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•  Research indicates that minorities are plagued by health care disparities.

•  Factors contributing to health disparities include: – Cultural and linguistic barriers – Subtle/subconscious bias and preconception.1

•  Cultural competency plays a vital role in: – Reducing health disparities – Improving health outcomes – Preparing culturally competent nurse anesthetists.1

•  Elisha et al4 concluded that Kaiser Permanente school of anesthesia (KPSA) recognized the lack of cultural competence and the need for it in formal nurse anesthesia education in 2002

•  Cultural Competence – Ongoing process involving efficient, culturally

appropriate, quality care. •  Wright5 stated that culturally competent clinicians:

– Overcome communication hurdles – Make patients comfortable – Encourage patients to share beliefs and concerns – Understand patients’ traditional healing methods.

•  A review of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane library, PubMed, and Medline was performed, and eleven articles selected based on their relevancy.

PICO Question

Racial and ethnic health disparities

•  According to Roberts et al,2 causes of health disparities are include: •  Lack of diversity among clinicians •  Clinicians’ own biases and prejudices` •  Lack of knowledge of different populations •  Institutional racism

• Wright5 argued that people from many minorities may elect not to seek help due to fear being misinterpreted or belittled, which may lead to lack of adherence to medical advice due to lack of understanding and trust.

Example of racial or ethnic health disparity

•  Butwick et al8 •  Maternal mortality is higher in general anesthesia recipients during childbirth, but minority

parturients are at higher odds of receiving general anesthesia in comparison to Whites.

Reduction of health disparities

•  In 2002, KPSA recognized the need for cultural competence and teamed up with ICCC to develop a 4-module cultural competency certification program into the curriculum.4

Patients’ cultural values •  Culturally competent clinicians become attuned to patients’ cultural cues.3 For example: •  Southeast Asian populations practice “coining” to treat wind-derived illnesses.5 •  Clinicians who are unfamiliar with such practice may suspect child abuse by mistaking the

coining marks with bruises.5 Cultural competency and skills-focused teaching

•  Teaching future clinicians regarding specific cultures alone is inadequate because an understanding of cultural competence is not attained.1

•  Clinicians must also conquer the skills necessary to provide culturally competent care.2 Module-based cultural competency training

•  The first module introduced the concepts of cultural competence, diversity, and self-assessment.

•  The second module promoted awareness and self-motivation. •  The third module allowed students to apply previously learned information during clinical

rotations. •  The last module for KPSA explored current access, cost, and quality of care.4 •  Another university-based graduate nursing program received a Health Resources and

Services Administration (HRSA) grant to create a 4-module in 2001: •  Also provided students a handbook on cultural groups, and during their third module,

students were assigned a culture to document during clinical rotations.10 •  The student presented their assigned culture during the last module.10

•  Cultural competence is a social solution that has the promise to reduce health disparities affecting minorities. •  Not every nurse anesthesia program provides skills-focused cultural competence education. •  Cultural competency training modules should allow students the opportunity to apply attained cultural knowledge through simulated exercises and

clinical rotations. •  Skills-focused cultural competence plays an important role in assuring that future SRNAs are equipped to provide culturally appropriate health

care.

•  Skills-focused cultural competence education involves attitudes, knowledge, and the necessary skills to deliver safe and culturally harmonious quality care to culturally diverse patients.

•  Nurse anesthesia curricula should equip students to care for patients belonging to culturally dissimilar populations.

•  Recommendations: •  Include a module-based system to intertwine

cultural competence into nurse anesthesia curricula

•  Mandate a handbook to increase students’ knowledge on particular cultures

•  Include theory-based exercises that mimic real-world situations

•  Assign a particular culture to each student for a presentation after completion of the last module

Contact Information

References

Cultural Competence

Cultural-Focused

Knowledge

Skills-Focused

Real-world Simulation

Face-à-face Clinical

Encounters

Acknowledging One's own Biases

Respecting Differences in Others