1 page Details: Weekly tasks or assignments (Individual or Group Projects) will

Question

1 page Details: Weekly tasks or assignments (Individual or Group Projects) will be due by Monday and late submissions will be assigned a late penalty in accordance with the late penalty policy found in the syllabus. NOTE: All submission posting times are based on midnight Central Time. Health care managers are often responsible for managing multidisciplinary teams consisting of doctors, nurses, managers, administrative staff, etc. The majority of patient registration staff at the Pediatric Community Care Center is predominately minority (African-American, Hispanic-American, and Asian-American). The majority of the medical staff (nurses, doctors, therapists, etc.) is predominately Caucasian. You have observed minor conflicts within the patient registration team and between the medical and patient registration teams. You suspect that some of the problems stem from a lack of cultural competency. At the same time, there have been conflicts between the nurses and doctors regarding direct patient care issues. In some cases, doctors have accused nurses of overstepping their boundaries and interfering with patient care inappropriately. You recognize the importance of taking action to address these different issues. However, you do not want to overreact and cause unnecessary tension with the staff. Develop an action plan that you can present to your vice president that explains the situation and includes recommendations that will do the following: Improve relations within the patient registration team and between the patient registration team and the medical staff Reduce conflict between nurses and doctors Ensure that patient safety and quality of care is not negatively impacted by team conflicts within the organization

Explanation / Answer

Appropriate Training to Create Successful Cultural

Competency

________________________________________________________________________________

There are no standards as to what constitutes effective cultural competency

training or what makes a qualified, culturally competent trainer. Effective cultural

competency training has to be wary of stereotypical representations of different racial and

ethnic groups and provide more than simply the trials and tribulations of specific

minority populations (Fuller, 2002, Kagawa-Singer & Kassim-Lakha, 2003). Training 18

also tends to overlook the heterogeneity within cultural groups %u2013 individuals and groups

do not always conform to their own culture (Surbone, 2004). Overly simplistic

approaches to cultural competence can do more harm than good (Fuller, 2002).

In the Bay Area after the 1989 Loma Prieta earthquake and 1991 Oakland Hills

Firestorm, %u201Ccultural sensitivity training%u201D became a hot topic. Attempts to bring cultural

sensitivity to some traditional emergency services agencies amounted to presenting onetime classes on %u201Cserving the diverse community.%u201D Some of the most egregious violators

left the class emboldened to continue their inappropriate behavior %u2013 they simply added

%u201Coh, but that%u201Fs not culturally appropriate%u201D after their offensive remarks or behavior. Also,

the focus on providing appropriate care for racial and linguistic minorities overlooks

other groups not traditionally defined as %u201Ccultures%u201D (Dysert-Gale, 2006). In CARD%u201Fs

model, any self-organized group can be seen as having its own %u201Cculture.%u201D Tervalon and

Murray-Garcia (1998) found that the emphasis on promoting understanding of the

client%u201Fs worldview typically neglected to address the provider%u201Fs own worldview. In

Tervalon and Murray-Garcia%u201Fs model, the problems are not defined by a lack of culturally

specific knowledge, as much as a provider%u201Fs failure to develop and practice selfawareness and reflection.

CARD%u201Fs position on cultural competency is that it is not something to be acquired

and possessed, unchanging, ever after %u2013 it must grow and develop in step with changing

times and situations, and it must always reflect the landscape of the community. As

Tervalon and Murray-Garcia state in %u201CCultural Humility versus Cultural Competence%u201D

(1998), %u201Ccultural competence in clinical practice is best defined not by a discrete endpoint

but as a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and with themselves%u201D (p.

118).

In particular, CARD emphasizes the role of community and faith agencies in the

development of a sustainable model for public engagement. While it is impossible to

reach, track and meaningfully engage many individual members of any given

community, it is possible to form sustainable, mutually beneficial relationships with

community agencies whose missions, services and structures support the most vulnerable

members of any community. Rather than getting a random smattering of public

feedback, this model fosters the ongoing input of individuals with a broad spectrum of

knowledge, skills and experiences with a given community. These groups also have

organizational resources to contribute to efforts to serve the health and wellness of the

community.

It is not reasonable to expect that each EMS responder would take numerous

classes in order to become intimately aware of every sub-category of special needs

groups, but it is reasonable to expect that an ongoing level of cultural competence could

be maintained, with cultural humility as a goal. The format and delivery of such training

should reflect the ever-changing landscape of contemporary American society.

Standardized classes and approaches assume that the content would be equally relevant to

every individual participating. Further, reliance upon written materials, as was found in

one study of organizations in California, also promotes a one-size-fits-all mentality

(Brach, Paez, & Fraser, 2006). It is difficult to gauge how much cultural competence an

individual has gained from such training experiences. How could it be determined if a 20

seemingly culturally competent person will respond appropriately under stress or with

every group?

The CARD model encourages raising the ambient level of cultural competence in

the community and creating a sustainable platform for the ongoing development of EMS

personnel in partnership with the community. CARD%u201Fs philosophy is to use the

community as experts and to respect and seek out local wisdom and knowledge. CARD

also believes in encouraging communities to flex their capacity to render self-care and in

helping build community capacity to work as full partners with EMS and others in

emergency services disciplines.

Even the most well-funded, well-staffed, well-trained EMS department cannot

hope to address all community issues and needs. And while population-specific training

yields some benefits, there is a limit to how much of this type of training any individual

EMS worker can absorb and recall. The shift therefore must be multifold, with suggested

primary goals of learning how to work with diverse community groups and how to access

their knowledge and resources.

CARD%u201Fs approach to training classes is to first ensure that the material is

absolutely relevant to the everyday realities of the audience. Giving generic information

that is virtually never needed wastes both time and resources. Adult learning dynamics

dictate that courses focus on issues the learner finds appropriate, useful, and valuable,

especially in the short term. Several of CARD%u201Fs training concepts, policies and

guidelines are appropriate and applicable to EMS cultural competency training needs. Five examples include: 21

Emphasize Universal Skills. Learning effective listening and questioning skills

will provide benefit in virtually every situation. Similarly, practicing peerdebriefing techniques allows for greater learning and helps build stronger

relationships. By contrast, learning the rudiments of American Sign Language

could help EMS workers to better serve some deaf and Hard-of-Hearing (HoH)

consumers, but would be of limited value serving others outside this community.

Make Learning Multi-Sensory. Use graphics, charts, pictures and colors to

engage visual learners. Include group exercises and team-building to engage

students who learn best through social interaction. Use tools, objects and props to

support kinesthetic learners.

Nurture Emotional Intelligence. Training in medical disciplines often centers on

technical skills and medical knowledge. Emotional intelligence by contrast refers

more to the ability or capacity to perceive, assess, and consequently effectively

manage emotions (in self, others, or groups). For example, CARD advocates

emotional preparedness %u2013 being emotionally prepared to respond to the needs,

concerns and upsets of your loved ones and community. Even the poorest

communities, with no ability to purchase kits, write plans or take classes can

embrace being emotionally ready to keep their community whole and calm in the

event of an emergency.

Use Positive Contexts for Action. Traditional emergency services training and

health education is awash in negative contexts for action. The warning mantra in

preparedness is familiar: %u201CDo what we say because terrible things %u2013 earthquakes,

pandemics, storms, fires, terrorist attacks, etc. %u2013 will happen sometime in the unspecified future.%u201D Using fear and threat-based messages to inspire long-term

behavioral change does not work. Private sector corporations spend billions of

dollars using positive images and contexts for action when they want to establish

long-term habits and relationships with consumers %u2013 because it works. The

CARD curriculum uses no fear or disaster-threat messages as contexts for

preparedness actions. The CARD philosophy is %u201CPrepare to Prosper!%u201D

Question Basic Assumptions. EMS and other traditional disaster responders have

long believed that the public will do as they are told in emergency situations.

There is an assumption that people will listen to government representative as

%u201Cthe experts%u201D and %u201Cthe officials.%u201D CARD has much anecdotal and empirical

evidence to the contrary. Further, scientific research conducted by the New York

Academy of Medicine validates this evidence (Lasker, 2004). Unquestioned, these

beliefs will leave EMS responders unprepared for the realities they will face in

their communities during emergencies and disasters.

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