Emerging Standards of Care Paper
Ron Perkins
NUR/531
December 23, 2013
Jane Jacks

Emerging Standards of Care Paper
In nursing, we care for patients from a variety of cultures and backgrounds. This diversity is dependent on location, population, and nursing specialty and may change at any point. In order to properly provide culturally competent care, we must be educated about the individual culture needs and limitations. It's also important to be mentally open to looking beyond our personal norms to care for patients with unique cultural backgrounds and beliefs. As a dialysis nurse, we are seeing the effects of chronic kidney disease affecting a larger, more diverse population of patients. Patients are going into renal failure earlier, family dynamics are uniquely affected, and patients from all walks of life are affected. The paper will look at dialysis at Fresenius Medical Care in St Louis Missouri located in The Hill neighborhood. It will define cultural competency, identify the different cultures served, discuss how the standards of culture competency are being met and what areas are not, and discuss nursing care delivery and possible solutions for areas lacking in cultural competency.
Culturally Competent Care at Fresenius Dialysis Centers It is imperative as health care providers that we not only care for a verity of people with different health conditions, but also from different backgrounds. We are given the task of caring for the physical and mental wellbeing of patients. Acknowledging and working with culture differences can help a patient feel safe and it shows the compassion of the health care team. According to "National Center For Cultural Competence" (n.d.), “cultural competence requires individual providers at a minimum to: acknowledge cultural differences, understand your own culture, engage in self-assessment, acquire cultural knowledge & skills, and view behavior within a cultural context” (Information for Providers and Practitioners). Fresenius medical care addresses the idea of cultural competence through their standards of Ultra Care on a broad level. There are no policies or guidelines specifically created to address the needs of cultural competency. However, Ultra Care is a guideline established by the company for the workers to provide the best quality care. According to "Fresenius Medical Care" (2006-2013), Fresenius demonstrate Ultra Care “. . . through innovative programs, the latest technology, continuous quality improvement and a focus on superior customer service. Ultra Care is delivered by highly trained staff and demonstrated through dedication, leadership, and compassion by every team member, every day” (Patient Care: Ultra Care). The concept of Ultra Care is taught during orientation, and there are several steps that are required to become certified. "Fresenius Medical Care" (2006-2013) states these steps include: “superior customer service, patient-centered care, and clinical leadership, team approach to care, continuous quality improvement, and innovative technology” (Patient Care: Ultra Care). The employees of the clinic strive to provide the best quality care possible in ordinance with Ultra Care standards. In order to improve care quality and provide superior customer service and patient-centered care, we respect the unique needs of each patient. Renal failure affects people of all backgrounds, and it is important to be aware of the cultural differences from one family to the next.
Populations Served
Fresenius medical care is a dialysis company that serves patients worldwide. They have several locations within the St Louis Missouri area. My personal clinic is located within St. Louis city in a neighborhood called The Hill. According to "Hill 2000 A Neighborhood Association", “once called Fairmount Heights, the highest point in the City, The Hill had German and Irish immigrants working the clay mines. Italians seeking a new future in America came to the area to work those same clay mines and made The Hill their neighborhood in the 1890’s” (History). This offers a rich cultural for this area that remains heavily saturated with German, Irish, and especially Italian descent. With about a third of our patients coming from this area, our clinic has many duel language speaking Italians from very large families. The clinic is within the limits of the city but is right on the boarder of county as well giving the remaining patients a mix of African American and Caucasian. Despite being near the area of the city with a large population of Hispanic and Bosnians, there are currently no patients with those backgrounds.
The patients come from a very diverse background. Some are younger, in their late 30's and early 40's and have young children. The majority of our patients are a bit older, in their late 50's to early 60's, and can care for themselves or have children that can offer assistance if needed. Then there are a few patient's that are in their early 90's and receive help from grandchildren and children. Some patients are severely disabled and live in nursing homes; others live with children, and a small portion live by themselves. All but one patient is no longer employed. Our younger patients qualify as disabled and are unable to work. Many of our older patients retired prior to getting sick. The age difference among our patients offers a unique angle from generational differences within the same culture. We care for the patient with the help and involvement of family. Understanding how culture affects family dynamics is essential for successful patient care.
Culture also makes a big difference in diet preferences. Dialysis patients have unique and often very restrictive diets, especially if co-morbidities are involved such as diabetes or heart disease. Being aware of culture dietary preferences and restrictions is important as education on diet may go beyond the basic list of good and bad foods. Food substitutions may be difficult if you are not familiar with the different diets just as determining if a food is compatible or not with renal failure. Staff, especially dieticians, must be aware of this difference to provide proper education to patients and their supportive family.
Guidelines of Cultural Competency Standards
To understand if cultural competency standards are being met or not, medical facilities must understand the guidelines and how they unequally fit different areas of health care. It is not only the job of the individual working for a company to understand their personal views on cultural diversity but also the duty of the institution to provide proper education for their staff. According to "Curricula Enhancement Module Series" (n.d.), Cultural competence requires that organizations: have a defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally. Have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural contexts of communities they serve. Incorporate the above in all aspects of policy-making, administration, practice and service delivery, systematically involve consumers, families and communities” Definitions of Cultural Competence). These rules of standards will be used to identify how Fresenius Medical care compare’s to other organizations in the medical field.
Meeting Standards
Fresenius has areas in which it meets culturally competent care. They acknowledge the diversity of cultures with its Ultra Care approach to individualized care. Through individualize patient care, we can cultivate things that are unique to each culture. We can sit down with patients and have them address any unique concerns that could interfere with their cultural beliefs and wishes. Workers of Fresenius are expected to respect the diversity between patients and cultures. Some culture beliefs may create extra work or inhibit the usually way of doing things; however, attitudes need to remain positive, and patients are to be treated with respect. We are taught to value diversity. This can be demonstrated through the unique care plans that are developed by all disciplines. Diets, social service request, as well as nursing request, are tailored to each patient. Despite the difference between patients and cultures, each patient is able to receive quality care that is designed just for them. Care plan meetings are a way to manage the differences. It gives staff time to address any concerns for the patient, but also allows the patient to express any concerns with issues that have not be addressed which could include cultural issues. Any area that staff continues to struggle with or is unable to address immediately due to lack of knowledge can be researched with the internet and all other available resources the company offers through their internet portal. Fresenius does a great job at including many of the above steps into its delivery of care as well as their ability to involve family and community. Family is an essential part to the care of patients in dialysis. No matter how able each patient is, there is some extent of help needed. We encourage family involvement from simple tasks such as transportation assistance to grocery and meal management. Patients with active family involvement tend to do better and have issues addressed much sooner. Family can also help address any unique cultural request and restrictions.
Delivery of Care for Meeting Standards
When standards of cultural competency are met, patients feel a sense of comfort and care. In dialysis, patients come three days a week. They see the same staff members day after day and a sense of family develops. When patients feel that they are being respected on all levels, they feel they are receiving quality care. Our goal as nurses and health care workers is to create quality care for our patients. We create a positive environment that patients want to come back to and patients trust our judgment and advice and are more willing to be complient when they are receiving quality care. Respecting the unique culture difference and creating a positive environment helps us to keep our patients not only happy but as healthy as possible.
Not Meeting Standards and Delivery of Care
A major department that lacks in cultural competency with Fresenius medical care is policies. There are policies for everything from machine care, cannulations, employee conduct, and breaks, but there is not an emphasis on cultural respect. As a worldwide organization, this topic would seem to be very important as staff, and patients come from all unique cultures. Without policies to express the way the company would like employees to conduct themselves in situations with diverse cultures, it doesn't encourage self-assessment or education on diversity of cultures. This could easily lead to problems with discrimination among staff and towards patients. If patients do not feel that they are being respected due to cultural beliefs, there is nothing keeping them at the company. Patients expect health care workers to be open to diversity and educated and profession on how to handle differences. Without compassion, patients who are forced to come so frequently will not be happy with their care and will not feel that they matter to the staff or company. Patients who are unhappy will not be compliant with treatments and that can create a vicious cycle that can lead to increased illness or complications from dialysis. It shows how quality of care can truly be a difference of life and death for patients.
Solutions
The above guidelines for organizations to follow to create cultural competency are a great start for any organization. Policies are the base of the organization. It is the first thing that new employees learn and study and are often tested. Writing policies to not only address the importance of culture diversity and the need to respect them can help staff become more aware of their own beliefs. Educators can develop or use existing assessments to help employees identify their beliefs and where they stand. This can help identify areas that need to be addressed with further education. Often times discrimination against different cultures can be caused by lack of understanding. Educators can identify primary cultures in the community and help educate staff on issues that may arise.
Another area that facilities can focus on is disciplining for cultural discrimination. Just as sexual or racial discrimination is punished, so should cultural discrimination. That is not limited to patients but also staff as well. Not tolerating it can help people to be more respectful and may even help them learn more about other cultures.
Understanding all cultures and their unique standards is impossible. There are many similar cultures with slight differences between them but we must try our best to educate. Implementing a cultural assessment tool would help to identify unique characteristics and request from patients from the start. Having a social worker update this assessment periodically will help the company and staff stay up to date on changes and help identify areas needing improvement. Assessment tools can be a great resource for staff and are easy for all members of the staff to read and understand.
Conclusion
Cultural diversity is a growing topic in health care. Our country is a melting pot and patients and staff are demanding unique, individualized care. Excluding culture diversity does not provide that. Fresenius medical care provides quality care and addresses some points of cultural competency in the delivery of the individualized care. However, a major area that could use improvement is with written policies. Written policies would ensure that staff are aware of the importance of respecting all cultures and their individual requests, help instruct staff on punishment for cultural disrespect, and also help identify assessments that can help identify cultural needs. Improving cultural competency can directly affect patients in dialysis and help improve quality care.

References

Curricula Enhancement Module Series. (n.d.). Retrieved from http://www.nccccurricula.info/ culturalcompetence.html

Fresenius Medical Care. (2006-2013). Retrieved from http://www.fmcna.com/ fmcna/

PatientCare/patient-care.html.

Hill 2000 A Neighborhood Association. (2014). Retrieved from http://www.hill2000.org/history/

National Center for Cultural Competence. (n.d.). Retrieved from http://nccc.georgetown.edu/

information/providers.html.