- Email: [email protected]
Creating an Organizational Diversity Vision: Goals, Outcomes, and Future Directions of the International Society of Psychiatric Nurses
ISPN
Creating an Organizational Diversity Vision: Goals, Outcomes, and Future Directions of the International Society of Psychiatric Nurses Edilma L. Yearwood, Vicki Hines-Martin, Candy Dato, and Mary Malone The aim of this article was to chronicle the development and status of a diversity vision within a psychiatric nursing organization. Organizational activities to support diversity and cultural competence, along with challenges to a full integration of these values, are presented. Psychiatric nurses need to be engaged in the process of developing personal and organizational cultural competence to eliminate barriers that contribute to disparities in effective mental health care. D 2006 Elsevier Inc. All rights reserved.
I
T HAS CLEARLY been shown in The Global Burden of Disease (2000) that psychiatric conditions such as depression, substance abuse, suicide, and violence in its many forms are adversely affecting the physical and mental health, quality of life, and overall functioning of a significant number of citizens worldwide. This fact has relevance for the United States as there has been a dramatic increase in individuals from diverse populations as a result of the vast numbers of immigrants entering the country and the increased numbers of live births within these immigrant groups. According to the surgeon general’s report on mental health (Department of Health and Human Services, 2001b, p. 3), bracial and ethnic minorities bear a greater burden from
From the Georgetown University School of Nursing and Health Studies, Washington, DC; University of Louisville School of Nursing, Louisville, KY; Long Island University School of Nursing, Brooklyn, NY; Jefferson Community and Technical College, Louisville, KY. Address reprint requests to Edilma L. Yearwood, PhD, APRN, BC, Georgetown University School of Nursing and Health Studies, 3700 Reservoir Road, NW, Washington, DC 20057. E-mail address: [email protected]. D 2006 Elsevier Inc. All rights reserved. 0883-9417/1801-0005$30.00/0 doi:10.1016/j.apnu.2006.01.001
152
unmet mental health needs and thus suffer a greater loss to their overall health and productivity.Q Globally and nationally, there are critical numbers of individuals across the life span who are unable to access a range of health care services or who experience barriers when they do access care. Consequently, both the World Health Organization (2001) and the Department of Health and Human Services, 2001a targeted the elimination of disparities in health care. At this critical time, psychiatric nurse educators, clinicians, researchers, and specialty groups are in unique positions to effect a change in reducing health care barriers and disparities through their practice. The Institute of Medicine [IOM] (2004), in its report entitled bIn the nation’s compelling interest: Ensuring diversity in the health-care workforce,Q endorsed the value and benefits of diversity as well as a diverse health care workforce and pointed out that b[d]iversity is associated with improved access to care for racial and ethnic minority patients and greater patient choice and satisfactionQ (p. 1) and that b[t]here is a need for competent, compassionate health professionals who have the necessary communication skills for our increasingly diverse societyQ (xiii). Its report identified four principles that enhance organizational diversity. These included (1) the need to affirm the value of diversity,
Archives of Psychiatric Nursing, Vol. 20, No. 3 (June), 2006: pp 152–156
DIVERSITY VISION
153
(2) a systematic assessment of the organizational climate, (3) a plan of action, and (4) a method for evaluating the plan. The Substance Abuse and Mental Health Services Administration (2001) supported the development of cultural competence standards that were targeted at providing desirable and effective care for the four largest underserved and underrepresented racial/ethnic groups in the United States. This body of work identified guiding principles, overall and clinical standards, implementation strategies, and provider competencies. The International Society of Psychiatric Nurses (ISPN) is primarily an advanced practice and specialty psychiatric nursing organization whose members possess a broad range of skills in practice, education, and research with individuals, families, and groups across the life span. The stated mission of the organization is to b[u]nite and strengthen the presence and the voice of specialty psychiatric– mental health nursing while influencing health care policy to promote equitable, evidence-based and effective treatment and care. . .Q (ISPN, 2000). Toward furthering this goal, in 2003, the ISPN undertook the development and approval of the Position Statement on Diversity, Cultural, Competence, and Access to Mental Health Care, which can be found among the position papers of the organization at www.ispn-psych.org. The document reaffirmed one of the organization’s core values, which is to support and strengthen the cultural competence of its members to improve mental health care delivered to diverse individuals, families, and groups coping with mental health concerns. In addition, the document serves as a guide for the organization’s journey into policy, advocacy, and critical research initiatives aimed at addressing health care disparities. Diversity encompasses differences in areas such as race, religion, age, disability, sex, sexual orientation, language, experiences, socioeconomic status, country or place of origin, and geographic residence (Campinha-Bacote, 2003). Cultural competence involves the ability to be responsive to the differences of others and to work effectively and respectfully within the context of the cultural values, traditions, beliefs, concerns, and needs of other individuals and groups (Cross, Bazron, Dennis, & Isaacs, 1989).
lowing organizations: the Association of Child and Adolescent Psychiatric Nurses (ACAPN), the International Society of Psychiatric Consultation Liaison Nurses (ISPCLN), and the Society for Education and Research in Psychiatric–Mental Health Nursing (SERPN). The vision was that, as one organization, the ISPN would serve as the voice for advanced practice psychiatric–mental health nurses holding diverse perspectives and complementary goals. The membership of these seminal organizations, including nurses from countries outside the United States, wanted each organization to expand its view and influence beyond the United States and focus on mental health globally. In addition, each organization wished to better reflect the populations clinicians were seeing in practice settings and the diversity of nursing students educators were teaching. International nurses who were already members of the founding organizations shared their psychiatric nursing practice and research experiences at annual conferences. The diversity of these members, along with the information they contributed at conferences, greatly enhanced discussions around best practices and the global needs of vulnerable mentally ill individuals and their families. A merger of organizations with these common values, missions, and philosophies was identified as a critical foundation for future directions in mental health nursing. Also, in 2003, an adult and geropsychiatric division was added to the organizational structure to best meet the needs of the membership whose practice was focused on adult and geriatric populations. As a way to test the proposed merger of the three groups that would become the ISPN (ACAPN, ISPCLN, and SERPN), the groups collaboratively worked on joint projects between 1997 and 1999. Groups of nurses with similar research interests began dialoguing, working together on nursing diagnosis specific to mental illness, and collaborating on position papers that reflected combined visions related to psychiatric nursing. The synergy that existed between the like-minded groups resulted in the articulated purpose of the newly formed organization in 1999 (see Table 1).
HISTORICAL PERSPECTIVE
At each national conference held by the ISPN since 1999, issues of diversity, culture, and cultural competence were addressed through participant
The ISPN was formed as a result of a grassroots movement and collaboration of the fol-
DIVERSITY ON THE RADAR: THE RESPONSE OF ISPN MEMBERSHIP
154
YEARWOOD ET AL
Table 1. Functions of the Organization 1. Promote quality psychiatric nursing care provided to infants, children, adults, and communities 2. Articulate essential components of psychiatric–mental health nursing in undergraduate and graduate education 3. Promote and encourage research, especially outcome studies, by advanced practice psychiatric–mental health nurses 4. Develop and promote health care policy which emanates from psychiatric–mental health education, clinical practice, and research 5. Articulate the role of psychiatric–mental health nurses in meeting the needs of those persons who have a mental illness, their families and others affected by mental illness, and those populations at high risk for mental illness 6. Create systems for the sharing of knowledge and resources with nursing and other psychiatric–mental health disciplines 7. Collaborate with other professionals to attain equitable access to mental health care for patients, families, and communities ISPN, 2000.
presentations and networking discussions. In addition, as an organization, the ISPN also focused on attracting individuals to the organization from diverse backgrounds and experiences through its national and international networking and membership drive. The ISPN continued to seek opportunities to collaborate with other professions working in the field of mental health to provide the best care to individuals served and to broaden our scope of practice and understanding within the global community. In 2002, ISPN members raised the issue that, as an organization, there was a need to have an explicit and documented position on the issue of diversity and cultural competence. As an international organization, with diverse members who work with diverse populations, assumptions regarding its vision of diversity were no longer sufficient. A task force was formed with volunteers from the membership to develop a position statement on diversity for the organization. Our role as advanced practice nurses who also function as advocates, educators, practitioners, researchers, and role models propelled the need to formulate an explicit diversity statement that would serve as a canon for our organization. The diversity statement serves as a best practice guide as the organization moves forward in delivering quality care to people from various cultures, engaging in culturally sensitive research, educating and socializing new nurses into the field of psychiatric– mental health nursing, and challenging some of the
views about diversity held by those within and outside the organization. CULTURAL COMPETENCE AND DIVERSITY GOALS AND OUTCOMES
As a result of the work of the Diversity Task Force, the Position Statement on Diversity, Cultural, Competence, and Access to Mental Health Care (www.ispn-psych.org) was completed in 2003. The position statement was unanimously supported by the membership as the foundational document from which the organization would develop culturally sensitive initiatives. As part of the goals and objectives set forth, the ISPN document reflected an intent to bsupport diversity and cultural competence in mental health careQ (p. 2). An immediate action plan (see Table 2) that included four action points focusing on conference presentations, recognition of culturally competent initiatives, membership outreach activities, and mentoring was identified. An additional step taken in support of the overall diversity goal was the inclusion of language reflecting culture, diversity, and cultural competence in organizational products such as the Position Statement on Palliative Care and various standards-of-practice documents. Outcome measurement strategies were then developed based on the organizational action plan. These included periodic survey of the membership about their engagement in any of the four action points. The first survey was distributed at the 2004
Table 2. Immediate Action Plan To achieve the ISPN goal of supporting diversity and cultural competency in mental health care, the organization will: 1. Offer at least one presentation at the annual conference that focuses on diversity and/or cultural competence and its impact on access to mental health care for individuals, families, or groups 2. Annually, at the ISPN conference, acknowledge an individual, program, or organization that demonstrates culturally competent clinical practice, research, policy initiatives, or advocacy in support of mental health services for the vulnerable or underserved 3. Attend at least one career in health day activity at a high school or health fair serving a predominantly minority population to disseminate information about mental health nursing; a summary of this activity will be incorporated into the organization’s annual report 4. Develop a list of ISPN members willing to serve as mentors for minority students in their geographic area who are contemplating a career in the mental health profession
DIVERSITY VISION
annual conference as a pilot; the results indicated that members were involved in diversity activities as co-presenters with students at conferences, through grant submissions and acquisition that included some focus on diverse populations, and via work that linked minority students with practicing nurses. Based on findings from the 2004 survey, the survey was revised and again piloted with attendees at the 2005 conference. In addition, it was posted on the ISPN website and remains available for members to complete and submit. The process functioned to test the feasibility of obtaining feedback from the members about their diversity/culture engagement and learning needs. The response rates to both the 2004 and the 2005 surveys were limited, with approximately 10% –12% of the membership responding. The current goal is to increase the number of responses about diversity from the membership, obtain completed surveys that would be used to help identify programmatic and strategic planning needs, and determine the best method for timely distribution and return of survey instruments used when assessing our membership. Based on the 2005 responses, members indicated that, to increase their cultural competence, they wanted the following: 1. more educational offerings specific to outcomes research; 2. to learn more about disparities in mental health assessment and interventions; 3. to hear more stories from consumers from various cultures about their mental health and mental illness experiences; and 4. to have exposure to facilitation strategies when working with multicultural groups. When asked what additional activities the Diversity Task Force and the ISPN should engage in to support the goals as stated in the diversity position paper, the following suggestions on how the organization could best meet a need of the membership were offered: (1) facilitate more exposure to specific areas such as mental health issues of lesbian, gay, bisexual, and transsexual individuals across the life span, (2) promote increased membership awareness of the diversity goals, and (3) have the ISPN assume a stronger role in the policy and education arenas to assist in combating the stigma of mental illness.
155
In 2004, another activity was pursued by the ISPN to further the diversity goal commenced in 2004. At that time, the first ISPN Diversity Award was given at the annual conference. The award was developed to recognize one or more individuals for their contributions in the area of culture and promotion of diversity in research, practice, or education. Specific guidelines were developed to assist in the selection process, addressing Action Plan Goal 2. The award is one of other organizational awards that symbolize the core values and mission of the ISPN. At the 2005 conference, a half-day preconference workshop entitled bCultural Competence: An Opportunity to Broaden Learning Horizons and Expand Excellence in Psychiatric–Mental Health NursingQ was conducted. Participants were exposed to unique experiential strategies to promote their own growth toward becoming a culturally aware practitioner and were afforded a forum to discuss issues related to diversity and inclusion. This offering is an example of Action Plan Goal 1. On the other hand, some members have indicated that they are involved as mentors to students and participate in school or health fairs in their communities (Action Plan Goals 3 and 4). These data provide only a snapshot of the membership; further assessment is planned through additional surveys of the membership. FUTURE DIRECTIONS
Challenges and Critical Assessment We have encountered some obstacles in incorporating and sustaining the cultural competence and diversity mission throughout the fabric of the organization. These obstacles include member ownership of cultural competence as an individual and organizational foundation, increasing membership engagement in this aspect of our mission, and a thorough and consistent inclusion of the language of diversity in all appropriate products developed by the organization. As the diversity statement has become an organizational document, one of the issues that the Diversity Task Force must bring to the forefront of discussion is that on who really owns the goals of the position statement? Organizational self-awareness requires that we address several key issues generated by this question. Although membership has endorsed the position statement as one of the missions of the organization, the task force members assume significant respon-
156
sibility for championing this critical aspect of our work in working groups within the organization, membership meetings, and in reviewed documents. An ongoing challenge is facilitation of institutional (organizational) memory, valuing and consistent incorporation of this important concept. Knowledge of diversity issues and ability to work effectively and competently with people from various cultures may not in fact be the priorities of the organization’s members, or it may be assumed that one is naturally culturally competent. Members may believe that other issues in the treatment relationship take priority or that culture and related issues of diversity and inclusion have unknown or secondary impact on the psychiatric behaviors presented by a client or family or the approach to care chosen by a nurse. The last challenge has been advocating for consistency within the organization as to the importance of including issues of diversity and culture in organizational documents. Critical values and beliefs that drive, define, and are core to organizations are methodically and thoughtfully woven through the mission statement and are reflected throughout key products of the organization. Cultural competence and diversity must reach that level of importance within the organization to demonstrate a commitment to improving mental health worldwide. Next Steps In supporting the elimination of health disparities, work that is related to raising individual and group consciousness about diversity cannot be ignored. The Diversity Task Force will work to become a standing committee within the organization. In addition, the ISPN as an organization will continue to offer education for its members around cutting-edge issues related to culture, inclusion, and diversity at annual conferences and through its online continuing education offerings. The organization will continue to focus on mental health advocacy, policy, and research that are inclusive of all individuals and populations. We believe that supporting outcomes research specific to diversity through the ISPN research council initiatives will help support the why ’s (benefits) of knowing how to work with diverse populations and the skills needed to be most effective. We will also continue to work toward better understanding and effectiveness when working with complex clients
YEARWOOD ET AL
as requested by members (e.g., lesbian, gay, bisexual, and transsexual individuals, Orthodox Jews, and foreign clients with whom there are significant sex disparities preventing adequate access to mental health care). In response to the underrepresentation of racial and ethnic minorities in the core health professions (IOM, 2004), recruitment efforts will continue with the goal of attracting and supporting the success of culturally diverse students to the specialty of psychiatric–mental health nursing. We will continue to work on ways to elicit timely and comprehensive feedback from our members and challenge them in their thinking and assumptions about diversity issues. By providing opportunities to dialogue and debate around cultural competence and diversity issues, the Diversity Task Force and the ISPN feel that they are supporting the best practice of its membership and that these actions will help reduce existing barriers to mental health care for diverse populations. REFERENCES Campinha-Bacote, J. (2003). Many faces: Addressing diversity in health care. Online Journal of Issues in Nursing, 8(1), Manuscript 2. Available at: http://NursingWorld.org/ oijn/topic20/tpc20_2.htm. Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a culturally competent system of care, vol. 1. Washington, DC7 CASSP Technical Assistance Center. Department of Health and Human Services. (2001a). Healthy people 2010: Understanding and improving health, (2nd ed.). Washington, DC7 Author. Department of Health and Human Services. (2001b). Surgeon general’s report—Mental health supplement: Culture, race & ethnicity. Washington, DC7 Author. http:// www.mentalhealth.samhsa.gov/cre. Institute of Medicine. (2004). In the nation’s compelling interest: Ensuring diversity in the health-care workforce. Washington, DC7 National Academies Press. International Society of Psychiatric Nurses. (2000). Functions of the organization. Bylaws, Article II: Purpose and functions. Washington, DC7 Philadelphia, PA: Author. Substance Abuse and Mental Health Services Administration. (2001). Cultural competence standards in managed care mental health services: Four underserved/underrepresented racial/ethnic groups. Retrieved December 3, 2005 from http://www.mentalhealth.samhsa.gov/publications/ allpubs/SMA00%2D3457. The global burden of disease. (2000). Retrieved December 15, 2002, from www.who.int/msa/mnh/ems/dalys/intro.htm. World Health Organization. (2001). The world health report 2001—Mental health: New understanding, new hope. www.who.int/whr2001/2001.
Creating an Organizational Diversity Vision: Goals, Outcomes, and Future Directions of the International Society of Psychiatric Nurses Edilma L. Yearwood, Vicki Hines-Martin, Candy Dato, and Mary Malone The aim of this article was to chronicle the development and status of a diversity vision within a psychiatric nursing organization. Organizational activities to support diversity and cultural competence, along with challenges to a full integration of these values, are presented. Psychiatric nurses need to be engaged in the process of developing personal and organizational cultural competence to eliminate barriers that contribute to disparities in effective mental health care. D 2006 Elsevier Inc. All rights reserved.
I
T HAS CLEARLY been shown in The Global Burden of Disease (2000) that psychiatric conditions such as depression, substance abuse, suicide, and violence in its many forms are adversely affecting the physical and mental health, quality of life, and overall functioning of a significant number of citizens worldwide. This fact has relevance for the United States as there has been a dramatic increase in individuals from diverse populations as a result of the vast numbers of immigrants entering the country and the increased numbers of live births within these immigrant groups. According to the surgeon general’s report on mental health (Department of Health and Human Services, 2001b, p. 3), bracial and ethnic minorities bear a greater burden from
From the Georgetown University School of Nursing and Health Studies, Washington, DC; University of Louisville School of Nursing, Louisville, KY; Long Island University School of Nursing, Brooklyn, NY; Jefferson Community and Technical College, Louisville, KY. Address reprint requests to Edilma L. Yearwood, PhD, APRN, BC, Georgetown University School of Nursing and Health Studies, 3700 Reservoir Road, NW, Washington, DC 20057. E-mail address: [email protected]. D 2006 Elsevier Inc. All rights reserved. 0883-9417/1801-0005$30.00/0 doi:10.1016/j.apnu.2006.01.001
152
unmet mental health needs and thus suffer a greater loss to their overall health and productivity.Q Globally and nationally, there are critical numbers of individuals across the life span who are unable to access a range of health care services or who experience barriers when they do access care. Consequently, both the World Health Organization (2001) and the Department of Health and Human Services, 2001a targeted the elimination of disparities in health care. At this critical time, psychiatric nurse educators, clinicians, researchers, and specialty groups are in unique positions to effect a change in reducing health care barriers and disparities through their practice. The Institute of Medicine [IOM] (2004), in its report entitled bIn the nation’s compelling interest: Ensuring diversity in the health-care workforce,Q endorsed the value and benefits of diversity as well as a diverse health care workforce and pointed out that b[d]iversity is associated with improved access to care for racial and ethnic minority patients and greater patient choice and satisfactionQ (p. 1) and that b[t]here is a need for competent, compassionate health professionals who have the necessary communication skills for our increasingly diverse societyQ (xiii). Its report identified four principles that enhance organizational diversity. These included (1) the need to affirm the value of diversity,
Archives of Psychiatric Nursing, Vol. 20, No. 3 (June), 2006: pp 152–156
DIVERSITY VISION
153
(2) a systematic assessment of the organizational climate, (3) a plan of action, and (4) a method for evaluating the plan. The Substance Abuse and Mental Health Services Administration (2001) supported the development of cultural competence standards that were targeted at providing desirable and effective care for the four largest underserved and underrepresented racial/ethnic groups in the United States. This body of work identified guiding principles, overall and clinical standards, implementation strategies, and provider competencies. The International Society of Psychiatric Nurses (ISPN) is primarily an advanced practice and specialty psychiatric nursing organization whose members possess a broad range of skills in practice, education, and research with individuals, families, and groups across the life span. The stated mission of the organization is to b[u]nite and strengthen the presence and the voice of specialty psychiatric– mental health nursing while influencing health care policy to promote equitable, evidence-based and effective treatment and care. . .Q (ISPN, 2000). Toward furthering this goal, in 2003, the ISPN undertook the development and approval of the Position Statement on Diversity, Cultural, Competence, and Access to Mental Health Care, which can be found among the position papers of the organization at www.ispn-psych.org. The document reaffirmed one of the organization’s core values, which is to support and strengthen the cultural competence of its members to improve mental health care delivered to diverse individuals, families, and groups coping with mental health concerns. In addition, the document serves as a guide for the organization’s journey into policy, advocacy, and critical research initiatives aimed at addressing health care disparities. Diversity encompasses differences in areas such as race, religion, age, disability, sex, sexual orientation, language, experiences, socioeconomic status, country or place of origin, and geographic residence (Campinha-Bacote, 2003). Cultural competence involves the ability to be responsive to the differences of others and to work effectively and respectfully within the context of the cultural values, traditions, beliefs, concerns, and needs of other individuals and groups (Cross, Bazron, Dennis, & Isaacs, 1989).
lowing organizations: the Association of Child and Adolescent Psychiatric Nurses (ACAPN), the International Society of Psychiatric Consultation Liaison Nurses (ISPCLN), and the Society for Education and Research in Psychiatric–Mental Health Nursing (SERPN). The vision was that, as one organization, the ISPN would serve as the voice for advanced practice psychiatric–mental health nurses holding diverse perspectives and complementary goals. The membership of these seminal organizations, including nurses from countries outside the United States, wanted each organization to expand its view and influence beyond the United States and focus on mental health globally. In addition, each organization wished to better reflect the populations clinicians were seeing in practice settings and the diversity of nursing students educators were teaching. International nurses who were already members of the founding organizations shared their psychiatric nursing practice and research experiences at annual conferences. The diversity of these members, along with the information they contributed at conferences, greatly enhanced discussions around best practices and the global needs of vulnerable mentally ill individuals and their families. A merger of organizations with these common values, missions, and philosophies was identified as a critical foundation for future directions in mental health nursing. Also, in 2003, an adult and geropsychiatric division was added to the organizational structure to best meet the needs of the membership whose practice was focused on adult and geriatric populations. As a way to test the proposed merger of the three groups that would become the ISPN (ACAPN, ISPCLN, and SERPN), the groups collaboratively worked on joint projects between 1997 and 1999. Groups of nurses with similar research interests began dialoguing, working together on nursing diagnosis specific to mental illness, and collaborating on position papers that reflected combined visions related to psychiatric nursing. The synergy that existed between the like-minded groups resulted in the articulated purpose of the newly formed organization in 1999 (see Table 1).
HISTORICAL PERSPECTIVE
At each national conference held by the ISPN since 1999, issues of diversity, culture, and cultural competence were addressed through participant
The ISPN was formed as a result of a grassroots movement and collaboration of the fol-
DIVERSITY ON THE RADAR: THE RESPONSE OF ISPN MEMBERSHIP
154
YEARWOOD ET AL
Table 1. Functions of the Organization 1. Promote quality psychiatric nursing care provided to infants, children, adults, and communities 2. Articulate essential components of psychiatric–mental health nursing in undergraduate and graduate education 3. Promote and encourage research, especially outcome studies, by advanced practice psychiatric–mental health nurses 4. Develop and promote health care policy which emanates from psychiatric–mental health education, clinical practice, and research 5. Articulate the role of psychiatric–mental health nurses in meeting the needs of those persons who have a mental illness, their families and others affected by mental illness, and those populations at high risk for mental illness 6. Create systems for the sharing of knowledge and resources with nursing and other psychiatric–mental health disciplines 7. Collaborate with other professionals to attain equitable access to mental health care for patients, families, and communities ISPN, 2000.
presentations and networking discussions. In addition, as an organization, the ISPN also focused on attracting individuals to the organization from diverse backgrounds and experiences through its national and international networking and membership drive. The ISPN continued to seek opportunities to collaborate with other professions working in the field of mental health to provide the best care to individuals served and to broaden our scope of practice and understanding within the global community. In 2002, ISPN members raised the issue that, as an organization, there was a need to have an explicit and documented position on the issue of diversity and cultural competence. As an international organization, with diverse members who work with diverse populations, assumptions regarding its vision of diversity were no longer sufficient. A task force was formed with volunteers from the membership to develop a position statement on diversity for the organization. Our role as advanced practice nurses who also function as advocates, educators, practitioners, researchers, and role models propelled the need to formulate an explicit diversity statement that would serve as a canon for our organization. The diversity statement serves as a best practice guide as the organization moves forward in delivering quality care to people from various cultures, engaging in culturally sensitive research, educating and socializing new nurses into the field of psychiatric– mental health nursing, and challenging some of the
views about diversity held by those within and outside the organization. CULTURAL COMPETENCE AND DIVERSITY GOALS AND OUTCOMES
As a result of the work of the Diversity Task Force, the Position Statement on Diversity, Cultural, Competence, and Access to Mental Health Care (www.ispn-psych.org) was completed in 2003. The position statement was unanimously supported by the membership as the foundational document from which the organization would develop culturally sensitive initiatives. As part of the goals and objectives set forth, the ISPN document reflected an intent to bsupport diversity and cultural competence in mental health careQ (p. 2). An immediate action plan (see Table 2) that included four action points focusing on conference presentations, recognition of culturally competent initiatives, membership outreach activities, and mentoring was identified. An additional step taken in support of the overall diversity goal was the inclusion of language reflecting culture, diversity, and cultural competence in organizational products such as the Position Statement on Palliative Care and various standards-of-practice documents. Outcome measurement strategies were then developed based on the organizational action plan. These included periodic survey of the membership about their engagement in any of the four action points. The first survey was distributed at the 2004
Table 2. Immediate Action Plan To achieve the ISPN goal of supporting diversity and cultural competency in mental health care, the organization will: 1. Offer at least one presentation at the annual conference that focuses on diversity and/or cultural competence and its impact on access to mental health care for individuals, families, or groups 2. Annually, at the ISPN conference, acknowledge an individual, program, or organization that demonstrates culturally competent clinical practice, research, policy initiatives, or advocacy in support of mental health services for the vulnerable or underserved 3. Attend at least one career in health day activity at a high school or health fair serving a predominantly minority population to disseminate information about mental health nursing; a summary of this activity will be incorporated into the organization’s annual report 4. Develop a list of ISPN members willing to serve as mentors for minority students in their geographic area who are contemplating a career in the mental health profession
DIVERSITY VISION
annual conference as a pilot; the results indicated that members were involved in diversity activities as co-presenters with students at conferences, through grant submissions and acquisition that included some focus on diverse populations, and via work that linked minority students with practicing nurses. Based on findings from the 2004 survey, the survey was revised and again piloted with attendees at the 2005 conference. In addition, it was posted on the ISPN website and remains available for members to complete and submit. The process functioned to test the feasibility of obtaining feedback from the members about their diversity/culture engagement and learning needs. The response rates to both the 2004 and the 2005 surveys were limited, with approximately 10% –12% of the membership responding. The current goal is to increase the number of responses about diversity from the membership, obtain completed surveys that would be used to help identify programmatic and strategic planning needs, and determine the best method for timely distribution and return of survey instruments used when assessing our membership. Based on the 2005 responses, members indicated that, to increase their cultural competence, they wanted the following: 1. more educational offerings specific to outcomes research; 2. to learn more about disparities in mental health assessment and interventions; 3. to hear more stories from consumers from various cultures about their mental health and mental illness experiences; and 4. to have exposure to facilitation strategies when working with multicultural groups. When asked what additional activities the Diversity Task Force and the ISPN should engage in to support the goals as stated in the diversity position paper, the following suggestions on how the organization could best meet a need of the membership were offered: (1) facilitate more exposure to specific areas such as mental health issues of lesbian, gay, bisexual, and transsexual individuals across the life span, (2) promote increased membership awareness of the diversity goals, and (3) have the ISPN assume a stronger role in the policy and education arenas to assist in combating the stigma of mental illness.
155
In 2004, another activity was pursued by the ISPN to further the diversity goal commenced in 2004. At that time, the first ISPN Diversity Award was given at the annual conference. The award was developed to recognize one or more individuals for their contributions in the area of culture and promotion of diversity in research, practice, or education. Specific guidelines were developed to assist in the selection process, addressing Action Plan Goal 2. The award is one of other organizational awards that symbolize the core values and mission of the ISPN. At the 2005 conference, a half-day preconference workshop entitled bCultural Competence: An Opportunity to Broaden Learning Horizons and Expand Excellence in Psychiatric–Mental Health NursingQ was conducted. Participants were exposed to unique experiential strategies to promote their own growth toward becoming a culturally aware practitioner and were afforded a forum to discuss issues related to diversity and inclusion. This offering is an example of Action Plan Goal 1. On the other hand, some members have indicated that they are involved as mentors to students and participate in school or health fairs in their communities (Action Plan Goals 3 and 4). These data provide only a snapshot of the membership; further assessment is planned through additional surveys of the membership. FUTURE DIRECTIONS
Challenges and Critical Assessment We have encountered some obstacles in incorporating and sustaining the cultural competence and diversity mission throughout the fabric of the organization. These obstacles include member ownership of cultural competence as an individual and organizational foundation, increasing membership engagement in this aspect of our mission, and a thorough and consistent inclusion of the language of diversity in all appropriate products developed by the organization. As the diversity statement has become an organizational document, one of the issues that the Diversity Task Force must bring to the forefront of discussion is that on who really owns the goals of the position statement? Organizational self-awareness requires that we address several key issues generated by this question. Although membership has endorsed the position statement as one of the missions of the organization, the task force members assume significant respon-
156
sibility for championing this critical aspect of our work in working groups within the organization, membership meetings, and in reviewed documents. An ongoing challenge is facilitation of institutional (organizational) memory, valuing and consistent incorporation of this important concept. Knowledge of diversity issues and ability to work effectively and competently with people from various cultures may not in fact be the priorities of the organization’s members, or it may be assumed that one is naturally culturally competent. Members may believe that other issues in the treatment relationship take priority or that culture and related issues of diversity and inclusion have unknown or secondary impact on the psychiatric behaviors presented by a client or family or the approach to care chosen by a nurse. The last challenge has been advocating for consistency within the organization as to the importance of including issues of diversity and culture in organizational documents. Critical values and beliefs that drive, define, and are core to organizations are methodically and thoughtfully woven through the mission statement and are reflected throughout key products of the organization. Cultural competence and diversity must reach that level of importance within the organization to demonstrate a commitment to improving mental health worldwide. Next Steps In supporting the elimination of health disparities, work that is related to raising individual and group consciousness about diversity cannot be ignored. The Diversity Task Force will work to become a standing committee within the organization. In addition, the ISPN as an organization will continue to offer education for its members around cutting-edge issues related to culture, inclusion, and diversity at annual conferences and through its online continuing education offerings. The organization will continue to focus on mental health advocacy, policy, and research that are inclusive of all individuals and populations. We believe that supporting outcomes research specific to diversity through the ISPN research council initiatives will help support the why ’s (benefits) of knowing how to work with diverse populations and the skills needed to be most effective. We will also continue to work toward better understanding and effectiveness when working with complex clients
YEARWOOD ET AL
as requested by members (e.g., lesbian, gay, bisexual, and transsexual individuals, Orthodox Jews, and foreign clients with whom there are significant sex disparities preventing adequate access to mental health care). In response to the underrepresentation of racial and ethnic minorities in the core health professions (IOM, 2004), recruitment efforts will continue with the goal of attracting and supporting the success of culturally diverse students to the specialty of psychiatric–mental health nursing. We will continue to work on ways to elicit timely and comprehensive feedback from our members and challenge them in their thinking and assumptions about diversity issues. By providing opportunities to dialogue and debate around cultural competence and diversity issues, the Diversity Task Force and the ISPN feel that they are supporting the best practice of its membership and that these actions will help reduce existing barriers to mental health care for diverse populations. REFERENCES Campinha-Bacote, J. (2003). Many faces: Addressing diversity in health care. Online Journal of Issues in Nursing, 8(1), Manuscript 2. Available at: http://NursingWorld.org/ oijn/topic20/tpc20_2.htm. Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Towards a culturally competent system of care, vol. 1. Washington, DC7 CASSP Technical Assistance Center. Department of Health and Human Services. (2001a). Healthy people 2010: Understanding and improving health, (2nd ed.). Washington, DC7 Author. Department of Health and Human Services. (2001b). Surgeon general’s report—Mental health supplement: Culture, race & ethnicity. Washington, DC7 Author. http:// www.mentalhealth.samhsa.gov/cre. Institute of Medicine. (2004). In the nation’s compelling interest: Ensuring diversity in the health-care workforce. Washington, DC7 National Academies Press. International Society of Psychiatric Nurses. (2000). Functions of the organization. Bylaws, Article II: Purpose and functions. Washington, DC7 Philadelphia, PA: Author. Substance Abuse and Mental Health Services Administration. (2001). Cultural competence standards in managed care mental health services: Four underserved/underrepresented racial/ethnic groups. Retrieved December 3, 2005 from http://www.mentalhealth.samhsa.gov/publications/ allpubs/SMA00%2D3457. The global burden of disease. (2000). Retrieved December 15, 2002, from www.who.int/msa/mnh/ems/dalys/intro.htm. World Health Organization. (2001). The world health report 2001—Mental health: New understanding, new hope. www.who.int/whr2001/2001.