Minority patients are at high risk for poor pain outcomes. When patients belong to a culture or speak a language that's different from that of their health care provider, the provider faces additional challenges in successfully assessing and managing the patients' pain. This article describes how and why culture affects both patients and nurses. It also discusses why members of cultural minority groups frequently receive suboptimal pain management and how nurses can improve patients' pain outcomes by using culturally sensitive assessments and providing culturally comfortable care.

Each year, more than 2.5 million people in the United States develop pressure ulcers. These skin lesions bring pain, associated risk for serious infection, and increased health care utilization. Moreover, the Centers for Medicare & Medicaid (CMS) no longer provides additional reimbursement to hospitals to care for a patient who has acquired a pressure ulcer while under the hospital's care. Thus, pressure ulcer prevention presents an important challenge in acute care hospitals. A number of best practices have been shown to be effective in reducing the occurrence of pressure ulcers, but these practices are not used systematically in all hospitals. The Challenges of Pressure Ulcer Prevention Pressure ulcer prevention requires an interdisciplinary approach to care. Some parts of pressure ulcer prevention care are highly routinized, but care must also be tailored to the specific risk profile of each patient. No individual clinician working alone, regardless of how talented, can prevent all pressure ulcers from developing. Rather, pressure ulcer prevention requires activities among many individuals, including the multiple disciplines and multiple teams involved in developing and implementing the care plan. To accomplish this coordination, high-quality prevention requires an organizational culture and operational practices that promote teamwork and communication, as well as individual expertise. Therefore, improvement in pressure ulcer prevention calls for a system focus to make needed changes. Toolkit Designed for Multiple Audiences The aim of this toolkit is to assist hospital staff in implementing effective pressure ulcer prevention practices. The toolkit was developed under a contract with the Agency for Healthcare Research and Quality through the ACTION program (Accelerating Change and Transformation in Organizations and Networks), with additional support from the Health Services Research and Development Service of the Department of Veterans Affairs. It was created by a core team with expertise in pressure ulcers and organizational change at the Boston University School of Public Health. An expert advisory panel and quality improvement teams at six participating medical centers provided input. The toolkit's content draws on literature on best practices in pressure ulcer prevention and includes both validated and newly developed tools. The toolkit was tested in the six participating medical centers. Their feedback influenced this final version and their experiences are reflected in many of the examples provided.

The National Healthcare Quality and Disparities Report (QDR) is the product of collaboration among agencies from the U.S. Department of Health and Human Services (HHS), other federal departments, and the private sector. Many individuals guided and contributed to this effort. Without their magnanimous support, the report would not have been possible.

Home health care disparities exist and efforts should be made to provide culturally and linguistically appropriate care to all patients.

Introduction: Culture-sensitive (CS) and patient-centered (PC) care are considered essential to achieve high-quality equitable care. The purpose of this study was to determine how expert nurses incorporate CS/PC care into their assessment and care planning practices, especially for culturally diverse and marginalized patients. Methodology: Using a qualitative, descriptive design, we conducted a focus group at the October 2019 Transcultural Nursing Society Conference. Participants ( n = 9) discussed how they instilled cultural sensitivity and patient-centeredness into their assessment and care planning skills. Results: Participants revealed attitudes, knowledge, and skills associated with CS/PC assessment and care planning. They also identified specific strategies for translating CS/PC theory into assessment and care planning practices. Discussion: Three principles and many pragmatic strategies for incorporating CS/PC care into daily practice emerged from the data. Nurses may find these principles and strategies helpful in integrating CS/PC care into their daily care of patients in busy clinical settings.

Situation-Background-Assessment-Recommendation (SBAR) communication has become the standard for communicating across disciplines. It has demonstrated its effectiveness at improving patient outcomes, enhancing patient and clinician satisfaction, and helping to control healthcare costs. It can help home healthcare clinicians with efforts to prevent avoidable hospitalizations. But how often and how well do home health clinicians use this method of shared communications with physicians? This article explores why communication between physicians and home health clinicians can be so problematic. It introduces the SBAR communication method, its origins, its features, and some of the published evidence that it provides effective and efficient communication, thereby promoting better patient outcomes.

Throughout the world, healthcare is increasingly being provided in home and community-based settings. There is a growing awareness that the most effective, least costly, patient-preferred setting is patients' home. Thus, home healthcare nursing is a growing nursing specialty, requiring a unique set of nursing knowledge and skills. Unlike many other nursing specialties, home healthcare nursing has few professional organizations to develop or support its practice. This article describes how an international network of home healthcare nurses developed international guidelines for home healthcare nurses throughout the world. It outlines how the guidelines for home healthcare nursing practice were developed, how an international panel of reviewers was recruited, and the process they used for reaching a consensus. It also describes the plan for nurses to contribute to future updates to the guidelines.

Introduction. Home health patients, who are members of minority and vulnerable groups, suffer disparate outcomes. Patient-centered care (PCC) and culturally-competent care (CCC) aim to facilitate high-quality, equitable care. How home health nurses incorporate PCC and CCC principles into their assessment and care-planning practices has not been -investigated. This study answers the question, “ What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?” Methods. Home health nurses (n= 20) were recruited into this grounded theory study from agencies around the United States via flyers, websites, and contacts. We conducted in-depth recorded interviews using a semi-structured interview guide to ask questions about nurses’ assessment and care-planning practices, their understanding of CCC and PCC principles, and facilitators/barriers to CCC and PCC practice. Results. Participants primarily gained their CCC and PCC assessment and care-planning skills through a “seat of your pants,” trial-and-error process, with little educational or agency assistance. They combined caring, diverse patient experiences, and critical, creative self-reflection on their experiences to gradually learn helpful, though not optimal, CCC and PCC strategies. However, they reported numerous barriers that discouraged or distressed them in their quest to deliver culturally-competent and patient-centered care. Only a few nurses demonstrated the resilience to overcome these challenges creatively and happily. Conclusion. If we accept that patient-centered care and culturally competent care are key elements of high-quality, equitable care, this grounded theory may help home healthcare clinicians, administrators, educators, and policy-makers identify impact points for enhancing CS/PC practices.