Approximately one-third of those who turned 65 in 2010 will enter a nursing home for short or long-term stay in their lifetime. Although the older adult population is growing more diverse, the current population of nursing home residents is 86% White and 62% female. An increasingly diverse staff is caring for the comparatively homogeneous long term care (LTC) resident population. Sixteen percent of nurses working in LTC are foreign born and may be learning how to collaborate and communicate in a new system, while caring for both majority and minority patients. Nurses who are native to the U.S. healthcare system find themselves challenged to work effectively with foreign-born colleagues and a diversifying resident population. Regardless of origin, nurses are charged with managing direct care workers, 50% of whom are racial or ethnic minorities. Specifically, 30% are African American, 15% are Latino, and 23% are foreign born. Direct care workers are likely to differ from the nurses who supervise them and the residents for whom they care on several important dimensions, including country of origin, race, ethnicity, primary language, education, and earning power. Cultural preferences regarding care can be obstacles to successful interactions if the caregiver does not understand and address those preferences. Moreover, cultural preferences can easily shade into prejudice against workers from a different cultural background, which can also impede the effectiveness of care. This application proposes to develop a web-based Cultural and Communication Skills course for nurses and direct care workers in LTC. Cultural competence requires taking an interest in what people think and say and what they have experienced, that is, in"the story of the person."The objectives of the proposed course are to improve communication skills for engaging cultural difference in care giving and in building effective working relationships among staff at every level. The course content will be presented via interactive video case studies in which learners are asked to take the perspectives of residents, direct care workers, and nurses. Throughout the course, communication and problem solving skills will be taught and practiced via audio recordings in response to video simulated residents or coworkers. Learning is intended to be cumulative throughout the course, which ultimately will consist of eight free standing but integrated modules on topics relevant across the full continuum of LTC. In Phase I, two 30-minute modules with interactive case studies will be developed, Pathways to Long Term Care and Team Communication Basics, along with a knowledge test and a skills scale specific to the course content. The modules and new measures will be subjected to usability and pilot testing with 30 target users to establish proof of concept.
Public Health Relevance: Approximately 1.6 million people 65 or older live in more than 16,500 Medicare and Medicaid skilled nursing facilities where some 3 million direct care workers provide 70 percent to 80 percent of the paid, hands-on, long-term care. Fifty percent of the direct care workforce is racially/ethnically diverse or foreign born, while the nurses who supervise them are typically White. The proposed web-based course, Culture &Communication Skills, will teach nurses and direct care workers communication skills for engaging cultural difference in care giving and in building effective working relationships among staff at every level. The proposed course is relevant to the growing and complex field of long-term care.
