Is the Front Line Prepared for the Changing Faces of Patients? Predictors of Cross-Cultural Preparedness Among Clinical Nurses and Resident Physicians in Lausanne, Switzerland.
PHENOMENON: Assuring quality medical care for all persons requires that healthcare providers understand how sociocultural factors affect a patient's health beliefs/behaviors. Switzerland's changing demographics highlight the importance of provider cross-cultural preparedness for all patients-especially those at risk for social/health precarity. We evaluated healthcare provider cross-cultural preparedness for commonly encountered vulnerable patient profiles.


METHODS
A survey on cross-cultural care was mailed to Lausanne University hospital's "front-line healthcare providers": clinical nurses and resident physicians at our institution. Preparedness items asked "How prepared do you feel to care for … ?" (referring to example patient profiles) on an ascending 5-point Likert scale. We examined proportions of "4 - well/5 - very well prepared" and the mean composite score for preparedness. We used linear regression to examine the adjusted effect of demographics, work context, cultural-competence training, and cross-cultural care problem awareness, on preparedness.


RESULTS
Of 885 questionnaires, 368 (41.2%) were returned: 124 (33.6%) physicians and 244 (66.4%) nurses. Mean preparedness composite was 3.30 (SD = 0.70), with the lowest proportion of healthcare providers feeling prepared for patients "whose religious beliefs affect treatment" (22%). After adjustment, working in a sensitized department (β = 0.21, p = .01), training on the history/culture of a specific group (β = 0.25, p = .03), and awareness regarding (a) a lack of practical experience caring for diverse populations (β = 0.25, p = .004) and (b) inadequate cross-cultural training (β = 0.18, p = .04) were associated with higher preparedness. Speaking French as a dominant language and physician role (vs. nurse) were negatively associated with preparedness (β = -0.26, p = .01; β = -0.22, p = .01). INSIGHTS: The state of cross-cultural care preparedness among Lausanne's front-line healthcare providers leaves room for improvement. Our study points toward institutional strategies to improve preparedness: notably, making sure departments are sensitized to cross-cultural care resources and increasing provider diversity to reflect the changing Swiss demographic.
a Department of Ambulatory Care and Community Medicine , Lausanne University Hospital , Lausanne , Switzerland.
Alejandra
A
Casillas
b Department of Community Medicine and Public Health , Lausanne University Hospital , Lausanne , Switzerland.
Sophie
S
Paroz
c Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School , Boston , Massachusetts , USA.
Alexander R
AR
Green
d Department of Primary Care, Community Medicine, and Emergencies , Geneva University Hospitals , Geneva , Switzerland.
Hans
H
Wolff
e Department of Psychiatry , Lausanne University Hospital , Lausanne , Switzerland.
Orest
O
Weber
e Department of Psychiatry , Lausanne University Hospital , Lausanne , Switzerland.
Florence
F
Faucherre
a Department of Ambulatory Care and Community Medicine , Lausanne University Hospital , Lausanne , Switzerland.
Françoise
F
Ninane
a Department of Ambulatory Care and Community Medicine , Lausanne University Hospital , Lausanne , Switzerland.
Patrick
P
Bodenmann
D065246:Culturally Competent Care; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital; D010817:Physician-Patient Relations; D011361:Professional Competence; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires; D013557:Switzerland
cross-cultural preparedness; cultural competency; health disparities