Nurses Need Cultural Competence

For more than 30 years, NYU Lutheran has embraced the diversity of its community and patients. Few places around the world can rival the diversity of New York City-particularly southwest Brooklyn. This area, which surrounds NYU Lutheran Medical Center (NYU Lutheran), includes large populations of Latino, Chinese, Arab-American, Orthodox Jewish, Caribbean, and Russian residents, all of whom have varied cultural values and beliefs.

Years ago, in keeping with the medical center’s mission to serve the community, goals were set to make residents feel welcome and comfortable with our healthcare providers and our facilities. Our aim was to make NYU Lutheran the health system of choice in our community.

Attaining our goals meant becoming culturally competent and inclusive, to garner the greatest engagement of our patients and their families. We needed to understand and treat our diverse patients as “whole persons”-acknowledging not only their clinical symptoms and medical problems, but truly understanding and serving their underlying values and beliefs. Cultural competence is an essential part of patient engagement, communication, and improved outcomes.

Best If It Trickles Down
So how does an organization become an expert in cultural competence? NYU Lutheran was fortunate to have support from senior leadership to develop a role focused on cultural competence. In fulfilling this role, I am responsible for patient, community and physician engagement of our diverse communities. When I first began this job, I reported directly to the CEO, who was critical in providing the support and resources necessary to be successful.

I also supervise our “community liaisons,” who meet with hospital patients from their communities, coordinate services with community-based physicians, and collaborate with and do outreach for various community-based organizations. Advisory committees for each of the various communities discuss services (after they have been rendered), get feedback from the community and plan for improvements and upgrades to these services, to better serve each community.traditional Chinse dancers

Talking the Talk
In order to be successful, linguistic and cultural appropriateness are vital to providing care, services and outreach to our varied communities. The provision of interpretation services and the translation of vital documents are critical components to proper communication with patients. In addition, the hiring of bilingual and bicultural staff assure that not only are they able to communicate with our patients, but our patients’ cultural beliefs and values are understood and respected.

We know, for example, that close to 40% of our patients do not prefer to speak English for their medical care. They speak Spanish (28%), a dialect of Chinese (7%), Arabic (2%) or Russian (1%).

Because of this, annual data on our patients’ race and the language they prefer to speak is collected, and then compared for congruence to our data regarding our staff’s race and language abilities. Currently, our staff members are 61% bilingual. Approximately 24% of our staff speak Spanish, 10% speak Chinese, 5% speak Russian, and 2% speak Arabic. NYU Lutheran is a major employer in southwest Brooklyn, and many of our staff members are recruited from the community.

Community Input Is Crucial
Our ambulatory network, called NYU Lutheran Family Health Centers, is a federally-qualified health center. Half of its governing board is comprised of health care consumers from the community, and their input is instrumental in understanding the demographic changes in the neighborhood and providing us with feedback on the types of services needed.

In addition, by partnering with community-based organizations, faith-based organizations and community leaders, NYU Lutheran has been better able to determine the needs of the various communities and develop community health assessments, focus groups and programs to serve each one.

We have community health centers that are located in various neighborhoods, and focus on the healthcare needs of Latino, Chinese, Caribbean, and many other diverse communities. NYU Lutheran’s main hospital building has a mosque, a Bikur Cholim room, Sabbath elevators, and an interfaith chapel. We serve Chinese, Halal, and Kosher meals. The patient guides and other documents are in five languages: English, Spanish, Chinese, Russian, and Arabic.

We developed a dedicated Chinese medical unit in our medical center, a Chinese unit in the NYU Lutheran Augustana Center (our system’s nursing and rehabilitation facility), and a Chinese outpatient health center with primary care, rehab, and dental services. These were all developed with the input and cooperation of the community, staff, and physician partners.

SEE ALSO: Retaining a Diverse Workforce

On a lighter side, cultural celebrations for our patients as well as our staff are held on a routine basis. Whether it is Mexican Independence Day or St. Patrick’s Day, the main lobby of the hospital is appropriately decorated by staff, culturally-appropriate food is served and entertainment is presented. These “lobby events” are enjoyed by all- staff, patients and visitors come together to eat and learn about a different culture. Close to 20 celebrations are held annually, and these fun events really help everybody appreciate our diversity.

Ongoing Education Required
NYU Lutheran continually educates and trains staff on cultural competence through a multitude of classes and methodologies. About 10 years ago, NYU Lutheran had the good fortunate to receive grant funds and was able to send all staff members (approximately 3,000 people) to a full-day cultural competence training seminar; and two years later, to a half-day “refresher.” Outside consultants were hired to provide didactic and group training which included role-playing and small-group discussion.

Nowadays, all new hires receive one hour of training during their employee orientation. This training involves a video about the diversity of NYU Lutheran’s patient population, followed by discussion. Interpreter policies and procedures are also presented.

On an ongoing basis, nurses, house staff and medical students receive additional training on cultural competence within their disciplinary training. Medical residents also receive eight hours annually on topics such as: cross-cultural communication, values and health beliefs, death and dying, alternative medicine, health literacy, gender roles among others.

Patient diversity and cultural competence are also incorporated into other routine staff training modules coordinated by NYU Lutheran’s organizational learning department. These trainings include information about customer service, conflict resolution, and supervisor and sexual harassment.

Special training sessions, open to all staff members, have been conducted on the following topics and have included guest speakers with expertise on: Chinese and Latino values and health beliefs; Ramadan; Latino health disparities; working with Muslim families; LGBT patients and hormonal therapy; mental health issues with respect to Latinos, Chinese and Muslims; working with patients with disabilities and service animals; spiritual beliefs among various communities; palliative care; and medical interpretation.

In 2013, NYU Lutheran piloted a cultural competence training program through a rounding methodology. On a monthly basis, for a few hours, teams would round to different units in the hospital to discuss different cultural topics. Policies, case studies, and educational materials would be distributed a week beforehand; and teams would “round” to the different units to gather staff to discuss and review the materials. These sessions were found to be more effective in reaching more staff members in the areas where they work, eliminating the need to release staff, find backfill and stretch limited staff resources. Cultural competence huddles and fairs are being considered going forward.

Patient-Centered Care at its Best
In 2016, NYU Lutheran merged with NYU Langone Medical Center, which will result in more collaboration with and services and resources going to the southwest Brooklyn community. New computer systems will enhance our ability to track limited-English patients throughout the health system, bettering our ability to offer them services. In-person interpretation services will be expanded and video-enabled remote interpretation systems will be offered when an in-person interpreter is not available. Cultural competence training will be also available via online resources, and therefore more accessible to staff.

Cultural competence programs and services are patient-centered care at its best. Patient satisfaction scores will improve if your facility implements programs and services tailored to various diverse patient populations. If implemented successfully, patients will stay healthy longer-and choose your organization over others in the area because they feel more comfortable there.

Virginia Tong is the vice president of cultural competence and partnership innovation at NYU Lutheran.

About The Author