Interprofessional Cultural Competency to Improve Equitable Care  

Objectives: 

Using a scenario and a privilege exercise related to the provision of culturally competent and equitable care, interprofessionals will enhance their ability:

1. To apply concepts of power and privilege to relationship-building values and the principles of team dynamics to understand how it impact  the provision of patient- centered care that is culturally appropriate, safe, timely, and equitable.
2. To communicate with other health professions, patients, families, communities, in a responsive and responsible manner that supports a team approach to provide equitable care to all patients despite challenging situations.
3. To collaborate with multiple professions (nursing, law, and social work, among others)  in order to establish a climate of mutual respect and shared values.

Scenario: 

The patient presented the urgent care center complaining of chest pain and left arm pain. He was triaged by a nurse and quickly taken to a room and an EKG was done. There was evidence of a prior infarct and his EKG was abnormal. The doctor was notified right away and immediately assessed the patient and the decision was made to call 911 for transport to the local ED. Upon evaluation of the patient, it was discovered that the patient was HIV positive. The medical doctor made the decision not to start an IV because of the risk of blood exposure to the healthcare team. The nurse who triaged the patient and was providing care to the patient called the administrator and said it is not right that the same care is not given to someone with HIV.  According to the nurse, it is routine policy that anyone being transported 911 have IV access. By the time the nurse alerted the administrator, the ambulance had already arrived and the patient’s care was transferred to EMS. The doctor’s perspective in this situation was protecting his staff. The nurse’s perspective was treating each patient the same no matter what disease or illness the patient may have. The nurse believed that as healthcare workers, there are risks of exposure to blood borne pathogens; and each person working the center receives education on blood borne pathogens annually. As a society, this is an ethical issue because people with stigmatized diseases may be subjected to inequitable care, especially in emergent situations. Provision 1 of the Code of ethics for nurses says “the nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems” (Code of Ethics, 2010). According to Jeffreys (2010), “culturally competent nurses and physicians should realize the importance of differentiating between many subgroups within the broad ethical/racial categories to avoid stereotyping” (p. 34). Likewise, culturally congruent care is a basic right, and should be provided to all (Jeffreys, 2010).

Activity Description:

The scenario opens the interprofessional discussion related to education of  the interprofessional team on providing culturally competent care to groups that differ,  including by differences by race, gender, socioeconomic and social class, and health status (Enhancing Cultural Competence, 2013).  Participants will be asked to discuss the knowledge, attitudes, and difficulties that the health professionals may have toward cultural competence and discriminatory care in the presence of HIV and other vulnerable populations.  Participants will also engage in a privilege exercise (Based on an exercise by: Gerakina Arlene Sgoutas and colleagues, Metropolitan State College; Denver, CO, Brenda J. Allen, Differencematters.info) that allows allow participants to explore ways that health professionals enjoy privilege within the American healthcare system. By illuminating our various privileged positions, we can recognize ways that we have power differentials with our patients and we can seek to use our privileged positions to advocate for change. Finally, participants will be challenged to consider how they can enhance the organization’s ability to ensure culturally competence care so that systematic inequity in care can be eliminated.