Cultural Assessment Tool Research Articles

Advancing Cultural Assessments in Palliative Care Using Web-Based Education

Research supports the premise that cultural competence in health care improves care delivery and patient outcomes. Despite efforts to promote patient-centered care and respect for choices across the illness trajectories, cultural considerations of palliative care remain poorly understood. The purpose of the study was to determine if, after completing cultural competence education, registered nurses working in a combined palliative care and hospice unit increased their cultural awareness, sensitivity, and cultural assessment documentation. The study used a quasi-experimental design and took place in a 1070-bed Midwestern hospital. Fifteen registered nurses participated. The intervention consisted of 3 Web-based cultural competence education modules. A preintervention and postintervention electronic chart audit identified 80 charts meeting inclusion criteria. The charts’ cultural assessment data, which had been completed by nurses upon patient admission, were extracted and analyzed. The nurses also completed the Cultural Competence Assessment tool preintervention and postintervention. Analysis of the postintervention data showed the nurses had increased their cultural awareness, sensitivity, and cultural assessment documentation. These findings support the use of Web-based education and show how this format can translate cultural competency knowledge into nursing practice. Providing this education is an important component in creating an environment that provides culturally congruent palliative care.

Using the Nursing Culture Assessment Tool (NCAT) in Long-Term Care: An Update on Psychometrics and Scoring Standardization.

An effective workforce performing within the context of a positive cultural environment is central to a healthcare organization’s ability to achieve quality outcomes. The Nursing Culture Assessment Tool (NCAT) provides nurses with a valid and reliable tool that captures the general aspects of nursing culture. This study extends earlier work confirming the tool’s construct validity and dimensionality by standardizing the scoring approach and establishing norm-referenced scoring. Scoring standardization provides a reliable point of comparison for NCAT users. NCAT assessments support nursing’s ability to evaluate nursing culture, use results to shape the culture into one that supports change, and advance nursing’s best practices and care outcomes. Registered nurses, licensed practical nurses, and certified nursing assistants from 54 long-term care facilities in Kentucky, Nevada, North Carolina, and Oregon were surveyed. Confirmatory factor analysis yielded six first order factors forming the NCAT’s subscales (Expectations, Behaviors, Teamwork, Communication, Satisfaction, Commitment) (Comparative Fit Index 0.93) and a second order factor—The Total Culture Score. Aggregated facility level comparisons of observed group variance with expected random variance using rwg(J) statistics is presented. Normative scores and cumulative rank percentages and how the NCAT can be used in implementing planned change are provided.

Prospective controlled study to compare the effects of a basic patient safety course on healthcare worker patient safety culture

It is estimated that about one in 10 patients may be harmed by adverse events during their hospital stay [1]. Transforming organizational culture to improve patient safety culture is considered important. We conducted a prospective, controlled study to assess the impact of a standardized patient safety course on an ICU's patient safety culture, using a validated patient safety culture assessment tool.

PRACTICAL ASPECTS OF OSAI METHODOLOGY IN ASSESSING THE ORGANIZATIONAL CULTURE OF AN ENGINEERING COMPANY

This article is intended to generalize and highlight the practical application of certain science-based approaches to assessment of an engineering company’s organizational culture. The OSAI method application has enabled determining the type of the organizational culture existing within a company and the desirable type thereof, i.e. the one which would produce a positive effect on the competitive status of a company, as well as on the utilization of its human resources. This is important because an appropriate level of the organizational culture within a company would enhance the psychological climate within a company and would provide an opportunity for improving its performance. Methodology . In order to attain the goal of our research, it is necessary to diagnose the type of the organizational culture of some selected companies and draw a conclusion as to amendment of their organizational culture. In order to ensure the successful outcome of the corporate organizational culture diagnosing procedure, let us use the OSAI tool to determine the foundation of such culture. This organizational culture assessment tool helps to define the organizational culture which members of a company are to achieve in order to meet the demands and to respond to the dynamic changes in the business environment. The results showed that the assessment of organizational culture using the method made it possible to determine the OSAI required type of organizational culture on the test plants. Practical implications . Definition of recommendation type of organizational culture has enabled the leadership to change the style of his behavior and better motivate the labor collective. Pay attention to the existing problems and improve the psychological atmosphere in the team, as well as improve the efficiency of plant personnel. Value/originality . The data obtained for the four businesses lead to the conclusion that it is the method of evaluation the optimum procedure for organizational culture assessment.

Whakawhiti Kōrero, a Method for the Development of a Cultural Assessment Tool, Te Waka Kuaka, in Māori Traumatic Brain Injury.

The importance of tools for the measurement of outcomes and needs in traumatic brain injury is well recognised. The development of tools for these injuries in indigenous communities has been limited despite the well-documented disparity of brain injury. The wairua theory of traumatic brain injury (TBI) in Māori proposes that a culturally defined injury occurs in tandem with the physical injury. A cultural response is therefore indicated. This research investigates a Māori method used in the development of cultural needs assessment tool designed to further examine needs associated with the culturally determined injury and in preparation for formal validation. Whakawhiti kōrero is a method used to develop better statements in the development of the assessment tool. Four wānanga (traditional fora) were held including one with whānau (extended family) with experience of traumatic brain injury. The approach was well received. A final version, Te Waka Kuaka, is now ready for validation. Whakawhiti kōrero is an indigenous method used in the development of cultural needs assessment tool in Māori traumatic brain injury. This method is likely to have wider applicability, such as Mental Health and Addictions Services, to ensure robust process of outcome measure and needs assessment development.

An implementation evaluation of a qualitative culture assessment tool

Safety culture has been identified as a critical element of healthy and safe workplaces and as such warrants the attention of ergonomists involved in occupational health and safety (OHS). This study sought to evaluate a tool for assessing organisational safety culture as it impacts a common OHS problem: musculoskeletal disorders (MSD). The level of advancement across nine cultural aspects was assessed in two implementation site organisations. These organisations, in residential healthcare and timber processing, enabled evaluation of the tool in contrasting settings, with reported MSD rates also high in both sectors. Interviews were conducted with 39 managers and workers across the two organisations. Interview responses and company documentation were compared by two researchers to the descriptor items for each MSD culture aspect. An assignment of the level of advancement, using a five stage framework, was made for each aspect. The tool was readily adapted to each implementation site context and provided sufficient evidence to assess their levels of advancement. Assessments for most MSD culture aspects were in the mid to upper levels of advancement, although the levels differed within each organisation, indicating that different aspects of MSD culture, as with safety culture, develop at a different pace within organisations. Areas for MSD culture improvement were identified for each organisation. Reflections are made on the use and merits of the tool by ergonomists for addressing MSD risk.

Nursing culture assessment tool (NCAT): Empirical validation for use in long-term care

BackgroundCapturing general aspects of the occupational subculture of nursing is needed in long-term care (LTC) given its latent influence on the quality of care that residents receive and on the ability of nursing staff (licensed nurses and certified nursing assistants) to implement evidence-based practice innovations. The psychometrically validated Nursing Culture Assessment Tool (NCAT) provides a comprehensive assessment using six dimensions (teamwork, communication, satisfaction, professional commitment, behaviors, and expectations), and evaluation of these dimensions could help positively reshape the culture before any change implementation. PurposeAims were to: (1) assess the validity and reliability of the NCAT across nursing staff in a single type of clinical setting – LTC facilities, and (2) present a refined theoretical model of the interaction of culture and practice implementation. MethodsA cross-sectional, exploratory investigation of the NCAT in LTC settings was conducted. Empirical construct validity of the 19-item NCAT's six subscales was investigated by confirmatory factor analysis using a sample of licensed nurses and certified nursing assistants (n = 318). ResultsThe model fit was judged using the comparative fit index (0.94) and standardized root mean-square residual (0.05). Cronbach's alpha correlation coefficients of items in each subscale and in the overall scale ranged from 0.76 to 0.94. ConclusionA summary of the NCAT development and report on its psychometric properties when administered in LTC settings is provided, extending previous findings of the NCAT's enhanced stability when used in assessing nursing staff perceptions in LTC and by demonstrating that the NCAT is a reliable and valid psychometric screening tool for nursing culture.

Nursing Culture Assessment Tool (NCAT): Empirical validation for use in long-term care

BackgroundCapturing general aspects of the occupational subculture of nursing is needed in long-term care (LTC) given it's latent influence on the quality of care that residents receive and on the ability of nursing staff (licensed nurses and certified nursing assistants) to implement evidence-based practice innovations. The psychometrically validated Nursing Culture Assessment Tool (NCAT) provides a comprehensive assessment using six dimensions (teamwork, communication, satisfaction, professional commitment, behaviors, and expectations), and evaluation of these dimensions could help positively reshape the culture before any change implementation. AimsTo: (1) assess the validity and reliability of the NCAT across nursing staff in a single type of clinical setting – LTC facilities, and (2) present a refined theoretical model of the interaction of culture and practice implementation. MethodA cross-sectional, exploratory investigation of the NCAT in LTC settings was conducted. Empirical construct validity of the nineteen item NCAT's six subscales was investigated by confirmatory factor analysis using a sample of licensed nurses and certified nursing assistants (n = 318). ResultsThe model fit was judged using the comparative fit index (0.94) and standardized root mean-square residual (0.05). Cronbach's alpha correlation coefficients of items in each subscale and in the overall scale ranged from 0.76 to 0.94. ConclusionA summary of the NCAT development and report on its psychometric properties when administered in LTC settings is provided, extending previous findings of the NCAT's enhanced stability when used in assessing nursing staff perceptions in LTC and by demonstrating the NCAT is a reliable and valid psychometric screening tool for nursing culture.

The Development and validation of organizational cultural competence assessment tools for early childhood institutions

The Development and validation of organizational cultural competence assessment tools for early childhood institutions

Evaluating the linguistic appropriateness and cultural sensitivity of a self-report system for spanish-speaking patients with cancer.

Spanish speakers in the United States encounter numerous communication barriers during cancer treatment. Communication-focused interventions may help Spanish speakers communicate better with healthcare providers and manage symptoms and quality of life issues (SQOL). For this study, we developed a Spanish version of the electronic self-report assessment for cancer (ESRA-C), a web-based program that helps people with cancer report, track, and manage cancer-related SQOL. Four methods were used to evaluate the Spanish version. Focus groups and cognitive interviews were conducted with 51 Spanish-speaking individuals to elicit feedback. Readability was assessed using the Fry readability formula. The cultural sensitivity assessment tool was applied by three bilingual, bicultural reviewers. Revisions were made to personalize the introduction using a patient story and photos and to simplify language. Focus group participants endorsed changes to the program in a second round of focus groups. Cultural sensitivity of the program was scored unacceptable () for audiovisual material and acceptable () for written material. Fry reading levels ranged from 4th to 10th grade. Findings from this study provide several next steps to refine ESRA-C for Spanish speakers with cancer.

Development of the Just Culture Assessment Tool

Given the growing support for establishing a just patient safety culture in health-care settings, a valid tool is needed to assess and improve just patient safety culture. The purpose of this study was to develop a measure of individual perceptions of just culture for a hospital setting. The 27-item survey was administered to 998 members of a health-care staff in a pediatric research hospital as part of the hospital's ongoing patient safety culture assessment process. Subscales included balancing a blame-free approach with accountability, feedback and communication, openness of communication, quality of the event reporting process, continuous improvement, and trust. The final sample of 404 participants (40% response rate) included nurses, physicians, pharmacists, and other hospital staff members involved in patient care. Confirmatory factor analysis was used to test the internal structure of the measure and reliability analyses were conducted on the subscales. Moderate support for the factor structure was established with confirmatory factor analysis. After modifications were made to improve statistical fit, the final version of the measure included 6 subscales loading onto one higher-order dimension. Additionally, Cronbach α reliability scores for the subscales were positive, with each dimension being above 0.7 with the exception of one. The instrument designed and tested in this study demonstrated adequate structure and reliability. Given the uniqueness of the current sample, further verification of the JCAT is needed from hospitals that serve broader populations. A validated tool could also be used to evaluate the relation between just culture and patient safety outcomes.

Cultural competence education for practicing physicians: lessons in cultural humility, nonjudgmental behaviors, and health beliefs elicitation.

Although numerous studies have examined cultural competence training, debate still exists about efficacious approaches to this training. Furthermore, little focus has been placed on training and evaluating practicing physicians. A skills-based course on culturally competent diabetes care was developed and subsequently tested in a controlled trial of primary physicians caring for patients enrolled in one state's Medicaid program. We hypothesized that physicians completing the course would show higher levels of self-reported cultural competence as measured by a Cultural Competence Assessment Tool (CCAT) than those in the control group. Differences in CCAT subscale scores were also compared. Ninety physicians completed the study, with 41 in the control and 49 in the intervention group. Most were female (66%), with an average age of 44, and 12 years in practice. There were no significant differences on total CCAT score (212.7 ± 26.7 for control versus 217.2 ± 28.6 for intervention, p = .444) or subscales measuring cultural knowledge. There were significant positive differences on the subscales measuring physicians' nonjudgmental attitudes/behaviors (subscale score 2.38 ± 0.46 for control versus 2.69 ± 0.52 for intervention, p = .004) and future likelihood of eliciting patients' beliefs about diabetes and treatment preferences (3.11 ± 0.53 for control versus 3.37 ± 0.45 for intervention, p = .014). There was, however, a significant negative difference on the subscale measuring cultural self-awareness (3.48 ± 0.36 for control versus 3.26 ± 0.48 for intervention, p = .018). A predominantly skills-based approach to training physicians did not change aggregate measures of cultural competence, but did affect key attitudes and behaviors, which may better reflect the goals of cultural competence training.

An assessment of organisational values, culture and performance in Cape Town's primary healthcare services

AbstractObjectives: Improving the quality of primary health care in South Africa is a national priority and the Western Cape Department of Health has identified staff and patient experience as a key component. Its strategic plan, Vision 2020, espouses caring, competence, accountability, integrity, responsiveness and respect as the most important organisational values. This study aimed to measure the personal values of staff, as well as current and desired organisational values.Design: A cross-sectional survey used the cultural values assessment tool. Data were analysed by the Barrett Value Centre.Setting and subjects: Staff and managers at five community health centres in the Cape Town Metropole.Outcome measures: Personal values, current and desired organisational values, organisational entropy and organisational scorecard.Results: In total, 154 staff members completed the survey. Participants reported personal values that are congruent with a move towards more patient-centred care. The top 10 current org...

A Comparative Analysis of Cultural Competence in Beginning and Graduating Nursing Students

The ethnic proportions of the population in the United States are rapidly changing, with the nation's minority population at approximately 101 million. This is also true for the West Texas region, where locally in a city with 183,000 residents, 43 different languages are spoken suggesting that cultural education needs to be included in nursing program curricula. Therefore, a study was conducted during a period of curriculum revision to determine if the current nursing curriculum at a public university offers enough education and experience for graduating nurses to care for such a diverse population by comparing their perceptions of cultural competence with beginning sophomore nursing students' perceptions. Participants were asked to complete the Cultural Competence Assessment (CCA) tool in order to evaluate perceptions of cultural competence. Upon analysis of the data, perceptions of cultural competence among graduating nursing students were significantly higher (P = .002) than the perceptions of cultural competence among beginning nursing students. These results support that nursing students perceive that they have become culturally competent during their nursing education, leading to implications of the need for continued education relating to this concept, beginning with the first course and continuing throughout the nursing curriculum.

Information culture in a government organization

PurposeThe purpose of this paper is to use information culture assessment tools (from work by Curry and Moore) to examine the information culture within a regulated, government environment. In particular, it aims to study the relationship between records management training provided to staff, staff self‐perceptions of records management competencies and compliance with a formal records management program.Design/methodology/approachThe survey employs a questionnaire to gather the data from a provincial government ministry in Ontario, Canada. A questionnaire was used for data collection from a sample of 350 records management personnel from a population of 3,510 in five divisions of the ministry. A total of 207 participants responded and the copies of their questionnaire were found valid for analysis. The response rate realized was 66.7 percent.FindingsThe results from this study show that the there is a potential relationship between formal training delivered to staff, and the self‐perceived level of records management competency, namely that the more training staff receive, the more staff perceive the need for further training, and the greater level of compliance with the records management program. However, as the records management training strategy is informal in nature, it is difficult to determine a holistic influence of the training program on the organization's information culture.Research limitations/implicationsThe study is based on one ministry with an informal training records management strategy in place. The findings may not apply to organizations where there is a more formal training strategy. The findings should also be tested in private sector organizational settings.Practical implicationsKnowledge and understanding of the features of information culture will assist with identifying gaps in addressing the challenges of organizational record management training and its effect on compliance with organizational information and record management programs.Originality/valueThis research adds to the body of knowledge about information culture and user‐information behavior, particularly in regards to connections between training and compliance in government organizations. This paper provides evidence from an original study.

Building a Community of Research Practice

This article explicates the intragroup social dynamics and work of a nursing and education research team as a community of research practice interested in organizational cultures and occupational subcultures. Dynamics were characterized by processes of socialization through reeducation and group social identity formation that enabled members to cross discipline-bordered traditions and produce interdisciplinary mixed methods combinations. Combinations were achieved at the paradigm level through the generation of a shared viewing position and theoretical model. At methods and technique levels, such achievements were accomplished through methodological capitalization and prioritization and the development of a quantitative culture assessment tool that can be used in combination with complementary qualitative observation and interview protocols. Recommendations for other teams are provided.

Evaluating the Integration of Cultural Competence Skills Into Health and Physical Assessment Tools

Currently used audiovisual (AV) teaching tools to teach health and physical assessment reflect a Eurocentric bias using the biomedical model. The purpose of our study was to (a) identify commonly used AV teaching tools of Canadian schools of nursing and (b) evaluate the identified tools. A two-part descriptive quantitative method design was used. First, we surveyed schools of nursing across Canada. Second, the identified AV teaching tools were evaluated for content and modeling of cultural competence. The majority of the schools (67%) used publisher-produced videos associated with a physical assessment textbook. Major findings included minimal demonstration of negotiation with a client around cultural aspects of the interview including the need for an interpreter, modesty, and inclusion of support persons. Identification of culturally specific examples given during the videos was superficial and did not provide students with a comprehensive understanding of necessary culturally competent skills.

Examining the Risk Factors among Omani Women: Risk Assessment and Their Implications

Osteoporosis is common among postmenopausal women, giving rise to morbidity and diminishing the quality of life. There is lack of information about the risk factors of osteoporosis among local Omani women. To explore the risk factors of Osteoporosis among Omani Women using a Modified Fracture Risk Assessment Tool. This is an exploratory research design using a simple random sampling. A pilot study was conducted among 35 local Omani women from the Muscat region, who completed the validated and reliable Modified Fracture Risk Assessment Tool (MFRAT). Bone Mineral Density (BMD) was measured among 11 women at moderate-high risk based on MFRAT. The data was analyzed using inferential statistics. Fourteen Omani women were at moderate-high risk for Osteoporosis fracture due to premenopausal, Vitamin D Deficiency, increased parity, increased lactation period and sedentary lifestyle. Among these five women revealed low BMD and required early intervention and support. Determinants of Osteoporosis can be elicited among premenaopausal Omani women with a specific risk assessment tool. There is a need to construct a cultural sensitive risk assessment tool for Omani women for early screening and detection of Osteoporosis. Nurses can identify, provide intervention and education for Omani women at-risk of fracture.

Can Hospital Cultural Competency Reduce Disparities in Patient Experiences With Care?

Cultural competency has been espoused as an organizational strategy to reduce health disparities in care. To examine the relationship between hospital cultural competency and inpatient experiences with care. The first model predicted Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from hospital random effects, plus fixed effects for hospital cultural competency, individual race/ethnicity/language, and case-mix variables. The second model tested if the association between a hospital's cultural competency and HCAHPS scores differed for minority and non-Hispanic white patients. The National CAHPS Benchmarking Database's (NCBD) HCAHPS Surveys and the Cultural Competency Assessment Tool of Hospitals Surveys for California hospitals were merged, resulting in 66 hospitals and 19,583 HCAHPS respondents in 2006. Dependent variables include 10 HCAHPS measures: 6 composites (communication with doctors, communication with nurses, staff responsiveness, pain control, communication about medications, and discharge information), 2 individual items (cleanliness and quietness of patient rooms), and 2 global items (overall hospital rating, and whether patient would recommend hospital). Hospitals with greater cultural competency have better HCAHPS scores for doctor communication, hospital rating, and hospital recommendation. Furthermore, HCAHPS scores for minorities were higher at hospitals with greater cultural competency on 4 other dimensions: nurse communication, staff responsiveness, quiet room, and pain control. Greater hospital cultural competency may improve overall patient experiences, but may particularly benefit minorities in their interactions with nurses and hospital staff. Such effort may not only serve longstanding goals of reducing racial/ethnic disparities in inpatient experience, but may also contribute to general quality improvement.

Moving towards culturally competent health systems: Organizational and market factors

Cultural competency has been proposed as an organizational strategy to address racial/ethnic disparities in the healthcare system; disparities are a long-standing policy challenge whose relevance is only increasing with the increasing population diversity of the US and across the world. Using an integrative conceptual framework based on the resource dependency and institutional theories, we examine the relationship between organizational and market factors and hospitals' degree of cultural competency. Our sample consists of 119 hospitals located in the state of California (US) and is constructed using the following datasets for the year 2006: Cultural Competency Assessment Tool of Hospitals (CCATH) Survey, California's Office of Statewide Health Planning & Development's Hospital Inpatient Discharges and Annual Hospital Financial Data, American Hospital Association's Annual Survey, and the Area Resource File. The dependent variable consists of the degree of hospital cultural competency, as assessed by the CCATH overall score. Organizational variables include ownership status, teaching hospital, payer mix, size, system membership, financial performance, and the proportion of inpatient racial/ethnic minorities. Market characteristics included hospital competition, the proportion of racial/ethnic minorities in the area, metropolitan area, and per capita income. Regression analyses were conducted to assess the relationship between the CCATH overall score and organizational and market variables. Our results show that hospitals which are not-for-profit, serve a more diverse inpatient population, and are located in more competitive and affluent markets exhibit a higher degree of cultural competency. Our results underscore the importance of both institutional and competitive market pressures in guiding hospital behavior. For instance, while not-for-profit may adopt innovative/progressive policies like cultural competency simply as a function of their organizational goals, linking cultural competency with organizational performance may be essential to attract more profit driven hospitals.