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E-learning tool helps clinicians develop cultural competence

An e-learning tool developed by Katie de Freitas is helping nurses and midwives to reduce health inequalities and improve patient care.
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An e-learning tool developed by Katie de Freitas is helping nurses and midwives to reduce health inequalities and improve patient care

Katie de Freitas insists that a greater awareness of cultures is crucial if clinicians are to meet the needs of patients and families.

Cultural competency is a matter of quality and safety,' says the quality improvement lead at Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH). 'It can help to bridge the gap between those providing care and those accessing services.'

As healthcare professionals, we need to be able to communicate effectively with our patients. We need to be responsive to individual needs understanding what particular care or treatments may be accepted, how individuals perceive their own health and wellbeing and how

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An e-learning tool developed by Katie de Freitas is helping nurses and midwives to reduce health inequalities and improve patient care


Katie de Freitas created an e-learning tool to support clinicians in developing
cultural competence. Picture: Barney Newman

Katie de Freitas insists that a greater awareness of cultures is crucial if clinicians are to meet the needs of patients and families.

‘Cultural competency is a matter of quality and safety,' says the quality improvement lead at Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH). 'It can help to bridge the gap between those providing care and those accessing services.' 

‘As healthcare professionals, we need to be able to communicate effectively with our patients. We need to be responsive to individual needs – understanding what particular care or treatments may be accepted, how individuals perceive their own health and wellbeing and how we can enable them to feel comfortable and safe.’ 

Her e-learning tool to support cultural competence originated in work she did for a Mary Seacole development award project. The tool has now received funding from Health Education England and backing by NHS England chief nursing officer Jane Cummings and Royal College of Midwives general secretary Cathy Warwick.  It is available on the HEE e-Learning for Healthcare website and is free to NHS healthcare professionals. 

England’s chief nursing officer Jane Cummings says: ‘Everyone accessing NHS services has a right to receive unbiased, non-judgmental care which supports their individual needs, values and beliefs. We all need to be culturally competent in the NHS, so that the care we provide is not only safe but of the best quality.’

Tailored approach

The tool consists of three modules with written content, animation, interactive activities and opportunities for reflection on the user’s experience and evaluation.

The first two modules apply to all healthcare professional groups, while the third is specifically aimed at midwives; Ms de Freitas says that where specialties need a tailored approach, they can build on the first two modules.

Ms de Freitas won the Mary Seacole development award in 2014 and part of her project was to look at cultural competence in the maternity setting. She moved from a post in Newham, London, to take up a role as clinical projects midwife at Dartford and Gravesham NHS Trust. 

‘It was very different in terms of cultural diversity,’ she says. ‘Most of the midwives had trained and lived in the area, with many of them born relatively locally. ‘They wanted to ask potentially sensitive questions around cultural issues but didn't know how to approach it. They wanted to give great care.’

Head of midwifery at the trust Deborah McAllion says that in 2012/2013 'we had a spate of clinical and social issues that were creating challenges in the working environment.  We experienced a change in demographics for our pregnant population that resulted in shifts in its ethnic diversity. Midwives wanted to try to understand the difficult situations faced by women in pregnancy and provide support.'

She adds: ‘Most midwives will have had some limited training in cultural and social aspects of childbirth but not enough to help with the range of situations that might arise. By understanding the community, they are able to gain perspective into the needs of pregnant women. 

'Cultural diversity is now discussed in most aspects of training and the human factors of individualised patient care are given priority. Women see a much stronger relationship with their named midwives as a result of this work.’

Without stress or fear 

Crucially, Ms de Freitas ensured that service-users were directly involved in its development. Fionah Kurangwa agreed to take part in the work to repay her ‘absolutely fantastic’ care from her midwife. 

‘The project was dealing with the experiences of African-Caribbean women around maternity and I thought this was a brilliant opportunity to air my views as one,’ she says. ‘How often do you get asked to put your views across vocally in public health?’

Given the challenges nurses and midwives face on a daily basis, she adds, she recognises that trying to work out social and cultural needs can sometimes feel like an additional pressure. 

‘This tool can help them address those needs without stress and fear of being judged,’ says Ms Kurangwa. ‘I hope the tool answers some of their concerns and questions.’

Accessing healthcare 

She believes the training will improve patient care. ‘Pregnancy and the time immediately following childbirth are some of the most stressful periods in a woman’s life. A nurse or midwife who understands your social or cultural issues would go a long way towards minimising that stress.’ 

Ms de Freitas says understanding other cultures is important in terms of access – those who have poor experiences of care might be reluctant to have contact with health services in the future.

‘The tool aims to make healthcare professionals able to communicate with and care for each individual, no matter what cultural influences there might be,’ she says.  ‘Importantly, it helps them to encourage discussion of cultural and religious beliefs and how this may influence the health behaviours, choices and preferences of their patients. 

‘It is not a one-size-fits-all approach but one in which you attempt to work within the individual, family, cultural, religious context of an individual’s life.

‘Becoming culturally competent is not about having all the answers or becoming an expert on all cultural and religious beliefs. It’s about being able to ask questions, listen and be able to respond appropriately – and continually learning and reflecting on your practice.’

Her chief nurse at GOSH Juliette Greenwood points out that cultural competency has been shown to contribute to reducing healthcare disparities. ‘This leads to improved patient care outcomes and experiences. This new resource will better support clinicians in achieving that,’ she says. 

The three modules

The first session aims to describe what is meant by ‘culture’ and why it is important for health professionals to be aware of how it can affect health. Learning outcomes include being able to:

  • Describe what constitutes culture.
  • Describe how culture can affect individuals’ values, beliefs, behaviours and decision-making.
  • Explain how culture can affect care and treatment decisions.

The second session describes cultural competence and its importance for health professionals working in cross-cultural situations. Learning outcomes include being able to:

  • Explain the importance of self-awareness and the effect your own prejudices, beliefs, values and cultural roots have on your interactions and care of patients who are not from your own social and cultural group.
  • Describe the impact of making assumptions based on individuals’ cultural background or behaviour in particular circumstances.

The third session looks at the importance of cultural competence in the context of maternity care and aims to help healthcare professionals support and meet the needs of a changing population. Learning outcomes include being able to:

  • Give examples of how you could proactively address and respond to cultural needs and expectations.
  • Describe why it is important to respectfully communicate with women when cultural wishes conflict with recommended treatment options.
  • Employ skillful questioning or discussion techniques to support effective communication and identify individual choices and preferences.

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