgical patients. I do believe that my institution is working on opening more beds in the mental health units. This is a safety issue to all members of the community and the staff. Mental health patients are held on medical units until a room becomes available on the psychiatric floor. If we could move these patients to their own section of the unit and train the nurses to care for patients in mental health crisis this would alleviate a lot of fear and anxiety from the patients as well as the staff. This intervention would help the social workers on the medical floors to focus on their patients, and educate social workers for the mental health and detox patients on the resources that are available for that specific patient population.
Technology Assessment and Recommendation
The third factor I used when conducting this organizational assessment is technology. My institution uses technology for everything from our staff scheduling, to the patients electronic medical record, medication administration and so much more. All staff members are provided a work email address and are trained on how to use or electronic charting system. They do a thorough training on this at the time of hire. I think that my institution is behind the times when it comes to new medical equipment. I find myself having issues with old monitors and IV pumps that need updating. However, we do have a new system in place that allows nurses or providers to video chat with a provider from our Primary hospital at any time. There are video cameras in every patient room on my unit and we can video chat with an ICU physician at our larger medical center at any time. My ICU only has one doctor in house at a time, so if that doctor is occupied with another patient, this is a great piece of technology that provides an extra layer of safety for our patients. I believe one barrier to this technology is nurses unfamiliarity to the system. I believe that with more exposure to how this on-call video doctor works, this would make nurses more confident and more likely to use it. A study was conducted in 2020 regarding nurses responses to new information technology (IT) at their hospitals. The study states that lack of adoption of new technologies can have consequences such as “the failure of IT implementations, or suboptimal user-system interactions, which in turn lead to nurses’ frustration, and adverse patient outcomes” (Farokhzadian et al., 2020, p. 2). So I believe my institution should hold trainings or mock situations where we have to actually use the technology and become familiar with it. I think this would encourage staff to utilize it more. My facility also uses video interpreters for those patients who do not speak English. I think this is a great step towards cultural competence. I believe that my institution should have an interpreter for every unit, as a large population of our patients are non-English speaking and we nurses find ourselves running around searching for this video interpreter and not having it when we need it. This is one way the institution can improve.
Conclusion
While analyzing and assessing my institution using the guidelines provided in the textbook, I found a lot of things my organization does well. However, I believe there is room for improvement in all 9 of these factors of organizational cultural competence.
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