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What does cultural competency mean to OR nurses?

Publish Date: 10/16/2013

"Patients are the center of the wheel," says Donna A. Pritchard, RN, BSN, MA, NE-BC, CN OR, director of perioperative services at Kingsbrook Jewish Medical Center in Brooklyn, N.Y. "They — and their families — are our primary focus. We need to provide a safe, high-quality care environment, and to do this we must try to meet each patient's unique cultural and religious needs."

The country is becoming more culturally, ethnically and religiously diverse, and this rapid diversification can be seen in operating rooms in all settings and in all cities — both big and small — throughout the country.

"It seems that there's not only greater and greater diversity, but greater diversity in cities you wouldn't expect to see it," says Mary J. Ogg, MSN, RN, CNOR, perioperative nursing specialist for AORN. "When you typically think of diversity, you think of the huge cities in this country — New York, Los Angeles, Chicago. But major cultural populations are developing in smaller cities nationwide."

When a perioperative RN provides care to a patient with cultural-specific needs, it is the responsibility of that perioperative professional to ensure the patient receives the best care possible — care that must take these needs into account, says Pritchard, who is also chair of AORN's Clinical Nursing Practice Committee.

To accomplish this objective requires perioperative professionals to develop cultural competency. In recognition of the increasing diversification of the patient population and to assist perioperative professionals with strengthening their cultural competency, AORN is taking steps to ensure perioperative professionals have access to the resources they need to continue to provide excellent, personalized surgical care.;

Understanding cultural competency

The Office of Minority Health defines cultural and linguistic competence as "a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. ... Cultural competency is one of the main ingredients in closing the disparities gap in health care. Quite simply, health care services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients can help bring about positive health outcomes."

"Cultural competency is being respectful of patients' culture, religious and ethnic background, and trying to provide care that is respectful of these values," Ogg says. "I think that's what it boils down to in a nutshell: being respectful of different religions and cultures."

To be respectful requires perioperative professionals to understand these values, learn how they may affect what a patient needs for a good surgical experience and, whenever possible, to take these considerations into account when approaching the provision of care.

"For example, some patients may prefer an all-female or all-male staff," Pritchard says. "They may not be able to take cold fluids postoperatively. They may be required to wear a certain type of head covering. It is our responsibility to work to accommodate these needs during surgery, and then to ensure the patient can comply with discharge instructions. It's very important to tailor patient education to patients' cultural needs, especially for us in the perioperative environment. If we don't understand when there is a cultural taboo, the patient may be more susceptible to infections if they have some issues with bathing, for example. There are nuances perioperative professionals need to be aware of."

How AORN will help

"One of the initiatives of the Clinical Nursing Practice Committee this year is to develop resources to assist in effective communication and culturally competent care during the preoperative phase of surgical intervention," Pritchard says.

Once the committee was assigned this initiative, committee members conducted extensive research into what resources addressing cultural competency were already available. "There are a lot of resources out there from AHRQ, AHA and The Joint Commission, for example," Ogg says. "The more you look, the more you find. But whether our members are using these resources, whether they know about these resources or whether these particular resources meet or do not meet their needs, we aren't sure."

To answer these questions, a 20-plus question survey has been developed. This survey will go out in the coming weeks to AORN's leadership specialty assembly, ambulatory surgery specialty assembly, its educators and a randomized sampling of the membership.

Questions on the survey include the following:

  • Has your practice setting addressed the cultural/ religious needs of perioperative patients?
  • How adequate are your resources to assist you in addressing ethnic and cultural needs of your surgical patients?
  • Would you like to see more ethnic/cultural initiatives implemented in your practice setting?
  • What type of barriers do you encounter in providing culturally competent care?
  • Do you have adequate resources to assist you in addressing special care needs of your surgical patients?

"The objective of the survey is to determine what resources our members are already using, whether they need additional resources and, if they do, what types of resources they might need to provide culturally competent care for our patients," Ogg says.

"We want to query our members to find out if in their workplace, have they addressed the ethnicity, cultural and religious needs of patients, and if so, how," Pritchard says. "We don't want to reinvent the wheel when it comes to creating new resources and toolkits, but we want our members to know about the resources already available to them and to identify opportunities to develop new resources that can fill educational gaps."

The survey includes open-ended questions that provide survey recipients with an opportunity to share tools and stories about how their facility has accommodated different cultural populations as well as a demographics section to help identify specific state and regional needs.

Survey recipients will have two weeks to fill out and return the survey to AORN. Then the clinical nursing practice committee will get to work analyzing the results and putting a plan in action.

"We'll explore many different avenues to help members and enrich the patient experience," Pritchard says. "It's about delivering quality, safe care. You have to be able to communicate effectively with your patient. That's a core need. That must be successful in your partnership with the patient."

Guidelines for Perioperative Practice


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