The impact of service–learning on students' cultural competence

A service-learning framework to address accreditation standards: Self-Assessment, communication skills, health literacy, and cultural competence

OBJECTIVES

Pre-doctoral dental programs must provide opportunities for students to become proficient in self-assessment, communication skills, health literacy, and cultural competence, essential for independent unsupervised practice. This study aimed to assess how student learning through a classroom education service-learning program addresses the Commission on Dental Accreditation (CODA) standards 2-11 and 2-17; specifically through the examination of self-assessment, communication skills, health literacy, and cultural competence.

METHODS

This 2022 retrospective mixed methods cohort study examined unstructured faculty comments on drafted lesson plans and structured evaluations of classroom education service-learning rehearsal sessions. A random sample of faculty comments from three academic years, 2018, 2019, and 2020, were deidentified and analyzed by five researchers for emerging themes using NVivo. Quantitative data from rehearsal presentations were analyzed with descriptive statistics to assess the concordance of self and faculty feedback on specific evaluation criteria.

RESULTS

Six major themes from faculty lesson plan feedback emerged: knowledge, professionalism, communication, presentation skills, cultural competence, and program logistics. Concordance between faculty feedback and student self-assessment ranged from 83% to 92.4% across all evaluation criteria over the 3 years: spoke clearly and confidently at the right pace, provided accurate dental terminology and facts, used grade-appropriate language, provided clear instructions to follow, appeared enthusiastic throughout the rehearsal presentation, and designed a well thought out lesson plan that will engage children for the entire presentation.

CONCLUSION

Findings support the classroom education service-learning program as a framework to provide opportunities for student self-assessment and feedback on communication skills, health literacy, and cultural competence aligned with CODA standards 2-11 and 2-17.

"A life-changing experience and the beginning of a lifelong commitment": experiences and impact of Global Health Community Service-Learning in undergraduate dental curriculum in Canada

BACKGROUND

Global Health Community Service-Learning (GHCSL) can have a profound professional and personal impact on learners. This pedagogy provides understanding of unfamiliar environments and challenges learners to step out of their comfort zones, adapt to new cultures, and navigate unique situations. Yet, there are relatively few studies exploring the experiences of learners participating in community service-learning placements in global regions as part of undergraduate dental curriculum. This study aimed to explore the experiences and impact of the GHCSL program in East Africa among undergraduate dental learners at the Schulich School of Dentistry.

METHODS

Eight undergraduate dental learners were enrolled in GHCSL pilot placements. Placement agreements were established with Makerere University in Kampala, Uganda, and the University of Rwanda in Kigali, Rwanda for the summer of 2022. Stakeholders from both institutions were engaged in the development and implementation of these placements. Learners were required to engage in weekly reflection through a 'storytelling and incident-based narrative' while carrying out their placement. A qualitative study design was employed, and an inductive interpretive approach was utilized to thematically analyze the learners' reflective essays.

RESULTS

Five major themes emerged from the learners' reflective essays: (1) experiential clinical learning; (2) cultural humility and social awareness; (3) awareness of contrasting healthcare systems; (4) commitment to service; and (5) personal and professional growth. Most learners reflected on their engagement with diverse communities, being exposed to unique patient cases, and witnessing the adaptability exuded in resource-constrained environments. These experiences presented the learners with an opportunity to develop cultural humility and gain a newfound motivation to mitigate global oral health disparities in populations beyond that of their local communities. Learners also reflected on enhanced social awareness experiences and the awareness of contrasting healthcare systems in Canada and their placements, which encouraged the development of empathy, communication, and compassion skills, as well as an understanding of the disproportionate burden of conditions in low-resource settings.

CONCLUSION

The reflective essays concluded that the GHCSL placements had a positive impact on the learners, encouraging many to develop a heightened desire for lifelong learning to address oral health disparities within a global context.

Linking Immigrants with Nutrition Knowledge (Project LINK): An Innovative Approach to Improve Cultural Competence in Dietetic Education

Linking Immigrants with Nutrition Knowledge (Project LINK) was a service-learning cultural competence training programme completed by undergraduate dietetic students enrolled in the University of Saskatchewan's (USASK) nutrition and dietetic programme.This paper evaluates the impact of participation in the programme on students' cultural competence. We conducted a cross-sectional survey and qualitative analysis of reflective essays of 107 participants of Project LINK from 2011 to 2014. Cumulative logistic regression models assessed the impact of the intervention on students' cultural competencies. The Akaike information criterion compared models and Spearman correlation coefficient identified possible correlation among pre- and post-intervention data points. Student reflective essays were analyzed by inductive thematic analysis.All cultural competencies improved comparing pre- and post-participation in Project LINK. Odds of increasing one level of student knowledge were 110 times of that prior to Project LINK. Comparing student competencies before and after Project LINK, the odds of increasing one level of students' skills were six times greater, five times greater for increasing one level of students' ability to interact or encounter, and 2.8 times greater for increasing one level of students' attitude.The results of this study indicate Project LINK has successfully increased cultural competence and underscores the importance of combining opportunities for practical experience in addition to classroom-based training on cultural competence.

The Effects of the Situated Simulation Program on the Cultural Competence of Hemodialysis Nurses: A Quasi-Experimental Study

The rise in the number of hemodialysis (HD) patients underscores the importance of culturally competent HD nurses. This study aimed to examine the effectiveness of a situated simulation program on HD nurses' cultural competence. This was a quasi-experimental pilot study with a total of 40 participants who met the inclusion criteria from an HD center in northern Taiwan. Participants took part in two separate 3 h education programs. The first program focused on the basic concepts of cultural competence, while the second program involved situated simulations utilizing the Gather-Analyze-Summarize (GAS) method of debriefing. The generalized estimating equations (GEEs) were employed to estimate the intervention effect. The baseline scores were divided into low-score and high-score groups using the median score for subgroup analysis. The subgroup analysis revealed that a significant group-time interaction was identified regarding cultural competence and subscale, verifying the situated simulation's immediate effect. In this study, an integration of the GAS method of debriefing and situated simulation teaching was implemented. The results showed that this approach empowered HD nurses with the ability to foster positive attitudes and demonstrate professional expertise in an organized manner when facing similar clinical scenarios in the future.

Social justice in nursing education: A review of the literature

BACKGROUND

Social justice is a cornerstone of nursing because nurses have responsibilities for providing equal and fair care for people from all background. Social justice as nursing imperative is clearly recognised by some professional nursing organisations, but not so by others.

AIM AND OBJECTIVES

The aim of this review was to establish the current state of the literature on social justice and nursing education. The objectives included to understand the meaning of social justice for the nursing profession, assess the visibility of social justice learning in nursing education, and explore frameworks for integrating social justice learning in nursing education.

METHODS

The SPICE framework was applied to identify the phrases social justice and nursing education. Inclusion and exclusion criteria were used to search the EBSCOhost database, set email alerts on three databases, and search the grey literature. Eighteen literatures were identified for evaluation of predetermined themes on meaning of social justice, visibility of social justice learning, and frameworks for social justice nursing education.

FINDINGS

Firstly, the meaning of social justice relates to general theories rather than practical issues in nursing. Secondly, social justice is embraced as an imperative in nursing profession. Lastly, critical pedagogies can support social justice learning in nursing education.

DISCUSSION

There is consensus on need for social justice issues to be incorporated in nursing education. This would create paths for nurses to engage in actions that change health inequalities.

CONCLUSION

Nursing organisations embrace social justice as nursing imperative in different ways. It is important to explore how this imperative is upheld by nursing professional organisations and education institutions.

Educational effects of community service-learning involving older adults in nursing education: An integrative review

BACKGROUND

Community service-learning is a structured experiential learning approach in which students engage in service activities in response to identified community need(s). Service-learning programmes are developed to promote understanding of societal issues and facilitates critical learning for the learners, with emphasis on learning through reflection.

OBJECTIVES

To synthesize findings from published and grey literature related to the educational effects of community service-learning involving older adults in nursing education and evaluate the quality of existing service-learning programmes.

DESIGN

Integrative review following Whittemore and Knafl's framework to analyse and synthesize a broader range of evidence.

DATA SOURCES

Six databases (PubMed, ScienceDirect, CINAHL, PsycINFO, ERIC and ProQuest) were systematically searched from inception until 30 July 2021. Reference lists of relevant studies and reviews were also assessed for eligible studies. We also searched for grey literature and dissertations in ProQuest and Google Scholar.

REVIEW METHODS

The 5-step method was used: problem identification, literature search, data evaluation, analysis, and presentation. Included studies were appraised using the Mixed Methods Appraisal Tool checklist. Service-learning programmes were evaluated using the Service-Learning Quality Assessment Tool.

RESULTS

A total of 21 studies were included. Educational benefits of service-learning in the three domains of learning (cognitive, affective and psychomotor) were identified. Nine service-learning programmes achieved adequate quality and implementation of service-learning principles, while 12 exhibited emergent quality and implementation.

CONCLUSIONS

Service-learning provides various benefits in nursing education. Existing empirical studies do not always follow established service-learning principles, and the quality of evidence is considered low. Future studies should use more rigorous methodologies and improve the reporting of research.

Transversal Competences and Employability of University Students: Converging towards Service-Learning

We are living in times of great transformations within the field of education and the labor market. These changes are connected and have to do with an expanded knowledge society, whose implications reach the levels of employability in times of uncertainty. Within this framework, the main purpose of our study is to perform a theoretical analysis and an empirical approach to the influence that transversal competences (soft skills) may have on the degree of employability of university students. We have identified some of those competences and we have tested them with a sample of 83 employers and 1249 students using a Likert scale. Our results show the interest of employers in the mastery of transversal competences and inequalities in terms of students’ perception thereof. We did not find any significant differences between students starting their degree and those who were about to complete it. However, we did find differences between the students who participated in experiential activities and those who did not, in favor of the former. Due to the importance of experiential learning in our results, we dedicate our discussion to theoretically exploring whether the pedagogical approach of Service-Learning (SL) might contribute to a better connection between transversal competences and employability.

Open-mindedness trait affects the development of intercultural communication competence in short-term overseas study programs: a mixed-method exploration

BACKGROUND

Overseas study trips can enhance healthcare students' intercultural communication competence. An opportunity to immerse in the new culture enables them to develop their ability to offer services to people from different countries. However, the role that open-mindedness (i.e., a personality trait) can play in this process has not been explored.

METHODS

The present study adopted a mixed-method design to identify how open-mindedness trait affected this overseas learning process. Thirty-two undergraduate healthcare students in Australia took part in the study. Questionnaires, which measured socio-demographic information, intercultural communication competence and open-mindedness trait were administered to the participants before and after their overseas trip. Half of the participants (n = 16) were interviewed after the overseas trip.

RESULTS

The correlational analysis showed that the open-mindedness trait was correlated with cultural skills, a component of intercultural communication competence, but not significant with the other three components. Three themes emerging from the qualitative data indicated that the open-mindedness trait affected students' cultural exposure. This trait enabled participants to be actively involved in the immersion in the local culture. They were willing to learn from peer fellows, and keen to embrace novel challenges.

CONCLUSION

It is concluded that open-mindedness trait is vital for increasing cultural immersion, and hence promote intercultural communication skills.

Development and Evaluation of Cultural Competence Course on Undergraduate Nursing Students in Vietnam

Cultural competence is a crucial requirement of nursing to promote caring for patients with diverse backgrounds. The purpose of this study was to develop a cultural competence course and to evaluate the effects of the course on undergraduate nursing students in Vietnam. A concurrent triangulation mixed-methods study was adopted using quantitative and qualitative data sources. Sixty-six nursing students were recruited for the following groups: cultural competence course with field experience (n = 22), stand-alone cultural competence course (n = 22), and a control group (n = 22). The findings indicated that significant group by time interactions in total cultural competence score (F = 66.73, p < 0.001) were found. Participants’ perceptions reflected on three categories: (a) journey to cultural competence, (b) satisfaction of cultural competence course, and (c) suggestions for improvements. No statistically significant differences between the two experimental groups were revealed, but “obtaining cultural experiences” and “expanding understanding of cultural competence through field experience” were immersed from participants having field experience. It is vital to expand cultural competency education into nursing curricula to enhance nursing students’ perspective of culturally competent care.

Addressing diversity, equity and inclusion (DEI) through service learning in management education: insights from India

Purpose

The paper makes an endeavour to explore the efficacy of service learning (SL) pedagogy in inculcating the value of diversity, equity and inclusion (DEI) with a focus on management education in India.

Design/methodology/approach

The research methodology comprises a systematic survey of select relevant literature on SL and applying a novel approach to bring out certain key traits of SL initiatives. The paper also tries to decipher how the identified key traits could be regarded as contributing to the ethos of DEI among the learners. Based on insights from the systematic literature review and identified research gaps, an in-depth study of three SL initiatives in India, have been undertaken to demonstrate how implementation of the SL pedagogy in management education creates an impact on the attributes of DEI and inculcates an inclusive mindset.

Findings

Although the design, process and learning outcomes of SL pedagogy varies depending on the context, there is commonality in the core attributes that emerges from the literature review which has a potential impact on inculcation of the values of inclusion and appreciation of diversity. The select case studies successfully expand on the list of these identified relevant attributes. The findings have also been corroborated by participants' reflection.

Research limitations/implications

The paper is, however, limited in its scope of assessing the impact in creating an inclusive mindset. To gauge whether such impact is pervasive and persists in the long run, one needs to examine if these values are carried forward by the participants in their professional and daily life. It would, therefore, be more meaningful to carry out a primary survey of the participants, who took part in such SL initiatives, to understand whether the values have really been assimilated in the real life. This is outside the scope of this paper but does open the scope for further research.

Practical implications

The paper would be highly relevant for the accreditation agencies who are increasingly prescribing the role that business schools can and should play towards inculcating the ethos of diversity and inclusion among future business leaders and managers. For the administrators of business schools and other higher education institutions who may be considering how to incorporate the ethos of diversity and inclusion in the curriculum and pedagogy, the paper will provide some direction through the SL route. The detailed exposition of the three SL initiatives will enlighten the administrators or the faculty responsible for designing and delivering any SL programme in other business schools or higher educational institutions as to how to go about developing and delivering such an initiative. To the extent such SL initiatives succeed in leaving a lasting impact on the participants regarding ethos of inclusion and diversity, the business implications in the long run could be immense.

Social implications

The purpose of the paper by itself establishes its social relevance. The very fact that the paper is focused on SL initiatives that involve social problem-solving approaches through hands-on working on social projects and working with communities the social implications are rather obvious.

Originality/value

Given the paucity of information and analysis on potential fit of SL for fostering DEI especially in developing countries, the present paper contributes to the existing body of literature and aptly fills the void. It builds a theoretical construct relating SL with the traits of DEI and then bridges theory and practice by demonstrating the efficacy of three SL programmes in Indian context to internalise the elements of DEI.

Validation of the first peoples cultural capability measurement tool with undergraduate health students: A descriptive cohort study

BACKGROUND

Health professional graduates require the capacity to work safely, both clinically and culturally, when delivering care to Indigenous peoples worldwide. In the Australian context, the Aboriginal and Torres Strait Islander Health Curriculum Framework (The Framework) provides guidance for health professional programs to integrate, teach and assess Aboriginal and Torres Strait Islander peoples' (First Peoples) health content. There is, however, a lack of validated tools that measure the development of students' cultural capabilities.

OBJECTIVES

To validate the Cultural Capability Measurement Tool with a cohort of health professional students.

DESIGN

A descriptive cohort design was used.

SETTING AND PARTICIPANTS

All students (N = 753) enrolled in a discrete First Peoples Health course at an Australian university were invited to complete the Cultural Capability Measurement Tool.

METHODS

The tool was tested for reliability, content and construct validity using confirmatory factor analysis; and concurrent validity using and the Cultural Understanding Self-Assessment Tool.

RESULTS

A sample of 418 (73% response rate) was recruited. Most participants were enrolled in the Bachelor of Nursing program (n = 369, 82%). The Cultural Capability Measurement Tool had a Cronbach's alpha coefficient of 0.86. A five-factor solution was confirmed which reflected the cultural capability domains and accounted for 51% of the variance. Scores correlated with students' cultural understanding (r = 0.28, p < 0.001).

CONCLUSIONS

Successful implementation of The Framework requires instruments to measure changes in students' cultural capabilities. Measuring nursing students' cultural capabilities can inform their development, identify areas of strengths and deficits for educators, and will ultimately contribute to the development of a culturally safe nursing workforce.

The Cultural Competence of Graduating Nursing Students

Purpose: Cultural competence is an essential component in nursing. The purpose of this study was to evaluate the level of cultural competence of graduating nursing students, to identify associated background factors to cultural competence, and furthermore to establish whether teaching multicultural nursing was implemented in nursing education. Design: A structured Cultural Competence Assessment Tool was used in a correlational design with a sample of 295 nursing students in southern Finland. Findings and Conclusions: The level of cultural competence was moderate, and the majority of students had studied multicultural nursing. Minority background ( p = .001), frequency of interacting with different cultures ( p = .002), linguistic skills ( p = .002), and exchange studies ( p = .024) were positively associated to higher cultural competence. Implications for Practice: To improve cultural competence in students, nursing education should provide continuous opportunities for students to interact with different cultures, develop linguistic skills, and provide possibilities for internationalization both at home and abroad.

Culture and Cultural Competence in Nursing Education and Practice: The State of the Art

PROBLEM

The concept of cultural competency has developed a substantial presence in nursing education and practice since first attracting widespread attention in the 1990s. While several theories and corresponding measures of cultural competency have been advanced and tried, much work remains, as many nursing professionals continue to call for greater evidence-based research and attention to patient perspectives and outcomes.

METHODS

Using a method provided by Hawker et al. to appraise articles, this paper compares nine recent (2008-2013) studies (including two composite studies) related to cultural competency, undergraduate curricula, and teaching strategies in nursing to assess the state of the art in this important area of care.

FINDINGS

The studies applied phenomenological, study abroad, online, and service learning strategies, four of which relied on some version of Campinha-Bacote's IAPCC© model. These studies reported a general improvement in competency among students, though generally only to a level of cultural awareness, and admitted being constrained by several common limitations.

CONCLUSION

Improved results and more realistic expectations in this area may require a closer understanding of the nature of the "culture" that underlies cultural competence. Harkess Kaddoura.

Cultural competence course for nursing students in Taiwan: A longitudinal study

BACKGROUND

Culturally competent care is an essential ability for nursing students. However, little is known about the effects of educational intervention on attitudes or behavior changes with regard to cultural competence in Taiwan.

PURPOSE

This study evaluates the effects of a cultural competence course for nursing students.

METHODS

Using a longitudinal study design, 105 participants were assigned to an experiment group (51 participants) and control group (54 participants) based on the school they attended. Students in the experiment group received a two-credit course on cultural competence care. Using the Cultural Competence Assessment Instrument-Chinese Version (CCA-CV), data were collected between 2012 and 2013 at three points in time: before and after the course and again 6 to 8 months after the two groups (experiment and control) had completed the clinical practicum.

RESULTS

The results of a generalized estimating equation (GEE) analysis indicate that the cultural competence of all participants had improved at the posttest assessment, with the experiment group showing a significantly better improvement over the control group. However, the overall effectiveness of the training diminished with time. This study supports that taking a cultural competence course effectively enhances the cultural competence of nursing students for a limited period of time immediately following the course.

CONCLUSIONS AND APPLICATIONS

These results support that the benefits of incorporating a cultural competence course in clinical practice should be considered in the future. Furthermore, healthcare institutions should be encouraged to provide greater support and consideration to cultural competence issues in the nursing workplace in order to reinforce and extend the benefits of cultural competence courses provided at nursing schools.

A meta-analysis of educational interventions designed to enhance cultural competence in professional nurses and nursing students

OBJECTIVES

Increasing professional nurses' and nursing students cultural competence has been identified as one way to decrease the disparity of care for vulnerable and minority groups, but effectiveness of training programs to increase competence remains equivocal. The purpose of this project is to synthesize educational interventions designed to increase cultural competence in professional nurses and nursing students.

DESIGN

A systematic review and meta-analysis was conducted to synthesize all existing studies on increasing cultural competence.

DATA SOURCES

A comprehensive search and screen procedures was conducted to locate all cultural competence interventions implemented with professional nurses and nursing students.

REVIEW METHODS

Two independent researchers screened and coded the included studies. Effect sizes were calculated for each study and a random-effects meta-analysis was conducted.

RESULTS

A total of 25 studies were included in the review. Two independent syntheses were conducted given the disparate nature of the effect size metrics. For the synthesis of treatment-control designed studies, the results revealed a non-statistically significant increase in cultural competence (g¯=.38, 95% CI: -.05, .79, p=.08). Moderator analyses indicated significant variation as a function of the measurements, participant types, and funding source. The pretest-posttest effect size synthesis revealed a significant increase in overall cultural competence (g¯=.45, 95% CI: .24, .66, p<.01). Moderator analyses indicated, however, that the effect sizes varied as functions of the measurement, funding source, and publication type.

CONCLUSIONS

Interventions to increase cultural competence have shown varied effectiveness. Greater research is required to improve these interventions and promote cultural competence.

Knowing Self and Caring Through Service Learning

Professional caring is the essence of nursing practice. Reflection on personal assumptions and beliefs challenge stereotypic views that influence professional caring and nursing care. An innovative educational pedagogy known as service learning creates an opportunity for students to reflect on self in the context of service to others; it is through this pedagogy that personal assumptions and beliefs are challenged as students become registered nurses.A qualitative descriptive study engaged undergraduate first and second year nursing students through interviews and reflections. The purposes of this study were to describe students’ perception of self and caring in service learning, any changes in the perceptions of self over time, and the connection of self to others. Results identified three major themes: understanding self, becoming a nurse and learning to care with increasing depth over the two years. Implications for nursing curriculum and further research are discussed.