Title : Fostering team cohesion on multicultural nursing units: Goodtalk workshop builds bridges
Abstract:
Background: Internationally qualified nurses are increasingly seeking to immigrate to the US, which can create more culturally competent care for US patients; however, workplace integration in a unit with many represented cultures can create challenges. Language barriers, cultural differences, and othering/subgroup creation can cause rifts withing a diverse team and create worse outcomes for patients. Our Acute Rehabilitation Unit (ARU) includes over 60 nurses and clinical techs immigrating from 11 different countries with only a small number of staff born in the US. This triggered the unit’s clinical director to seek help addressing common communication and relationship concerns among culturally and linguistically diverse units.
Methods: GoodTalk is a simulation-based communication training designed to improve patient-centered and interprofessional communication. In partnership with the ARU’s leadership, the GoodTalk team developed simulation scenarios based on real unit challenges. A multidisciplinary facilitation team including nurses, patient experience professionals, and former patients led the sessions using a structured format: reflection, didactic teaching of communication frameworks, two-part scenario demonstrations, small-group practice, and debrief. The in-person session allowed for real-time coaching and observation. Pre-session surveys captured demographics and baseline confidence in key communication strategies using 5-point Likert scales. Participants self-rated their confidence in module-specific skills before and after the session. After each scenario, facilitators, actors, and peers evaluated learners’ use of target skills using a standardized 1–5 scale. Course evaluations included open-ended feedback; narrative data from debriefs and written evaluations informed future sessions and ongoing team coaching.
Results: Fifty staff members from the ARU participated in one of three workshops offered. Participants endorsed positive change for all target viewpoints, including feeling “empowered to provide feedback” (pre-test mean 4.18, post-test mean 4.85 [p<0.001]), “comfortable supporting teammates when they need help” (pre 4.62, post 4.88 [p=0.01]), “strong relationship with coworkers” (4.26, 4.84 [p<0.001]), and “my coworkers are interested in my unique perspective and culture” (4.19, 7.8, [p<0.001]). Participants were particularly engaged in the small group discussions managed by trained facilitators, universally describing the exercises as “psychologically safe,” leading them to feel “comfortable sharing their unique perspectives,” and that their team members were “open to learn new ways to support their colleagues.” Typical feedback included, “This is going to help me have good relationships with my team,” and “This was a great session that included real life scenarios and an excellent exchange of ideas.” Importantly, many participants noted that, “I learned when to avoid using my native language at work, and how to avoid gossip.”
Conclusion: Differences in culture and language can hinder a nurse’s self-perceived ability to speak up or be heard by others. However, nursing management can empower nurses to overcome these barriers and build confidence with interactive programming staffed by skilled facilitators. Creating a welcoming, open environment enables discussion about difficult workplace experiences can improve interprofessional communication and team cohesion.
