An Innovative Master of Science Program for the Development of Culturally Competent Nursing Leaders

Abstract: The increasingly diverse population of the United States poses many challenges to the provision of health care services. Academic health care centers, community health clinics, and private providers all struggle to make services accessible and acceptable to people of many cultures, and who speak many languages. A level of cultural competence is required and organizations are having a difficult time incorporating knowledge, attitude and value changes. Studies continue to document differences in the quality of care that racial and ethnic groups are receiving. Nursing leaders are in a critical position to influence environments to optimize cultural and linguistic services. This document discusses the effectiveness of a cultural competence focus in a new master program in nurse administration. Hopefully, other educational programs will utilize lessons learned for nurse administrators.Key Words: Cultural Competence, Nurse Administrators and Leaders, Master of Science ProgramThe Department of Health and Human Services (DHHS) Office of Minority Health (2001) published fourteen standards for Culturally and Linguistically Appropriate Services (CLAS) that strive to achieve goals of ensuring access to care, quality care (patient centered and safe), and reducing disparities in health and treatment. These standards assist in clarifying Title IV of the Civil Rights Act of 1968, and require agencies that receive federal funds to provide language assistant services to people with limited use of tne English language. These services must be provided without charge and within a reasonable timeframe at all times the agency is open at all points of contact. Some agencies nave dealt with these mandates by fully embracing opportunities to enhance quality of care that is provided to diverse populations. Others have taken more limited measures attempting to meet the standards.Studies that have evaluated initiatives by agencies enhancing the delivery of cultural and linguistic services have recommended educational interventions for staff and providers (Medrano et al., 2005; Hunt, 2007; and Raso, 2006). In response, many educational efforts have been implemented in academic and practice settings. Bull & Miller (2008) described a PhD program designed to prepare teacher-scholars in leadership to reduce health disparities. Mun oz et al., (2009) discussed an interdisciplinary professional course to enhance provider cultural competence. Other authors who have discussed professional and staff development in an educational curricular in cultural competence include Braithwaite & Majumdar, 2006; Ndiwane et al., 2004.Measuring the effectiveness of cultural competence training has been extremely difficult, in part because of a lack of a clear definition of cultural competence and inadequate tools for measurement. Most models of cultural competence have included cognitive, affective and behavioral components. Some existing tools only measure the participant's self-perception of competence, and have been shown to be fraught with potential errors in establishing reliability, validity and social desirability bias. Other studies on the effectiveness of educational interventions designed to improve cultural competence relied on self-report measures, such as cognitive, which only captures one aspect of the concept and independent verification of responses that are costly and labor intensive.Barriers to the provision of cultural competent care have been cited that have little to do with content knowledge and more to do with the provider's personal choices and values. Changing the habitual beliefs and behaviors of adults is difficult when the changes require them to "first confront and overcome self-deception and bias" (Swanson, 2004, p. 207). Being culturally competent requires the complex mental ana attitudinal skills of adaptation to change, respect for difference, being sensitive with empathy, willingness to accept challenges, and a strong commitment to equality and social justice. …