Setting competent and sensitive in order to deliver



The setting for
the DNP project is a healthcare setting, where primary, secondary and tertiary
levels of care are provided.  Kings
County Hospital Center (KCHC) is a teaching hospital, which has 639 certified beds
and the everyday client demographic includes Fifty-six percent (56%) of females
and 44% of males.  The hospital serves culturally
diverse clients.  According to 2016
Community Health Needs Assessment (CHNA), the typical clients served are 82% of
Black Non-Hispanic; 8% Hispanic or Latino; 5% White Non-Hispanic; 3%
Multi-Race/Other; and 2% declined to identify. 
Among the total recipients of care (ROC), 15% are under age 21; 29% are
ages 21-44; 39% are ages 45-64; and 16% aged 65 and older.  The most commonly seen diagnosis are
Hypertension, Heart disease, cancer, Asthma, etc.

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The vision of
KCHC is ” to be the hospital of choice for the residents of Brooklyn and for
the employees.  KCHC strive to provide
the highest quality healthcare services with an emphasis in patient safety in a
customer-centered environment”.  The
mission of the hospital is to “provide quality healthcare services to a
culturally and linguistically diverse population, regardless of their ability to
pay.  KCHC recognize that every patient
and every employee has great value and therefore the highest organizational
priority must be respect for the patients, visitors and one another” (KCHC – Vision
& Mission statement).  The mission
and the vision align with the DNP project since the purpose of the project is
to train the staff to be culturally competent and sensitive in order to deliver
the highest quality care in a client-centered environment. 


KCHC adopted
shared governance practice model as part of its journey towards Magnet status
and to empower nurses, improve job satisfaction and retention.  Since the adoption of shared governance
practice model, nurses feel more “at the table” and being part of decision-making.  According to Kutney-Lee, et al. (2016),
organizations that foster shared governance promote culture of engagement among
nurses in the organizational decision-making. 
It is not always easy to have a welcoming attitude towards culture
change among staff.  In order to overcome
staff resistance, multiple strategies will be incorporated including creating
focus groups, educational workshops/journal clubs, supporting and mentoring
staff by super users/champions, engaging leaders, providing resources such as
educational materials, etc.  KCHC has
history of being under Department of Justice (DOJ) monitoring after some
unfortunate events and had made significant culture change.  DOJ found KCHC to be in substantial
compliance with their recommendations and ended their five-year oversight in


Organizational Need


The need assessment
conducted within the practicum site includes dialogues with clients, who had
complaints regarding their cultural beliefs are not being respected or
incorporated in their plan of care and staff, who felt not being culturally
competent about caring for culturally diverse clients.  The discussion with leadership regarding the
patients’ unsatisfactory HCAHPS (Hospital Consumer Assessment of Healthcare
Providers and Systems), the patient satisfaction survey results also impacted
the project. 



The stakeholders
for the project include clients, who felt their cultural needs are not met and
the staff, who felt not as knowledgeable as they need to in order to provide
the quality care.  Organizational leaders
are also considered as a key stakeholder since the DNP project will impact the
delivery of care, which improves patient experience and staff satisfaction


Organizational Support

Organizational support is critical for the implementation,
the organizational change and the success of the project.   The
sustainability of the DNP project also determined by the support of the
organizational leaders


Please see
attached letter of organizational support.




The practice
change associated with the DNP project is expected to sustain after the
completion of the project.  The practice
change will be sustained by continuing to train the new nurses during
orientation and yearly annual mandatory training online as part of their
competency.  In order to promote
sustainability, a questionnaire will be incorporated into their annual
mandatory exam online as part of their performance evaluation.  All managers will be held accountable for
ascertaining that the staff on their units attends the online training and
completing the questionnaire, which will be updated as needed by the education
and training department.   The
implementation and the sustainability of the DNP project
will be determined by the support of the organizational leaders



Internal Forces (project)

External Forces (Organization or      



of successful practice change
of DOJ recommended practice change

offering to help in anyway they can to implement the project



of support from some leadership
from some staff

enough staff attending the training due to shortage of staff
of funding for overtimes



of staff is a possible threat that could be encountered with this project.  The processes to overcome this risk would include
communicating with the leadership,  educators, unit managers and nursing staff
regarding the project and working with unit managers to schedule an appropriate
number of staff for the training.   Another way to overcome the potential risk is
to have flyers posted in advance in all units informing staff about the
upcoming training (with refreshments served) to motivate staff and to avoid any
unintentional absences.