Dealing with Differences
Nursing Educators Are Leaders in Helping to Bridge Cultural Gaps

Medical professionals often complain that they have trouble dealing effectively with patients from minority cultures or subcultures. But, thanks to researchers at Old Dominion University, help is on the way.

Faculty members in the university’s College of Health Sciences, led by Carolyn Rutledge, associate professor of nursing, received a grant worth $765,000 from the U.S. Health Resources and Services Administration (HRSA) in 2008 to develop ways to better equip nursing educators and administrators to deal with cultural diversity and other barriers to health care.

This project is the latest in a series of research initiatives that have established ODU’s School of Nursing as a leading designer of training programs that address potential clashes and miscommunication between healthcare professionals and certain types of patients. Since 2003, the school has received more than $3 million for cultural awareness projects led by Rutledge, as well as Richardean Benjamin, chair of the School of Nursing, and Laurel Garzon, associate professor of nursing.

Two decisions by the ODU researchers have distinguished their work.

The first is the broad definition they have given to “culture.” “I have a problem being too narrow with the definition,” Rutledge said. “It involves a lot more than ethnicity.” In fact, she often refers to “subcultures” and “people of similar orientation” to describe groups—teenage Goths, overweight older women and gay people, for example—who often report unsatisfactory health-care experiences.

Don’t Roll Those Eyes
The second strategy that has led to the researchers’ success involves their use of diverse resources. One is ODU’s vaunted distance learning program, which is one of the largest of its kind, beaming live lectures and making online courses available to students scattered about the nation and the world. Another resource is Monarch General Hospital, a virtual hospital training facility in the recently updated College of Health Sciences Building. Also, according to Garzon, the researchers are relying on help from the Theresa Thomas Professional Skills Teaching and Assessment Center at the nearby Eastern Virginia Medical School. The center is recognized nationwide for its program with standardized patients (SP), actors who are specially trained to help health-care professionals hone their patient interviewing and diagnostic skills.

“There is no way you can teach students everything they need to know about every culture,” Garzon explained. “What we can teach is a process to help you work with various people, and then we can give you the opportunity to put that process to work with standardized patients.” The researchers contract with the Thomas Center to use SPs for cultural diversity training.

Rutledge said that an SP recently portrayed a lesbian patient during a classroom encounter with a nursing student. “When the standardized patient stepped out of her role and assessed the student’s performance, she said to the student, ‘After you rolled your eyes, it cut down on our communication.’”

Three previous $750,000 grants, each from the HRSA, which is part of the U.S. Department of Health and Human Services, have allowed the School of Nursing to provide cultural competency training in the Nurse Practitioner Program, Nurse Midwifery Program and undergraduate Registered Nurse Program. The latest grant, which extends through June 30, 2011, will provide the training to the graduate Nurse Administrator Program and Nurse Educator Program.

Value in Teaching Teachers
Rutledge sees the upcoming initiative as potentially more valuable than the predecessors because the researchers will be designing training for advanced professionals who can, in turn, train and influence many nursing students and nurses. “The project will refocus the master’s-level Nurse Administrator Program and the post-master’s Nurse Educator Program in order to address issues of cultural competency, health disparities and barriers to care,” Rutledge said.

A nurse practitioner, Rutledge took a position at EVMS in 1988—and still sees patients there—before moving to ODU in 2002. Garzon credits Rutledge with being the “grant writer extraordinaire” who has made the cultural competency initiatives possible.

The latest grant is designed to have auxiliary benefits, such as helping future leaders in the field of nursing to understand the need for healthcare professionals to be culturally competent in their dealings with co-workers as well as patients. Rutledge also believes the project’s design will make minorities feel more welcome in advanced nursing courses and could lead to more diversity among healthcare professionals, and to more nursing educators overall. “The nursing shortage is really a problem caused by a shortage of nursing educators,” she said.

Two decades ago, Rutledge spent a few years living in West Berlin, where her husband was stationed as an Army dentist, and she said she never forgot how diverse the people were. “We had the British, the Russians, the French, the Americans, the Turks, the Germans and so forth, and I found it fascinating trying to understand the different cultures. It opened my eyes about diversity. What is acceptable to some is not acceptable to others.”

Her interest in diversity merged with her professional interest in access to health care to produce her current push for cultural competency. She says the researchers want to take students who may be “unconsciously incompetent” or “consciously incompetent,” depending on how aware they are of their prejudices, and move them to categories of more tolerant behavior. “Consciously competent” describes someone who wants to be nonjudgmental, but who has to consciously work at it. The best category, “unconsciously competent,” describes someone who is open to diversity and sensitive as a general practice, Rutledge explained.
In a word, the ODU researchers, along with faculty colleagues Kimberly Tufts and Karen Karlowicz, want to eliminate any spoken language or body language with which a healthcare professional might belittle or insult patients, preventing the patients from getting the care they need.