Cultural Competence training and Patient Care Associates: A Way to Improving Patient
Satisfaction Scores
Paule Joseph, BSN, RN-BC, CRRN, ASLNC-C
The Mount Sinai Hospital ● New York, New York
Cultural Competence has become an important topic. It is said that by the
year 2042 minorities will account for nearly half the population. Our
country is increasingly more culturally and linguistically diverse, and
disparities in health care access, health outcomes, and health status are
major issues (Swirsky, 2009).
The topic of cultural competence has become well-known issue for three
reasons: 1- the United States has become more diverse, 2-research has
shown that culturally appropriate provider-patient communication is
linked to patient satisfaction, adherence to medical instructions, and better
health outcomes and 3-the Institute of Medicine (IOM) reports stresses the
importance of patient-centered care and cultural competence in improving
quality and eliminating racial/ethnic health care disparities (Betancourt, et.
al, 2005).
Cultural Competence refers to the ability to provide health care
measures that are congruent with patient needs by: 1-Accepting and
respecting differences and 2- Not allowing one’s personal belief to have an
influence on those whose worldview is different from one’s own ( Ginger et
al, 2007).
The purpose of this project is to pilot an educational program for Patient
care Associates (PCAs) at The Mount Sinai Hospital with the aim of
improving patient care.
This project was part of collaboration between The Department of Nursing,
The Mount Sinai Hospital and The Lienhard School of Nursing, Pace
University. Graduate students had the opportunity to participate in the
Cultural Competence Class, in which I became interested in developing
this project. This project focused on:
• Assessment of demographic data for the population being served by
Mount Sinai
• Development of PICO question: Does providing patient care associates
(PCAs) with cultural competent training improve patient’s satisfaction
• The project assessed the needs of the patient care associate in learning
about culture.
• Assessed baseline knowledge and cultural experiences of PCAs
• Piloted a educational program on cultural competence for a group of newly
hired PCAs at the hospital as part of the hospital’s BEST orientation
• A literature review was conducted to identify the current research in the
influence of patient care associates training on culture and direct effect on
patient satisfaction scores.
Prior to the educational intervention, the following questions were asked to gain a general
understanding on their views of culture:
Where are you from?
What languages do you speak?
What cultural values do you have?
What holidays do you celebrate?
What do you do when you have cold or start feeling sick?, How do you see death and dying?
How does your culture view time?
What do you think you would need to know to work with people of different backgrounds?
Do you have close personal relationships with people who are culturally and socio-economically
• Do you have the desire to integrate culturally relevant considerations into your work? And
• How do your own cultural experiences and values impact they way you work?
The educational tool used were PowerPoint presentations that included videos. The videos presented
showed the language as a barrier in communication in health care.
• Development of researched based education materials.
• Implementation of Cultural Competence training for the Patient Care Associates in BEST Orientation.
• Embracement of the Cultural Competence concept in the PCAs orientation to teach them how to
provide cultural based care to patients admitted to the institution.
• Present initiative in Nursing Grand Rounds.
• Start data collection to analyze the impact of Cultural Competence Classes.
• Target PCA population not previously taught-prior to initial cohort.
• Increase awareness and sensitivity toward diverse patient populations is
a first step in understanding culturally influences health behaviors at The
Mount Sinai Hospital .
• Development of Cultural Competence training for PCAs can assist in
improving the quality of care for diverse patients in New York City.
• It will help to validate the role and importance of PCAs in improving
patient satisfaction scores
• The importance of culturally focused PCAs education in direct relation to
patient’s experiences and satisfaction
• Development of Cultural Competence training for PCAs helps to
respond to demographic changes; eliminating disparities in the health
status of people of diverse, ethnic & cultural backgrounds; improving
quality of services and outcomes; gain a competitive edge in the
• Betancourt, J., et al. (2005). Cultural Competence And Health Care
Disparities: Key Perspectives And Trends. Journal of health Affairs. 24, 2,
• Challenges Encountered When Teaching Cultural Competence,
• Gardner, Marilyn. (nd). Communicating Across Boundaries: Beliefs and
• Giger, J. et al. (2007). American Academy of Nursing Expert Panel Report:
Developing cultural competence to eliminate health disparities in ethnic
minorities and other vulnerable populations. Journal of Transcultural
Nursing. 18 (2): pp 95-102.
• Swirsky, L. (2009). Disparities. In covering Health Issues. 5th Eds. The
Alliance for Health Reform. Retrieved from
• The State of Health Care Diversity and Disparity : A Benchmark Study of
U.S. Hospitals, Institute for Diversity in Health Management, October 2008.
• Marilyn Jaffe-Ruiz, EdD, RN for her continued support and
encouragement. Professor, the Lienhard School of Nursing, Pace
University.New York, NY
• Patricia Reineke, PhD, RN for helping identify the needs of teaching the
PCAs about Cultural Competence. Assistant Professor, The Henry P.
Becton School of Nursing & Allied Health, Fairleigh Dickinson University.
Madison New Jersey.
• Virginia Defina, NP, RN, Nurse Educator at The Mount Sinai Hospital for
her contribution during the implementation process and her continued
support and The Nursing Education Department of Mount Sinai Hospital
for allowing current training of PCAs during orientation.