NUR661 Pediatric Critical Care Nurse Orientation

Welcome to the Pediatric Critical Care Nursing Orientation at the UVM Children's Hospital!

Providing nursing care for sick and injured children can be challenging and rewarding.  During the critical phase of care, nurses are often faced with unstable patient conditions and parents who are bewildered by the fast pace of the intensive care unit. 

A carefully designed orientation to pediatric critical care prepares nurses for successful practice and ensures clinical competency.  Moreover, a nursing orientation that emphasizes interprofessional education and collaborative practice aligns with nationally recommended strategies for improving quality and safety in health care (IOM, 2001). 

In order to be eligible for the pediatric critical care nursing orientation, nurses must first complete the adult critical care internship program as well as one year of independent practice.  The pediatric critical care orientation nursing orientation program will be guided by a master's prepared nurse educator who emphasizes interprofessional collaborative practice (AACN, 2012; QSEN, 2020; IECEP, 2011).

PICU Nurse Orientation Week 3:  Cultural Competency

Click here for a welcome message.

Welcome to Week 3 of the Pediatric Critical Care Nursing Orientation!  This week, the Interprofessional Education Discussion Group will explore the concept of cultural competency in health care as it relates to the care of the child in the ICU.  According to the U.S. Department of Health and Human Services Office of Minority Health,

“Culturally and linguistically appropriate services are respectful of and responsive to the health beliefs, practices, and needs of diverse patients. The percentage of Americans who are racial and ethnic minorities and who speak a primary language other than English continues to grow rapidly. Organizations are looking to meet the challenges of serving diverse communities and provide high-quality services and care.  By tailoring services to an individual's culture and language preference, health professionals can help bring about positive health outcomes for diverse populations,” (2019).

The IPE Discussion Group will be co-led by the PICU nurse educator and the medical director of the PICU.  Other participants include a representative from the respiratory therapy department, a PICU nurse preceptor, and a pediatric resident physician.  It is expected that all members of the group will contribute to the discussion.  Failure to participate in the IPE discussion group will require a joint meeting with the SICU/PICU nurse manager and nurse educator to determine continued eligibility for the PCCNO program. 

We will meet in the SICU/PICU conference room from 1100-1230, with access to the large-display computer to view hyperlinked material.  Each participant will complete a 10-question content quiz that promotes self-reflection at the completion of the discussion.  Please direct any questions or issues to the PICU nurse educator via email PICU.Educator@uvmhealth.org or page via the hospital operator.  Technology assistance is available via the UVMMC Information Services Helpdesk at extension 71414.

IPE Discussion Group Questions and Learning Resources

1. Define cultural competency in healthcare.  Learning resource:  U.S. Department of Health and Human Services (2018).
2. What does cultural competency mean to you as a healthcare provider in the PICU?  Does cultural competency differ between members of the PICU team (nurse, respiratory therapist, and physician)?  Learning resources:  Cultural competence in pediatrics: Health care provider knowledge, awareness, and skills (Dabney et al., 2015); and The National CLAS Standards.
3. Examine the graph below of population percentages of race & ethnicity in Vermont (Datawheel, 2018).  In 2015, there were 584,851 White residents in Vermont.  There were 10,939 residents identifying as multiracial and 10,422 Hispanic residents, the second and third most common racial or ethnic groups.  The following bar chart depicts the eight races and ethnicities represented in Vermont as a share of the total population.  What do you think about our population demographic?  Learning resources:  Factors influencing nurse-to-parent communication in culturally sensitive pediatric care: A qualitative study (Valizadeh et al., 2017).

Population percentages of race & ethnicity in Vermont, 2015 (Datawheel, 2018)

4. You are assigned to care for a two-month-old baby girl with bronchiolitis.  Her mother is a young refugee from Somalia with limited English language skills.  What resources are available to you from the hospital?  What information can you find on the internet that might help you provide culturally competent care for this patient and her family?  According to the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, what services should we offer this family?  Learning resources:  Slota, 2019 (text), EthnoMed, and The National CLAS Standards.

Image source:  www.unicef.org

5. Let’s finish by watching the following video from the HHS Office of Minority Health (2016):

Think Cultural Health Case Study: Using Language Access Services.

Course Description

The Pediatric Critical Care Nursing Orientation (PCCNO) is a 15-week hybrid clinical course designed to provide both education and clinical exposure for nurses with adult critical care experience as a foundation for developing independent practice as a pediatric critical care nurse in the University of Vermont Medical Center (UVMMC) combined adult surgical and pediatric intensive care unit (henceforth referred to as the SICU/PICU).  The course is delivered annually from January to April using a calendar that is aligned with patient census data extracted from the electronic health record (EHR) to optimize forecasted pediatric clinical experiences.  Components of the program include:

• Essentials in Pediatric Critical Care Online (EPCCO) is a web-based course with standardized content and up-to-date, evidence-informed instruction delivered through the American Association of Critical-Care Nurses (AACN) learning management system that includes interactive learning activities and modular assessments;
• an interprofessional education (IPE) discussion group facilitated by the nurse educator that includes pediatric intensivists and members of the interprofessional care team to explore topics not included in the online course such as cultural competency, impaired family dynamics, children with special healthcare needs and more;
• clinical simulation with an interprofessional care team for psychomotor skill and patient care scenario practice;
• clinical experience in the form of shadowing opportunities within the UVMMC inpatient and outpatient pediatric care areas; and
• a supervised clinical practicum in the PICU with a trained preceptor.

Program and Module Outcomes

Upon completion of the PCCNO program, the Program Learning Outcomes (PLO) include:

• PLO1   Evaluate assessment data and implement a plan of care that is evidence-informed, patient and family-centered, and was created as part of an interprofessional care team.

• PLO2   Apply knowledge of lifespan development and common pediatric health conditions to acutely and critically ill pediatric patients.
• PLO3   Evaluate and communicate the effectiveness of the plan of care for the acutely and critically ill pediatric patient.

Upon completion of the Week 3 IPE Discussion Group, the Module Outcomes include:

• MO1   Describe culturally competent healthcare.
• MO2   Identify two resources for cultural information.
• MO3   Construct two patient care examples that describe how the interprofessional PICU team provides culturally competent care.

                Interprofessional education is defined as, “a shared learning experience among health profession students across disciplines, with the goals of professional identification, the edification of strong clinical teams and the improvement of health outcomes” (Bressler and Persico, 2015, p. 144).  Many national healthcare and nursing organizations have expressly stated the compulsory need for IPE and team collaboration as a means of delivering quality care in a safe manner, achieving optimal patient outcomes, and improving the overall work environment which results in increased job satisfaction (AACN 2011; AACN 2016; IOM ,2013).  IPE supports the mission, vision, and values of UVMMC.

                Health disparities are differences in health for a specific group of people (HHS OMH, 2019).  According to Dabney et al., “the causes of health and health care disparities are complex and include the social determinants of health, structural barriers at the health care system level, leadership/workforce barriers, and patient/provider communication barriers,” (2016, p. e2).  Cultural competence training (CCT) for healthcare providers is one way to reduce health care disparities related to patient/provider communication barriers (Dabney et al., 2016).  CCT has been shown to improve the attitudes, knowledge, and/or skills of the health care provider (Dabney et al., 2016).

Program Schedule

Learning Assessment and Self-Reflection

Please complete the following 10-question quiz, used with permission from Health Inclusion (2020):

1. A really conscientious health provider can eliminate his or her own prejudices or negative assumptions about certain types of patients (MO1).

• True
• False

2. When the patient and provider come from different cultural backgrounds, the medical history obtained may not be accurate (MO1).

• True
• False

3. When taking a medical history from a patient with a limited ability to speak English, which of the following is LEAST useful (PLO1, MO1, MO3)?

• Asking questions that require the patient to give a simple “yes” or “no” answer, such as “Do you have trouble breathing?” or “Does your knee hurt?”

• Encouraging the patient to give a description of her/his medical situation, and beliefs about health and illness.

• Asking the patient whether he or she would like to have a qualified interpreter for the medical visit.

• Asking the patient questions such as “How has your condition changed over the past two days?” or “What makes your condition get better or worse?”

4. If a family member speaks English as well as the patient’s native language, and is willing to act as interpreter, this is the best possible solution to the problem of interpreting (MO1, MO3).

• True
• False

5. Which of the following is good advice for a provider attempting to use and interpret non-verbal communication (PLO1, MO1, MO2, MO3)?

• The provider should recognize that a smile may express unhappiness or dissatisfaction in some cultures.

• To express sympathy, a health care provider can lightly touch a patient’s arm or pat the patient on the back.

• If a patient will not make eye contact with a health care provider, it is likely that the patient is hiding the truth.

• When there is a language barrier, the provider can use hand gestures to bridge the gap.

6. Out of respect for a patient’s privacy, the provider should always begin a relationship by seeing an adult patient alone and drawing the family in as needed (PLO1, MO1, MO2).

• True
• False

7. Minority and immigrant patients in the US who go to traditional healers and use traditional medicines generally avoid conventional Western treatments (PLO1, MO1).

• True
• False

8. Cross-cultural misunderstandings between providers and patients can lead to mistrust and frustration but are unlikely to have an impact on objectively measured clinical outcomes (PLO1, MO1).

• True
• False

9. Which of the following is NOT TRUE of an organization that values cultural competence (PLO1, PLO3, MO1, MO3):

• The organization employs or has access to professional interpreters that speak all or at least most of the languages of its clients.

• The organization posts signs in different languages and has patient education materials in different languages.

• The organization tries to hire staff that mirrors the ethnic and cultural mix of its clients.

• The organization assumes that professional medical staff does not need to be reminded to treat all patients with respect.

10. What do you NOT need to achieve cultural competence (PLO1, PLO3, MO1, MO2, MO3)?

• Understand your own cultural beliefs and practices.
• Perceive the health care setting from a patient's point of view.
• Be open and sensitive to a patient's cultural values.
• Uphold and defend your own beliefs before anything else.

References

American Association of Colleges of Nursing. (2011). The essentials of masters of education in nursing. http://www.aacn.nche.edu.

American Association of Critical-Care Nurses. (2016). AACN standards for establishing and sustaining healthy work environments: A journey to excellence, 2nd edition. Aliso Viejo, CA: American Association of Critical-Care Nurses.

Bressler, T., & Persico, L. (2015). Interprofessional education: Partnerships in the educational process. Nurse Education in Practice, 16(1), 144-147. doi:http://dx.doi.org/10.1016/j.nepr.2015.07.004.

Dabney, K., McClarin, L., Romano, E., Fitzgerald, D., Bayne, L., Oceanic, P., Nettles, A. L., & Holmes, L., Jr. (2015). Cultural competence in pediatrics: Health care provider knowledge, awareness, and skills. International Journal of Environmental Research and Public Health, 13(1), e1-e10. https://doi.org/10.3390/ijerph13010014.

Datawheel. (2018). Bar chart of race & ethnicity in Vermont 2015. https://commons.wikimedia.org.

EthnoMed. (2020). Somali. https://ethnomed.org/culture/somali/.

Health Inclusion. (2020). Cultural competence quiz. https://healthinclusion.com.

Institute of Medicine (IOM). (2013). Interprofessional education for collaboration: Learning how to improve health from interprofessional models across the continuum of education to practice. The National Academies Press. https://www.nap.edu.

Interprofessional Education Collaborative Expert Panel (IECEP). (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. https://www.aacom.org.

Quality & Safety Education for Nurses (QSEN) Institute. (2020). QSEN competencies. https://www.qsen.org/.

Slota, M. C. (2019). AACN core curriculum for pediatric high acuity, progressive, and critical care nursing (3rd ed.). Springer Publishing Company. ISBN: 9780826133021.

U.S. Census Bureau. (2019). Quick facts: Vermont. https://www.census.gov/quickfacts/VT.

U.S. Department of Health & Human Services (HHS). (2018, August 28). Cultural competence. https://www.hhs.gov.

U.S. Department of Health & Human Services (HHS) Office of Minority Health (OMH). (2019, September 4). Cultural and linguistic competency. https://minorityhealth.hhs.gov.

U.S. Department of Health & Human Services (HHS) Office of Minority Health (OMH). (2018, October 2). The National CLAS Standards. https://minorityhealth.hhs.gov.

U.S. Department of Health & Human Services (HHS) Office of Minority Health (OMH). (2016, August 8). Think cultural health case study: Using language access services [Video]. YouTube. https://youtu.be/cxT9VILjXAU.

Valizadeh, L., Zamanzadeh, V., Ghahramanian, A., Aghajari, P., & Foronda, C. (2017). Factors influencing nurse-to-parent communication in culturally sensitive pediatric care: A qualitative study. Contemporary Nurse: A Journal for the Australian Nursing Profession, 53(4), 474–488. https://doi.org/10.1080/10376178.2017.1409644.