Observed and personally experienced discrimination: findings of a cross-sectional survey of physicians and nursing staff

Background: Discrimination against hospital staff based on ascribed features is prevalent in healthcare systems worldwide. Detrimental effects on health and quality of patient care have been shown. Our study aims to describe and analyse the discrimination experiences of both physicians and nurses, specifically for the German hospital context. Methods: A cross-sectional online survey on observed and personally experienced discrimination at work addressed staff from 22 hospitals of two organizations in Germany. Sociodemographic and occupational as well as institutional characteristics served as independent variables. In multivariable analyses, block- and stepwise logistic regressions were calculated for the two dependent variables (witness and victim of discrimination). Sensitivity analyses with imputed data for missings were performed. Results: N = 800 healthcare professionals (n = 243 physicians, n = 557 nurses; response rate: 5.9%) participated in the survey. 305 respondents (38.1%) were witnesses of discrimination, while 108 respondents (13.5%) were victims of discrimination in their wards. Reasons for observed discriminatory acts were predominantly attributed to the ethnicity of the person concerned, their appearance and language, whereas personally affected staff most frequently cited gender as a reason, followed by ethnicity, and physical appearance. In multivariable models, cultural competence significantly increased the likelihood of witnessing discrimination (beta = .575; p = .037). In terms of the likelihood of being a victim of discrimination, in addition to cultural competence (beta = 2.838; p = < .001), the interaction of the effects of gender and professional group was statistically significant (beta = .280; p = .010). Conclusions: Given the extent of experienced and observed discrimination, appropriate institutional responses are needed. Further research on discriminatory structures in the German-speaking health care system should focus on discrimination at the intersection of ethnicity, gender and occupation

Organisational and staff-related effects on cultural competence in the hospital setting: a cross-sectional online survey of nursing and medical staff

Background: Cultural competence is considered a core qualification for dealing with socio-cultural diversity and balancing disparities in health care. Objectives: To explore features supporting and inhibiting cultural competence in the hospital at both organisational and staff levels. Design: Cross-sectional online survey in the form of a full census from May to November 2018. Setting: Two organisations that run a total of 22 hospitals in Germany. Participants: Eight hundred nursing and medical professionals [nurses: n = 557; doctors: n = 243]. Methods: Using the Short Form Cultural Intelligence SCALE (SFCQ), cultural competence was measured and its relation to potential influencing factors at staff level and organisational level examined, using bivariate (t-Test, one-way ANOVA, Pearson and Spearman correlations) and multivariate (multiple linear regression) approaches. Model 1 examined features at organisational level, Model 2 at individual level and Model 3 included organisational and individual features. Results: The mean cultural competence measured was 3.49 [min.: 1.3; max.: 5.0]. In the bivariate and isolated multivariate models [Models 1 and 2], factors on both organisational and individual levels were significantly related to the hospital staff's cultural competence. The multivariate overview [Model 3], however, revealed that individual features at staff level were the statistically relevant predictors. Positive influencing features included staff's assessment of the importance of cultural competence in their professional context [B: 0.368, 95% confidence interval 0.307; 0.429], participation in competence training [B: 0.193; 95% confidence interval 0.112; 0.276] and having a migration background [B: 0.175; 95% confidence interval 0.074; 0.278], while negative features included length of medical service [B: -0.004; 95% confidence interval -0.007; -0.001]. Conclusions: The development and practice of cultural competence appear to be determined less by organisational features and more on the level of individual actors. In addition to staff development, adequate organisational structures and an economic incentive system are required to promote sociocultural diversity in hospitals

Connected Making: Designing for Youth Learning in Online Maker Communities In and Out of Schools

While here is ample research on how youth are connected in online spaces and how youth participate online via sharing and reviewing artifacts, yet less is known about how these social connections and contributions emerge, especially in the context of physical making and what can they contribute to learning and assessment. Thus, our symposium primarily addresses two questions: (1) How do youth connect and learn in online maker communities? and (2) How can we design online maker tools for learning in and out of schools? We share efforts examining how sharing artifacts, documenting design processes, and providing feedback via online tools can support young makers in creating physical artifacts and offer insights to new assessment models