If you’re a nurse who wants to gain more insight into how a patient’s culture affects the care you provide, or a nursing educator who wants to enhance the cultural awareness, knowledge and skills of your students or nursing staff, the Culturally Competent Nursing Modules (CCNMs) online training program may be just the tool you need. And nurses who complete the free program can even earn continuing education credits.
A little more than a year old, the CCNMs are a case-based curriculum designed to help nurses better meet the cultural and linguistic needs of an increasingly multicultural patient population. According to 2000 U.S. Census data, Caucasians account for 75% of the country’s population, but that percentage is expected to drop to 47% by the year 2050 as the nation continues to attract immigrants, causing a dramatic shift in its cultural and ethnic diversity.
Created with support from the federal Office of Minority Health (OMH), the CCNMs were three years in the making. The curriculum’s development was guided by a National Project Advisory Committee comprised of nationally recognized experts on culturally competent nursing. In 2004, CCNM project staff conducted focus group sessions with practicing nurses in various specialties and geographic locations to obtain “real world” information that would help in developing the content and structure of the modules. In 2006, the CCNMs were pilot tested in seven health care organizations across the country. Based on feedback from those tests, the modules underwent minor revisions and were officially launched in 2007, under the title “Culturally Competent Nursing Care: A Cornerstone of Caring.”
“The Culturally Competent Nursing Models are designed to provide some tools for improving cultural competence, and these tools should be incorporated into one’s daily practices and expanded upon over time,” says Ann S. Kenny, MPH, BSN, RN, project director for the CCNMs. “Keep in mind that even the most culturally competent individual can still make cultural mistakes. However, the more culturally competent one is, the easier it should be to right a situation where a cultural mistake has occurred.”
Interactive Learning
The training program consists of an introduction followed by three modules (courses) that can be taken together or separately (see sidebar on page TK). The content is based on the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care, which were issued by OMH in 2000. The 14 CLAS standards–which cover culturally competent care, language access services and organizational supports–
are designed to provide health care facilities with guidelines for “improving the health of racial and ethnic minority populations through the development of effective health policies and programs that help to eliminate disparities in health care.”
The CCNMs’ content is presented in an interactive, Web-based format. It includes such features as streaming-video case study vignettes that depict realistic patient/provider scenarios, and “stories from the front lines” from actual nurses. There are also short, user-friendly sections entitled “Fast Facts,” “Cultural Insights” and “Pulse Points.” All of these features are designed to hold users’ interest and reinforce the learning points, Kenny notes.
In addition to the online self-study format, the CCNMs are also available as a DVD featuring the case studies, which works better in group settings such as nursing school classrooms and hospital staff-training sessions. “The majority of users do complete the program in the online version, because it is convenient for busy nurses to start and stop as their schedule permits,” says Kenny. “The online program allows users to complete the courses anytime and anywhere.”
As of this past April, there were more than 7,000 registered users working on the CCNMs. More than 3,000 participants have completed the first module, nearly 2,000 have finished the second course and more than 1,500 have completed the third one.
A nurse can earn a total of nine continuing education units (CEUs) for completing the curriculum: three CEUs per module. To receive credit, users must also complete a pre-test, a post-test (with a score of 70% or better) and the course evaluation. The pre- and post-test are designed to measure the participant’s knowledge of the material presented in the course, explains Kenny.
The CCNMs are accredited for continuing education by the American Nurses Credentialing Center and the National Association of Social Workers. As of April, nearly 6,000 nurses and more than 300 social workers have received CEUs from the program. Almost 1,200 Statement of Participation certificates have been awarded.
Something for Everybody
What kinds of nurses are taking the Culturally Competent Nursing Modules and in what kinds of settings? The majority of CCNM users are nurses working in hospitals, says Kenny. Students and health educators comprise the largest portion of this group, followed by nurses working in public/community health, psychiatric/mental health, medical-surgical nursing and pediatrics. Most users work in urban locations, followed by suburban and rural areas. A few users worked in multiple practice settings or in a military facility.
As for the demographic breakdown, 92% of nurses who are taking the courses are female and 74.5% are non-Hispanic whites. Age-wise, the majority of participants are between the ages of 45 and 55 years old.
Many health care insurance companies, such as Aetna, Humana and Blue Cross Blue Shield, are using the CCNMs to train their nurses, adds Kenny.
“We have also been approached by several educators, such as nursing school professors, who are interested in incorporating the course into their current ethics or cultural competency training,” she continues. “They typically have their students register for and complete the online program, then submit their certificates as proof of completion.” Other nursing faculty are using the modules as extra-credit options for students.
CCNMs in the Classroom
Before Mary K. Kirkpatrick, EdD, MSN, RN, professor and international coordinator at East Carolina University College of Nursing in Greenville, N.C., assigned the CCNMs to her students, she took them herself. Kirkpatrick was so impressed with the modules that she incorporated parts of them into two of her courses. One of the courses focuses on globalization and health care; the other addresses chronic illness.
“Globalization begins with becoming culturally competent,” she says. “And cultural competence sets the stage for the remainder of the chronic illness course.” The CCNMs will count for 10% of the students’ graded work.
Beginning this August, Kirkpatrick will incorporate the CCNMs into the nursing school’s orientation program. She plans to assign students to take the course as a self-directed learning experience during the orientation process.
“I like several things about the CCNM course,” she says. “First, it is comprehensive with a strong conceptual, theoretical basis. Secondly, I like how interactive it is with the videos and case studies. It is visually appealing and has an evaluative component for each module.”
Kirkpatrick believes it is an effective teaching tool because it appeals to a variety of learning styles. “The adopted strategies and models, as well as videos and case studies, were excellent,” she adds. “The course provides [students] with the opportunity to gain knowledge of these concepts [and then] apply the concepts to several different [population] groups.”
To assist nurse educators and staff trainers in leading group sessions of the CCNMs, Kenny and her team are currently developing a Facilitator’s Toolkit. The toolkit includes a DVD of case studies and a CD with PowerPoint slides. It also has a facilitator’s guide and an iDVD site, which is supplemental to the CCNMs. The guide and iDVD site are currently undergoing pilot testing and the toolkit is tentatively scheduled for release this summer.
Also in the works are a facilitators’ administrative site and corresponding participant site, which will enable facilitator participants to receive continuing education credit for completing the course. Any registered nurse can become a facilitator upon successfully completing the CCNMs, Kenny says.
Positive Feedback
Nurses and students who have completed the modules have nothing but praise for them. Overall, the program has been well received by the nursing community and has been endorsed by Rebecca Patton, MSN, RN, CNOR, the current president of the American Nurses Association (ANA), Kenny reports.
“We have received a lot of positive feedback about the course,” she adds. “Ninety-five percent of the participants who completed the modules indicated that they would recommend the program to their colleagues.” Many nurse educators tell Kenny that the availability of the modules has saved them from having to develop a whole new curriculum.
“User-friendly,” “interesting” and “informative” are common phrases participants have used to describe the course.
“It enabled me to understand how to relate to patients of different cultures, especially how to communicate with them and handle any problems or medical needs they may have,” says Shannon Harper, BSN, RN, an African American nursing student at Valdosta State University in Valdosta, Georgia. Harper completed the CCNMs as a requirement for a med-surg nursing course this spring. Prior to that, he did not know of any courses focusing on cultural competence being offered to nursing students.
Nurses should be required to be trained in cultural competency, says Abel Rodriguez, RN, CCM, who went back to nursing school at Miami Dade College part time to obtain a BSN. Like Harper, he took the modules as part of a class assignment. “The course made me aware of the need for nurses to become culturally competent because it impacts the quality and outcomes of patient care.”
Jackson Memorial Hospital in Miami, where Rodriguez has worked for the past nine years, serves a highly diverse community, including immigrants from the Caribbean, Latin America, Asia and Europe. “Nurses have to be aware of patients’ cultural backgrounds because different cultures value things differently,” says Rodriguez, who is of Afro-Cuban descent. “Those cultural nuances, habits and mores have an impact on patients and their families.”
Additional Options
Although the CCNMs can serve as a stand-alone educational tool, nurses shouldn’t stop there for their cultural competency training, Kenny emphasizes. “Increasing one’s cultural competence is a continual process and can always be built upon by combining multiple learning experiences and training programs.”
One such program is the OMH’s newest initiative, the Culturally Competent Curriculum for Disaster Preparedness and Crisis Response, which is currently being developed. Its purpose is to equip first responders with the knowledge, awareness and skills needed to provide emergency health care services to racially and ethnically diverse populations during times of disaster, says Kenny. This course, which may be of particular interest to nurses working in emergency situations or environments, is scheduled to launch in spring 2009.
For advanced practice nurses, there are the Cultural Competency Curriculum Modules, which have been available since 2003. Although these modules are geared toward doctors—the actual course title is “A Physician’s Practical Guide to Culturally Competent Care”—they also carry accreditation for nurse practitioners.
Whichever course (or courses) nurses choose to take, there’s no question that the end result will be better patient care. As ANA President Patton states in the introduction to the CCNM facilitator’s DVD, “By practicing culturally competent care, nurses will integrate the needs and values of all persons in their professional relationships and help to reduce racial and ethnic disparities in health care.”
For more information about the Culturally Competent Nursing Modules, visit www.thinkculturalhealth.org.
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