Evaluating the utility of the FamCHAT ethnocultural nursing assessment tool at a Canadian tertiary care hospital: A pilot study with recommendations for hospital management

Abstract

Objectives: The multicultural nature of Canadian society and the decline in health of immigrants after relocation toCanada prioritizes a commitment to ensure equity in health care access and outcomes. An important feature shaping healthcare access and outcomes is the reception of culturally safe and competent care. Partnering with senior management at atertiary care hospital, this pilot study aimed to investigate whether an identified cultural assessment tool, the FamilyCultural Heritage Assessment Tool (FamCHAT), validated for use in a rural primary care setting, was suitable for use intertiary care. The objectives were to investigate: 1) whether using the FamCHAT enabled the nurses to elicit assessmentinformation from their patients who represent diverse ethnocultural groups, and 2) the nurses’ perspectives on the practicaluse of this form in their clinical practice.

Methods: Nurses purposively selected from the Women’s, Surgery and Medicine units were asked to complete theFamCHAT form with all patients admitted during a three-month period in 2009. Focus group interviews were then held tolearn the nurses’ perspectives related to the form’s constructs and its use in their practice. The data from the completedFamCHAT forms were tabulated and analyzed using descriptive statistics to determine the extent of completion andaccuracy, and the sample characteristics. The interview data was analyzed using qualitative analytical software (ATLAS.tiScientific Software Development, GmbH, Germany) and Roper and Shapira’s framework for analysis of ethnographicdata.

Results: The nurses filled out forty-four FamCHAT forms with patients having a diverse ethnocultural profile. In manyforms, several questions were either left blank or answered incorrectly with regard to the guidance notes containingcategorical answers for the variables of family size and language. Nine nurses participated in two focus groups (n = 4 andn = 5) and one in an individual interview. Five themes emerged from the qualitative data analysis: feasibility of using theFamCHAT in acute care practice; ethnocultural awareness needs of the participating nurses; perspectives of nurses aboutpatient concerns; potential for enhancement to nursing care assessments; and suggestions for enhancing and facilitating anew tool or approach. Nurses participating in the interviews thought that the constructs within FamCHAT could be useful for enhancing nursing assessments in their practice, but thought the tool was too long, was repetitive to some of theircurrent assessment data, and had questions many patients were uncomfortable answering. One option suggested in bothfocus groups was to embed the most useful constructs into existing assessment frameworks. Some of the variables werethought to be of limited relevancy for some nursing specialties.

Conclusions: The findings provided valuable information for the hospital management in their efforts to revise nursingassessment tools. Consideration is being given to integrating some of the constructs into their existing nursing assessment,with recognition that each unit might benefit from different approaches. Other, systematic, approaches to enhancingcultural competency also need to be considered. This study highlights the importance of validating practice tools for use insettings that differ from those used for their original development.