Bridging the Gap: DNP Graduate Teaches Culturally Competent Care

As a patient, have you ever felt that a nurse or doctor didn’t ‘get’ you? If so, did you follow the provider’s instructions, or want to go back to see him or her again?

Healthcare provider attitudes are extremely important to a patient’s comfort level, satisfaction and even follow-through, said Catherine Browning, DNP, RN, PMHNP-BC, a Missouri-based psychiatric nurse practitioner and recent graduate of Chamberlain’s Doctor of Nursing Practice (DNP) degree program.

The potential for disconnect between the patient and the provider can be even more acute when the two are from different cultural backgrounds.

Fortunately, said Dr. Browning, a little understanding can go a long way. As part of her DNP project and practicum, she put her skills, knowledge and experience to work to improve the cultural competency of the staff at her facility in working with Middle Eastern clients – all with the goal of improving patient care.

Care and Cultural Differences

Dr. Browning’s first experience with culturally appropriate care came during the early 1980s. She was working as a psychiatric nurse in San Francisco, and one of her patients was an Iraqi man who was catatonic from the trauma he experienced during the Iran-Iraq war.

When it came to cross-cultural norms and etiquette, “I made all these mistakes in the beginning,” she explained. “Eventually, we brought in a cultural liaison from the Middle East, and she helped me realize the mistakes I was making, culturally speaking.”

This experience sharpened her already keen interest in Middle Eastern cultures. Over the next several decades, Dr. Browning traveled extensively throughout the region. She lived in Kuwait for almost 10 years, teaching psychiatric nursing and providing counseling to Kuwaitis, Iraqis and others.

Furthering Her Education

Upon her return to the United States in 2009, Dr. Browning began to consider pursuing a DNP, a practice-focused doctorate that prepares nurses to enhance patient care and serve as champions for a more effective healthcare system.

She eventually chose to enroll at Chamberlain, where the centerpiece of the program is a four-part project and practicum experience that students can tailor to their area of specialty and professional development needs.

In Dr. Browning’s case, the experience provided the opportunity for her to advance patient care by combining her deep knowledge of Middle Eastern culture with her expertise in psychiatric nursing.

She explained that the facility where she works – The Arthur Center, in Mexico, Missouri – is considering expanding its outreach to Middle Eastern clients in need of mental health services. Although it is located in a rural area, the center has a multi-cultural staff and is within driving distance of Columbia, Missouri, a city with a sizeable Middle Eastern population.

The problem, Dr. Browning explained, was that many of the staff at her clinic – from the receptionists to the nurses and the social workers – were not well versed in the culturally-specific needs of people from the Middle East.

The president of the Arthur Center, Terry Mackey, was very supportive of Dr. Browning’s interest in Middle East culture care.

Other leaders at the center also agreed that cultural education of the staff would make for better patient outcomes.

Medical Director Dr. Ahmed Taranissi said, “Knowing about [a patient’s] culture can make them feel comfortable and will enhance the working alliance….I believe it is crucial to use the patient’s own cultural values to help them get better, rather than trying to make them fit our cultural values.”

A Project Takes Shape

After Dr. Browning got buy-in from the various stakeholders at her organization, she began by performing extensive research on topics such as cultural competency, educational training, assessment tools, organizational change models and healthcare issues relevant to Middle Eastern patients.

The culmination of her research was an interprofessional educational program for the staff at the clinic that focused specifically on Middle Eastern culture. Topics included gender relations, nonverbal cues, religion, cultural views of mental illness, dietary restrictions and more.

“I talked a lot about how you are going to build trust with the patient,” said Dr. Browning. “For example, in their culture, small talk is very important. You can’t just jump in and say, ‘What’s your pharmacy?’ For us, that’s a very efficient thing. We love that as Americans because we’re busy. In those Middle Eastern cultures, social graces are very important. You need to take a few minutes and say, ‘How are you? How’s your family?’ That’s how you build trust with people.”

Pre- and post-tests confirmed that after her presentation, attendees had an increased knowledge base and comfort level in interacting with Middle Eastern clients.

“The overall feedback was very encouraging,” she said. “People learned a lot.” As an added bonus, she said, the staff has expressed interest in learning about other cultures.

Serving as a Bridge

As for Dr. Browning, she plans to continue building on what she has learned to further her own practice and work effectively with her interprofessional colleagues.

“Most importantly,” she said, “I hope to share my knowledge of Middle East cultural care issues through writing, teaching and presenting. I hope to be an even more responsible liaison, building peace and cultural understanding between two unique and gifted regions of the world – the United States and the Middle East.”

By Danielle Logacho