Culture-Sensitive/Patient-Centered Assessment and Care Planning Skills in Home Health Nursing

Abstract

Introduction. Home health patients, who are members of minority and other vulnerable groups, suffer disparate outcomes. Culturally-competent care (CCC) and patient-centered care (PCC) aim to facilitate equitable, high-quality care. Both CCC and PCC share the same priorities and strategies, so they can be merged into one concept: culture-sensitive/patient-centered (CS/PC) care. No research about how home health nurses incorporate either CCC or PCC principles into their assessment and care-planning practices currently exist. This study explored “What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?”Methods: Using a multi-method grounded theory design, two subsamples were recruited. Sub-sample one consisted of transcultural nurses (n=9) who participated in a focus group and sub-sample two consisted of home health nurses (n=20) who participated in in-depth, audio-recorded interviews. The purpose of the transcultural group was to identify characteristics of CS/PC assessment and care planning, which were used to better understand home health nurses’ approach to CS/PC skills. Using a semi-structured interview guide, both sets of participants discussed questions such as, their understanding of CS/PC principles, how they developed their skills, how they instilled CS/PC principles into their assessment and care planning activities and the facilitators/barriers to CS/PC practice. Results. The grounded theory that emerged was that home health nurses learned CS/PC assessment skills along a journey, primarily through a trial-and error process by ‘the seat of their pants.” The journey began with caring attitudes and caring nurse-patient relationships, which formed the milieu for their experiences with diverse patient populations and their learning of their first CS/PC skills. Some nurses travel further and refine their skills through self-reflection and strong critical and creative thinking skills. However, many nurses felt stymied in their ability to practice their CS/PC assessment and care planning skills by agency and Medicare processes. They perceived these processes and policies as having a negative impact on their ability to practice their CS/PC skills. Only the most resilient nurses were able to continue their journey towards further developing their CS/PC skills in a changing home health care environment. The study also provided data to answer several other questions, such as what are the characteristics of a CS/PC nurse? These characteristics include: caring and humble attitudes/values; knowledge about self, uniqueness of persons, and norms of populations served; and skills related to forming a caring relationship with the patient, assessing to understand patients as unique cultural, valued persons, and planning care that enhances the patient’s health, well-being and quality of their lives from their perspectives. Additional questions can also be explored with the data collected, such as 1) what the is the relationship of caring to CS/PC care, 2) what are the specific, pragmatic, measurable CS/PC strategies that home health nurses can incorporate into their assessment and care planning skills, 3) how can academic and agency educators support the knowledge needed by nurses in a multicultural world, and 4) home health nurses’ perceptions of, and recommendations to ameliorate, barriers to CS/PC practice. Discussion. If we accept that CCC and PCC are key elements of high-quality, equitable care, the grounded theory process – Home Health Nurses’ Journey to CS/PC Assessment and Care-Planning Skills - may help home healthcare clinicians, administrators, educators and policy-makers identify impact points for enhancing CS/PC practices. For instance, nurse clinicians may use the CS/PC attitudes, knowledge, and skills as a blueprint for their professional development, educators my wish to highlight how nurses can incorporate CS/PC strategies into their practice, and administrators may wish to consider ways to minimize barriers and promote nurse resilience.