Diversity: From the White House to “Our House”

Article Outline

• Guidelines, Mandates, and Recommendations
• Advisory Panel
• Conclusion
• References
• Copyright

The Presidential inauguration is over and now only time will tell whether President Obama will be able to fulfill the great expectations placed on him and his cabinet. One of those expectations is greater diversity in government. It is commonly believed that diversity brings a competitive advantage, and that by having diverse thinking at the table, we gain tremendous benefits. One of those benefits is the ability to think globally while still acting locally.

As perioperative nurses, we have been providing invaluable health care services to an increasingly diverse population. As a workforce, we are diverse in two different ways—by virtue of our different racial and ethnic backgrounds and by virtue of our experiences in other countries and with people of different cultures. It is this diversity that will allow us to fulfill the expectations placed on us by the general public, the government, and health care accreditation agencies. In addition to maintaining patient safety, we have been expected to maintain national standards for culturally and linguistically appropriate services (CLAS)¹ in health care since 2001.

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Guidelines, Mandates, and Recommendations 

In 2001 the US Department of Health and Human Services (HHS) Office of Minority Health issued a collective set of CLAS mandates, guidelines, and recommendations intended to guide and facilitate implementation of required and recommended practices related to the cultural and linguistic appropriateness of health care services (Table 1). Although these standards are not new, few of us are aware of their existence and importance. As perioperative nurses, many of us have received cross-cultural education and training so that our skills in providing culturally competent care can be assessed through testing, direct observation, and monitoring of patient satisfaction. This is just one of the training aspects that may be addressed with managers and nursing staff members during Joint Commission accreditation visits. Research has shown that a lack of sensitivity and responsiveness to cultural and language needs affects quality, safety, and patient satisfaction.²

Table 1. The 14 Culturally and Linguistically Appropriate Services (CLAS) Standards¹

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Advisory Panel 

In August 2008, the Joint Commission issued a call for nominations to an expert advisory panel that will review evidence-based practices and identify principles that will form the basis for new and revised accreditation standards for culturally competent and patient-centered care in hospitals.³ This panel will be a continuation of the Hospitals, Language, and Culture (HCL) study.² The HCL study gathered information about the activities that hospitals have undertaken to address cultural and linguistic needs among an increasingly diverse patient population.

The panel will explore how diversity, culture, language, and health literacy issues can be incorporated into current Joint Commission standards or drafted into new accreditation requirements.³

Especially important for perioperative nurses is the HCL finding regarding informed consent. The HCL report states that although most hospitals included in the study indicated that they took patient linguistic needs into account during the informed consent process, many also indicated that “our informed consent form is translated into Spanish” without acknowledging the use of an interpreter to explain to the patient the condition, the treatment options, and the proposed treatment.²

As a result, the HCL investigators have recommended that hospitals implement a uniform framework for the collection of data on race, ethnicity, and language, as well as provide ongoing inservice training to hospital staff members on ways to meet the unique needs of their patient population, including regular inservice programs on how and when to access language services for patients with limited English language proficiency (ELP). In addition, health care interpreters should be involved in facilitating communication during all informed consent processes involving patients with limited ELP, and cultural brokers should be used as a resource when a patient's cultural beliefs affect care.

Cultural brokers are intermediaries that bridge cultural gaps by communicating differences and similarities between cultures. Brokers can mediate and negotiate complex processes with organizations and between interest groups. Cultural brokers aim to build an awareness and understanding not only of the cultural factors of the diverse communities they serve, but also the factors that can influence communities. Although a cultural broker does not have to be a member of a particular cultural group, a broker must be someone who has a history and experience with the cultural group he or she serves.⁴

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Conclusion 

Nurses need to become familiar with CLAS standards, not only because they will be reflected in the new accreditation requirements set forth by the Joint Commission, but also because we all play a pivotal role in keeping our patients safe, serving as patient advocates, providing quality care, and maintaining patients' satisfaction as health care consumers. We already have a diverse patient population that deserves the best health care we can provide. As diversity increases in our government, our health care institutions and work settings also should reflect readiness to deliver culturally competent health care. Our awareness of the cultural and ethnic richness among us, acknowledgement of the different languages we speak, and respect for each others' belief systems can give us a head start as we strive to maintain excellence in what we do best—act as patient advocates.

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References 

1. National Standards for Culturally and Linguistically Appropriate Services in Health Care: Final Report. US Department of Health and Human Services Office of Minority Health . http://www.omhrc.gov/assets/pdf/checked/finalreport.pdf Accessed December 12, 2008.
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2. Hospitals, Language, and Culture: A Snapshot of the Nation. Exploring Cultural and Linguistic Services in the Nation's Hospitals, A Report of Findings . http://www.jointcommission.org/NR/rdonlyres/E64E5E89-5734-4D1D-BB4D-C4ACD4BF8BD3/0/hlc_paper.pdf 2007; Accessed December 30, 2008.
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3. Joint Commission project to explore cultural competency standards  . AHA News Now . http://www.ahanews.com/ahanews_app/jsp/display.jsp?dcrpath=AHANEWS/AHANewsNowArticle/data/ann_080825_JCo&domain=AHANEWS Accessed December 12, 2008.
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4. National Center for Cultural Competence  . Bridging the Cultural Divide in Health Care Settings: The Essential Role of Cultural Broker Programs . Washington, DC: Georgetown University Center for Child and Human Development, Georgetown University Medical Center; 2004; http://www11.georgetown.edu/research/gucchd/nccc/documents/Cultural_Broker_Guide_English.pdf
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