Broadening cultural sensitivity at the end of life: an interprofessional education program incorporating critical reflection.
BACKGROUND/PROBLEM: End-of-life beliefs and practices are as varied as one's culture. Little is known about what interventions are effective in developing clinician's skills to deliver culturally sensitive end-of-life care.


OBJECTIVE
Using a pre-post design, this pilot study aimed to evaluate the impact of a 2-stage educational program on enhancing clinician's knowledge and comfort in addressing and honoring diverse end-of-life care beliefs, as well as developing higher levels of cultural competence.


METHODS
Twenty-four interprofessional team members practicing on a combined medical-surgical oncology unit attended an in-service session on the end-of-life care beliefs, practices, and preferences of the Latino, Russian, and Micronesian cultures and then participated in critical reflection sessions where culturally specific end-of-life care cases were discussed using a structured dialogue guide. Outcomes measured were cultural competence using the Intercultural Development Inventory, Frommelt Attitudes Toward Caring of the Dying, knowledge of cultural beliefs/traditions, and self-perceived comfort in providing culturally sensitive end-of-life care.


RESULTS
Collectively, the Intercultural Development Inventory showed that the team's perceived cultural competence was at the level of "acceptance" whereas team's developmental orientation was "minimization," meaning that the team overestimated its cultural competence. The t tests showed no significant differences between pre-post attitude and knowledge scores (P > .05). Despite these findings, staffs' perceived level of understanding of end-of-life care beliefs, preferences, and practices of the Latino, Russian, and Micronesian cultures, as well as comfort and effectiveness in providing culturally sensitive end-of-life care, were higher after the in-service and critical reflection sessions (P < .05).


CONCLUSIONS
This 2-stage educational program did not significantly advance the team along the intercultural development continuum, nor did it significantly change knowledge and attitudes, likely due to the small sample and that maturity in cultural competence, evolves over a longer period of time. Educational programs that incorporate critical reflection sessions that promote interprofessional dialogue and learning, however, are promising practices for advancing cultural competence that are worthy of more rigorous study.
Nursing Administration Department, Salem Hospital, Salem, Oregon, USA. Margo.halm@salemhealth.org
Margo A
MA
Halm
Rhonda
R
Evans
Amie
A
Wittenberg
Edward
E
Wilgus
D000328:Adult; D044466:Asian People; D001291:Attitude of Health Personnel; D054521:Cultural Competency / Q000193:education* / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D016746:Transcultural Nursing / Q000193:education*; D044465:White People