Ch04

Transcultural Health Care: A Culturally Competent AApppprrooaacchh,, 44tthh EEddiittiioonn
Copyright © 2013 F.A. Davis Company
Chapter 4
Organizational Cultural Competence
Larry Purnell, PhD, RN, FAAN

Organizational Cultural
Competence
 Every Department in an organization has
responsibilities for assuring cultural
competence
 Administration has the primary responsibility
for the integration of cultural competence

Administration and Governance
 Diversity is addressed in mission and
philosophy
 Policies are in place that address the needs of
employees, visitors, and patients
 Diversity is addressed during orientation –
patients and staff

 Art work in common areas is reflective of the
diversity of the community
 Does the organization engage in community
diversity fairs, help organize wellness days,
health screenings?
 Does the organization partner with
community ethnic agencies?

 Does the organization network with
community leaders?
 Does a committee for cultural competence
exist? Does it include staff, managers,
chaplains, administrators, and members
representative of the community?

 Are fiscal resources allocated to diversity
training?
 Do policies address bias and prejudice of staff
and patients?
 Is input on research priorities sought from
consumers?

 Are researchers reflective of staff, clients, and
the community?
 Are the organization’s programs advertised in
community newspapers and on the radio and
television in the languages of the community?

 Does Human Resources recruitment and
hiring activities reflect the diversity of the
community?
 Do position descriptions and performance
evaluations reflect cultural competence?
 Is there active recruitment of bilingual staff –
higher pay if certified?

 Does data collection include race, ethnicity,
culture, and language preferences and
abilities of the staff and clients?
 Do conflict and grievance procedures reflect
the languages of the staff?
 Are patients’ rights documents in the major
languages if the community?

 Is there a holiday calendar that represents the
client and staff population base?
 Is there a mentoring program to entice
recruitment into the health professions?
 Do intake forms reflect cultural assessment?

 Are culturally appropriate toys available:
Hispanic Santas, Black dolls, Jewish and
Muslim considerations?
 Signage is in the languages of the community
 Are directions to referral facilities are in the
languages of the populations served?

 Ethics Committee has representatives
reflective of the diversity of the community
 Library has cultural diversity resources –
online resources?

 Directions to the hospital and clinics in
language of the patient
 Advertise services where the patient can see
them: grocery stores, neighborhood stores,
local newspapers, bars, restaurants, bus stops,
beauty salons, barber shops, etc.

 Knowledgeable about the community
 Accesses community leaders
 Hours of operation meet the patient needs
 Direction to and from organization and to and
from other essential services are in the
languages of the patient population

 Classes for ESL employees are available
 Foreign language classes for employees
 Religious needs of patients and employees are
accommodated – scheduling
 Complementary and alternative therapies are
incorporated in patient care

Organizational Competence:
Orientation
 Orientation to the healthcare system
 Diversity in the health professions addressed
 Influence of insurance companies on
healthcare decision-making is addressed
 Concerns related to malpractice are discussed

Orientation
 Nursing care delivery systems are explained
 Issues related to autonomy are discussed
 Ongoing in-services at all levels of staff
 Cultural general programs for professional
staff exist

Orientation
 Cultural specific programs that address the
ethnicity of the workforce and patients are
conducted at least annually
 Cultural celebrations are valued

Organizational Competence
Staff
 Flexibility in scheduling – religious holidays
 Food selections are in the ethnicity of the staff
and patients
 Cultural brokers for staff exist
 Staff resources are available on the unit and in
the library

Organizational Competence: Staff
 Is certification for cultural competence
offered at diverse levels?
 Are staff surveys in the languages of the staff?

Organizational Competence
 Food selections meet the ethnicity of the
patient and staff

ClickerCheck
All departments in an organization have a responsibility
for organizational cultural competence. The primary
responsibility for ensuring integration belongs to
a. The Board of Trustees
b. Nurse managers
c. Administration
d. Physicians

Correct Answer
Correct answer: C
Whereas all departments and professionals
participate in assuring that and organization is
culturally competent, the primary
responsibility for ensuring integration is
administration

Language
 Does the organization engage in activities that
address health literacy of the population
served?
 Do written documents undergo a cultural
sensitivity review?
 Is the need for an interpreter determined
ahead of time?

Language
 Does the telephone system have a menu for
diverse languages?
 Are television channels in the languages of the
community?
 Are satisfaction surveys in the languages of
the community/patients?

Language
 Organization actively recruits bilingual staff
 Guidelines are in place that address the needs
for an interpreter
 Guidelines exist for using interpreters
 Directional and informational signs are in the
languages of the catchment area

Language
 Discharge instructions are in appropriate
languages
 Consent forms are translated
 Community resources are made available
 Reading material in lobbies, waiting areas, etc.
is available in the languages of the
patients/visitors

Language
 Patient education materials are in different
languages
 Videos are in different languages and with the
ethnicity of the patients

Language
 Pain scales are in the language of patients and
faces of the ethnicity served
 Prescriptions are in the language of the
patient
 Dietary instructions are in the language of
patient

Translation and Interpretation
 Translation: The written word
 Interpretation: The spoken word
 Interpretation in Health Care: Know the
language and the culture
 Interpreters are qualified in both languages

ClickerCheck
Mrs. Alvarez, age 34 years, speaks very little English. She comes
to the hospital clinic because of vaginal bleeding. She and is
accompanied by her 6 year old daughter and 12 year old son
who both speak English. The best interpreter would be
a. Her daughter
b. Her son
c. A bilingual person from the dietary department
d. Someone from the language hotline

Correct Answer
Correct answer: D
Children should not be used as interpreters for
their parents except in emergencies or
collecting initial admitting information. We do
not know if the dietary employee is certified
as an interpreter.

Ch04

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