Roles of Perceived Provider Cultural Sensitivity and Health Care Justice in African American/Black Patients’ Satisfaction with Provider

Belief in a just world and fair behavior among clinical nurses: a moderated mediation model of empathy and observer justice sensitivity

BACKGROUND

Exploration of the relationship between nursing staffs' justice in belief world and fair behavior is important to promote equity and access to health services in health organizations, as well as to enhance the quality of care. In order to further dissect the influencing factors of fair behavior among clinical nurses, the current study aims to investigate how belief in a just world influences the fair behavior among nurses. Based on the belief in a just world theory, the empathy-altruism theory and the protective-protective model, the current study aimed to provide a deeper understanding of the effect of belief in a just world on fair behavior by investigating the mediating role of empathy and the moderating role of observer justice sensitivity.

METHOD

This was a cross-sectional study. 571 registered clinical nurses were included from five hospitals in Fuzhou through a convenience sampling method. Measurements included Chinese translations of belief in a just world scale, empathy scale, observer justice sensitivity scale, fair behavior scale. SPSS 22.0 was used to describe descriptive statistics and the variables' Pearson correlation coefficient. SPSS PROCESS macro Model 4 and model 14 were used to examine the mediation and the moderation between the relationship of belief in a just world and fairness behavior.

RESULT

The results shower that fairness behavior was positively correlated with one's belief in a just world (r = 0.26, p < 0.01); (2)empathy mediated the relationship between belief in a just world and fair behavior. The mediation model explains 20.83%; (3) Observer justice sensitivity moderated the relationship between empathy and fair behavior.

CONCLUSIONS

Belief in a just world, empathy, and observer justice sensitivity were motivations for nurses' fair behavior. Nursing administrators should focus on cultivating nurses' belief in a just world, their empathy abilities, and positive qualities of justice sensitivity to enhance fair behavior in a healthcare setting.

Race and prevalence of percutaneous endoscopic gastrostomy tubes in patients with advanced dementia

OBJECTIVE

Millions of Americans may face hard decisions when it comes to providing nutrition for their loved ones with advanced dementia. This study aimed to ascertain whether there is a difference in feeding tube placement between White and Black patients with advanced dementia and whether this potential difference varied by patient's other demographic and clinical characteristics.

METHOD

This is a retrospective, observational study conducted at Novant Health, a 15-hospital system in the southeastern United States. Data were obtained from Epic systems and included all hospital admissions with a diagnosis of advanced dementia, a total of 21,939, between July 1, 2015, and December 31, 2018. Descriptive statistics and logistics analyses were conducted to assess the relationship between receiving percutaneous endoscopic gastrostomy (PEG) and race, controlling for demographic and clinical characteristics.

RESULTS

Among patients admitted with advanced dementia, the multivariable logistic regression, controlled for age, gender, LOS, palliative care, and vascular etiology showed that Blacks had higher odds of having PEG tubes inserted than White patients (OR 1.97; CI 1.51-2.55; P < 0.001). Patients with longer stays had higher odds of PEG tube insertion. Females had lower odds of PEG tube insertion than males. There was no statistical significance in PEG insertion based on age, etiology, and palliative care consult.

SIGNIFICANCE OF RESULTS

The reasons for the observed higher odds of receiving PEG tubes among Black patients than White patients are likely multifactorial and embedded in a different approach to end-of-life care conversations by providers and caregivers of Black and White patients. Providers may need to be more aware of potential unconscious biases when talking to caregivers, especially in race-discordant relationships, have courageous conversations with caregivers, and be more aware of the importance of keeping in mind families' and caregivers' culture, including spirituality, when making end-of-life decisions.

Factors influencing patient loyalty to outpatient medical services: an empirical analysis of the UAE's government healthcare system

Purpose

The aim of this research is to uncover issues that inhibit patients' satisfaction and loyalty and identify factors that could enhance customer retention by government hospitals in the United Arab Emirates (UAE). The mediating impact of outpatient satisfaction on service quality, word of mouth (WoM), hospital image, outpatient–physician relationship and outpatient loyalty were tested.

Design/methodology/approach

The sample data used to test the hypotheses were drawn from a pool of patients served by a government healthcare agency in Abu Dhabi. Questionnaires were provided to 418 participants using methods such as short message service, e-mail and face-to-face delivery. The data were analyzed using SmartPLS 3.3.2 software.

Findings

The results indicate that service quality, WoM and outpatient–physician relationship positively impact outpatient satisfaction and indirectly effect outpatient loyalty; that hospital image positively impacts outpatient satisfaction and loyalty and has a partially mediating effect on loyalty; that waiting time satisfaction has no effect on outpatient satisfaction and no moderating effect on the outpatient satisfaction–loyalty relationship and that switching cost has a positive effect on loyalty but no moderating effect on the outpatient satisfaction–loyalty relationship.

Research limitations/implications

The first limitation of this study concerns the fact that only patients who had previously been served by these hospitals' outpatient units were included. Furthermore, the research was not able to obtain extensive findings related to the various factors that negatively impacted patient satisfaction and loyalty among all of the departments of government hospitals, such as inpatient care and emergency care.

Practical implications

Centered on the findings from this research, increasing switching costs would prevent patients from switching to other healthcare providers. Therefore, it has the potential to create a false loyalty or a hostage customer (Jones and Sasser, 1995). Additionally, making patients feel connected to their treatment plan and engaged in their care by developing a tool to maintain their enthusiasm about their health is important. It is therefore recommended that government hospital care providers and management consider providing online tools that patients can use to self-manage their care.

Social implications

The results regarding patients' satisfaction level suggest several areas for improvement. The first pertains to waiting area entertainment and comfort because patients indicated that there is not enough entertainment or ways to pass the time when waiting for services. In addition to enhancing the entertainment and comfort of waiting areas, government hospital staff should maintain contact with patients who are waiting to ensure that they are aware of the time they will spend. Another area for improvement is the parking lot. During summer, patients prefer to walk less in the sun, which causes them to seek parking closer to the door. Government hospital management should consider different methods for transporting patients closer to the door, such as golf carts or valet services.

Originality/value

This is the first study to investigate the mediating impact of outpatients' satisfaction between its antecedents and loyalty in the UAE. These results provide an improved understanding of the factors influencing patient choices and establish more accurate methods for increasing patient loyalty to retain more patients.

Communication and Control: Hearing the Voices of Low-Income African American Adults to Improve Relationships with Healthcare Providers

Patient-provider relationships can either impede or encourage patient utilization of healthcare services and adherence to treatment. Given the significant health disparities found among low-income African Americans, it is imperative to understand this population's experiences with healthcare providers and how to improve their patient-provider relationships in order to increase successful treatment outcomes. Relationship management is a well-tested theory that examines factors that improve outcomes between organizations and their publics. This exploratory study uses relationship management theory to understand how African Americans who are medically underserved perceive the quality of their relationships with healthcare providers. Focus groups were held with low-income African American adults. Findings reveal that communication is key to improving trust, but other characteristics needed for a quality relationship were lacking, particularly perceived commitment, which impedes better healthcare. The low-income, medically underserved context influenced participant perceptions of factors such as commitment, but participants also expressed efficacy in feeling in control of healthcare situations, which may help them maintain quality relationships. This study offers theoretical elaboration as well as practical suggestions for how providers may wish to address an important population of patients through communication.

Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics, and Metabolomics (SEMOARS + GEM): an Explanatory Model for Breast Cancer Treatment Disparity

Even after controlling for stage, comorbidity, age, and insurance status, black women with breast cancer (BC) in the USA have the lowest 5-year survival as compared with all other races for stage-matched disease. One potential cause of this survival difference is the disparity in cancer treatment, evident in many population clinical trials. Specifically, during BC chemotherapy, black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with white women. Symptom incidence, cancer-related distress, and ineffective communication, including the disparity in patient-centeredness of care surrounding patient symptom reporting and clinician assessment, are important factors contributing to racial disparity in dose reduction and early therapy termination. We present an evidence-based overview and an explanatory model for racial disparity in the symptom experience during BC chemotherapy that may lead to a reduction in dose intensity and a subsequent disparity in outcomes. This explanatory model, the Symptom Experience, Management, Outcomes and Adherence according to Race and Social determinants + Genomics Epigenomics and Metabolomics (SEMOARS + GEM), considers essential factors such as social determinants of health, clinician communication, symptoms and symptom management, genomics, epigenomics, and pharmacologic metabolism as contributory factors.

Scoping Review of Economical, Efficient, and Effective Cultural Competency Measures

Identifying practical and effective tools to evaluate the efficacy of cultural competency (cc) training in medicine continues to be a challenge. Multiple measures of various lengths and stages of psychometric testing exist, but none have emerged as a "gold standard." This review attempts to identify cc measures with potential to economically, efficiently, and effectively provide insight regarding the value of cc training efforts to make it easier for wider audience utilization. A scoping review of 11 online reference databases/search engines initially yielded 9,626 items mentioning cc measures. After the initial review, focus was placed on measures that assessed cultural competence of medical students, residents, and/or attending physicians. Six measures were identified and reviewed: (1) Cross-Cultural Care Survey, (2) Cultural Competence Health Practitioner Assessment, (3) Cultural Humility Scale, (4) Health Beliefs Attitudes Survey, (5) Tool for Assessing Cultural Competency Training, and (6) the Tucker-Culturally Sensitive Health-Care Provider Inventory. Relevant literature documenting use and current psychometric assessments for each measure were noted. Each measure was found to be of value for its particular purpose but needs more strenuous reliability and validity testing. A commitment to include psychometric assessments should be an expected part of studies utilizing these measures.

Counseling Psychologists and Behavioral Health: Promoting Mental and Physical Health Outcomes

On the occasion of the 50th Anniversary of The Counseling Psychologist, we reflect on the many contributions that counseling psychologists have made and are poised to make in the areas of behavioral health and behavioral health care. We note that psychologists’ engagement in health promotion and prevention of behavioral, mental, and emotional disorders is consistent with counseling psychology values. We provide a concise review of theories that are widely applied in behavioral health contexts and discuss ways in which counseling psychologists may apply these theories to help ameliorate health disparities, empower communities to take control of their own health, and promote social justice. In addition, we highlight the need to create interdisciplinary partnerships to conduct culturally sensitive research on the bi-directional relationship between mental health and physical health. The article ends with wide-ranging implications and recommendations for theory development, research, training, practice, and advocacy.

Using Transcultural Nursing Education to Increase Cultural Sensitivity and Cultural Assessment Documentation by Staff in an In-Home Chronic Disease Self-Management Program

BACKGROUND

Despite literature indicating that culturally sensitive care promotes a positive patient environment and may help improve outcomes, limited data exist on the documentation of patients' cultural concerns in electronic medical records (EMR).

OBJECTIVE

The project's objective was to use an educational intervention to increase clinic staff's cultural sensitivity and cultural assessment documentation.

METHODS

Researchers conducted this 3-month project at a Midwestern clinic's in-home, self-care chronic disease management program. The voluntary sample of clinical staff (n = 8) received an educational intervention on transcultural nursing practices. Researchers administered the Transcultural Self-Efficacy Tool for the Multidisciplinary Healthcare Provider (TSET-MHP) to participants before and after the intervention. A pre- and postintervention EMR audit was completed on 128 charts to evaluate cultural assessment documentation.

RESULTS

TSET-MHP cognitive and practical subscales scores increased postintervention. Affective subscales scores decreased slightly. Electronic cultural assessment documentation increased by 10%. An assessment questionnaire showed an increase in participants' cultural self-awareness and comfort with cultural assessment.

CONCLUSIONS

An educational intervention demonstrated an increase in providers' cultural awareness and cultural assessment documentation.

IMPLICATIONS FOR NURSING

Transcultural nursing education may help increase providers' perceived cultural self-efficacy, which may improve cultural assessments and culturally competent care.

The Influence of Self-Relevance and Cultural Values on Moral Orientation

Moral orientation refers to moral values that have a consistent guiding orientation toward an individual's moral cognition and behavior. Gilligan (1982) proposed that individuals have two moral orientations, namely “justice” and “care.” In the current study, we investigated the influence of self-relevance and cultural values on justice and care by using Single Attribute Implicit Association Test (SA-IAT). In Experiments 1 and 2, we adopted cultural icon prime paradigm to examine the effects of different self-referential stimuli (self, friend, and stranger) on implicit moral justice and care orientation under two cultural value conditions: traditionality, modernity, and neutral cultural values. Participants exhibited more difference toward different self-referential stimuli in the traditionality condition than in the modernity condition; the priming of traditional culture aggravated the differential order, whereas the priming of modernity weakened the differential order regarding implicitly just moral orientation. In the implicit care orientation, participants in the modern culture group exhibited the least difference to different self-referential stimuli compared with the other two groups, and the traditional group and the control group did not differ significantly. These findings indicate that psychological modernity weakens the degree of self-related effect in implicit justice and care orientation, whereas traditional culture aggravates the differential order in justice orientation. The current studies provide empirical support for theories relating moral orientation, also informing the literature on the role of self-relevance information and cultural values in moral decision making.

Cultural sensitivity in paediatric nursing care: a concept analysis using the Hybrid method

BACKGROUND

Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing.

AIMS

The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran.

METHODS

The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed.

RESULTS

In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing.

CONCLUSION

With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for the development of a theoretical model.

Are primary healthcare services culturally appropriate for Aboriginal people? Findings from a remote community

This study explored the views of key stakeholders on cultural appropriateness of primary health care (PHC) services for Aboriginal people. A total of 78 participants, including healthcare providers, administrative team members (n=24, ~30% of study sample) and Aboriginal community members (n=54, ~70% of study sample) living in remote North West Queensland participated in the study. Outcome measures were assessed by administering survey questionnaires comprising qualitative questions and various subscales (e.g. provider behaviours and attitudes, communication, physical environment and facilities, and support from administrative staff). Descriptive statistics were used to present quantitative findings, whereas inductive thematic analysis was used for qualitative data. In contrast to the views of PHC providers, a significant number of Aboriginal people did not perceive that they were receiving culturally appropriate services. Although PHC providers acknowledged cultural awareness training for familiarising themselves with Aboriginal culture, they found the training to be general, superficial and lacking prospective evaluation. PHC providers should understand that culturally inappropriate clinical encounters generate mistrust and dissatisfaction. Therefore, a broad approach involving culturally respectful association between PHC providers, Aboriginal consumers and administrative staff is required to bring sustainable changes at the practice level to improve the health of Aboriginal people.