Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
Chapter 10: Diversity and Disparities in Healthcare
LEARNING OUTCOMES AND SUGGESTED CLASSROOM AND CLINICAL
ACTIVITIES
LEARNING OUTCOME 1
Discuss the problem of health disparities.
Suggestions and Strategies for Classroom Experience
• Review current data from the National Disparities Health Care Report.
Suggestions and Strategies for Clinical Experience
• Ask students to review current data from the National Disparities Health Care
LEARNING OUTCOME 2
Analyze the status of patient diversity in health care.
Suggestions and Strategies for Classroom Experience
• Discuss the implications of diversity. Ask students for examples from their
clinical experience.
Suggestions and Strategies for Clinical Experience
LEARNING OUTCOME 3
Apply strategies to improve health literacy and the role of the nurse manager.
Suggestions and Strategies for Classroom Experience
• Show the students examples of actual medical information documents and
consents. Discuss the documents in small teams. Are they easy to understand?
Why or why not?
Suggestions and Strategies for Clinical Experience
• Ask students to be aware of written information given to their patients and to ask
LEARNING OUTCOME 4
Examine the implications of a diverse patient population for the staff and organization.
Suggestions and Strategies for Classroom Experience
• Provide examples of when a multicultural patient population has had an impact on
a HCO and discuss.
Suggestions and Strategies for Clinical Experience
LEARNING OUTCOME 5
Explain how organizational culture impacts the healthcare organization, patient care, and
professional competency.
Suggestions and Strategies for Classroom Experience
• Explain how a dissonant culture can affect an organization and patient care.
• Ask students if they have ever worked in or been involved in an organization that
had a dissonant culture. What was it like?
Suggestions and Strategies for Clinical Experience
• Through observation can students describe the culture of the organization? Is it a
dissonant culture and why or why not?
• If students are assigned patients from different cultures, they should apply
LEARNING OUTCOME 6
Examine workplace diversity in healthcare organizations.
Suggestions and Strategies for Classroom Experience
• Ask students to search sources on the Internet to find current information about
healthcare workforce diversity. Discuss the data found and implications.
Suggestions and Strategies for Clinical Experience
• In the clinical settings, have students noticed workplace diversity? How would
they describe it? Did they observe any situations that might have caused problems
related to employee diversity, and if so, what did they observe? Discuss the
LEARNING OUTCOME 7
Apply strategies that may be used to improve an organization’s culture.
Suggestions and Strategies for Classroom Experience
• Have students develop specific ideas for how health organizations can employ
some of the strategies listed above to improve organizational culture.
Suggestions and Strategies for Clinical Experience
• In post-conference discuss any strategies the HCO is using to improve its culture.
KEY CHAPTER CONCEPTS
1. The IOM states that “a culturally diverse population poses challenges that go beyond
simple language competency and include the need to understand the effects of lifestyle
2. Nurses are caring for patients who come from a variety of cultural backgrounds; they
3. The process of developing cultural competence is a means of responding effectively to
4. There will be new demands to provide more culturally appropriate health care. Nursing
leaders must understand the implications of staff members’ personal cultural background,
5. The definition of health disparities assumes not only a difference in health but a
6. These differences are often attributed to conscious or unconscious bias, provider bias,
7. The disparity issues that are found are barriers to effective communication; such as the
9. HHS describes its goals related to diversity and disparities in its HHS Action Plan (see
10. Elements that need to be understood are diverse patient population, demographics,
11. The IOM reports on disparities in health care in its report Unequal Treatment. The
12. Migrant health care is also a critical a complex issue in many area. One barrier is
13. Health literacy is “the ability to read, understand, and act on healthcare information”
(IOM, 2004, p. 52).
14. Healthcare organizations (including nurse managers) need to carefully review forms
15. Nurses and nurse managers must recognize the importance of culture to each patient
and family. Then it is important to incorporate cultural competency into healthcare
17. Nurses and healthcare organizations are caring for patients who come from a variety
18. Organizations must develop cultural competence through staff education in order to
effectively treat a diverse population.
19. A dissonant culture is one that is dysfunctional or ineffective. An organization with a
dissonant culture will interfere with new staff becoming part of the organization, affect
20. If an organization ignores its culture, this can lead to major problems. To prevent this,
leaders must recognize the importance of culture to the organization and work toward
21. Healthcare staff affects an organization’s culture and are also affected by the culture.
22. Staff members can be just as culturally diverse as their patient population. The
multicultural work environment means that nurse leaders must consider its impact on
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24. Four generations have an impact on diversity in the nursing profession (see Box 10-
25. The AACN recommends more education content focused on diversity and culture,
and provides resources to nurse educators.
26. Factors that make a difference in organization culture are: trust, match of staff values
27. The IOM recommends the following to improve organization culture and problems
with disparities: Care based on continuous healing relationships, customization based on
28. Assessment of organizational culture identifies the acceptable attitudes and values
within the organization, which are defined by both formal and informal aspects. The
29. A healing organization is concerned with the effectiveness of patient-centered care. A
healing environment takes the following into consideration: level of privacy, air quality,
30. Dimensions of a healing organization and of care valued by patients are: respect for
patients’ values, preferences, and expressed needs; coordination and integration of care;
31. A healing organization should include/offer some of the following: have access to a
continuous sequence of environments that support one’s dignity and the dignity of others;
32. There are many strategies that might be used to improve an organization’s culture.
Some of these strategies focus on improving the physical environment to make it more
APPLYING LEADERSHIP AND MANAGEMENT
BSN and Master’s Essentials: Application to Content
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Chapter identifies which Essentials apply to the chapter content. This information is
primarily for the instructor, but students should understand the how these nursing
education standards apply to the chapter content and the nursing profession.
My Hospital Unit: An Evolving Case Experience
See the overview of the My Hospital Unit feature found in the front of the textbook.
Refer students to the specific My Hospital Unit scenario found in the chapter.
This chapter feature can be used in a variety of ways within a course. Students can be
Applying AONE Competencies
The AONE competencies for nurse leaders are found in Appendix A. Ask students to
identify which of the AONE competencies apply to the content in the chapter.
Engaging in the Content: Critical Thinking and Clinical Reasoning and Judgment
See Discussion Questions and Application Exercises at the end of the chapter. Online
options are noted.
Chapter Features: Case Study and Applying Evidence-Based Practice
The Chapter Features: Case Study and Applying Evidence-Based Practice features may
ADDITIONAL CASE
This case is not found in the textbook. It may be used for individual or team assignments:
written assignment and classroom or online team discussions. It may also be used as an
essay question for exams.
Case:
Staff from the county public health department is meeting today for their annual staff
retreat. The all day meeting gives the staff the opportunity to come together once a year
to share successes, and discuss problems—and just have time to talk with one another.
The administrator for the department asks one of the data management staff to present
data about the changing demographics in the county. He notes that there is an increase in
diversity, with growth in Hispanics. This is attributed to the use of migrant workers in the
agricultural areas in the county. In addition, one factory has started hiring a more diverse
work staff. The number of elderly in the county is also increasing. One elementary school
has closed. Drugs and alcohol use is on the upswing in all segments of the community,
with an increasing number of DUIs. The Affordable Care Act has provided other health
insurance options for many who could not afford insurance and yet did not qualify for
Medicaid, and this has increased clinic payments. After the data are presented, the
administrator opens the meeting up for discussion by asking the following questions.
Whiteboards are used to document the responses for later discussion and development.
Questions:
1. What are the critical factors included in this data report?
2. Are more data needed, and if so what data?
3. What are the potential problems that might be identified?
4. What national and state reports might be reviewed to benchmark (compare data)?
5. How might Healthy People and Healthy Communities be applied by the staff?