What is Cultural Competence & Why is it Critical for RIC's School of Nursing?

In January RIC's School of Nursing held a virtual faculty development workshop on cultural competency that featured two guest speakers: alumna Valerie Almeida-Monroe '11, director of clinical services at Clinica Esperanza, a free clinic for uninsured Rhode Islanders; and Dionne Poulton, vice president and chief diversity officer at Care New England.

According to Almeida-Monroe, often it is the lack of cultural competence that interferes with the quality of care patients of color and non-English-speaking patients receive.

Almeida-Monroe is of Haitian heritage and speaks three languages: Haitian Creole, English and Spanish, the latter of which she learned while working at Clinica Esperanza for the last 10 years. She learned other critical matters, too, like the very real cultural differences in the way patients express and manage pain.

"About 70 percent of the people who come to Clinica Esperanza are Hispanic," she says. "When our patients come in for pain, the pain is usually pretty high, but they often don't rate it that way. They may rate it a 3 out of 10. But the fact that they're taking a day out of work, uncompensated, to come to the clinic tells me the pain is higher than that. The people we see also tend to live with pain for longer periods of time before coming in for help. They will have had that pain for nine months or for over a year."

When healthcare workers don't understand these kinds of cultural differences, it can lead to health disparities, she says.

"We had a patient who we referred to a rheumatologist," says Almeida-Monroe, "but the rheumatologist was somewhat dismissive and told the patient she didn't need to see a specialist because her pain was well managed on ibuprofen. It turns out that the patient actually had a diagnosis of lupus which was missed on the initial visit. Culturally competent care goes a long way in decreasing health disparities."

Poulton describes cultural competence as the ability to look at patients through the lens of their culture.

"We have to make sure we are considering the communities they live in and the health disparities they face to make sure we are treating the whole person," she says.

Poulton notes that the highest health disparities are around race. "My Ph.D. was on unconscious biases with respect to teacher educators," she says. "In my research I found that race is the most enduring, recognizable and inflammatory feature of identity of a person, which impacts how we see and treat people."

To become more culturally competent, Poulton recommends that institutions conduct sensitivity trainings and that institutional leaders make a commitment to inclusivity, which may mean mandating sensitivity trainings and establishing an accountability system.

It is also extremely important, she says, to have a diverse healthcare workforce.

"From a personal perspective, as a person of color, I know that when I walk into a healthcare institution, I look for people who look like me," says Poulton. "I look to see if a concerted effort has been made to ensure that there are diverse people working in these environments who are reflective of our society, which is multicultural."

To help faculty become more equipped to address issues of diversity and inclusion and teach cultural competence in their courses, RIC's School of Nursing established the Diversity and Inclusion Taskforce.

The Multicultural Student Nurse Organization was founded at the same time on the belief that if cultural competence is considered a requisite skill in the School of Nursing, the school will be better equipped to prepare students for real-world situations by working closely with an organization whose members live these experiences daily.

Lastly, Care New England and the School of Nursing are working on formalizing a partnership to further both of their diversity efforts and to create a workforce pipeline of prospective nurses of color who come from Rhode Island College.

"The increasing diversity of our society brings opportunities for health-care providers, health-care systems and policy makers to create and deliver culturally competent services," says Carolynn Masters, dean of the School of Nursing. "It is imperative that we, as nursing faculty, increase our cultural awareness, knowledge and skills and incorporate culture-specific attitudes and values into our nursing curriculum."