WS2 Information you provided: “I will create two forms. One for the providers and another for the patients. The patient form will have sections for a pat

WS2 Information you provided: “I will create two forms. One for the providers and another for the patients. The patient form will have sections for a pat

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WS2 Information you provided: “I will create two forms. One for the providers and another for the patients. The patient form will have sections for a patient to fill their name, race, ethnicity, immigration status, and country of origin. This will be given to all patients at the intake level. This is what the provider will use to screen the patient. The providers’ form will contain the initials of the participant, the number of the week, the number of African immigrant patients attended to, the number of resources toolkit at the beginning of the week and at the end, and the number of instances the provider referred to the African immigrant cultural competence toolkit when attending to the patient. This form will be filled at end of the week and it will be collected weekly. It will provide the project lead with all the information needed to calculate the outcomes.

INSTRUCTOR: Please describe this process in your stats worksheet.

DNP Project: Statistics Plan Worksheet

Please provide a brief description of each section. Attach supporting documents (instruments) to the end of this form as appendices.

Name:

G. Nana

Date:

7/27/21

Section

Description

Project Title

Cultural Competence Training for African Immigrants

Project Purpose

The purpose of this project is to improve the cultural competence skills of healthcare professionals attending to African immigrants visiting the clinic for primary care services with the aim of improving the African immigrant population’s healthcare experience.

Project Question

In healthcare workers caring for African Immigrant groups (P), how can an effective cultural competence training program (I) compared to no training program (C) be developed to improve the resource allocation and referrals for African Immigrants (O) in less than 4 weeks (T).

Project Design (general description how treatments are assigned/observational/repeated measures of X # of people, etc.)

The project design is a quality improvement project. In the beginning, a pretest questionnaire will be administered to determine the cultural competence level of the participants. A cultural competence training program for African immigrants will then be conducted as an intervention. There will be a delivery of an African Immigrant Cultural Competence Toolkit to act as a guideline and reference point for participants. Resources Toolkit handouts will also be delivered and it will be observed that patients are getting it. Data will be collected and documented weekly. A post-test questionnaire will then be administered to determine the effectiveness of the intervention.

Population of Interest

Healthcare professionals (clinical staff).

Variables

Independent Variable(s) – Cultural competence training
Dependent Variable(s) – Cultural sensitiveness
Relevant Constant(s)- Healthcare professionals

Sample Size

20 healthcare professionals’.

Recruitment Methods

Mandatory recruitment of all the healthcare professionals on site.

Instruments/Tools (Validity/Reliability)

African Immigrant Cultural Competence Toolkit (AICCT)

This is a one-page guideline that acts as a reference point for the African immigrants cultural competence issues. The guideline has cultural issues, their descriptions, and the solutions. It is to be handed to the healthcare providers. The toolkit is self-developed and will utilize project team consultation for validation.

Pre and Post Test Questionnaires.

For collecting the data before and after the interventions. . The toolkit is self-developed and will utilize project team consultation for validation.

African Immigrant Resources Toolkit

This is a one-page toolkit with information about the various resources and where they can be found. It is to be handed to the patients during their visits to the clinic. It is self-developed and will utilize project team consultation for validation.

Educational Presentation

This is a power point presentation currently being developed that will be used for the training sessions. It will be presented to the project site and team for consultation and validation.

Chart Audit Tool

This is a tool for auditing whether the handouts were given to the patients and whether the participants used the African Immigrant Cultural Competence Toolkit when attending to the patients.

Proposed Descriptive Statistics and Statistical Test(s)

Regression and correlation. Used to measure the relationship between cultural competence training programs and cultural sensitivity rates of healthcare professionals (Young & Gou, 2020).

Data Collection Approach

Due to the sensitivity of data in health care, the data collection procedures will follow strict guidelines that will be aimed at protecting privacy and confidentiality. These data collection procedures will also aim at ensuring that only data required for this project is collected and no unauthorized parties have access to this information. Anonymity of the data will also be upheld for the purposes of preserving identities, locations, and addresses as private (Martinez et al., 2018). As mentioned above, the first data collection segment will be the pre-survey about the cultural competence of the participants. This will be administered a day before the educational presentation and it will be stored in digital form for the purposes of ensuring that it remains discreet and accurate. In the following day, an educational training regarding cultural competence will take place in the form of a PowerPoint presentation and it will be headed by the project lead. This educational training will include information regarding the purpose, goals, expected outcomes, and the flow of activities of the project. A post -survey will be administered after the session and the data will be collected. The surveys will have a label with the names of each participant but they will be recorded using unidentified initials for the purposes of privacy and confidentiality (Young & Guo, 2020).
At the end of the educational training session, the participants will receive both the resources toolkits that they will hand to patients visiting the clinic and the developed cultural competence toolkit that will act as a guideline as they attend to the patients. The intervention will then commence and there will be data collection at the end of every week. The data collected will include information regarding whether the African immigrant patients visiting the clinic have been given the resource toolkit and whether the participants are utilizing the cultural competence guideline tool handed to them. Since the project lead cannot directly interact with patients, one participant will be tasked with randomly asking African immigrant patients visiting the clinic whether they received a resources toolkit from their medical providers. The information will then be relayed to the Project Lead. This data will be assessed following the guidelines outlined in Appendix F. Determining whether the participants are utilizing the cultural competence guideline tool handed to them will be assessed following the guidelines outlined in Appendix F. Additionally, the participants will provide information regarding any challenges they face with the resources toolkit and the competence guideline or any other issues and this data will be collected weekly as well. This data will help to understand which additional support is needed and how issues arising during the intervention can be addressed. Upon the completion of the project implementation, data analysis will be carried out and the results and discussion will be developed.

Reference

Young, S., & Guo, K. L. (2020). Cultural diversity training: The necessity of cultural competence for health care providers and in nursing practice. The health care manager, 39(2), 100-108.

Appendices

(Appendix A)

Permission to complete project at the site

(Appendix B )African Immigrant Cultural Competence Toolkit (AICCT).

(Appendix C)

African Immigrants Resources Toolkit (AIRT).

AFRICAN IMMIGRANT RESOURCES TOOLKIT (AIRT)

(This toolkit contains the various resources available for African immigrants in Texas)

Resource

Information

Food Assistance

AVANCE
4301 Dacoma Street. Houston, Texas 77092

(713) 812-0033

https://www.avancehouston.org/

Access Health Bellville WIC
800 E. Wendt Street. Bellville, Texas 77418

(979) 865-9140

WIC Services

Braes Interfaith Ministries
4300 West Belfort, 77096. Houston, Texas 77035

(713) 723-2671

http://braesinterfaithministries.org/services/

Legal Services

BakerRipley Legal Consultations
6535 Rookin St. Houston, Texas 77074

(346) 867-3871

bakerripleyimmigration.as.me/schedule.php

Boat People SOS
11360 Bellaire Boulevard, Suite 910, 77072-2531. Houston, Texas 77072

(281) 530-6888

http://www.bpsos.org/

Housing Services

Avenue 360
2150 West 18th Street, Suite 300. Houston, Texas 77008

(713) 426-0027

Housing

Baytown Housing Authority
1805 Cedar Bayou Road. Baytown, Texas 77520

(281) 427-6686

http://www.baytownhousing.org/family-self-sufficiency-fss

Employment Services

AVANCE Training Center
4625 North Freeway, #301. Houston, Texas 77022

(713) 239-2656

https://www.avancehouston.org/locations/avance-training-center/

BakerRipley Workforce Solutions
9315 Stella Link. Houston, Texas 77025

(713) 661-3220

https://www.bakerripley.org/services/workforce-solutions-astrodome

Cypress Assistance Ministries
11202 Huffmeister, Houston. Houston, Texas 77065

(281) 955-7684

www.cypressassistance.org

Financial Assistance

An-Nisa
7211 Regency Square Drive. Houston, Texas 77036

(832) 324-9111

ABOUT US

Braes Interfaith Ministries
4300 West Belfort, 77096. Houston, Texas 77035

(713) 723-2671

http://braesinterfaithministries.org/services/

Health Services

AccessHealth Brookshire Clinic
533 FM 359 S. Brookshire, Texas 77423

(281) 342-4530

Adult Care

ADAPT Programs
2512 N. Velasco, Suite 300. Angleton, Texas 77515

(979) 480-3327

Intensive Outpatient

Appendix D (Educational Presentation)

(Appendix E)

Test Construction

Purpose

The purpose of this document is to assess the healthcare professionals’ level of cultural competence regarding the African immigrant group. The information in the document will be used as guidance in the implementation of the health care professionals’ cultural competence training program for African immigrants and when handing out a resources toolkit for African immigrant patients.

Objectives

To assess understanding of the participants regarding the basics of cultural competence.
To evaluate the participant’s knowledge on the effects of cultural incompetence when attending to African immigrants.
To examine the participant’s understanding on the basic resources needed by African immigrants as related to health care.
To evaluate the participant’s understanding regarding the challenges faced by African immigrants as they relate to health care.
To determine the participant’s understanding of the solutions to these challenges faced by African immigrants.

Population

The population is made up of healthcare professionals attending to African immigrants who visit the clinic for primary care services.

Length of the Test

The test has a maximum of 10 questions.

Difficulty and Discrimination Levels of Test Items

The test contains questions ranging from low-level to moderate level of difficulty.

Scoring Procedures to be Used

The aim is to use a separate answer sheet which can then be used in developing a computer-generated item analysis report.

Item Format

The test is in the form of a selected response multiple choice format.

Test Blueprint

Content

Level of Cognitive Skill

K

C

AP

AN

Total

Basics of cultural competence

1

1

1

Effects of Cultural Incompetence

1

1

Basic resources for African immigrants

1

Healthcare-related challenges faced by African immigrants

1

1

Solutions to the challenges

1

1

Total

1

2

2

5

10

General Directions for the Test

(Please answer all the questions to the best of your ability. Please circle the most appropriate answer. Kindly note that your responses are strictly confidential and will only be seen by the appropriate leader(s) of the project. Your participation is highly valued. Thank you!)

Questions

1. What is cultural competence in healthcare?
A. The ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic, or cultural heritage.
B. The inevitable variety in customs, attitudes, practices, and behavior that exists among groups of people from different ethnic, racial, or national backgrounds who come into contact.
C. The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.
D. A long process of self-reflection and self-critique, which allows nurses to examine differences and similarities between their own beliefs, values, and health care goals with those of their patients.

Answer: C. Knowledge- Basics of Cultural Competence

Rationale:
All the definitions above are related to important terms in cultural issues of healthcare but the definition in option C is the meaning of cultural competence in healthcare (Allison et al., 2016). Option A defines Cultural sensitivity, Option B defines Cultural diversity, and Option D defines Cultural humility. Even though the terms are inter-related, understanding the correct definition of cultural competence is the first step to ensuring that all the other terms are understood appropriately (Allison et al., 2016).

2. A healthcare professional will know that he/she is culturally competent when
A. He/ she has successfully completed a cultural competence program.
B. He/she is able to obtain knowledge of a patient’s individualized culturally-influenced worldview and how their culture affects their physical and mental health.
C. He/she is able to answer key cultural competence questions regarding a particular cultural group.
D. He/she is able to treat a patient belonging to a different culture.

Answer: B

Comprehension- Basics of Cultural Competence

Rationale:
The only way to measure the cultural competence of a healthcare professional is by assessing their ability to look at healthcare needs and experience from the view of the patient (Allison et al., 2016). Completing a cultural competence program and answering cultural questions are only the first way to sharpening one’s cultural competence skills. Treating a patient from a different culture does not indicate cultural competence because the quality of the care the patient’s healthcare experience have not been discussed (Allison et al., 2016).

3. Which of the following would
not
be an immediate result of a failed effective communication between a healthcare provider and an African immigrant patient?
A. Difficulty understanding medical instructions.
B. Problem with the reliability of information.
C. Possible medical errors.
D. Increased readmission for the patient.

Answer: D Application-Effects of Cultural Incompetence

Rationale:
While increased readmissions of patient may be a possible effect of language barrier between a healthcare professional and a patient, it is not immediate. All the other three options are likely to emerge during the communication session. The readmission effect may be noticed after a period of time (about 30 days). Additionally, the immediate effects can be resolved through ways such as interpretation hence improving the healthcare outcome and preventing the readmission (Allison et al., 2016).

4. Which of the following is
not
a
basic
resource needed by African immigrants as they seek healthcare services?
A. Legal Resources
B. Housing Resources
C. Food Assistance Resources
D. Finance Aid Resources

Answer: A Analysis- Basic resources for African immigrants

Rationale:
Apart from legal resources, all the other resources have a direct impact on an African immigrant seeking healthcare services (Chikanda & Morris, 2021). For example, poor housing may result in poor health through ways like increased allergens and risk for cardiovascular diseases. Lack of food and poor nutrition can cause certain diseases and negatively affect the mental health, energy levels, and general well-being. Lack of finance and poverty limit the resources that the African immigrants can use to avoid health risks and implement healthy behaviors (Chikanda & Morris, 2021.

5. The main reason for cultural competence in healthcare is
A. Delivering quality care.
B. Improving cultural awareness.
C. Demographic change
D. Changing policies.

Answer: C Analysis- Basics of cultural competence

Rationale:
The main reason for cultural competence in healthcare is the demographic shifts which exert pressure on health systems and demand for new directions to be applied in the delivery of care (Chikanda & Morris, 2021). All the other listed options (A, B, D) are ways of adapting to the newer forms of delivering quality care for everyone (Chikanda & Morris, 2021).

6. What is the relationship between poverty and quality care among African immigrants?
A. African immigrants are barred from accessing healthcare when needed.
B. African immigrants are not able to purchase those things that are needed for good health.
C. B only.
D. A and B.

Answer: D Analysis- Healthcare-related challenges faced by African immigrants

Rationale:
The relationship between poverty and quality care among African immigrants is financial (Omenka et al., 2020). They are not able to purchase those things that are needed for good health and this prevents them from accessing quality care when needed (Omenka et al., 2020).

7. What evidence may point to cultural incompetence when a healthcare provider is attending to an African immigrant ?
A. Failing to understand the social determinants of the health of the patient.
B. Failing to communicate in the patient’s language.
C. Involving a third party (e.g. translator) to help in the communication process.
D. All of the above.

Answer: A Application- Effects of cultural incompetence

Rationale:
African immigrants have unfavorable social determinants of health which contribute to their lack of quality healthcare (Chikanda & Morris, 2021). A healthcare provider is culturally incompetent if he/she cannot understand these social determinants of health because the lack of understanding will lead to poor attendance to the patient and a subsequent poor health experience (Omenka et al., 2020).

8. African immigrants may fear seeking health care services due to the following reasons
except
:
A. Fear of racial discrimination.
B. Difference in culture and beliefs.
C. Fear of new environments.
D. Inability to pay for the services.

Answer: C
A
pplication-

Healthcare-related challenges faced by African immigrants

Rationale:

By agreeing to move into a newer country, the African immigrants show that they have made peace with the idea of newer environments and may be focused on how to adapt rather than the fear of the environments (Chikanda & Morris, 2021). However, all the other three are reported to be leading causes of African immigrants failing to seek healthcare services (Chikanda & Morris, 2021).

9. You are the triage nurse in the emergency department and perform the initial intake assessment on a patient who does not speak English. Based on your understanding of linguistic competence, which of the following would
not
provide solutions to the communication barrier you are experiencing?
A. Finding an effective translating software.
B. Asking a (present) member of the family to provide interpretation in the communication process.
C. Seeking the services of a professional interpreter.
D. All of the above.

Answer: B

Analysis- Solutions to the challenges

Rationale:
Relatives have an emotional involvement, their language ability is untested, and they do not possess any skills regarding medical terminology (Allison et al., 2016). Additionally, using as interpreters is breaches confidentiality for the patient and there is lack of guarantee of impartiality or professional conduct (Allison et al., 2016).

10. Which of the following is an example of an
immediate
remedy for a cultural challenge when attending to African immigrants?
A. Learning about different cultures.
B. Employing diversity training.
C. Ensuring effective communication.
D. Working towards cultural humility.

Answer: C Comprehension-

Solutions to the challenges

Rationale:
An effective communication strategy can provide an immediate solution to language barrier which is a common challenge when attending to African immigrants(Chikanda & Morris, 2021). All the other strategies are long-term solutions and they also require long-term planning (Omenka et al., 2020).

Experts Rating Form Instructions

Rating instructions: For each item, please indicate the following:
Please rate how relevant each item is to the assessment of the cultural competence of health care professionals regarding African immigrants by placing a number in the first box to the right of each item.

1 = Not relevant at all
2 = Slightly relevant
3 = Moderately relevant
4= Highly relevant

Expert Rating Form

Item

Relevance Rating

1. What is cultural competence in healthcare?
A. The ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic, or cultural heritage.
B. The inevitable variety in customs, attitudes, practices, and behavior that exists among groups of people from different ethnic, racial, or national backgrounds who come into contact.
C. The ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.
D. A long process of self-reflection and self-critique, which allows nurses to examine differences and similarities between their own beliefs, values, and health care goals with those of their patients.

2. A healthcare professional will know that he/she is culturally competent when
A. He/ she has successfully completed a cultural competence program.
B. He/she is able to obtain knowledge of a patient’s individualized culturally-influenced worldview and how their culture affects their physical and mental health.
C. He/she is able to answer key cultural competence questions regarding a particular cultural group.
D. He/she is able to treat a patient belonging to a different culture.

3. Which of the following would
not
be an immediate result of a failed effective communication between a healthcare provider and an African immigrant patient?
A. Difficulty understanding medical instructions.
B. Problem with the reliability of information.
C. Possible medical errors.
D. Increased readmission for the patient.

4. Which of the following is
not
a
basic
resource needed by African immigrants as they seek healthcare services?
A. Legal Resources
B. Housing Resources
C. Food Assistance Resources
D. Finance Aid Resources

5. The main reason for cultural competence in healthcare is
A. Delivering quality care.
B. Improving cultural awareness.
C. Demographic change
D. Changing policies.

6. What is the relationship between poverty and quality care among African immigrants?
A. African immigrants are barred from accessing healthcare when needed.
B. African immigrants are not able to purchase those things that are needed for good health.
C. B only.
D. A and B.

7. What evidence may point to cultural incompetence when a healthcare provider is attending to an African immigrant ?
A. Failing to understand the social determinants of the health of the patient.
B. Failing to communicate in the patient’s language.
C. Involving a third party (e.g. translator) to help in the communication process.
D. All of the above.

8. African immigrants may fear seeking health care services due to the following reasons
except
:
A. Fear of racial discrimination.
B. Difference in culture and beliefs.
C. Fear of new environments.
D. Inability to pay for the services.

9. You are the triage nurse in the emergency department and perform the initial intake assessment on a patient who does not speak English. Based on your understanding of linguistic competence, which of the following would
not
provide solutions to the communication barrier you are experiencing?
A. Finding an effective translating software.
B. Asking a (present) member of the family to provide interpretation in the communication process.
C. Seeking the services of a professional interpreter.
D.
All of the above.

10. Which of the following is an example of an
immediate
remedy for a cultural challenge when attending to African immigrants?
A. Learning about different cultures.
B. Employing diversity training.
C. Ensuring effective communication.
D. Working towards cultural humility.

Content Validity Index Table

Item

Expert 1

Expert 2

Expert 3

Mean

1

2

3

4

5

6

7

8

9

10

(The procedure consists of having experts rate items on a four-point scale of relevance. Then, for each item, the item (CVI) (I-CVI) is computed as the number of experts giving a rating of 3 or 4, divided by the number of experts-the proportion in agreement about relevance)

(Appendix F)
Chat Audit Tool.

Chart Review Tool

Rate in Percentage (%)

The rate that the handout of resources was provided to African immigrant patients.

The rate at which the providers utilized the African immigrant toolkit when interacting with the patient.

Guidelines for the Chart Audit Toolkit

1. How to measure the rate that the handout of resources was provided to African immigrant patients.

· This process will involve having one participant speak to random patients during their visit to the clinic and ask them whether they are part of the African immigrant population because there is a study at the clinic involving the population.
· If the answer is yes, the patient will be asked whether he/she received a resources toolkit from the healthcare provider who attended to him or her.
· This will be carried out for 15 patients who fit the above criteria.
· Thereafter, the number of patients who admitted to receiving the toolkit will be divided by the total number of patients asked and the result will be multiplied by 100 to convert it into a percentage (rate).
· The formula is (x/N)*100% where x = number of patients who admitted to receiving the toolkit
· N= total number of patients asked

2. How to measure the rate at which the providers utilized the African immigrant toolkit when interacting with the patient.

· The healthcare providers will establish whether the patient they are attending to is part of the African immigrant population. This will help to identify the need for the resources toolkit or the African immigrant toolkit guideline during their interaction with the patient.
· If a patient is part of the African immigrant population, the healthcare provider will hand them a resources handout either during or at the end of the interaction.
· Every participant will record how many African immigrant patients they attended to during the week and the number of instances they utilized the African immigrant toolkit. For example, a healthcare provider may have attended to 4 African immigrant patients during the week and utilized the African immigrant toolkit in 2 of those occasions.
· This data will be collected weekly and a percentage will be calculated. For instance in the example above, the provider will have utilized the African immigrant toolkit 50% of the time.
· Calculation= (X/N)* 100% where N= total number of African immigrant patients attended to
· Y= number of times the African immigrant toolkit was utilized.
· The cumulative percentage results will be added together and then divided by the total number of healthcare providers.
Example: Let’s say healthcare provider A has used the African immigrant toolkit 50% of the time, provider B 100% of the time, and provider C 30 % of the time.
Rate = (A+B+C)
3
In this case, (50+100+30) = 60%
3
Therefore, the rate at which the providers utilized the African immigrant toolkit when interacting with the patient in this case is 60%.

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