The New Zealand development and trial of mental health nursing clinical indicators—a bicultural study

Organisational systems’ approaches to improving cultural competence in healthcare: a systematic scoping review of the literature

“…Australian hospitals scored higher on organisational change indicators; US hospitals on human resource indicators but there was more similarity than difference. Despite 30–40 years of “multicultural health”, neither has achieved best practice.Diversity management activities (planning, stakeholder satisfaction, diversity training, human resources, health care delivery, organisational change, diversity performance, external and internal influences on racial/ethnic diversity initiatives).Comparative exploratory study based on single point in time surveys.WeakWhitman and Davis [45] PaperUS Diversifying client populationCross- 101 general medical and surgical hospitals in Alabama sample of 53 respondents.Examined the awareness of and preparedness for the diversifying client population through their hospital cultural and linguistic competence practices.Hospitals are taking initial steps to meet the needs of the diversifying population, but have a long way to go to meet National Standards for culturally and linguistically appropriate services in health care.Hospital adherence to national standards.Self-report questionnaires to hospital chief executive officers on the measures and resources that the hospitals currently use to meet cultural and linguisticWeakWiley [18] PaperNZ Maori who are disabledKnowledge and attitudes to cross-cultural disability care.Consumers, carers, service providers and policy makers’ knowledge and attitudes.Conflict between Indigenous worldviews framed within a mainstream service; Need for increased coordination and collaboration, workforce development, resources and information development, and community engagement.Disability care and participation in services.Semi-structured interview instrument, focus groups.WeakO'Brien, O'Brien [46] PaperNZ Maori and non-Maori mental health clientsMental health services and mental health nursing.Health service audit tool using bicultural indicators for clinical records and cultural competence.No health care outcomes reported (paper describes development of indicators by expert committee).Health care deliveryDevelopment of Consumer Notes Clinical Indicators (CNCI) for clinical records and cultural competence and Professional Practice Audit Questionnaire (PPAQ) self-report survey.Siegel, Haugland [47] PaperUS African American, Hispanic, Asian and American IndianMental health servicesAudit tool to measure the cultural competence of health services.No health care outcomes reported (paper describes development by expert committee).Health care deliveryDevelopment of health service benchmarking audit tool and self-report survey.Weech-Maldonado, Dreachslin [48] PaperUS HospitalsHospitals in CaliforniaPilot tested an initial draft of the Cultural competency assessment tool for hospitals (CCATH), revised then field tested it with a sample of hospitals.The CCATH can be used to evaluate hospital performance in cultural competency and identify ...…”

“…One study documenting the full audit and quality improvement cycle from NZ described the development and use of culturally and clinically reliable bicultural audit tools, the 25-item Consumer Notes Clinical Indicators (CNCI), to measure the achievement of culturally competent mental health nursing practice standards against standards of expected health care [39, 46]. …”

“…Of these, two were from the US and focussed on diverse ethnic and racial groups, and one from NZ which described the development of clinical and cultural competence indicators for mental health service improvements for Maori clients. The rigorous processes of indicator development and testing described demonstrated the considerable resources which have been invested into developing and piloting instruments to audit service performance across sectors within health [19, 46]. …”

“…Also targeting mental health services, O’Brien et al [46] described the development and validation of the NZ culturally and clinically reliable bicultural audit tools to measure the achievement of their mental health nursing practice standards (evaluation of their implementation is described above). The CNCI audit tool was based on identification of ‘critical events’ from nursing notes in consumer’s case notes.…”

“…The CNCI audit tool was based on identification of ‘critical events’ from nursing notes in consumer’s case notes. Critical events were ‘non-sentinel rate- based clinical indicators considered crucial to achievement of practice standards which if not achieved, identified a need for immediate rectification [46]. Of 100 clinical indicator statements, 25 valid and reliable indicators were considered to be crucial to the achievement of the NZ standards.…”