Addressing Unequal Treatment: Leading Change through Groundbreaking Programs
To address the grave health consequences related to disparities in healthcare provision and outcomes, the Institute of Medicine’s (IOM) widely cited reports Unequal Treatment (2006) and Leading Change (2011) call for the transformation of the education of health professionals and the empowerment of nurses as front-line care providers. In 2011, health disparities continue to widen in numerous areas. Healthy People 2020 identifies the elimination of health disparities among diverse groups as a priority. In 2007, the American Association of Colleges of Nursing established core cultural competencies to be integrated into baccalaureate and graduate nursing education. In response, schools of nursing are revising curricula.
Teaching cultural competence requires a clear program vision and framework, evidence-based content, active on-going collaboration, and faculty expertise and skills at facilitating discussion of controversial topics. A groundbreaking model program, the "Spirit Seminars", at Samuel Merritt University’s School of Nursing (SMU SON), was developed and implemented by nursing faculty Miriam Eisenhardt and Marjorie Hammer in 2009 to systematically enhance students’ cultural responsiveness in caring for diverse populations.
The goal is that by graduation, SMU SON students will demonstrate increased awareness, knowledge and skills related to differences in patients’ values and needs, and contribute to the reduction of disparities in health outcomes. SMU’s SON also hired a director of Diversity, Aara Amidi-Nouri, PhD, RN, in 2009 to address recruitment and retention efforts and curriculum changes. These three faculty were invited for a return engagement to the June 2011 23th Annual National Conference for Race and Ethnicity in American Higher Education (NCORE) to lead a workshop that describes the birth and life of the Spirit Seminars and the tools necessary for its sustenance. This effective, low cost, easily replicable seminar series enhances student and faculty cultural awareness, knowledge, and skills, and serves as a model for meeting national mandates for cultural competence.
The Birth of the Spirit Seminars
The initial impetus to determine a vision for culturally responsive nursing education at SMU emerged from a small group of faculty in SMU’s Entry Level Masters of Nursing Science (ELMNS) program with the support of the program director, Teri Gwin, EdD(c). Journals and institutional reports nationally and internationally were examined. The search led to the carving of a unique path by Eisenhardt and Hammer that came to be named "The Spirit Seminars".
The Life of the Spirit Seminars
The Spirit Seminars expedite student development as culturally responsive care providers and change agents, beginning with students’ welcome letter to the university. The seminars provide self-reflection, group dialogue, and evidence-based knowledge and tools which serve as a foundation for the interweaving throughout the curriculum of shared case studies, including Lia, her family and providers from Anne Fadiman’s (1997) book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures. Fadiman insightfully examines the deleterious consequences that a Hmong family suffer as a result of lack of cultural responsiveness by care providers, illuminating health disparities and illustrating the multi-faceted issues that healthcare providers must grasp to provide optimal care.
The Spirit Seminars includes five workshops that punctuate the eighteen-month ELMSN curriculum. During orientation, students engage with peers and faculty, examining their own feelings, assumptions, biases, hopes, fears and dreams, initial encounters on the journey to become a professional nurse. A community of learning which encourages dialogue on challenging topics thus begins.
Each seminar, guided by the same faculty throughout the series, builds upon the previous one and students’ experiences, encouraging deeper levels of understanding. Assignments provide evidence-based tools and opportunities for individual self reflection relevant to cultural responsiveness; group discussion follows regarding assumptions, challenges, beliefs and vision related to addressing cultural challenges in healthcare provision and implications for health outcomes. Students are exposed to current thought leaders and documents, including the Institute of Medicine’s Unequal Treatment (2006) and Leading Change (2011); Arthur Kleinman’s (1978) cross-cultural assessment tool; and Berlin and Fowkes (1983) LEARN assessment guide.