"Cultural awareness requires more than theoretical education" - Nursing students' experiences

Nursing students' internationalization: Virtual exchange and clinical simulation impact cultural intelligence

BACKGROUND

There is a need for globally competent nurses; however, some cannot train abroad. Internationalization at home strategies seek to teach intercultural and international competencies to all students, regardless of location.

PURPOSE

This study evaluated the impact of a virtual exchange and clinical simulation program on nursing students' cultural intelligence.

METHODS

The Global Nursing Care (GNC) program was designed to improve nursing students' global competencies, particularly cultural intelligence. It was implemented in two universities in Spain and the USA. A quasi-experimental, analytic, and longitudinal study involved 261 nursing students, 57 from the GNC program and 204 in the control group. Sociodemographic data were collected, and the Cultural Intelligence Scale was used to measure cultural intelligence.

DISCUSSION

All cultural intelligence dimensions were augmented following program participation. Moreover, students who participated in the program presented higher cultural intelligence than the control group.

CONCLUSION

The results suggest that program participation was associated with a statistically significant gain in nursing students' cultural intelligence.

Multicultural personality profiles and nursing student attitudes towards refugee healthcare workers: A national, multi-institutional cross-sectional study

BACKGROUND

Multicultural organizations in the era of globalization require intercultural leadership skills. Healthcare, as a sector serving diverse populations, necessitates culturally sensitive staff. Intercultural nurse education should start in undergraduate education. A tailored approach is needed, especially in the context of Poland's refugee crisis.

OBJECTIVE

To investigate how a multicultural personality profile and specific intercultural perspectives affect the attitudes of nursing students towards Ukrainian refugee background healthcare professionals.

DESIGN

A nationwide cross-sectional multicentre online survey study was conducted. The questionnaire was distributed with the aid of the Lime Survey web platform.

METHODS

The study utilized a Polish version of the Multicultural Personality Questionnaire. The questionnaire also included demographics and questions assessing intercultural competence and attitudes towards refugee medical professionals. K-Means Cluster Analysis was used to classify different patterns of multicultural personality. P-value <0.05 was deemed to be statistically significant.

PARTICIPANTS

The study sample consisted of 1325 undergraduate nursing students from 39 nursing schools in Poland: 54.0% in first year, 28.7% in second year, and 17.3% in third year. Most respondents were female (N = 1229, 90%).

RESULTS

Using cluster analysis respondents were categorized into four groups based on their level of three analyzed multicultural personality traits: cultural empathy, social initiative, and open-mindedness (high, low, average or mixed level). Statistical analysis demonstrated that personality profiles significantly affected nursing students' attitudes towards refugee health professionals (p = 0.003). Additionally, students' willingness to engage in intercultural communication classes and their belief in the learnability of intercultural competence also impacted their attitudes (p < 0.001 for both). Further analysis revealed correlations between personality profiles, belief in competency acquisition, and willingness to enhance competencies.

CONCLUSION

The design of intercultural competence education for undergraduate nursing students should be preceded by a mapping of the students' personality profile and a needs analysis in this regard, which may contribute to long-term effectiveness of such initiatives.

The Effects of Reverse-Role Simulation on Nursing Students' Ethnocultural Empathy: A Quantitative Study

AIM

The aim of this study was to examine the impact of reverse-role simulation on nursing students' empathy levels toward ethnoculturally diverse patients.

BACKGROUND

Empathy is an essential component of culturally competent care; however, it is often left out of cultural competence education. Enhancing nursing students' cultural empathy may benefit students and patients.

METHOD

The study used a quasi-experimental one-group pretest-posttest design in a private nursing school in the Northeast. The sample consisted of 37 undergraduate nursing students.

RESULTS

Pretest and posttest scores were statistically different, indicating a significant increase in the students' ethnocultural empathy, t (36) = -3.20, p = .003.

CONCLUSION

This study supports using reverse-role simulation as an effective teaching strategy to enhance nursing students' empathy toward ethnocultural diverse patients. Placing students in the "shoes" of an ethnoculturally diverse patient can increase their empathy levels and enhance cultural competence education.

Developing the better and effective nursing education for improving transcultural nursing skills cultural competence and cultural sensitivity assessment tool (BENEFITS-CCCSAT)

BACKGROUND

A clear need for the development of new comprehensive, reliable, sensitive and valid measurement tools to adequately asses the cultural competence and cultural sensitivity of nursing students exists. This study aimed to develop a new measurement tool to assess the nursing students' cultural competence and sensitivity.

METHODS

This cross-sectional, instrument development study's first phase included postgraduate nursing students (n = 60) for the piloting study, and the second one included undergraduate nursing students (n = 459) for the main survey. This study used two data collection forms: The Student Descriptive Information Form and the Better and Effective Nursing Education for Improving Transcultural Nursing Skills Cultural Competence and Cultural Sensitivity Assessment Tool (BENEFITS-CCCSAT) draft. The content validity index was calculated using the Davis method. Cronbach's α coefficient and the item total correlation were calculated during the reliability analysis. The Kaiser-Meyer-Olkin (KMO) coefficient test, Bartlett significance test, and explanatory factor analysis (EFA) were used to evaluate the validity of the assessment tool.

RESULTS

Scale validity and reliability analyses showed that the BENEFITS-CCCSAT included 26 items and five sub-dimensions: respect for cultural diversity; culturally sensitive communication; achieving cultural competence; challenges and barriers in providing culturally competent care; and perceived meaning of cultural care.

CONCLUSION

The BENEFITS-CCCSAT appears to be a valid and reliable instrument for measuring the cultural sensitivity and cultural competence of nursing students. This can be of great use, especially before attending clinical areas, and can offer both students and faculty reliable information to promote reflective and critical thinking, especially in areas where improvement is needed.

Exploring the education in cultural competence and transcultural care in Spanish for nurses and future nurses: a scoping review and gap analysis

BACKGROUND

Globalization and population migration have led to increasingly culturally diverse societies, which has made nursing education in cultural competence and transcultural care a priority. This includes the ability to provide person-centered and culturally congruent care, even within one's own culture. However, this sort of training has been developed and implemented in practice comparatively more by English-speaking societies. Therefore, the aim of this study was to identify the existing educational initiatives for nurses and future ones in cultural competence and transcultural care in Spanish and explore their didactic characteristics in terms of teaching and learning formats, contents, skills, and evaluation methods at different academic levels.

METHODS

A scoping review was carried out by following the specific PRISMA recommendations and those of the Joanna Briggs Institute guidance throughout PudMed, Web of Science, Embase, Google Scholar, and Cinahl databases and also gray literature in the form of official documentation that later was complemented with a gap analysis including training programs published by Spanish and Latin-American educational institutions and the approaches of key academic informants.

RESULTS

The published evidence on nursing training in cultural competence or related topics in Spanish-speaking higher education for nurses is limited. Specific nursing programs in Spanish-speaking universities are primarily found in Spain, with fewer options available in Latin America. These contents are offered either as optional subjects or immersed in other courses and mainly taught in theoretical sessions. Practice in real contexts is supposed to be evaluated transversally under the cultural scope according to national educational recommendations though barely visible in students' evaluation reports. Even though postgraduate training dedicated to these issues exists, it is still limited, mixed with other contents, and generally depends on a few researchers investigating and publishing on the topic from very specific universities.

CONCLUSIONS

It is essential to establish a common global strategy including Spanish-speaking countries in nurses' higher education and professional training on topics focused on cultural competence as well as the provision of nurses' social and cultural sensitivity towards their own culture and to define whether those that currently exist are effective. It is also crucial that this training was evaluated in practice in order to achieve enough impact on students, health organizations, and population health.

'Learning by doing', a model for improving the promotion of healthy lifestyles by student nurses

BACKGROUND

'Learning by doing' is a learning model based on performing actions and gaining experience. The 'nursing process' is a systematic, rational method for providing nursing care. During their university education, nursing students need to acquire the ability to promote healthy lifestyles.

OBJECTIVE

To determine the effectiveness of a learning strategy based on learning by doing and grounded in the use of the nursing process, on the lifestyle of nursing students.

METHODS

This quasi-experimental intervention (before-after), performed over 2011-2022, involved 2300 nursing students at a university nursing school in Spain. The risk factors for chronic diseases-being a smoker, being overweight, or having high blood pressure-to which each student was exposed were recorded. Those positive for at least one risk factor selected companion students as 'support nursing students' who became responsible for designing an individualised care plan to reduce the risk(s) faced. To ensure the correct use of the nursing process, teachers approved and monitored the implementation of the care plans. Whether risk-reduction objectives were met was determined three months later.

RESULTS

The students with risk factors largely improved their lifestyles (targets for reducing smoking/body weight were met) with the help of their supporting peers.

CONCLUSIONS

The learning by doing method demonstrated its effectiveness, improving the lifestyle of at-risk students via the use of the nursing process.

Determinants of attitudes towards refugees and intercultural sensitivity of nursing students: A descriptive and correlational study

BACKGROUND

The number of refugees, asylum seekers, and migrants is increasing worldwide. It is crucial to determine attitudes and intercultural sensitivities of nursing students towards refugees and individuals from different cultures. These nursing students will be providing healthcare in the future to these diverse communities.

OBJECTIVES

To determine the attitudes towards refugees and intercultural sensitivity of nursing students and to identify the determinants of these parameters.

DESIGN

The study was conducted with a descriptive and correlational design.

SETTINGS

Nursing departments of two universities in Ankara, Turkey.

PARTICIPANTS

The population of the study consisted of nursing students at two universities (N = 1530). A total of 905 students were included in the study.

METHODS

Data were obtained by a personal information form, the Attitudes Towards Refugees Scale, and the Intercultural Sensitivity Scale. Linear regression analysis was used to analyze the data obtained from the scales.

RESULTS

The participants' mean Attitudes Towards Refugees Scale score was 82.49 ± 16.66 and the Intercultural Sensitivity Scale score was 91.31 ± 11.15. Caring for refugees, intercultural sensitivity, interaction engagement, and respect for cultural differences were associated with attitudes towards refugees. Academic level, income, place of residence, and attitude towards refugees were associated with intercultural sensitivity.

CONCLUSIONS

Most of the nursing students displayed a negative attitude towards refugees, although they presented a high level of intercultural sensitivity. Integration of refugee-related topics into the nursing education curriculum and designing education programs are recommended to increase awareness and positive attitudes, and to improve cultural competence of nursing students.

Testing the Assumptions in the Process of Cultural Competence in the Delivery of Healthcare Services Using Empirical Data, Focusing on Cultural Awareness

INTRODUCTION

Encounters with children of foreign origin call for school nurses' cultural competence during the health visits. This study aimed to investigate the statistical associations between the cultural constructs described by the Process of Cultural Competence in the Delivery of Healthcare Services (PCCDHS) model and whether school nurses' cultural encounters, cultural knowledge, and cultural skill could statistically predict their cultural awareness.

METHODOLOGY

Spearman correlation and hierarchical regression analyses were conducted using cross-sectional secondary data from 816 Swedish school nurses. The cultural constructs in the theoretical description of the PCCDHS model guided the selection and sorting of the items on cultural competence.

RESULTS

The constructs of cultural knowledge, cultural skill, cultural encounters, and cultural awareness were positively correlated with each other. However, becoming culturally aware was not statistically predicted by included cultural constructs (R² = 13.4, p = .06).

DISCUSSION

Despite the interrelations between the investigated cultural constructs of the PCCDHS model, understanding cultural awareness development requires further empirical testing.

Norwegian nursing students' experience during clinical placement in an African country: Communication, relationship building and nursing identity. A qualitative study

AIM

The aim of this study was to gain a deeper understanding of the experience of Norwegian bachelor nursing students during clinical placement in an African country, with a focus on communication, relationship building and nurse identity.

DESIGN

Explorative, qualitative methods were used.

METHODS

The data consisted of individual written reflection notes from 8 students' clinical placement in Africa, and transcripts from one semi-structured focus group interview. The materials were analysed with systematic text condensation.

RESULTS

The students described their experience with the community of practice as challenging and enlightening. They found themselves in contexts where communication and language problems occurred. The students described how important relationships were for their practical training, and how this helped shape their nursing identity.

Looking through racism in the nurse-patient relationship from the lens of culturally congruent care: A scoping review

AIM

This review aimed to identify the nature of racism in the nurse-patient relationship and summarize international research findings about it.

DESIGN

A scoping review of the international literature.

DATA SOURCES

The search process encompassed three main online databases of PubMed (including MEDLINE), Scopus and Embase, from 2009 until 2021.

REVIEW METHODS

The scoping review was informed by the Levac et al.'s framework to map the research phenomenon and summarize current empirical research findings. Also, the review findings were reflected in the three-dimensional puzzle model of culturally congruent care in the discussion section.

RESULTS

The search process led to retrieving 149 articles, of which 10 studies were entered into data analysis and reporting results. They had variations in the research methodology and the context of the nurse-patient relationship. The thematical analysis of the studies' findings led to the development of three categories as follows: bilateral ignition of racism, hidden and manifest consequences of racism and encountering strategies.

CONCLUSION

Racism threatens patients' and nurses' dignity in the healthcare system. There is a need to develop a framework of action based on the principles of culturally congruent care to eradicate racism from the nurse-patient relationship in the globalized context of healthcare.

IMPACT

Racism in the nurse-patient relationship has remained a relatively unexplored area of the nursing literature. It hinders efforts to meet patients' and families' needs and increases their dissatisfaction with nursing care. Also, racism from patients towards nurses causes emotional trauma and enhances job-related stress among nurses. Further research should be conducted on this culturally variant phenomenon. Also, the participation of patients and nurses should be sought to prohibit racism in healthcare settings.

Addressing the effects of transcultural nursing education on nursing students' cultural competence: A systematic review

AIM

This study aimed to synthesize the findings of studies evaluating educational programs providing curricular transcultural nursing education.

BACKGROUNDS

Nursing care education about cultural diversity and experience with taking care of patients from different cultures and special populations are significant factors that could likely influence cultural competence. The effect of transcultural nursing education given to nursing students has been investigated by different researchers and different methods. Addressing the effects of transcultural nursing education on nursing students' cultural awareness, knowledge and attitudes can contribute to future transcultural nursing education activities and the creation of training content.

DESIGN

This study was a methodological systematic review study.

METHODS

Methodological quality was assessed following the PRISMA guidelines. PubMed, Science Direct, APA PsycArticles, OVID, EBSCO, and Web of Science databases were searched from 2010 to 2020. The following keywords were used: "Transcultural nursing", "education", "curriculum", "course", "effectiveness", "cultural competence", "knowledge", "skills", "attitudes", and "nursing students". Studies published in peer-reviewed journals in English using both experimental and quasi-experimental designs were included.

RESULTS

Total of 11 research papers, (n = 1375) nursing students' outputs were included in this review. Cultural competence interventions/programs were provided as part of the core theoretical courses or as elective courses. Different durations and types of teaching methods included debates, discussions, case scenarios, practicums, simulation, international learning projects, experiential learning, storytelling, and traditional teaching lectures. In ten studies, an increase in the level of culture-related competences was reported as statistically significant (p < 0.05).

CONCLUSIONS

Limited studies have generally proven the effectiveness of transcultural nursing education provided to nursing students. Education content, training methods and training periods were not standard in the literature. More comprehensive, valid and reliable measurement tools are needed to evaluate the education provided for nursing students.

The impact of cultural immersion service learning on BSN graduates: A quasi-experimental evaluation

AIM/OBJECTIVE

The cultural immersion service-learning model evaluated in this study sought to facilitate cultural consciousness of culturally congruent nursing care among predominantly White nursing students attending a university that was racially and culturally homogeneous.

BACKGROUND

Evidence supports the use of cultural immersion service learning during undergraduate nursing programs in developing the skills necessary for effective transcultural healthcare; yet, little is known about its impact beyond the semester of the experience.

DESIGN

This project used a quasi-experimental design to determine if transcultural self-efficacy of BSN graduates among five campuses differed.

METHODS

One campus of the five conducted a mandatory cultural immersion service-learning experience during the graduates' junior year. From a population of 94 BSN graduates of which 30 (32%) graduates participated in the cultural immersion service-learning experience, 53 completed the Transcultural Self-Efficacy Tool. Eighteen (34%) of the graduates who participated in the cultural immersion service-learning experience participated in this study.

RESULTS

The transcultural self-efficacy was significantly greater in those graduates who participated in the cultural immersion service-learning experience; yet, no difference was found among graduates of the four campuses not offering the experience.

CONCLUSIONS

The cultural immersion service-learning experience seems to provide nursing students from racially and ethnically homogeneous communities with an experiential learning context which facilitates the development of transcultural self-efficacy.

Upgrading Nursing Students' Foreign Language and Communication Skills: A Qualitative Inquiry of the Afterschool Enhancement Programmes

Learning a foreign language is not easy for many students, particularly for nursing students who need to complete their internships in the hospital. However, motivation always drives them to the foreign language classrooms. The purpose of this study was to understand the motivations and reasons behind why these nursing students decided to study Mandarin Chinese as part of their personal development and enhancement beyond the curriculum. One main question and one sub-research question were written, why would nursing students decide to take Chinese as the tool for foreign language and culture development? What and why are the reasons and motivations for nursing students to take Chinese beyond their curriculum? The qualitative case study method was employed in order to investigate 36 nursing university students in the United Kingdom. The results of this study concluded that nursing students tend to study Chinese due to personal development and career goals. School leaders, department heads, government leaders, policymakers, human resources professionals, vocational trainers, and researchers may take this study as the opportunity to reform their current human resource and education plans to offer foreign language courses to university students, members of the public, learners, and interested parties for both personal development and career enhancements.

Rooting Out White Supremacy and Implementing Antiracism in Nursing Education

Discussing racism is challenging for nurse educators and nursing students, because White privilege and racial inequities are deeply embedded and normalized in our societal structures. Avoiding the topic of racism in nursing education renders White supremacy invisible and serves to perpetuate racial discrimination and disparities in health care. Nursing education has the potential to train both faculty and students to recognize and dismantle oppressive attitudes, structures, and practices that have led to negative health outcomes for patients. Equipping nurse educators with the tools to understand and address White supremacy as well as to educate themselves and their students about antiracist language, self-care, and patient care is an important step toward promoting health and creating an antiracist society.

Nursing Students' Attitudes towards Immigrants' Social Rights

The migrant population has increased in recent years and, as a result, so has cultural diversity. Universities are incorporating specific modules addressing cultural diversity. However, the native population has negative attitudes towards immigrants, as they believe that immigrants receive more social benefits and abuse healthcare services. Nurses may have these attitudes too, which may affect the way they treat patients. The objective of this study was to determine nursing students’ attitudes towards the rights of the migrant population. This is a descriptive ex post facto study using a cross-sectional design, with 821 nursing students in Melilla, Ceuta, and Almeria, Spain. An anonymous questionnaire was used for data collection. Students recognize the same rights for both the immigrant and native populations. More than 80% of the sample upholds the right of undocumented immigrants and their families to access publicly funded healthcare. Attitudes were more positive among students with a Berber background and first-year students. Students approved of the right of immigrants and their families to healthcare and education. The students’ negative attitudes towards the social rights of immigrants need to be addressed with intercultural training to reduce their prejudices as future professionals in a multicultural society.

Enhancing undergraduate nursing curricula to cultivate person-centred care for culturally and linguistically diverse older people

With an ageing global community and widening socio-cultural diversity, nurse educators are increasingly challenged to align responsive undergraduate nursing curricula to rapidly changing healthcare environments. In future-proofing nurse education, educators need to collectively examine ways of interconnecting and developing gerontological and cultural competence within undergraduate curricula. However, there is limited guidance as to how this can be achieved in already compacted curricula. We suggest that this could be achieved by critically examining undergraduate curricula to make explicit how they can be adapted to educate nurses in the provision of culturally competent person-centred care. This approach could help nurse educators adapt student nurse preparation to meet the needs of culturally diverse older people and their families.

Australian and Indian nursing students' skills and attitudes surrounding mental illness: Preparing for a transnational nursing education collaboration

Cultural competence is a viewed as a necessary set of skills within nursing, and there is a need for student support in this area. This is particularly important in mental health care, with two skills considered crucial for providing quality care: therapeutic relationship skills and positive attitudes. With the objective of initiating an educational collaboration between two educational institutions, this study examined Australian and Indian undergraduate nursing student's perceived therapeutic relationship skills and stigma attitudes associated with mental illness. Participants were five hundred and fifty-five (n = 555) undergraduate nursing students from two different universities in Indian and Australia. The modified version of the Scale To Assess Therapeutic Relationship (STAR-C) and the Social Distance Scale (SDS) were both used to examine student's perceived therapeutic relationship skills and stigma attitudes. Australian nursing students indicated lower levels of stigma with lower levels of self-reported therapeutic relationships skills, as compared with the Indian nursing student cohort. However, Indian nursing students indicated higher levels of stigma with higher self-reported therapeutic relationship skills. The results of this study may reflect cultural differences and meanings attached to mental illness.

Nursing students learning to care for refugee patients: a qualitative study†

BACKGROUND

Nursing students should gain cultural knowledge and skills necessary for providing care to all types of patients.

AIM

This study aimed to determine problems faced by nursing students who care for refugee patients.

METHOD

The study used phenomenological qualitative design. The sample comprised 25 nursing students who cared for refugee patients in a clinic. Data were analysed using Colaizzi's seven-step method following focus group interviews.

RESULTS

Two themes were identified for the interviews: (i) language barrier: insufficient care and (ii) students' perspectives on being a refugee. Furthermore, three subthemes were also identified by analysis of the interviews: (i) superficial communication and insufficiency in psychological support, (ii) health problems in difficult living conditions and (iii) unchanged basic human needs and unmet care needs.

CONCLUSIONS

Nursing students find it difficult to care for refugee patients, but nursing education programmes based on culture care improve their knowledge and perceptions and the quality of care they provide to patients from different cultures.

IMPLICATION FOR NURSING AND HEALTH POLICY

In a multicultural society, nursing students must recognize cultural differences. Consequently, a multicultural education programme helps lay the groundwork for successful integration of nursing students in new cultures.

Newly Qualified Nurses' Perception of Their Competency Achievement on Leaving University: A Qualitative Study

Background: After implementing the Tuning Educational Structures in Europe Project, numerous efforts have been made to define, establish, and evaluate nursing competences. The European Federation of Nurses Association played a key role in enacting the nursing competences included in Directive 2013/55/EU. Nevertheless, assessing competences remains elusive, and there is little research into nurses’ perceptions of the competency training provided by their universities. The purpose of the study was to explore the perceptions and experiences of newly qualified nurses about the competences they acquired during their university education. Methods: A qualitative research study was developed in a Spanish university. Twelve semi-structured interviews with newly qualified nurses were conducted, and two focus groups made up of twelve students were carried out in order to triangulate the results. Participants were recruited through email contact. Interviews focused on clinical training, theoretical content, and the reality of healthcare. Data was analyzed thematically. Results: Two main themes emerged: (1) improving theoretical content and (2) rethinking practical lessons and clinical training. A lack of knowledge about mental health, pharmacology, or critical care has been found; in addition, it was highlighted, among others, the need to improve communication skills in difficult and conflictive situations. Conclusions: Considering the participants’ perception of deficiency in some aspects of most of the competences established by the European Federation of Nurses Association, further research has been suggested to include other stakeholders’ views.