Module and Course Development Grant
Indiana University
Cultural Competency in Health Care and Human Services
Abstract
The demographics of the United Sates are dramatically changing. Central to these changes is a significant increase in non-White populations. A review of the relative percentages of population increases for ethnic groups between 1980 and 1992 reveals the following: Asian and Pacific Islanders 123.5%, Hispanic/Latinos 65.3%, Native American/Eskimo/Aleut 30.7%, African Americans 16.4%, and Non-Hispanic White 5.5%. These percentages not only represent sizable increases in actual numbers of these cultural/ethnic groups, but also a serious decline in the relative percentage of Whites in America from approximately 80% to less than 75%. If this trend continues, it will not take many generations before non-Hispanic Whites are a numerical minority of the population (Atkinson, Morten, and Sue 1993; Healy, 1995). Nurses and other health care practitioners need to be knowledgeable and culturally competent to work in multicultural settings. Some of the many reasons include but are not limited to the following: the perception of illness, disease and their causes varies by culture; diverse belief systems exist related to health, healing and wellness; culture influences help seeking behaviors and attitudes towards health care providers; individual preferences reflect traditional and non-traditional approaches to health care; patients must overcome personal experiences of biases within health care systems; and health care providers from culturally and linguistically diverse groups are under-represented in the current service delivery system (Cohen & Goode, 1999). In addition, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is currently reviewing standards for Culturally and Linguistically Appropriate Services (CLAS) in health care organizations (Office of Minority Health, 2000). The demographic changes discussed above are inevitably reflected in educational institutions. In 1976, for example, 24% of the total school enrollment in U.S. schools was non-White. In 1984, this percentage had increased to 29%. This year (2000) it is estimated that children of color comprise about one-third of all children enrolled in public schools, and it is projected that by 2020, they will comprise 46% (Hodgkinson, 1985). The purpose of this proposal is to develop a course offering to assist health care professionals including nurses and health care managers, teachers, school administrators and other professionals in education, to improve service delivery to multicultural populations. This proposal addresses the need for Indiana's workforce to receive education and training in contemporary management practices. Such practices include how to manage culturally diverse employees and how to provide human services to an increasingly multicultural population. The course will contain four modules. The objectives include providing learners with knowledge about changing demographics, developing learner's self awareness, helping learners to acquire guidelines and skills for working with culturally diverse individuals, and showing them strategies for taking action on this knowledge.
Need for course and learners to be served:
Leininger (1997) predicts that by 2010 all healthcare practitioners will need to be knowledgeable and culturally competent to work in multicultural settings. This requires the ability to analyze similarities and differences in culture care knowledge and practices. Health care providers will be required to shift from ethnocentric and monocultural positions to a multicultural knowledge base in order to be relevant and effective in working with multicultural populations (Leininger, 1997a). In order to prevent cultural bias, professionals will need to understand their own cultural values, beliefs and practices.
In addition, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is evaluating National Model Standards For Culturally and Linguistically Appropriate Services (CLAS) In Health Care. Under these new standards health care providers will be expected to receive professional education focused on providing high quality culturally competent care to all patients.
Until recently, nursing education and practice utilized the dominant culture's medical model that focused on the physical and emotional needs of individuals, or cure without cultural considerations. Educational programs need to be changed to incorporate "culture care" knowledge. Leininger (1995) challenged nurse educators to educate five million nurses worldwide to provide culturally competent care. How better to meet this challenge but through putting technology to work!
There also exists a considerable discrepancy between the makeup of the K-12 student population in most schools and that of the teaching force. While our nation's K-12 school population is becoming increasingly diverse as cited above, most of our nation's teachers come from a rather homogeneous group; approximately 88-90 percent are European-American middle class and two-thirds are women. Teachers, like most people, tend to be culture-bound and have little knowledge or experience with people from other cultures. This limits their ability to interact effectively with students who are different from them.
The Internet and emerging virtual communities now provide previously unimagined access to a rich local, national and international community of multicultural connections, resources and information databases. The Internet is not only a viable vehicle for delivery of educational programs but also has great potential for linking geographically dispersed and diverse cultural groups (Holmberg, 1990). Many examples of effective course delivery have been cited in recent literature. There are also increasing examples of a continuum of technologies for multicultural healthcare and education collaboration.
Rationale for choice of course and technologies to be used:
The Internet technology will permit individuals to access the on-line program at various times, accommodating shift personnel, orientation and in-service schedules, and other personal or institutional requirements. The purpose of this proposal is to develop and implement this course using an asynchronous mode of technology for culture linkages and human service information from culturally diverse perspectives. Learners to be served include managers in the Indiana workforce in general, nurses and other health care professionals, K-12 teachers, school counselors and administrators. If successful, additional funding sources will be sought for expanding the course to a Web/Virtual Asynchronous Classroom where learners and instructors together can acquire new skills and knowledge. Additional funding will also facilitate the development of courses with content designed to address specific issues unique to a particular profession.
Institution's capacity and commitment to the course-development project:
There is strong institutional support for the development of Cultural Competency in Health Care and Human Services. There is also a solid commitment to distributed education within the university. This proposal is consistent with the Indiana University Information Technology Strategic Plan (http://www.indiana.edu/~ovpit/strategic), and the IUPUI Campus initiatives to support distributed learning. This course will be offered through the Center for Teaching and Lifelong Learning at the School of Nursing (SON). The SON strategic plan, "Becoming a School of Nursing without Walls", calls for the development of academic and continuing education courses and provides the necessary support services from the School's instructional support team (learning resource coordinator, multimedia developer, database manager, instructional designer, web technician, and LAN manager) as well as campus team members from the IUPUI Library and Center for Teaching and Learning. This team will support the development and deployment of this proposed course. The SON has a six-semester experience of offering web-based courses using the course development team approach described above. In addition, participant support services are well developed. For example, the user's guide for the course management software has been developed and posted on-line; there is a student database for gathering evaluation data; the campus bookstore has capability for mailing course materials; the library can offer full text on-line resources and electronic resources; and participants can register on-line through the SON Continuing Education Department.
Instructional design and delivery plan:
This course is designed for the increasing numbers of health care professionals needing professional development for anticipated JCAHO standards in this subject matter, and, K-12 teachers and school counselors who wish to obtain Continuing Education Units (CEUs) and Certification Renewal Units (CRUs) in a flexible, convenient, and individually paced learning environment via the Internet. It is also designed for healthcare management in the workforce to facilitate a change in attitudes, to help them reflect on their values and explore alternative perspectives in an increasing multicultural environment.
The objectives of the course are to:
- Develop an awareness and knowledge of the values and characteristics
of various cultural and ethnic groups.
- Develop an awareness of the learner's personal beliefs and attitudes.
- Learn the guidelines for assessing, providing services, or supervising
culturally diverse individuals.
- Learn how to develop a personal commitment to multicultural understanding
and personal change.
- Develop a plan with specific steps to become more culturally competent
and to function more effectively in a multicultural environment.
- Developing knowledge of the facts (e.g. changing demographics, statistics
and models).
- Developing Awareness (identifying learner's emotional response to
the facts and providing motivation to change).
- Developing general guidelines and skills for working with culturally
diverse individuals and specific guidelines for working with specific
cultural groups.
- Taking action and commitment (learners will commit to using their
skills and abilities to help bring about change at the personal and/or
organizational level).
Explanation of how the instructional design will serve the needs of the target audience:
By 2020 African Americans are expected to comprise about 13% of the U.S. population. Hispanic and Asian Americans are the two most rapidly growing minorities in the United States. Asian Americans are expected to be about 6.5% of the population by 2020. In terms of absolute numbers, Hispanic/Latinos are the most rapidly growing group. They comprised 9% of the U. S. population in 1990. In 2020 they will comprise 16% of the overall U.S. population (Judy & D'Amico, 1997). By contrast, the Caucasian population is expected to decline to 62.1% by the year 2025 (U.S. Bureau of the Census, 1993). The United States has high immigration rates and population mobility. The aim of culturally competent health care and human services is to provide culturally sensitive services to all consumers. This becomes more important as members of ethnic minority groups are increasing in size. These are factors that mandate increased cultural awareness for human service professionals. At the same time worldwide communication, global corporations and international travel are expanding. Further, Indiana is a state where cultural diversity is growing but still somewhat limited. This proposal will meet a need for consumers of educational and other human service institutions, and, professionals by helping the latter to improve the quality of services they provide to multicultural populations.
Course evaluation plan:
Evaluation of the course will occur as follows:
- Peer review of course and course materials prior to the course offering.
- Usability testing of the online functionality by course development
and technical support teams prior to the course offering.
- Administering of an on-line pre-test of cultural knowledge at the
beginning of the course, and a post-test of cultural knowledge on-line
at completion of course.
- Summative evaluation using current SON Web-based evaluation instruments.
The quality of the course will be assured because qualified SON and IUPUI faculty will design and implement the course from two perspectives, cultural competency and technology applications. All faculty members have graduate status. The course will be peer reviewed and an instructional designer will assist faculty with web course design.
The development of an electronically delivered Cultural Competency in Health Care and Human Services course addresses a statewide need to provide effective healthcare and human services to multicultural populations and use technology as a tool for collaboration and information access.
Marketing of the Course:
The course will be marketed to institutions within ISPE, all healthcare agencies and systems in Indiana, the Indianapolis Public School system, and professional organizations with members requiring this content to comply with JCAHO standards. Marketing capabilities exist within the SON and will include posting course information on the SON Web site.
Project Schedule
The course, Cultural Competency in Health Care and Human Services, will be offered for the first time during fall semester of 2001.
| February 2001 | Grant funding notification. |
| March - June 2001 | Complete course design; develop learning activities; select on-line resources; prepare course guide. Begin marketing course to target audience. Technical specifications developed; course created in WebCT (course management software); course linked to SON home page. |
| May- June 2001 | Peer review course draft and revisions. |
| June - Sept 2001 | Technical usability testing by technical team, faculty colleagues, peer reviewer; develop/refine evaluation instruments. |
| July - Sept 2001 | Register and enroll students |
| September 2001 | Offer course. Summative evaluation by peer reviewer, participants, technical team, project course development personnel. |
Key course development personnel
| Lillian G. Stokes, Ph.D., R.N. | Director of Quality and Enrichment, Office of Educational Services and Department of Adult Health, IUPUI School of Nursing, will serve as Project Director, oversee content and coordinate peer review. |
| Joseph W. Smedley, Ph.D. | Assistant Professor of Psychology and Education, IUPUI. Dr. Smedley will develop and teach the course. |
| (TBA) | Instructional Designer will design user interfaces, tutorials, and case studies. |
| (TBA) | Video Coordinator will develop video vignettes for case studies. |
| (TBA) | Peer Reviewer |
Proposal Budget and Budget Narrative
The total budget request for this proposal is $15,000.00. The request to the IPSE Course Development Grant Program is for $15,000.00 for salaries for lead faculty, instructional design, and honorariums course developer and peer reviewer.
Following are salaries and fringe benefits:
| 1. Lillian Stokes, Principal Investigator and Project director. | $2000.00 |
| Salary: $1,549 Fringe: $451 (29.14%) | |
| 2. Joseph Smedley will develop and teach the course. Honorarium | $6000.00 |
| 3. TBA, Instructional Designer for user interfaces tutorials and case studies. | $4000.00 |
| 4. TBA, Video Coordinator video vignettes | $2000.00 |
| 5. TBA, Peer Reviewer | $1000.00 |
The School of Nursing contributes the following personnel, hardware, and software:
| 1. School
of Nursing Learning Resources Web Programmer (TBA) Will upload files, enroll students into course and manage site |
$2000.00 |
| Salary: $1,602 Fringe: $398 (24.88%) | |
| 2. Brochure development and marketing of course. | $2500.00 |
| 3. School of Nursing LAN Manager (TBA) | $1000.00 |
| Salary: $774 Fringe: $226 (29.14%) | |
| 4. File Server,
course management software (site license to IUPUI), Flashlight Student Inventory (site license to IUPUI), marketing (brochures, announcements, Web page). |
|
| 5. Administrative
Assistant Continuing Nursing Education (TBA) Will register participants, award certificates, CE coordination fees |
$ 500.00 |
| Salary: $387 Fringe: $113 (29.14%) | |
| 6. School
of Nursing Learning Resources Coordinator (TBA) Will identify appropriate on-line resources and Web sites |
$ 500.00 |
| Salary: $387 Fringe: $113 (29.14%) | |
| 7. School
of Nursing Database Manager (TBA) Will program database for on-line course evaluation and provide summary data and reports |
$ 500.00 |
| Salary: $387 Fringe: $113 (29.14%) | |
| 8. IUPUI Libraries | $ 500.00 |
APPENDIX A
Biographical Sketch - Dr. Lillian G. Stokes, Project Director
Dr. Lillian Gatlin Stokes is an Associate Professor and Director of Diversity and Enrichment at Indiana University School of Nursing. She has served as Associate Professor of Nursing at Purdue University and has held staff nurse positions in Virginia, Illinois, and Indiana.
She is a graduate of Kate Bitting Reynolds School of Nursing and holds a Bachelor of Science Degree in nursing from North Carolina Central University, a Master of Science Degree in nursing, and a Doctorate in Educational Psychology from Indiana University. She was a Fellow in the Ethnic-Racial Minority Fellowship Program (ANA).
Dr. Stokes received the Lucile Petry Leone Award at the 1975 National League for Nursing Convention. This award is given to an outstanding young nurse teacher who has made significant contributions to nursing education with no more than seven years of teaching experience within a ten-year period. An award is named in her honor at Indiana University School of Nursing. The Indiana University Alumni Association gives the Lillian G. Stokes Award annually to an associate degree student for excellent academic and clinical performance. She has received a number of awards including a Special Achievement Award and the Mabel Keaton Staupers Scholarship from Chi Eta Phi Sorority, Inc.; The Maynard K. Hine Award for distinguished service to Indiana University, distinguished service awards from Girls Clubs of Greater Indianapolis, Jack & Jill of America, and from Indiana University School of Nursing Alumni Association. She also received the Madame C. J. Walker Award (Outstanding Women of the Year), from the Center for Leadership Development and the Distinguished Hoosier Award from the Governor of the State of Indiana. She has been listed in Who's Who Among Black Americans, Who's Who Among American Women, Outstanding Teachers of America, and is included in Contemporary Minority Leaders in Nursing, which was published by the American Nurses' Association, and in The Paths we Tread. She has been named one of the outstanding teachers at Indiana University School of Nursing.
Dr. Stokes is very active in community activities. She has served on several local boards, and on the Executive Council of Indiana University Alumni Association, and has served in an advisory capacity to community agencies planning health initiatives specifically for the African-American community. She has served on the editorial board for Family and Community Health Nursing; and as Peer Reviewer for Special Projects Grants, Bethesda Maryland. She is currently editor of JOCEPS (Journal of Chi Eta Phi Sorority). She has been a presentation at workshops and seminars.
She is a member of Chi Eta Phi Sorority, Inc., Sigma Theta Tau International. Other memberships include the American Nurses' Association, the National League for Nursing, American Psychological Association, Association of Black Nursing Faculty, Coalition of 100 Black Women, Links, Inc., and Alpha Kappa Alpha Sorority.
She has published two books that have been widely used as textbooks in leading schools throughout the U.S., Canada and Australia. She has also published chapters in books related to health care in the African-American community. In addition, she serves on committees at her church and taught Sunday school at for 19 consecutive years.
Biographical Sketch - Dr. Joseph W. Smedley, Course Developer
Dr. Joseph Smedley is Adjunct Assistant Professor in the School of Science, Department of Psychology, Clinical Rehabilitation Psychology Program, at Indiana University-Purdue University Indianapolis. He is credited with developing the first graduate course in this department on "Counseling the Culturally Different". This course is now one of the core courses in the graduate program. He is also Adjunct Assistant Professor in the School of Education, Department of Counseling and Educational Psychology at Indiana University-Purdue University Indianapolis, where he teaches "Cross-Cultural Counseling".
Dr. Smedley also serves on the faculty of the American Healthcare Institute (AHI). He developed and taught the first diversity course for AHI, the leading provider of continuing education to nurses and mental health professionals throughout the United States. The course is entitled "Working with Culturally Diverse Clients". He has conducted numerous seminars for health care providers including nurses, counselors, psychologists, psychiatrists, social workers and students. He conducted seminars for public school teachers, administrators and school board members, and has also served as consultant to school districts serving the K-12 population, as well as higher education institutions and counseling centers.
Dr. Smedley obtained his BA in psychology from Roosevelt University in Chicago. He earned an MS and Ph.D. in psychology from Howard University in Washington, DC, and a Certificate for Social Scientists from the University of California, Irvine. He has received awards for service from various organizations, including of the Indiana State Personnel Department; the State of Indiana Labor/Management Committee; the 1992 Governors Public Service Internship Program; the U.S. Department of Housing and Urban Development, and the Student National Medical Association.
Dr. Smedley is a published author and holds memberships in the American Psychological Association, the Organizational Development Network, the American Counseling Association, The Indiana Counseling Association, the Association for Multicultural Counseling and Development, and the National Association for Diversity Management where he serves on the editorial board for the International Journal of Diversity and Synergy.
APPENDIX B
References
Atkinson, D. R., Morten, G., & Sue, D. W. (1993). Counseling American minorities: A cross-cultural perspective (4th ed.). Dubuque, IA: William C. Brown.
Cohen, E. & Goode, T. D. (1999) Policy Brief 1. Georgetown University Child Development Center - National for Cultural Competence.
Healy, J. F. (1995). Race, ethnicity, gender and class: The sociology of group conflict and change. Thousand Oaks, CA: Sage Press.
Hodgkinson, H. L. (1985). All one system: Demographics of education-kindergarten through graduate school. Washington, DC: Institute of Educational Leadership.
Holmberg, B. (1990). A paradigm shift in distance education? Mythology in the making. ICDE Bulletin, 22:51-55.
Judy, R. & D'Amico, C. (1997). Workforce 2000: Work and workers in the 21st century. Indiana: Hudson Institute.
Leininger, M. (1997). Overview of the theory of culture care with ethnonursing research method. Journal of Transcultural Nursing, 8, (2), 32-52.
Leininger, M. (1995). Teaching transcultural nursing in undergraduate and graduate programs. Journal of Transcultural Nursing, 6, (2), 10-26.
U.S. Department of Health and Human Services, OPHS, Office of Minority Health. Public Comment Regional Meeting: Establishing National Model Standards For Culturally and Linguistically Appropriate Services (CLAS) in Health Care. Chicago, IL, April 5, 2000.
U.S. Bureau of the Census (1993). Population profiles of the United States; 1993. Washington, DC Government Printing Office; CPR, series p-23, No. 185.
