The ELDER expansion project: building cultural competence among long term home care workers.

This study aimed to improve communication and care provision in five home or long term care settings by raising staff awareness about health beliefs and patterns among varied cultures. Lack of cultural competence is linked to ethnocentric attitudes that can lead to inappropriate communication and ineffective interventions. Understanding the culturally imbedded belief systems of patients and providers is an integral part of effective communication skills that are foundational to optimal team functioning. Participants included five home or long term care agencies in an underserved region of New England. Seventy-four nurses, aids and allied health professionals participated in 10-12 small group interactive sessions. Comparison of pre and post cultural self efficacy scores revealed that participant confidence regarding their knowledge and skills when interacting with other cultures improved interactions with patients and co-workers. Journal exemplars supported the ability of attendees to apply content to the workplace.

Using simulation pedagogy to enhance teamwork and communication in the care of older adults: the ELDER project.

The Expanded Learning and Dedication to Elders in the Region (ELDER) project addressed the needs of under-served older adults by educating health care providers in home health and long-term care facilities. Four agencies in a health professional shortage/medically underserved area participated. Focus groups were held to determine agency-specific educational needs. Curricula from the John A. Hartford Foundation were adapted to design unique curricula for each agency and level of personnel during the first 2 years. The focus of this report is the case-based simulation learning approach used in year 3 to validate application of knowledge and facilitate teamwork and interprofessional communication. Three simulation sessions on varying topics were conducted at each site. Postsimulation surveys and qualitative interviews with hired evaluators showed that participants found simulations helpful to their practice. Tailored on-site education incorporating mid-fidelity simulation was an effective model for translating gerontological knowledge into practice and encouraging communication and teamwork in these settings.

The ELDER Project: educational model and three-year outcomes of a community-based geriatric education initiative.

The purpose of the ELDER (Expanded Learning and Dedication to Elders in the Region) Project was to address the needs of underserved older adults by providing worksite education to individuals who provide nursing care to older adults in community health centers, home health agencies, and long-term care facilities. Four agencies located in a Health Professional Shortage and Medically Underserved Area participated. Project staff conducted separate focus groups with administrators and staff at each agency to determine educational needs and preferences. Curricula from the Hartford Institute, End-of-Life Nursing Education Consortium, and Geriatric Education Centers were adapted to design unique curricula for each agency and level of personnel (licensed nurse or unlicensed caregiver). Activities included focus group meetings to tailor content to the needs of each agency, on-site educational sessions, and identification of an agency champion to sustain the program after the funding ended. A case-based simulation-learning approach was used in the final year to validate application of knowledge and to facilitate teamwork and interprofessional communication. Over 100 nurses and nursing assistants and eight administrators and allied health professionals participated over the three-year period of the project. Retention over this period, independent evaluations, and simulations demonstrated participants' ability to integrate best practices into typical clinical scenarios and revealed improved communication among care providers. Tailored on-site education incorporating simulation was an effective model for translating gerontological knowledge into practice and improving the care of older adults in these multiple settings.

Measuring satisfaction with nursing care among hospitalized patients: refinement of a Spanish version.

This study was designed to improve the psychometrics of English and Spanish measures of hospitalized patients' satisfaction with nursing care. One hundred Spanish-speaking participants in the northeastern and southwestern United States completed a new 20-item Spanish version; 64 of the same participants also completed the English version. Correlations between item pairs (p < .001, r = .56-.96) and total scores of both versions (r = .92, p < .01), and similar factor structures support equivalence of the two versions. Evidence for construct validity is also presented. Results surpass standards for new instruments and support the utility of this much needed, bilingual measure of inpatient satisfaction with nursing care.

Transforming the organizational culture of a school of nursing through innovative program development.

This article illustrates how a grant designed to promote new program development provided a vehicle for organizational transformation. The collaboration surrounding this initiative created a common focus within the school that more effectively channeled its resources and resulted in an unprecedented level of scholarly achievement and recognition. Faculty leveraged the success of this initial grant to procure additional funding for related projects. The importance of partnerships and teamwork were two valuable lessons learned. We believe that our experience is replicable in other schools of nursing interested in organizational transformation. Gibson and Barsade's model of managed change guided the project's implementation and evaluation processes. Recommendations for engaging faculty, gaining support, and developing a collaborative network are discussed in the article, with findings from a stakeholder-focused evaluation demonstrating new program goal achievement as well as the transformative changes that occurred in the organizational culture. A focused, theory-derived program plan, with comprehensive process and outcome evaluation components resulted in a major transformation of one school of nursing. Unanticipated outcomes included renewed synergy among faculty; the development of a preferred vision for the future; scholarly collaboration around a central theme that effectively channeled limited resources and dramatically increased productivity; increased regional and national recognition; and the creation of regional, national, and international partnerships.

Integrating spirituality into undergraduate nursing curricula.

Nursing programs have done a commendable job keeping pace with the rapid advances in disease management. Yet, spirituality has received far less attention in nursing curricula (Keefe, 2005) and nursing students often do not have a strong foundation in this area. The purpose of this project was to integrate spirituality into the undergraduate nursing curricula and measure student outcomes related to spiritual knowledge and attitudes. Nursing faculty participated in a spirituality education program and followed this with sessions focused on integration of spiritual content into individual nursing courses. Student pre and post-tests were administered using a standard instrument to evaluate the effectiveness of the program. Significant differences in spirituality knowledge and attitudes among senior-level nursing students (t = -3.059, p = .004) were revealed. As the healthcare system becomes increasingly complex, providing students with tools to identify and strengthen inner resources is essential to patient care.

The journey toward geriatric excellence in a non-research-intensive university.

In response to the unprecedented rise in the U.S. older adult population, nurse educators have intensified efforts to produce graduates who are sensitive to older adults' health care concerns. Critical to accomplishing this goal is strengthening curricula to include specialized gerontological content. Although the science of gerontological nursing has grown significantly over the past several decades, large-scale research projects are often confined to research or doctoral level universities in which typically more support is available. Faculty members in smaller universities in which a great number of nursing students are educated do not always have the resources to readily contribute to science. Such a challenge was faced by one nursing school in a small Jesuit New England university. This article illustrates a process to develop excellence in gerontological nursing education, as well as to promote scholarship and collaboration among faculty members at baccalaureate or master's level universities. Three years ago, the John A. Hartford Foundation, in collaboration with the American Association of Colleges of Nursing, awarded grants to select nursing programs for curricular enhancement. Implementation of this project at a small Jesuit university led to synergy among faculty that resulted in joint publications, presentations, and newly funded projects. In addition, the school earned local and national recognition for excellence in gerontological nursing education/care. The process leading to the outstanding success of this curricular endeavor is presented as a replicable model for schools in other baccalaureate or master's level settings.

Testing equivalence of Spanish and English versions: the LaMonica-Oberst (revised) patient satisfaction with nursing care scale.

Despite recent emphasis on outcome measurement and an increasing proportion of Spanish speakers in the United States, most patient satisfaction studies exclude Spanish-speaking participants because Spanish versions of instruments are not available. A Spanish translation of the 15-item LaMonica-Oberst Patient Satisfaction Scale, completed by 64 Spanish-speaking patients living in the northeast and of predominantly Puerto Rican ancestry, produced two factors explaining 86.3% of score variation (alpha=.94 and.58). Evidence for equivalence to the English version and concurrent validity is presented. Generalizability and decision studies indicate that four additional items are needed on the dissatisfaction subscale to attain an acceptable dependability coefficient.

Methodological concerns for non-Hispanic investigators conducting research with Hispanic Americans.

The fastest-growing ethnic population in the United States, Hispanic Americans are underrepresented in health care research because of an insufficient number of Hispanic American researchers, study teams without Spanish-speaking members, a lack of Spanish-language instruments, and investigator ignorance about cultural differences. Culturally insensitive research produces biased results that can inaccurately represent Hispanic Americans. The purpose of this article is to discuss methodological concerns when conducting research with Hispanic Americans including: instrument response format, translation issues, population-related extraneous variables, and response tendencies that can influence results.

Patient identification of caregivers' titles: do they know who you are?

This study investigated patients' abilities to identify licensed nurse and unlicensed assistive personnel (UAP) and whether this knowledge is related to satisfaction with care. Of 100 patients from two hospitals, 28% did not know whether caregivers were nurses or UAP on sight. Fifteen percent of patients asked to identify UAP assumed that the caregiver was a nurse. Patients could not recognize their nurse or UAP caregivers 59% of the time from a list of names. Patients were three times more likely to know the names and titles of their nurses. Older patients were less likely to remember the names and titles of their caregivers. Satisfaction with nursing care was not predicted by patients' knowledge of caregiver name or title.