Date of Graduation

Fall 12-17-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


MSN project

First Advisor

Cathy Coleman


Problem: In one perinatal microsystem, an assessment revealed 49 reported events that alleged perceived bias occurred over a one-year period. This project aims to address implicit bias and educational solutions to improve communication and create a culture of humility and equity.

Context: The setting was an urban hospital within a large non-profit healthcare organization. The improvement team included registered nurse champions, obstetrical technicians, midwives, physicians, managers, and an educator.

Intervention: A virtual interactive education session for a multidisciplinary volunteer group (n=18) was introduced followed by five weekly follow-up discussions. The education focused on translating the cultural humility theory (Foronda, 2020) into clinical practice. Two tools were integrated into the education sessions: 1. the 5 R’s (reflection, respect, regard, relevance, and resiliency) and 2. the Quick Coherence technique (Buchanan & Reilly, 2019).

Measures: One primary outcome measure was defined as the percentage of participants (n=18) who completed both the pre and post cultural humility scale. The target was defined as 80% completion. The second outcome measure calculated the number of healthcare team members (n=18) who increased their ability to perform the Quick Coherence technique. The target was defined as 80% and measured via self-reports. Three process measures included 1. Percentage of learning needs assessments completed (n=18; target=80%); 2. Percentage of volunteers (n=18; target=80%) who completed initial education session; 3. Percentage of volunteers (n=18; target=65%) who completed all 6 education sessions. Two balancing measures were included and monitored: 1. the number of escalation events (target=weeks); 2. Percentage rate of weekly participant dropouts.

Results: The primary outcome resulted in 100% completion of both the pre and post cultural humility scale (n=18). The scores on the Cultural Humility Scale (Foronda et al., 2021) for three factors were relevant in the post education survey. Factor 1 (difference in perspective) indicated an increase in awareness of the different factors that may impact a shift in perspective. Compared to the pre-survey, Factor 2 (self-attributes) showed a decrease in three of four items reflecting the degree of flexibility, openness, and awareness related to cultural humility. Factor 3 (knowledge of cultural humility) scores increased in all 7 items concerning knowledge of cultural humility and beneficial teaching efforts. The second outcome measure resulted in 72% of team members who performed the Quick Coherence technique during the 6-week project. Results of process measures indicated 80% completion of learning needs assessment and 65% participant completion of 6 education sessions. Balancing measures indicated 2 escalation events over the 6-week project and a 50% dropout rate.

Conclusion: A structured evidence-based tool such as the Foronda Cultural Humility scale is strongly recommended for integration into interdisciplinary team development and education initiatives across systems. This Cultural Humility and Mindfulness practice quality improvement project demonstrated promising results despite the competing priorities related to a global pandemic. Nurse leaders need to provide caregivers with tools to evaluate their own biases and to communicate more effectively to improve patient interactions and outcomes.