Document Type

Report

Publication Date

Spring 2024

Date of Final Presentation

4-4-2024

Committee Chair

Katherine Doyon, PhD, MEd, RN, CHPN

Committee Member

Kim Martz, PhD, RN

Coordinator/ Chair of DNP Program

April Howell, DNP, RN

Abstract/ Executive Summary

Problem Description: The chasm of health inequality for underrepresented populations in the United States is growing, despite advances in healthcare and increased life expectancy. Disparities span the age and healthcare continuum for underrepresented populations, with increased mortality and morbidity rates in nearly every category. Non-white residents in Cook County face the same challenges. Historical lack of trust creates a reluctance to seek healthcare among Black populations, but when they do, they are disproportionately dissatisfied with their care, receive less aggressive treatment, and report higher levels of uncontrolled pain. Nurses, as the largest body of healthcare professionals, are uniquely positioned to facilitate a change in health outcomes for underrepresented populations.

Setting: The racial demographics in Cook County, Illinois varies by city. The Evergreen Park region, a suburb of Chicago, is approximately 64% white and 27.7% Black residents; however, Black nurses working in the local healthcare organization emergency department represent only 14.5% of the nurses.

Rationale: Despite growing evidence to support cultural humility and communication training to improve patient outcomes and satisfaction, review of available trainings for an urban medical center in Southwest Chicago revealed no access to cultural humility training and the available communication training was not framed through the lens of cultural awareness.

Project Aims: The project aimed to assess Emergency Department (ED) nurses perceived self-efficacy engaging in patient-centered communication using the tenants of cultural humility, provide cultural humility and communication training for ED nurses, and to then reassess nurses perceived self-efficacy in including cultural humility in their practice.

Project Outcomes: The project had seven short term change outcomes, one for preparing the intervention, four for the participants engagement in and endorsement of the intervention, and three for participant knowledge acquisition.

Implementation and Evaluation Plan: The implementation plan included training of the standardized patients, development of a pre-learning module, and eight simulation events spanning a two-week period. The simulation event consisted of communication self-efficacy and Cultural Humility Scale baseline assessment data collection, education discussion, simulation pre-briefing, 15-minute simulated event, de-briefing, and a reassessment of communication self-efficacy.

Results: Pre and post-test communication self-efficacy scores for the nurse participants (n=26) after the simulation event shows most nurses (76%) stated an increase in overall confidence with 10-25% confidence increase for each question. The two-month follow-up Cultural Humility self-assessment scale demonstrated higher than expected results.

Interpretation: The intervention findings aligned with literature suggesting that communication simulations utilizing live actors may improve self-efficacy in emergency department nurses. The educational discussion also aligned with the literature in that it provided a platform for self-reflection.

Conclusion: Nurses willingly engaged in the intervention, were open and self-disclosed during the cultural humility discussion, improved their communication self-efficacy scores, and rated the event highly in their evaluations. Nurses were able to discuss personal biases, power imbalance, and opportunities to improve communications with patients. Preliminary reports show the simulation may have led to improved patient experience scores. The organization has plans to continue the training and extend the program across the organization.

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