Teaching methods and an outcome tool for measuring cultural sensitivity in undergraduate nursing students

Cultural Competence Interventions in European Healthcare: A Scoping Review

Europe is undergoing rapid social change and is distinguished by its cultural superdiversity. Healthcare is facing an increasing need for professionals to adapt to this environment. Thus, the promotion of cultural competence in healthcare has become a priority. However, the training being developed and their suitability for the European context are not well known. The aim of this qualitative study has been to map the scientific literature in order to comprehend the current state of research on this topic. For this purpose, we conducted a systematic scoping review of the empirical publications focused on cultural competence interventions for healthcare professionals in European countries. The search was conducted in eight thematic (PsycINFO, MedLine, and PubPsych) and multidisciplinary databases (Academic Search Ultimate, E-Journals, Scopus, ProQuest, and Web of Science) to identify relevant publications up to 2023. Results were presented qualitatively. Out of the initial 6506 records screened, a total of 63 publications were included. Although the interventions were implemented in 23 different European countries, cultural competence interventions have not been widely adopted in Europe. Significant heterogeneity was observed in the conception and operacionalización of cultural competence models and in the implementation of the interventions. The interventions have mostly aimed at improving healthcare for minority population groups and have focused on the racial and ethnic dimensions of the individual. Future research is needed to contribute to the conceptual development of cultural competence to design programs tailored to European superdiversity. This scoping review has been registered in OSF and is available for consultation.

Investigation of Intercultural Sensitivity and Ethnocentrism Levels of Midwife Candidates in Turkey Sample: A Cross-Sectional Study

INTRODUCTION

As women experience cultural practices during their lifespan, midwives' displaying a culture-specific approach from the school years is of great importance for the quality of care. This study was conducted to determine the intercultural sensitivity and ethnocentrism levels of midwife candidates in Turkey.

METHOD

This cross-sectional study was conducted with 1,616 midwifery students who studied in seven different regions of Turkey in the 2018-2019 academic year. Data were collected through a questionnaire, Intercultural Sensitivity Scale, and Ethnocentrism Scale.

RESULTS

It was determined that the variables such as the region where the midwife candidates grew up and location of the university, their years at school, and having friends from different cultures were effective on their intercultural sensitivity and ethnocentrism levels (p < .05).

DISCUSSION

Consequently, it is concluded that international student exchange programs and culture-sensitive-based care approaches during midwifery education will increase the intercultural sensitivity levels of students and contribute to reducing ethnocentrism levels.

Team Belonging: Integrating Teamwork and Diversity Training Through Emotions

With the worldwide focus shifting toward important questions of what diversity means to society, organizations are attempting to keep up with employees’ needs to feel recognized and belong. Given that traditionally team and diversity trainings are provided separately, with different theoretical backgrounds and goals, they are often misaligned and ineffective. We review 339 empirical articles depicting a team, diversity, or emotional management training to extract themes and determine which methods are most effective. Although research has demonstrated the importance of belonging for providing positive workplace outcomes, we found that the traditional design of these trainings and lack of emotional management prevent a balance between team and diversity goals, preventing belonging. We propose an integrative training with emotional management to help teams foster optimal belonging, where members can unite together through their differences. Accordingly, our themes inform this training model that can inspire future research into more effective training.

Diversity Training Goals, Limitations, and Promise: A Review of the Multidisciplinary Literature

In this review, we utilize a narrative approach to synthesize the multidisciplinary literature on diversity training. In examining hundreds of articles on the topic, we discovered that the literature is amorphous and complex and does not allow us to reach decisive conclusions regarding best practices in diversity training. We note that scholars of diversity training, when testing the efficacy of their approaches, too often use proxy measures for success that are far removed from the types of consequential outcomes that reflect the purported goals of such trainings. We suggest that the enthusiasm for, and monetary investment in, diversity training has outpaced the available evidence that such programs are effective in achieving their goals. We recommend that researchers and practitioners work together for future investigations to propel the science of diversity training forward. We conclude with a roadmap for how to create a more rigorous and relevant science of diversity training. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Determining the effect of an intercultural nursing course on empathic skill and intercultural sensitivity levels: An intervention study

BACKGROUND

Providing culturally sensitive healthcare services requires to command on content and concepts. Moreover, it is essential to train nurses who are sensitive toward cultural values and beliefs and who can provide holistic and individual nursing care in an increasingly diverse population.

OBJECTIVE

This study determined the effect of the Intercultural Nursing Course on the empathic skill and intercultural sensitivity levels of nursing students in Turkey.

DESIGN

This study was an interventional study that adopted a pretest-posttest design with a control group.

PARTICIPANTS

The participants of the study were 165 nursing students from a school of health; these students were completing their fourth year of studies and in the spring term of the 2017-2018 academic year. However, the sample group comprised 113 students who agreed to participate in the study and completely filled out the administered forms. The intervention group consisted of 84 students admitted to Intercultural Nursing Course, whereas the control group consisted of 29 students who were not admitted to Intercultural Nursing Course.

METHODS

Intercultural Nursing Course, one of the elective courses in the fourth grade of the nursing program, was a 14-week course that was conducted through two contact hours per week. Data from both the groups were collected at the beginning and at the end of the course by the researchers using the "Introductory Information Form," the "Empathic Skill Scale", and the "Intercultural Sensitivity Scale". Data were analyzed through descriptive tests, t-test, the Mann-Whitney U test, and the Wilcoxon signed-rank test using statistical package software. In addition, the required approval was procured from the ethics committee of the relevant university and School of Health before the study was conducted.

RESULTS

No significant differences prevailed between the intervention and control groups in terms of total intragroup and intergroup Empathic Skill Scale and Intercultural Sensitivity Scale scores. However, a significant difference (Z = -4.000; p = 0.000) between the pretest and posttest scores was observed in the interaction confidence subdimension of the Intercultural Sensitivity Scale in the intervention group.

CONCLUSION

Although Intercultural Nursing Course did not lead to a significant change in students' empathic skills and cultural sensitivity levels, it enhanced their cultural sensitivity and self-confidence in intercultural communication and ensured maintenance of their empathic skills. Intercultural Nursing Course can thus valuably contribute to the understanding of cultural structure and values of society and to the development of techniques that can provide nursing care accordingly.

[Intercultural Sensitivity of University Students Studying At Health-Related Departments and Some Associated Factors]

Aim

This study was carried out to determine cultural sensitivity levels and affecting factors among the students who were studying at health-related departments.

Method

The study had a cross-sectional design. The universe of the study consisted of 1127 students who were studying at 1^st and 4^th years in nursing department of institute of health sciences, school of physical therapy and rehabilitation and medical faculty of a state university. 523 students who agreed to participate in the study and who were attending school on the day of data collection constituted the sample of the study. The data of the study were collected using a socio-demographic data form and Intercultural Sensitivity Scale. Descriptive statistics were used in data analysis. In addition, t test was used in paired groups, and one-way variance analysis (ANOVA) was used in more than two groups.

Results

The mean score of the students from Intercultural Sensitivity Scale was found to be 3.88±0.64. It was determined that cultural sensitivity was higher among the students who had interaction with people from different cultures, whose opinions about their jobs changed positively during their education, who wanted to attend student exchange programs and who spoke a foreign language (p<0.05).

Conclusion

In this study, the cultural sensitivity level of the students was found to be at a good level. In addition, gender, interaction with people from different cultures, participation in student exchange programs and knowledge of a foreign language were found to have a bearing on cultural sensitivity. Based on these results, the promotion of collaborations which would create opportunities allowing students to interact with individuals from different cultures might be offered. This would support them in the improvement of their language qualifications and would enable participation of more students in student exchange programs abroad.

An Intervention to Improve Cultural Competence in Graduate Nursing Education

Noting the small number of studies on the influence of an entire curriculum on graduate nursing students’ cultural competence, the researchers examined the effect of a curricular intervention using a pretest-posttest design. The study, conducted from 2012 to 2014, focused solely on the Doctor of Nursing Practice program at a midwestern university. Results from a pre- and postintervention faculty curriculum survey indicated that the percentage of courses including a cultural competence objective increased from 65 percent to 81 percent. Results from the pre- and postintervention administration of the Transcultural Self-Efficacy Tool showed a statistically significant improvement in students’ overall score and three subscale scores.

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.

Increasing undergraduate nursing students' cultural competence: an evaluation study

BACKGROUND

Cultural competence has become increasingly important for Chinese health professionals because of internationalization and the opening up of China to overseas visitors and business as well as a growing awareness of the needs of minority groups within China. This study aimed to evaluate a workshop designed to improve cultural competence among Chinese undergraduate nursing students.

METHODS

A one-group pretest and posttest design was applied. The intervention was a one-day workshop based on transformative learning theory using a variety of teaching strategies. Forty undergraduate nursing students from a university in Wuhan, China selected by convenient sampling received the intervention. Data were collected before the intervention (T1), immediately after the intervention (T2), and 1 month (T3) and 3 months (T4) following the intervention through the Chinese version of Cultural Competence Inventory for Nurses (CCIN). A researcher-designed evaluation form including open-ended questions was also used.

RESULTS

Participants' scores by CCIN increased significantly in the total score (p < .001) as well as the components of cultural awareness (p = .003), cultural knowledge (p < .001), cultural understanding (p = .007) and cultural skills (p < .001), but not in cultural respect. This improvement maintained at T3 and T4. Overall, participants were satisfied with the workshop, and the qualitative results supported the effects of this intervention.

CONCLUSIONS

The one-day workshop was effective in improving nursing students' cultural competence. Replication or further refinement of this workshop is recommended for future research among additional nursing students with diverse backgrounds.

Teaching qualitative research as a means of socialization to nursing

The aim of the present article is to present a model for teaching qualitative research as part of nursing education. The uniqueness of the course model is that it seeks to combine two objectives: (1) initial familiarization of the students with the clinical-nursing environment and the role of the nurse; and (2) understanding the qualitative research approach and inculcation of basic qualitative research skills. The article describes how teaching two central genres in qualitative research - ethnographic and narrative research - constitutes a way of teaching the important skills, concepts, and values of the nursing profession. The article presents the model's structure, details its principal stages, and explains the rationale of each stage. It also presents the central findings of an evaluation of the model's implementation in eight groups over a two-year period. In this way the article seeks to contribute to nursing education literature in general, and to those engaged in clinical training and teaching qualitative research in nursing education in particular.

The Impact of Nursing Students’ Cultural Diversity on the Intention and Attitudes Toward the Use of Information Technology

This research highlights the evidences that: The greater the threat, the lower the attitude toward information technology is, and the greater the sense of challenge, the greater self-efficacy is. Innovativeness was found to be a behavioral intention predictor in two groups, secular Jews and Arabs. This study provides nurses and nurse educators with some valuable insights about how culture, religion, and education may influence nursing students’ attitudes toward information technology.

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.

Measures of cultural competence in nurses: an integrative review

Background. There is limited literature available identifying and describing the instruments that measure cultural competence in nursing students and nursing professionals. Design. An integrative review was undertaken to identify the characteristics common to these instruments, examine their psychometric properties, and identify the concepts these instruments are designed to measure. Method. There were eleven instruments identified that measure cultural competence in nursing. Of these eleven instruments, four had been thoroughly tested in either initial development or in subsequent testing, with developers providing extensive details of the testing. Results. The current literature identifies that the instruments to assess cultural competence in nurses and nursing students are self-administered and based on individuals' perceptions. The instruments are commonly utilized to test the effectiveness of educational programs designed to increase cultural competence. Conclusions. The reviewed instruments measure nurses' self-perceptions or self-reported level of cultural competence but offer no objective measure of culturally competent care from a patient's perspective which can be problematic. Comparison of instruments reveals that they are based on a variety of conceptual frameworks and that multiple factors should be considered when deciding which instrument to use.

Cultural competence and cultural safety in Canadian schools of nursing: a mixed methods study

Cultural competence and cultural safety are essential knowledge in contemporary nursing care. Using a three-phase, mixed methods sequential triangulation design, this study examines the extent to which Anglophone Schools of Nursing in Canada have integrated cultural competence and/or cultural safety into the undergraduate nursing curricula. Factors that influence successful integration are identified through the lens of Donabedian's structure, process, and outcome model. Results suggest that several facilitating factors are present, such as leadership, partnerships and linkages, and educational supports for students. Of particular concern is the lack of policies to recruit and retain Aboriginal faculty, financial resources, and outcome evaluation indicators. A conceptual model of integration is offered to explain how Schools of Nursing function to support the implementation of these concepts into their curriculum. This study provides theoretical and practical implications for initiation and improvement of cultural competence and/or cultural safety integration strategies in Schools of Nursing.

Evaluating the Integration of Cultural Competence Skills Into Health and Physical Assessment Tools

Currently used audiovisual (AV) teaching tools to teach health and physical assessment reflect a Eurocentric bias using the biomedical model. The purpose of our study was to (a) identify commonly used AV teaching tools of Canadian schools of nursing and (b) evaluate the identified tools. A two-part descriptive quantitative method design was used. First, we surveyed schools of nursing across Canada. Second, the identified AV teaching tools were evaluated for content and modeling of cultural competence. The majority of the schools (67%) used publisher-produced videos associated with a physical assessment textbook. Major findings included minimal demonstration of negotiation with a client around cultural aspects of the interview including the need for an interpreter, modesty, and inclusion of support persons. Identification of culturally specific examples given during the videos was superficial and did not provide students with a comprehensive understanding of necessary culturally competent skills.

Cultural competence: an evolutionary concept analysis

AIM

The purpose of this article is to explore the concept of cultural competence in the nursing and nursing education literature.

BACKGROUND

The RN workforce, the nurse faculty population, and the pre-licensure nursing student population do not reflect the country's changing demographics, and cultural competence is identified as key to preparing nurses to meet clients' needs.

METHOD

Using Rogers' method of evolutionary concept analysis, key words (cultural competence, nursing, and nursing education) were searched in two databases for a five-year period. Of 388 articles found, 137 met inclusion criteria; of these, 30 articles were randomly selected for nursing and nursing education.

RESULTS

Three dimensions of cultural competence (awareness, attitudes, and behaviors) and related concepts were identified.

CONCLUSION

Results of this concept analysis reveal congruency between nursing and nursing education with regard to cultural competence. Further research is recommended.

Using a Virtual Community to Enhance Cultural Awareness

Purpose: Cultural competence is an expectation of professional practice, yet effectively teaching this concept to nursing students is challenging. The purpose of this study was to assess the use of a virtual community as a teaching application to foster cultural awareness among nursing students. Method: This correlational study involved the collection of two surveys from 342 first-semester students from five baccalaureate nursing programs that used The Neighborhood virtual community during one semester. Descriptive and comparative analyses were performed. Findings and Conclusions: Results suggest that use of the virtual community may have contributed to cultural awareness among student participants. There was a significant correlation between frequency of use and cultural awareness. Virtual communities may represent a useful teaching application for cultural competence in nursing education. Further research is needed to specifically test cultural competence education strategies using a virtual community platform.

Improving cross-cultural care and antiracism in nursing education: a literature review

PURPOSE

To appraise through literature review the available research evidence to guide teaching and learning regarding cross-cultural care for nursing students. Cross-cultural education of nurses with a focus on both culture and antiracism is one way of promoting ethical and effective cross-cultural health systems for people from culturally diverse backgrounds. Although cross-cultural care has long been recognised as necessary to nursing education there is no clear consensus regarding how it is to be taught or which theoretical perspectives should underpin this teaching.

FINDINGS

Current literature supports the effectiveness of cross-cultural teaching interventions in promoting cultural competence and in facilitating attitudinal and belief changes in nursing students. The literature further suggests that racism persists in some students following participation in cross-cultural education and that there is a paucity of theory, teaching interventions and evaluations addressing antiracism.

CONCLUSIONS

Cross-cultural education alone is insufficient to combat racism. Cross-cultural education focused on both cultural competence and antiracism is necessary to promote effective cultural care in nursing students.

Similarities and mutual understanding: exchange experiences in Malawi for host and guest students

BACKGROUND

A Malawian nursing college and a Norwegian university college have agreed to cooperate in facilitating clinical exchanges for nursing students at their respective institutions. This study describes the experiences of students in an innovative exchange. Norwegian and Malawian nursing students shared clinical placement in pairs of two in Malawi for 8 weeks. This study shows that both host and guest students benefit from the clinical placement as it enhances development of clinical competence.

METHODS

The design of the study is phenomenological/hermeneutical. The theoretical foundation is based upon Campinha-Bacote's model for the development of cultural competence. All participating nursing students were interviewed. Their stories provided the rationale for the three main categories that are discussed.

FINDINGS

Students experience both similarities and differences in practice, but similarities are regarded as the stronger impression. Learning relational skills is the primary learning outcome, but learning how to nurse patients is also an important outcome. During the exchange period all students developed cultural competence. This way of organizing shared placements for guest and host students from different countries is valuable for all students. It also met the curricular demands in both countries.

Partnering with community agencies to provide nursing students with cultural awareness experiences and refugee health promotion access

Refugees' cultural beliefs, communication barriers, and low health literacy may lead to health disparities within the Western health care system. This article describes a teaching-learning strategy emphasizing the community partnership between a baccalaureate school of nursing, an immigrant-refugee program, and a community literacy program in a rural state. Senior community health nursing students partnered with an immigrant-refugee program and a community literacy program to provide health promotion and prevention services to recently immigrated Hmong and Russian refugees. Priority health needs were identified and culturally appropriate health promotion and prevention education modules were designed and implemented by students. Students collaborated with community agencies and businesses to increase access to health resources for these vulnerable populations. Outcomes were the provision of cultural awareness experiences for nursing students and access to health care with increased knowledge of Western health care practices and beliefs for refugees.

Teaching ethics in religious or cultural conflict situations: a personal perspective

This article portrays the unique aspects of ethics education in a multicultural, multireligious and conflict-based atmosphere among Jewish and Arab nursing students in Jerusalem, Israel. It discusses the principles and the methods used for rising above this tension and dealing with this complicated situation, based on Yoder's ;bridging' method. An example is used of Jewish and Arab students together implementing two projects in 2008, when the faculty decided to co-operate with communities in East Jerusalem, the Arab side of the city. The students took it upon themselves to chaperon the teachers who came to watch them at work, translate, and facilitate interaction with a guarded and suspicious community. This approach could also be relevant to less extreme conditions in any inter-religious environment when trying to produce graduates with a strong ethical awareness.

Pain assessment and treatment disparities: a virtual human technology investigation

Pain assessment and treatment is influenced by patient demographic characteristics and nonverbal expressions. Methodological challenges have limited the empirical investigation of these issues. The current analogue study employed an innovative research design and novel virtual human (VH) technology to investigate disparities in pain-related clinical decision-making. Fifty-four nurses viewed vignettes consisting of a video clip of the VH patient and clinical summary information describing a post-surgical context. Participants made assessment (pain intensity and unpleasantness) and treatment (non-opioid and opioid medications) decisions on computerized visual analogue scales. VH demographic cues of sex, race, and age, as well as facial expression of pain, were systematically manipulated and hypothesized to influence decision ratings. Idiographic and nomothetic statistical analyses were conducted to test these hypotheses. Idiographic results indicated that sex, race, age, and pain expression cues accounted for significant, unique variance in decision policies among many nurses. Pain expression was the most salient cue in this context. Nomothetic results indicated differences within VH cues of interest; the size and consistency of these differences varied across policy domains. This study demonstrates the application of VH technology and lens model methodology to the study of disparities in pain-related decision-making. Assessment and treatment of acute post-surgical pain often varies based on VH demographic and facial expression cues. These data contribute to the existing literature on disparities in pain practice and highlight the potential of a novel approach that may serve as a model for future investigation of these critical issues.

Transcultural nursing courses online: implications for culturally competent care

Cultural diversity must be taken seriously by both faculty and students, and requires action by both parties for successful integration into online learning. Limited diversity in the nursing workforce or student population creates a need for learning cultural competence. Online transcultural nursing courses meet this learning need and provide opportunities for a variety of students and faculty participation from around the world. Successful online learning experiences can contribute to the provision of culturally competent nursing care.