August 7, 2000

When Jeanette Ives Erickson, RN, MS, senior vice president for Patient Care Services and chief nurse, took her position in October 1996, she set out to learn as much as she could about the professional needs of clinicians in Patient Care Services (PCS).

It became clear to her that professional development was a high priority. This need for further education sparked the creation of the Center for Clinical and Professional Development for PCS. The center focuses on orientation, training and continuing education, research and evaluation, health policy and professional development for all staff in PCS.

Under the direction of Marianne Ditomassi, RN, MSN, MBA, and staffed by a team of professional development coordinators, clinical education and training coordinators, the center offers a vast range of education opportunities and programs for clinicians throughout PCS. The new graduate nursing program and culturally competent care training are two examples of the programming created to help perpetuate the hospital's commitment to teaching health care professionals.

In 1998, Erickson developed a program to help new graduate nurses adapt to the MGH environment. More than 65 new graduate nurses have enrolled in the Mentor/ New Graduate Nurse Development Program, organized by Carol Comooso-Markus, RN, professional development coordinator for PCS. Every new nurse hired by the MGH with less than six months experience goes through the program.

The program's goals are to help educate nurses about how to develop therapeutic, caring relationships with patients and families; recognize diverse human values, cultures and spiritual needs; prioritize care for patients through clinical experience; and develop effective relationships with other caregivers. The six-month program combines mentoring and lecturing sessions, as well as journal writing and learning how to write a clinical narrative.

The first six weeks of the program are devoted to orienting nurses to the hospital. During these first weeks, the new graduate nurse will pick a mentor who may be a fellow nurse on the unit or someone else he or she looks up to and respects. Together, they attend lectures and care for patients.

Mary Ellin Smith, RN, professional development coordinator, believes that journal and clinical narrative writing are the most vital parts of the program, "The journal and the narrative are records of growth for the nurse," she says. "He or she can look back and say, 'Wow, I can't believe I used to think that' or 'I can't believe I went through that.' It shows how far the nurse has come."

Along with orienting new graduate nurses to the hospital, PCS also developed a program to teach staff about providing care that is culturally sensitive to patients. The MGH treats thousands of patients each year, and each one has individual cultural influences: religion, ethnicity, race, sexual orientation, socioeconomic status, language, gender, personality and style. They all, however, have something in common: They want quality care.

Over the past year, the center sent Brian French, RN, MS; Donna Jenkins, RN, MS, CS; Lin-Ti Chang, RN, BSN; Leanne Espindle, RN, MSN; Ruth Bryan, RN, MSN, CCRN; Beth Nagle, RN, MSN, CA, ANP; Taryn Pittman, RN, MSN; and Eileen DeGrann, RN, MBA, MPH; to attend the Cross Cultural Health Care Program in Seattle, to become certified to teach clinicians about culturally competent health care. The attendees of the Seattle program then came back to the MGH to apply what they had learned. The program helped teach the attendees how to provide and teach culturally competent care.

The MGH Culturally Competent Care Training Program is an eight-hour session designed to raise awareness about how caregivers can be more culturally sensitive to their patients. Examples of such care are how caregivers can incorporate cherished home remedies into the asthma treatment of a Mexican patient or how caregivers can work with an interpreter to explain to a child and family member what an EEG test is.

It is important for caregivers to understand the potential cultural barriers when caring for patients. For example, Imam Talal Eid, the Muslim chaplain at the MGH, worked with a clinical team to resolve a delicate matter involving a female Muslim patient who was uncomfortable receiving care from a male clinician. Issues like this arise every day at the MGH, and caregivers can improve the way they meet patient care needs by increasing their awareness of cultural issues and incorporating this information into the plan of care.

"The culturally competent care curriculum is important to broaden our understanding of what constitutes effective and meaningful health care," says Deborah Washington, RN, MSN, director of the PCS Diversity Program. "Historically, the understanding has been grounded in one perspective. As the meaning of health care has become more holistic, that understanding is maturing into something less narrow and unaccommodating. Culturally competent care, as an educational tool, has made patient care even more dynamic and focused on the individual."

From left, Melanie Andrade, RN, and patient care associate Ilia Lepores