Write a 35 page executive summary that examines an organization’s diversity policies and practices.
Becoming a nursing leader requires a good deal of thought, consideration, and evaluation of the qualities you believe are essential for a nurse to effectively lead in the delivery of health care.
Competency 3: Analyze the role of multiculturalism and diversity in organizational and systems structure and leadership.By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
- Analyze the impact of a diverse nursing workforce on patient outcomes.
- Analyze how the health care system integrates diversity and multiculturalism into its practices.
- Analyze current recruitment and retention policies to identify gaps between best practices and current policies.
- Competency 4: Evaluate how power relates to health care organizational structure, behavior, and leadership.
- Assess the level of integration and importance of multiculturalism and diversity in a health care organization.
- Recommend evidence-based changes to the organizational structure and systems leadership that empower a diverse workforce.
- Competency 5: Communicate in a manner that is consistent with the expectations of a nursing professional.
- Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.
- Correctly format citations and references using current APA style.
Multiculturalism and Diversity
Multiculturalism and diversity are significant factors in U.S. society, impacting all organizations; but in health care, the impact has significant consequences that can be seen in quality of care and patient outcomes. Due to constantly changing demographics, nursing leaders must remain vigilant when monitoring the impact of multiculturalism and diversity within their organizations and the communities served by the organizations. The multiple stakeholders affected by a multicultural and diverse workforce include patients, families, communities, system partnerships, et cetera. Nursing leaders must incorporate approaches that are inclusive and respectful of all stakeholders in the health care workforce, patient population, and the larger community that is served by the organization.
The following optional resources are provided to support you in completing the assessment or to provide a helpful context. For additional resources, refer to the Research Resources and Supplemental Resources in the left navigation menu of your courseroom.
Click the link provided below to view the following multimedia piece:
INTRODUCTION: WELCOME TO RIVERBEND CITY
Riverbend City Medical Center has a reputation for being one of the top medical facilities in the region. One persistent area of weakness is the ability to provide culturally competent care. Cultural competence goes beyond simply providing interpreter services or educational materials in a language other than English. Culturally competent care means that health care providers work to understand the different attitudes, values, and expectations their patients have when seeking health care.
This mission asks you to consider the ramifications of misunderstandings that arise when culturally competent care is lacking. Observe the actions of the medical staff throughout this mission and consider how nurse leaders could communicate with patients and staff to avoid conflict, misunderstandings, and barriers to quality health care.
Characters in this Mission:
- Chandra Capshaw – Hospital Social Worker
- Christina Cha – ER Receptionist
- Wade Field – EMT
- Candace Hong – Pediatric Nurse
- Mary Jackson – School Nurse
- Jessica Jameson – Novice Nurse
- Carl Lauderback – ER Nurse Supervisor
- Stewart Mason – EMT
- Farouk Massoud – EMT
- Christine Sassman – Pediatric Intensive Care Specialist
- Bo Vang – Resident
- Jason Vang – Resident
- Kaying Vang – Resident
SCENE 1: WASHINGTON ALLSTON ELEMENTARY SCHOOL, SCHOOL YARD
At the elementary school, several children and some teachers have been exposed to a chemical cloud that emanated from the derailed freight train. The school nurse has performed initial triage and called 911 to request assistance. An ambulance was dispatched and has now arrived on the scene.
Click on highlighted characters to hear how they are responding to the incident.
Dialogue 01: Stewart reports the situation to his dispatcher.
Dispatch, this is Unit 9 reporting from the Washington Allston School.
WADE (On the Radio):
Go ahead, Unit 9.
Yeah… there’s kids here exposed to some sort of chemical cloud… chlorine is my guess, but something else, too. Do you have any information on this?
WADE (On the Radio):
Yes, Unit 9. There’s been a train derailment just past the Clellen Bridge. Initial reports are that several cars have been breached, including at least one carrying chlorine. The HAZMAT teams are en route to the derailment. You say that the cloud is over the school, though?
That’s affirmative. We’re getting the injured kids and getting out of here. There’s no way to know the concentration, but we’re seeing skin and eye irritation and respiratory problems. We’re definitely in a contaminated area.
WADE (On the Radio):
Okay, Unit 9, get the exposed kids and get out of there. I’ll contact the onsite commander and find out if they’ve started plume analysis. My guess is that they’ll want the school to shelter in place for anyone not already exposed.
What have you got in terms of injuries?
Three or four kids with severe respiratory distress. Several with irritation and burns to their skin and eyes. One girl with a head injury from falling. One… I don’t know the full extent of his injuries – he apparently doesn’t speak any English and he’s hysterical and uncooperative.
WADE (On the Radio):
What language does he speak? I could get you someone who speaks Spanish if you need?
I wish… I speak enough Spanish to get the job done usually. No… this kid is Hmong.
WADE (On the Radio):
Sorry… can’t offer any help, except to let RCMC know that they should have their interpreter ready.
Okay… I’m going to get Farouk and get out of here. Unit 9 out.
Dialogue 02: Mary provides an update on what she and her colleagues at the school have done for the injured children.
Okay… Joanne and Scott and I have moved the kids who weren’t badly injured into our cars and we’re ready to follow you to RCMC. I need to give our principal the update on what’s happened, but I’ll be right behind you.
Okay, we need to move everyone out of here. This is a HAZMAT situation and we need to get out of here.
What about the kids in the school?
The school has an emergency preparedness plan-follow the protocol for a hazardous chemical spill.
Something else, though… that Hmong kid. Do you have anyone in the school who speaks Hmong?
Normally we do, but she’s out sick today. Can you communicate with him at all?
Not really… I went to school for emergency medicine, not poli-sci and languages definitely aren’t my thing.
It’s not like Hmong people are never seen in Riverbend City. Shouldn’t you have a plan for when you encounter someone who doesn’t speak English?
We have lots of plans… including not driving straight into a HAZMAT scenario. The plans are one thing; the job is something else altogether.
I know, I know… I’m not meaning to criticize. Lue is new to this country – he’s only been here about four months. His cousin often comes in with him when there is something the family wants communicated. He’s a student at the high school.
Well, we’re going to need this kid’s parents. Not that they’re likely to be able to provide any useful information, but they’ve got to be in the loop.
Of course. I’ll grab my laptop on my way back out. I can access student records through it and should be able to get contact information.
Dialogue 03: Farouk tries to help Stewart understand how cultural competence affects their response to their patients.
Stewart – I’ve got that one boy stabilized, but we need to get him to RCMC stat. His vitals are really unstable. I am worried about possible respiratory arrest.
Right… okay. The Hmong kid… I haven’t been able to do a very thorough assessment – he’s totally hysterical. I can’t get him to calm down enough to get a handle on how badly injured he may be.
Maybe something about the train and chemicals has triggered an emotional response. Refugees have often been through a lot.
For crying out loud… the kid is what, seven or eight? What kind of emotional baggage can a kid that young have picked up?
You’d be surprised.
I know that he’s hurt and he’s scared, but let’s not make more out of this than there already is. The problem is that he doesn’t speak English and I can’t do my job if I can’t communicate with the patient.
I understand that. Communication is more than just language, though. That’s all I’m saying. Let’s get these kids out of here, though. That’s our main problem.
SCENE 2: RCMC, AMBULANCE BAY
Having received notification that EMTs are en route with two children who were exposed to the chemical cloud, RCMC emergency department personnel wait in the ambulance bay.
Click on all highlighted characters to learn the status of the incoming patients.
Dialogue 04: Stewart gives Carl the report on his patient, Lue Vang, an elementary school child who was exposed to the chemical cloud.
Carl… over here!
What have you got for us, Stewart?
Approximately 8- or 9-year-old boy exposed to chemicals released by the train derailment. Some chemical burns on his skin and apparent respiratory involvement. It’s hard to tell for sure because he is hysterical and speaks virtually no English.
Did someone contact his parents?
I’m not sure. The school nurse is coming in behind us with more kids… less injured. She should have that information.
Do you know what language he speaks?
I am pretty sure the nurse said he’s Hmong.
Okay… Jessica, go with Stewart and put the boy in an ER bed, then page Christina Chang to whatever room you’re in. Start your assessment and the intake paperwork… can you handle that?
You bet. Let’s go, Stewart.
Dialogue 05: Carl probes for more information about the incoming patients.
How did these kids get exposed to chemicals?
It’s from the train derailment. We got a call to the school… the school nurse called 911 because a cloud of chemicals came up from the derailment site. They aren’t sure of all the chemicals involved, but definitely chlorine and anhydrous ammonia.
Got it. Have the parents for these two been notified?
Not by us. The nurse though… she’s on her way in with more children… not so badly exposed. She can give you more information.
I hope so. We’re going to need all the information we can get. This kind of thing can turn into a circus.
SCENE 3: RCMC, EMERGENCY ROOM WAITING AREA
In the emergency department waiting room, members of Lue Vang’s family have arrived and are trying to get information about his condition. The family wants Jason Vang, Lue’s 17-year-old cousin to represent them, but the hospital workers consider him a minor and want to deal with an adult.
Click highlighted characters to hear their concerns.
Dialogue 06: Carl attempts to defuse the deteriorating situation.
Hey Chandra, how you doing?
Hey Carl, I’m fine. This is the family of one of the children who came in earlier from the Washington Allston school.
The Vang boy, yes. He was my patient when he was here in the ER. I think there may have been some misunderstandings about his condition.
What do you mean?
One of our nurses mistook the marks on Lue’s back for signs of abuse and called CPS. By the time I found out, the boy had already been moved up to the PICU.
I am totally confused.
The marks were probably from coining. It’s a folk treatment that lots of Hmong people use.
Can you ask the family?
Dialogue 07: Christina tries to explain the misunderstanding about the marks on Lue’s back to his family.
Mrs. Vang, My name is Christina Chang. I’ve been asked to help interpret for Lue’s mother.
BO (to Kaying in Hmong):
They want to have this woman talk to you about Lue. She is Hmong and can interpret.
KAYING (to Bo in Hmong):
Why should we do that? Can’t Jason talk for us?
BO (to Christina):
Lue’s mother wants Jason to interpret for us.
We prefer to not use minors for interpreting.
Well, we prefer not to have to deal with ignorant jerks, but we didn’t get our choice now, did we?
Take it easy, son.
I’m not your son, dude.
Jason, this isn’t helping.
I don’t care. I am sick of these people. I just want to get Lue and get him out of here before they kill him like they did that other kid.
CHRISTINA (in Hmong):
There is a problem. The nurses saw marks on Lue’s back and they reported them to Child Protective Services. You need to explain what caused the marks and that no-one is hurting Lue.
SCENE 4: RCMC, PEDIATRIC ICU
Once the Vang family is reunited with Lue, Carl Lauderback, the ER nurse manager and Christine Sassman, the PICU nurse manager, take a moment to talk to Jessica about the incident.
Click on highlighted characters to hear their thoughts.
Optional Content – Hospital Computer:
Information about RCMC policies can be found in the folders and emails on the computer.
From: Shannon Moe, Nurse Training Manager
To: Linda Paulus
Subject: Upcoming Continuing Ed Opportunities
We have two seminars coming up – register early because space is limited!
Simulated Bedside Emergencies: For the New Nurse
Medical Arts Building Ste 419 July. 20 – 7:00am – 2:30pm
Cultural Competence and Your Nursing Practice
RCMC Ingham Auditorium Aug. 13 – 7:30 pm – 9:30pm
From: Shannon Moe, Nurse Training Manager
To: Linda Paulus
Subject: Online CLAS Refresher Training
The online CLAS refresher training will be available next week. All nursing personnel are required to complete the training by the 31st of this month. For a self-paced tutorial on this subject, go to the Training folder on the RCMC website and open the document named CLAS_training.pdf.
Dialogue 08: Carl checks in with Christine.
Chris, I don’t have much time – we’re getting slammed down in the ER – but I wanted to touch base and make sure the Vang boy and his family are okay.
We’re getting there. Apparently he’s had an upper respiratory infection for the last several days, so his lungs and bronchia were already inflamed when he was exposed to the chlorine.
It helps that we’re all communicating, now.
I apologize again for my role in this. I honestly thought I was helping my patient.
I understand and I’ll be the first to admit that I hate seeing a kid come in with those marks all over his back. In the long run, though, the more trust we can establish with our Hmong patients, the more likely they are to come to us instead of turning to folk remedies like that.
Dialogue 09: Jessica expresses the doubts and concerns she is feeling.
Don’t you ever feel like this all goes too far?
In what way?
Well… like we’re so focused on not offending anyone that we don’t want to say a practice is bad or dangerous?
I can see how you might feel that way, but maybe if you looked at it from another perspective, it might make more sense. What do we gain by telling the Vangs that this coining is bad and potentially dangerous? They feel like we don’t know what we’re talking about – it’s pretty rare for someone to be injured by this, though not unheard of – so they feel like we don’t know anything about the way they do things. And if they tell us about what folk medicines or remedies they’ve tried, we’re going to disapprove. So… they don’t tell us. They don’t necessarily stop using these things; they just stop telling us about them.
That makes sense, but I still feel like we’re giving tacit approval to all this stuff-like we’re putting it on the same level as science-based medicine.
I do get the need for communication, though. I just wonder how far is too far when it comes to trying to be politically correct.
Is it okay if I head back to the ER, Carl?
Sure… I’ll see you there.
Dialogue 10: Christine expresses her observations about Jessica to Carl.
That was… interesting.
Yeah. I worry about her. She has the potential to be a good nurse, but there are definitely areas she needs to work on and this is one of them.
I guess she’s just got to work through some of this on her own.
Christine… excuse me, but I noticed you talking to that nurse from the ER.
Well… I don’t want to be a tattle tale, but she was talking to me and Jill earlier about the Vang boy she brought up. I understand that we all have our own beliefs, but… well, from some of the things she was saying, I almost feel like she’s so against anything that isn’t mainstream medicine that she can’t help seeing the world in terms of absolutes. It’s either right or wrong. I’m just concerned that her attitudes are going to get in the way of actually hearing what her patients’ needs and concerns are.
Interesting. Thanks for sharing that.
I get the impression that she doesn’t see a difference between understanding and respecting differences and endorsing them.
Congratulations! You have successfully completed the Cultural Competence Mission.
Health care providers in all settings deal with the challenge of caring for patients who have different cultural backgrounds. Understanding the role of culture in a person’s health beliefs and behavior helps the health care professional provide the most comprehensive plan of care for the patient. In this mission, culture was a factor not only because of the cao gia (coining) that had been done, but also because the Vang family had expected Jason, a responsible teenager, to be able to represent them. Health care providers at all levels need to consider how their attitudes and understanding affect a patient’s outcome.
SUMMARY DOCUMENT CONTENT
Cultural Competence Mission
In this mission, you were able to observe the effect of culture, cultural competence, and the lack of cultural competence on health care workers’ ability to provide the best possible care. From the elementary school yard to the emergency room and on to the pediatric ICU, you were able to watch health-care providers respond to language barriers and cultural practices that were not always familiar.
In this mission, the impact of cultural competence on a specific individual was illustrated. Significant differences in understanding caused by cultural expectations caused misunderstandings, confusion, and ill-will. The scenes that you viewed demonstrated how something as simple as the concept of adulthood can vary from one culture to another and can affect the quality of care provided by medical personnel. Additionally, the use of folk remedies and other CAM was addressed. These scenes, while focused on a specific event, should help you articulate broader issues related to cultural competence.
For this mission, you were able to download the EMT report for Lue Vang. You were also able to access e-mails and other documents related to policy and training from the perspective of cultural competence.
- Library Resources
The following e-books or articles from the Capella University Library are linked directly in this course:
- Banister, G., & Winfrey, M. E. (2012). Enhancing diversity in nursing: A partnership approach. The Journal of Nursing Administration, 42(3), 176181.
- Degazon, C. E., & Mancha, C. (2012). Changing the face of nursing: Reducing ethnic and racial disparities in health. Family & community health, 35(1), 514.
- Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidencebased practice models for organizational change: Overview and practical applications. Journal of Advanced Nursing, 69(5), 11971209.
- Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709724.
- Suominen, T., Härkönen, E., Rankinen, S., Kuokkanen, L., Kukkurainen, M., & Doran, D. (2011). Perceived organizational change and its connection to the work-related empowerment. Nordic Journal of Nursing Research and Clinical Studies, 31(1), 49.
- Rao, A. (2012). The contemporary construction of nurse empowerment. Journal of Nursing Scholarship, 41(4), 726743.
- Munro, E., & Hubbard, A. (2011). A systems approach to evaluating organisational change in children’s social care.British Journal of Social Work, 41(4), 726743.
- Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., . . . Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), 109121.
Course Library Guide
A Capella University library guide has been created specifically for your use in this course. You are encouraged to refer to the resources in the BSN-FP4008 Organizational and Systems Management for Quality Outcomes Library Guide to help direct your research.
Access the following resources by clicking the links provided. Please note that URLs change frequently. Permissions for the following links have been either granted or deemed appropriate for educational use at the time of course publication.
- American Association of Colleges of Nursing. (n.d.).
Needs help with similar assignment?
We are available 24x7 to deliver the best services and assignment ready within 3-4 hours? Order a custom-written, plagiarism-free paperOrder Over WhatsApp Place an Order Online