A concept analysis of cultural competence in nursing: A hybrid model approach

BACKGROUND

Cultural competence is considered one of the criteria for high-quality nursing care.

AIM

This study aimed to analyse cultural competence in nursing.

METHODS

This study was performed using the hybrid concept analysis approach in three phases. In the theoretical phase, literature was reviewed by searching Persian and English language databases, and 94 articles were included. In the second or fieldwork phase, 11 semi-structured interviews were conducted with purposefully selected nurses. The results of both theoretical and fieldwork phases were analysed using conventional content analysis, and in the final analysis phase, the results of the previous phases were triangulated.

RESULTS

The attributes of cultural competence were obtained in the theoretical phase in six and the fieldwork phase in three categories. In the final phase, the categories obtained in both previous phases were triangulated: cultural competence in nursing is a continuous, developmental, flexible, extensive and complex process that is patient- and justice-oriented and emerges through learning and skills acquisition, including cultural knowledge, attitudes and practices.

CONCLUSION

Managers and planners of nursing education can use the results of this study to educate nursing students and nurses and evaluate outcomes as one of the criteria for quality care.

Cultural competencies in Polish and Lithuanian nurses: A cross‐sectional comparative study

BACKGROUND

Cultural competencies are known as a multidimensionalconstruct; however, they usually refer to an individual's sensitivity orcultural attitudes, cultural awareness, knowledge, and skills.

AIM

The aim of the study was to compare the cultural competences of nurses in Poland and Lithuania based on an adaptation of the Nurse Cultural Competence Scale (NCCS).

DESIGN

The design was a comparative cross-sectional study.

METHODS

A total of 383 Polish nurses and 184 Lithuanian nurses took part in the study. The questionnaires of the NCCS-Polish version (NCCS-v.PL) and the NCCS-Lithuanian version (NCCS-v.L) were used after linguistic adaptation and an evaluation of psychometric properties.

RESULTS

As a result of the comparative analysis, a higher general level of cultural competences (based on the NCCS) was found in the Lithuanian group M-148.09 (SD = 22.85). The results show statistically significant differences among the respondents in the subscale of Nurse Cultural Competence Scale-Cultural Knowledge (NCCS-CK; p ˂ 0.001); higher competences of the nurses were found in the Group LT (M = 31.05; SD = 6.75) than in the Group PL (M = 28.82; SD = 7.82). In the group of Polish nurses (Group PL), the intensity of cultural competences was found to increase along with age (NCCS-v.P r = 0.157, p < 0.05); this, however, was not observed in the Group LT (NCCS-v.LT, p > 0.05).

CONCLUSIONS

Both the nurses in Poland and in Lithuania are characterised by an average level of cultural competences. Diversity in the level of cultural competences was found in both groups depending on age, education and work experience.

Ultra-Orthodox Nursing Students’ Cultural Challenges Inside and Outside Their Community during the COVID-19 Pandemic

In line with findings that nurses from minority groups have an important role in making health services accessible to their community, our study aimed to identify the challenges ultra-Orthodox Jewish nurses faced during COVID-19 in their encounters with patients and health staff from other communities, as well as their own community. The ultra-Orthodox community is a highly religious group that maintains isolation from general society, a phenomenon that affected its member experiences during COVID-19. Our research followed sequential explanatory mixed methods. The quantitative phase included a questionnaire completed by 235 female students (111 ultra-Orthodox and 124 non-ultra-Orthodox), followed by a qualitative phase, which included six focus-groups (n = 15). The quantitative analysis showed that the ultra-Orthodox students felt a higher sense of responsibility toward their community. They used their authority and knowledge to guide their community during the pandemic. The qualitative analysis identified two themes expressed as challenges ultra-Orthodox nursing students encountered within their community and with other sections of Israeli society. Our research shows the important role that transcultural nurses play in mediating updated health information otherwise inaccessible to their community, especially in times of crises. It is important to address dilemmas this group faces inside and outside their respective communities.

Cultural Competence in Healthcare Leadership Education and Development

Cultural competence is a phenomenon that straddles many disciplines and fields of study. There is no settled definition of the term, and it is argued that this is not necessary to explore or discuss the phenomenon as it is context-dependent across diverse societies. Explorations of cultural competence in clinical education and training are well-established, but there has been less attention towards its expression in the field of developing healthcare leaders. There is a debate about whether cultural competence is best achieved primarily through training-based educational inputs or by being infused in all areas of curriculum development. Using an exploration of selected literature followed by the case of an ambitious set of leadership development programmes in the English National Health Service, this paper explores the balance and interdependencies of cultural competence in healthcare leadership development as knowledge, skills and attitudes. The paper concludes that it is important for educators in this field to provide space for reflection, develop skills of reflexivity and facilitate sensitive discussions of sometimes contested ideas and concepts. A further evaluation of the impact of teaching and learning interventions, while mapping developments in perceptions of knowledge, skill and attitudes would be an area ripe for future research.

Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review

When assessing the fragility that characterizes the health of an immigrant person, a culturally competent transformation of the nurse-patient teaching-learning process is necessary. Therefore, it is considered essential to incorporate cultural competence and intercultural communication in higher nursing education.

OBJECTIVE

To determine the content and knowledge of cultural competence and intercultural communication offered in higher education in nursing courses.

DESIGN

The Campinha-Bacote model of cultural competence was used as the primary reference.

METHOD

A scoping review was conducted about studies published in the period 2003 and 2020. The research was conducted between May and October 2020. More than a hundred documents (books, chapters, articles, conference proceedings) have been consulted.

RESULTS

Undergraduate nursing courses and postgraduate education move toward promoting cultural competence and sensitivity through teaching strategies.

CONCLUSIONS

Teaching projects that combine multiple competencies are more effective, including teacher training. A predominant element is a need for continuous and transversal projects. University nursing education must adapt culturally competent curricula.

Patient satisfaction with the emergency department services at an academic teaching hospital

Introduction:

Healthcare reform efforts focus on patient-centered care is measured by patient satisfaction. Emergency department (ED) satisfaction ratings are often the lowest. Since ED is the first point of contact for the patient care to receive primary care, we aimed to explore patient satisfaction related to ED healthcare services at our institution.

Methods:

In this cross-sectional study, ED-CAHPS, a standardized validated nine-item survey questionnaire, was administered via telephonic interviews to Arabic-speaking patients who attended ED at our institution. Patient demographics, ED operation parameters, and healthcare utilization factors were evaluated as patient satisfaction predictors.

Results:

Out of 713 patients who were contacted 200 patients responded to the survey. In all, 70% of respondents were aged 35-64 years and 55% had secondary or higher education levels. The dimension average for the questions regarding arrival, waiting time, and urgency of treatment was 36%. Regarding satisfaction with pain management was 42%, medication information was 34% and interpreter services were only 40%. The overall dimension average for satisfaction regarding nursing care was 43%, doctor care was 36%. The overall dimension average for satisfaction regarding the discharge process was 56%. The highest scores were observed for whether the patients were asked about follow-up care (61%), whether they understood the symptoms to look for after leaving the ED (58%), and whether they received care within 30 min of arriving at the ED (56%). On the other hand, the worst scores were recorded for whether the patients were made to understand regarding the side effects of new medications (29%), whether nurses spent enough time with them (33%), and whether doctors spent enough time with them (34%).

Conclusions:

Based on these results, recommendations were made to improve patients' perceptions/experience in receiving the care and the overall rating. This study presents specific recommendations for maximizing patient satisfaction in primary ED settings in Saudi Arabia.

Preparation of undergraduate health and care students from the United Kingdom for an international learning experience in Japan: A phenomenological study

BACKGROUND

Globalisation, economic migration and people seeking refugee status require cultural competence skills and knowledge to be embedded in undergraduate health and care programmes. International learning experiences can support the development of cultural competence skills. Students require preparation before undertaking international learning experiences to support adjustment to cultural differences. Inadequate preparation could have a negative impact on their ability to learn. Therefore, investigating concerns undergraduate health and care student experience prior to an international learning experience has the potential to enhance the preparation received.

OBJECTIVES

To investigate the experiences of undergraduate health and care students from the United Kingdom prior to participating in an international cultural visit to Japan.

DESIGN

A qualitative study using Interpretative phenomenological analysis.

METHODS

The lived experience of 7 undergraduate health and care students were explored using reflective semi structured surveys.

FINDINGS

The findings suggest that prior to the visit, undergraduate health and care students experienced a range of fears and anxieties. These were themed under the heading of "Barriers to Learning" and further sub themes of "Being a Stranger", "Cultural Differences and "Communication".

CONCLUSION

Preparation for undergraduate health and care students undertaking international learning activities is required to enable them to adapt to the culture they are visiting as well as the culture of the group they are travelling with. Recommendations are made for preparing undergraduate health and students for this.

An interactive teaching module for increasing undergraduate physiotherapy students' cultural competence: A quantitative survey

OBJECTIVES

To provide safe and effective healthcare, physiotherapists must be aware of, and able to appropriately respond to, the individual needs of their clients. Cultural competence is an essential part of the curriculum to prepare physiotherapy students for their graduate practice. The primary aim of this study was to investigate the effectiveness of a 4-week educational intervention to increase the perceived cultural competence of undergraduate physiotherapy students and whether effectiveness changed as students progressed in their education. Secondary aims were to understand if a clinical placement prior to the course intervention, or the student's cultural background, influenced the effectiveness of the intervention.

METHODS

A prospective cohort study was conducted with 73 students in their second year of an Australian Bachelor of Physiotherapy programme who participated in a 4-week tutorial module to develop their cultural competence. Perception of cultural competence was measured at three time points (pre, post, post 18 months) using the Cultural Intelligence Scale questionnaire which assesses metacognitive, cognitive, motivational and behavioural domains. Participant and their parents' country of birth data were collected.

RESULTS

Cultural intelligence scores for the cohort significantly increased from pre- to post-intervention (mean change 0.4, p < 0.001). A 3-week clinical placement prior to the teaching intervention had no effect on the change in scores. Students who were not born in Australia, or who had a parent not born in Australia, demonstrated less change in overall cultural intelligence score than Australian-born participants.

CONCLUSION

Undergraduate physiotherapy students at an Australian university can increase their perceived level of cultural competence by participating in a 4-week classroom-based tutorial module, and this effect can be sustained over an 18-month period. Exposure to cultural diversity is not sufficient by itself for a change in perceived cultural competence. However, classroom-based teaching needs to be responsive to the cultural characteristics of the students.

California State University (CSU) System nursing faculty: Are you culturally competent to teach in a multicultural state?

BACKGROUND

The predicted changes in demographics are forcing health care professionals to recognize they must become not only more culturally sensitive, but also culturally competent.

PURPOSE

The purpose of this descriptive, correlational study was to describe the level of cultural competence of faculty teaching BSN pre-licensure programs, and faculty personal (age, gender, race/ethnicity, ability to speak another language) and professional characteristics (years in nursing education, highest degree earned, certification, continuing education in cultural competency, and nursing specialty areas) predictive of cultural competency, and the relationship between cultural competency and transcultural teaching behaviors.

METHOD

Campinha-Bacote's (1999) model of cultural competence theoretical framework guided the study. The Cultural Diversity Questionnaire for Nurse Educator-Revised Scale measured a sample of 152 (n = 152) faculty cultural competence and transcultural teaching behaviors.

RESULTS

CSU System faculty were moderately culturally competent. The overall regression model with faculty personal predictors were statistically significant F(4, 145) = 2.98, p = .02, and variables accounted for 7.6% of the variance in cultural competency (R² = 0.076). The overall regression model with faculty professional predictors were statistically significant F(9, 139) = 3.62, p < .001, and variables accounted for 19% of the variance in cultural competency (R² = 0.190). Major findings revealed four aspects of cultural competence predictive of transcultural teaching behaviors. The overall regression model was statistically significant F(5, 146) = 182.71, p < .001, and variables accounted for 86.2% of the variance in transcultural teaching behaviors (R² = 0.862).

CONCLUSION

The personal characteristic ability to speak another language was predictive of cultural competence. Professional characteristics nursing specialty area of mental health, and continuing education in cultural competency were predictive of cultural competence. The four aspects of cultural competence awareness, knowledge, skills, desire are predictive of transcultural teaching behaviors.

Assessment of Patient Safety and Cultural Competencies among Senior Baccalaureate Nursing Students

This descriptive, correlational, cross-sectional study examined nursing students' educational experiences on self-reported perceptions of patient safety and cultural competence in terms of curriculum content and learning venues. We performed descriptive analyses and a one-way analysis of variance with a sample of senior-year nursing students (N = 249) attending three state universities in the United States. We used the Nurse of the Future Nursing Core Competency Model, the Patient Safety Competency Self-Evaluation Tool for Nursing Students, and The Cultural Competence Assessment Instrument. Overall, participants reported that patient safety and cultural competencies were addressed in their curricula primarily through classroom activities as opposed to laboratory/simulation or clinical settings. Among the required patient safety knowledge topics, elements of highly reliable organizations were covered the least. For patient safety competency, participants reported higher scores for attitude and lower scores for skill and knowledge. For cultural competency, participants scored much higher for cultural awareness and sensitivity than behavior. There was no statistically significant difference between scores for patient safety and cultural competencies by nursing school. The results support the need for curriculum development to include all important aspects of patient safety and cultural competencies in various teaching/learning venues.

Blended learning in undergraduate nursing education - A scoping review

OBJECTIVES

To provide a comprehensive scoping review of the existing literature regarding the use of blended learning in undergraduate nursing education. To align the varied educational terms and definitions with the broad definition of blended learning.

DESIGN

Scoping review following established methodology.

DATA SOURCES

In consultation with library services, the academic literature was searched. Electronic databases searched included ERIC (OVID), Medline (OVID), PubMed, Nursing and Allied Health, and CINAHL Plus.

REVIEW METHODS

A total of 189 potentially relevant nursing research articles published between the years of 2009 and 2019. Three reviewers independently reviewed the articles, leaving 37 relevant primary articles in the nursing field to be included in the scoping review.

RESULTS

Nursing content delivered using blended learning approaches were organized into 8 themes. Themes include Professional Nursing Skills; Mental Health Nursing; Bioscience; Pharmacology, Specialty Populations; Nursing Assessment; Acute Care Nursing; and the Art of Nursing. A variety of blended learning approaches are being utilized in Undergraduate nursing education, the majority of which are happening in the classroom.

CONCLUSION

This scoping review presents explicit the degrees to which blended learning is referred to in the nursing education literature and expanded the definition of blended learning to encompass the terminology associated with distributed, decentralized, hybrid, and flexible learning. There is a wide, varied, and expanding number of blended learning approaches currently being utilized in nursing education to teach a wide range of nursing content and skills. An expanded scoping review focused on blended learning in psychiatric nursing, licenced practical nursing, nurse practitioners, and all graduate level nursing education programs is recommended as is additional research into the use of blended learning in the lab or clinical setting.

Examining the implementation of teaching and learning interactions of transition cultural competence through a qualitative study of Taiwan mentors untaking the postgraduate nursing program

BACKGROUND

Cultural competency has been identified as an essential curricular element in undergraduate and graduate nursing programmes. Supporting successful transition to practice is essential for retaining graduate nurses in the workforce and meeting the demand for cultural diversity in health care services.

OBJECTIVES

This study aimed to explore the teaching and learning interactions of transition cultural competence from the perspective of mentors of newly graduated nurses in a Taiwanese postgraduate nursing programme.

DESIGN

A qualitative design that utilised focus group interviews was adopted for this study. A framework approach-a content and thematic analysis strategy-was used to analyse the interviews.

SETTING

The study setting consisted of two hospitals in northern Taiwan.

PARTICIPANTS

The study participants consisted of 24 new graduate nurse mentors.

METHODS

Three focus group sessions were conducted (two at a medical centre and one at a district hospital), where the participants were interviewed.

RESULTS

Four themes were derived from the data-transition process, teaching strategies according to the transition stage, learning after overcoming clinical stress, and awareness of cultural diversity among new graduate nurses. The clinical routine and physical stress of caring for patients did not allow the newly graduated nurses to appropriately demonstrate cultural competence in the first three months. Mentors were only able to provide resources for new graduate nurses when they first started to care for patients in cultural groups. The point of catalysis was when learners finally gained awareness of cultural differences, and, consequently, they could encounter the teaching and learning process.

CONCLUSION

The different learning stages and teaching strategies illustrated the interactive process between new nurses and educators. Facilitating the cultural awareness of learners is a challenge for teachers who provide cultural competence training. This model could serve as a reference for curriculum and clinical training programmes.

Exploring the cultural competence of undergraduate nursing students in Saudi Arabia

PURPOSE

To explore the cultural competence of undergraduate nursing students at a college of nursing, Saudi Arabia.

DESIGN

A descriptive exploratory design was used to explore the Saudi undergraduate nursing students' level of cultural competency.

METHOD

The convenience sample included 205 nursing students affiliated with a college of nursing at a health science university in Jeddah, Saudi Arabia. Data was collected using the Inventory for Assessing the Process of Cultural Competence-Revised (IAPCC-R) consisting of 25 items. The tool reported acceptable reliability of Cronbach alpha 0.89.

RESULTS

The majority of students were culturally aware and dealt with people from different cultures. One-third preferred to have training on culture over a period of time. Half the students preferred studying a special course related to working with people from different cultures. Cultural desire reported the highest mean while cultural knowledge scored the lowest among the cultural competence subscales despite students being exposed to some cultural knowledge content in their training.

CONCLUSIONS

Implementing the guidelines for culturally competent care assure covering all aspects of care with consideration of cultural heritage as a main concept. Comparative study of nurses' and students' perception is further recommended.

A Multicountry Perspective on Cultural Competence Among Baccalaureate Nursing Students

PURPOSE

To assess cultural competence among nursing students from nine countries to provide an international perspective on cultural competence.

DESIGN

A descriptive, cross-sectional design.

METHODS

A convenience sample of 2,163 nursing students from nine countries was surveyed using the Cultural Capacity Scale from April to November 2016.

RESULTS

The study found a moderate range of cultural competence among the students. The ability to teach and guide other nursing colleagues to display culturally appropriate behavior received the highest competence rating, while the ability to discuss differences between the client's health beliefs or behaviors and nursing knowledge with each client received the lowest competence rating. Differences in cultural competence were observed between students from different countries. Country of residence, gender, age, year of study, attendance at cultural-related training, the experience of taking care of patients from culturally diverse backgrounds and patients belonging to special population groups, and living in a multicultural environment were identified as factors affecting cultural competence.

CONCLUSIONS

The international perspective of cultural competence among nursing students provided by this study serves as a vital preview of where nursing education currently stands in terms of providing the necessary preparatory competence in the cultural aspect of care. The variation of cultural competence among nursing students from different nations should serve as a cue for designing a focused yet multimodal nursing education program in guiding them to be culturally sensitive, culturally adaptive, and culturally motivated.

CLINICAL RELEVANCE

The training of nursing students in providing competent culturally appropriate care should be ensured considering that adequate preparation of nursing students guarantees future competent nursing practice, which can positively impact the nursing profession in any part of the globe.

Perceived Transcultural Self-Efficacy of Nurses in General Hospitals in Guangzhou, China

Background

Conflicts arising from cultural diversity among patients and hospital staff in China have become intense. Hospitals have an urgent need to improve transcultural self-efficacy of nurses for providing effective transcultural nursing.

Objective

The purpose of the research was to (a) evaluate the current status of perceived transcultural self-efficacy of nurses in general hospitals in Guangzhou, China; (b) explore associations between demographic characteristics of nurses and their perceived transcultural self-efficacy; and (c) assess the reliability and validity of scores on the Chinese version of the Transcultural Self-Efficacy Tool (TSET).

Methods

A cross-sectional survey of registered nurses from three general hospitals was conducted. Quota and convenience sampling were used. Participants provided demographic information and answered questions on the TSET.

Results

A total of 1,156 registered nurses took part. Most nurses had a moderate level of self-efficacy on the Cognitive (87.9%), Practical (87%), and Affective (89.2%) TSET subscales. Nurses who were older; who had more years of work experience, higher professional titles, higher incomes, and a minority background; and who were officially employed (not temporary positions) had higher perceived transcultural self-efficacy. Reliability estimated using Cronbach’s alpha was .99 for the total TSET score; reliability for the three subscales ranged from .97 to .98. Confirmatory factor analysis of TSET scores showed good fit with a three-factor model.

Conclusion

The results of this study can provide insights and guidelines for hospital nursing management to facilitate design of in-service education systems to improve transcultural self-efficacy of nurses.

What is the role of nephrologists and nurses of the dialysis department in providing fertility care to CKD patients? A questionnaire study among care providers

Purpose

This study evaluated current fertility care for CKD patients by assessing the perspectives of nephrologists and nurses in the dialysis department.

Methods

Two different surveys were distributed for this cross-sectional study among Dutch nephrologists (N = 312) and dialysis nurses (N = 1211).

Results

Response rates were 50.9% (nephrologists) and 45.4% (nurses). Guidelines on fertility care were present in the departments of 9.0% of the nephrologists and 15.6% of the nurses. 61.7% of the nephrologists and 23.6% of the nurses informed ≥50% of their patients on potential changes in fertility due to a decline in renal function. Fertility subjects discussed by nephrologists included “wish to have children” (91.2%), “risk of pregnancy for patients’ health” (85.8%), and “inheritance of the disease” (81.4%). Barriers withholding nurses from discussing FD were based on “the age of the patient” (62.6%), “insufficient training” (55.2%), and “language and ethnicity” (51.6%). 29.2% of the nurses felt competent in discussing fertility, 8.3% had sufficient knowledge about fertility, and 75.7% needed to expand their knowledge. More knowledge and competence were associated with providing fertility health care (p < 0.01).

Conclusions

In most nephrology departments, the guidelines to appoint which care provider should provide fertility care to CKD patients are absent. Fertility counseling is routinely provided by most nephrologists, nurses often skip this part of care mainly due to insufficiencies in self-imposed competence and knowledge and barriers based on cultural diversity. The outcomes identified a need for fertility guidelines in the nephrology department and training and education for nurses on providing fertility care.

Evaluating Cultural Competency Concepts Using Program Theory-Driven Evaluation Framework

Research has shown that there is no consistent method of teaching cultural competence or incorporating it into nursing curricula. Thus, nursing programs are at risk for misinterpretation or not meeting required program outcomes or accreditation standards. Although considered social research, program theory-driven evaluation has been cited as an acceptable evaluation method for nursing programs. This research looks at program inputs and program outputs to establish congruency with accreditation standards and to ensure validity and reliability of future research on cultural competency levels of nursing graduates.

REM

The well-documented health disparities between the Australian Indigenous and non-Indigenous population mandates a comprehensive response from health professionals. This article outlines the approach taken by one faculty of health in a large urban Australian university to enhance cultural competence in students from a variety of fields. Here we outline a collaborative and deeply respectful process of Indigenous and non-Indigenous university staff collectively developing a model that has framed the embedding of a common faculty Indigenous graduate attribute across the curriculum. Through collaborative committee processes, the development of the principles of “Respect; Engagement and sharing; Moving forward” (REM) has provided both a framework and way of “being and doing” our work. By drawing together the recurring principles and qualities that characterize Indigenous cultural competence the result will be students and staff learning and bringing into their lives and practice, important Indigenous cultural understanding.

A Cross Sectional and Longitudinal Study of Pharmacy Student Perceptions of Readiness to Serve Diverse Populations

Objective. To examine students' self-perceptions at different stages in a pharmacy curriculum of competence related to serving culturally diverse patients and to compare self-reported competence of a student cohort near the beginning and end of the degree program. Methods. Student perceptions across four pharmacy class years were measured in a cross-sectional survey, with a follow-up longitudinal survey of one cohort three years later. Results. Based on an 81.9% response rate (537/656), scores showed no attitude changes. Reported knowledge, skills, comfort in clinical encounters, and curricular preparedness increased across program years. Fourth-year (P4) pharmacy students reported the highest scores. Scores differed by gender, age, and race/ethnicity. Students in the fourth year scored lower on importance of diversity training. Conclusion. Improved perceptions of readiness (ie, knowledge and behavior) to serve diverse groups suggest the curriculum impacts these constructs, while the invariance of student attitudes and association of self-reports with programmatic outcomes warrant further investigation.

Caring for terminally ill Muslim patients: Lived experiences of non-Muslim nurses

Objective:

The nursing profession demands knowledge, awareness, and experience regarding the ethnic, religious, cultural, and social constructs involved in patient care. Non-Muslim nurses must have theoretical and empirical insights into treatment methods and caring for terminally ill Muslim patients. In particular, non-Muslim nurses should acquire knowledge of Islamic rules and regulations. They should also be familiar with the unique religious and sociocultural practices that pertain to healthcare practices. Our study aimed to explore non-Muslim nurses' experiences in caring for terminally ill Muslim patients and their families regarding physical, social, cultural, spiritual, and religious practices. The study also sought to investigate the context or situations that influence these experiences as described by the nurses.

Method:

In this qualitative descriptive study, 10 nurses working in medical, oncology, and oncology/palliative care units in a tertiary care hospital in Saudi Arabia were interviewed. A modified Stevick–Colaizzi–Keen method was employed for data analysis.

Results:

Three main themes constituted the nurses' lived experiences: family matters, end-of-life practices, and nurse challenges. Cultural values, religious practices, and a family approach to the process of care influenced nurses' experiences. Issues related to an absence of palliative care integration and the unavailability of members in the interdisciplinary team also influenced their experiences. Nurses showed a lack of cultural knowledge of some practices due to a lack of awareness of cultural diversity and the unavailability of formal cultural education.

Significance of Results:

Provision of culturally competent care at the end of life for Muslim patients in Saudi Arabia requires a thoughtful understanding of religious and cultural practices as well as knowledge of the role of the family throughout the care process. The introduction of a cultural care nursing delivery model that incorporates a cultural education program with Islamic teachings and practices at its core is recommended.

A constructivist theoretical proposition of cultural competence development in nursing

Cultural competence development in healthcare professions is considered an essential condition to promote quality and equity in healthcare. Even if cultural competence has been recognized as continuous, evolutionary, dynamic, and developmental by most researchers, current models of cultural competence fail to present developmental levels of this competence. These models have also been criticized for their essentialist perspective of culture and their limited application to competency-based approach programs. To our knowledge, there have been no published studies, from a constructivist perspective, of the processes involved in the development of cultural competence among nurses and undergraduate student nurses. The purpose of this study was to develop a theoretical proposition of cultural competence development in nursing from a constructivist perspective. We used a grounded theory design to study cultural competence development among nurses and student nurses in a healthcare center located in a culturally diverse urban area. Data collection involved participant observation and semi-structured interviews with 24 participants (13 nurses and 11 students) working in three community health settings. The core category, 'learning to bring the different realities together to provide effective care in a culturally diverse context', was constructed using inductive qualitative data analysis. This core category encompasses three dimensions of cultural competence: 'building a relationship with the other', 'working outside the usual practice framework', and 'reinventing practice in action.' The resulting model describes the concurrent evolution of these three dimensions at three different levels of cultural competence development. This study reveals that clinical experience and interactions between students or nurses and their environment both contribute significantly to cultural competence development. The resulting theoretical proposition of cultural competence development could be used not only to guide initial and continuing nursing education, but also to help redefine quality of care in a culturally diverse context.

Supporting families of dying patients in the intensive care units

Family support in the intensive care units is a challenge for nurses who take care of dying patients. This article aimed to determine the Iranian nurses' experience of supporting families in end-of-life care. Using grounded theory methodology, 23 critical care nurses were interviewed. The theme of family support was extracted and divided into 5 categories: death with dignity; facilitate visitation; value orientation; preparing; and distress. With implementation of family support approaches, family-centered care plans will be realized in the standard framework.

Cultural competence: a constructivist definition

In nursing education, most of the current teaching practices perpetuate an essentialist perspective of culture and make it imperative to refresh the concept of cultural competence in nursing. The purpose of this article is to propose a constructivist definition of cultural competence that stems from the conclusions of an extensive critical review of the literature on the concepts of culture, cultural competence, and cultural safety among nurses and other health professionals. The proposed constructivist definition is situated in the unitary-transformative paradigm in nursing as defined by Newman and colleagues. It makes the connection between the field of competency-based education and the nursing discipline. Cultural competence in a constructivist paradigm that is oriented toward critical, reflective practice can help us develop knowledge about the role of nurses in reducing health inequalities and lead to a comprehensive ethical reflection about the social mandate of health care professionals.

Cultural competency in health care and its implications for pharmacy part 3A: emphasis on pharmacy education, curriculums, and future directions

Culture influences patients' beliefs and behaviors toward health and illness. As the U.S. population becomes more diverse, a critical need exists for pharmacy education to incorporate patient-centered culturally sensitive health care knowledge and skills into the curriculum. Nursing was the first profession to incorporate this type of learning and training into its curriculums, followed by medicine. Pharmacy has also made great progress to revise curriculums, but inconsistency exists in depth, breadth, and methods across pharmacy colleges. This article addresses important aspects of pharmacy education such as curriculum development, incorporation of educational innovations and techniques into the teaching of patient-centered culturally sensitive health care across the curriculum from didactic to experiential learning, assessment tools, and global education. A preliminary model curriculum with objectives and examples of teaching methods is proposed. Future directions in pharmacy education, teaching and learning scholarship, postgraduate education, licensure, and continuing education are also presented.

The Effect of a Cultural Competence Educational Intervention for First-Year Nursing Students in Israel

Purpose: To evaluate the effectiveness of an educational intervention to increase general cultural competence of first-year nursing students. Design: This was a quasi-experimental study that used a convenience sample with an experimental group and a control group and pre- and posttesting. The sample comprised 146 first-year nursing students enrolled in the Introduction to Nursing course divided into an intervention group ( n = 58) of students from one school and a control group ( n = 88) including students from two schools. The intervention group received a 2-hour faculty lecture on cultural competence, and students prepared and delivered a student group presentation about a cultural group in Israel, basing the presentation on Campinha-Bacote’s five constructs. A demographic data instrument and Campinha-Bacote’s Inventory for Assessing the Process of Cultural Competence Among Healthcare Professional–Revised© were used for pre- and posttesting. Findings: Students who received the educational intervention increased scores significantly (68 ± 6 to 73 ± 6, p = .000), students who did not receive the educational intervention had no significant increase (67 ± 6 to 66 ± 6). Discussion/Conclusions: Introducing the topic of cultural competence for nursing students in the first-year Introduction to Nursing course as an integrative learning strategy revealed significant increases in cultural competence scores. Implications for Practice: Recommendations are to include evidence-based cultural competence teaching strategies into the nursing curriculum.

Teaching about vulnerable populations: nursing students' experience in a homeless center

Cultural competence is not limited to ethnicity, religion, or race but is inclusive of vulnerable groups, such as the homeless. The complex health and social issues related to homelessness requires educational instruction that supports students' ability to address and care for the multidimensional elements that surround this group. Exposure to homeless populations provides nursing students with increased awareness of the issues related to health disparities, while promoting introspective reflection on one's values and beliefs. To increase student exposure to working with homeless clients, a service-learning project using a critical social theory (CST) lens was offered at a homeless center. The students' response that clients were "just like" them, coupled with ambiguity regarding the complex social-economic-political issues surrounding the homeless, may indicate a need for further education regarding cultural understanding, sensitivity, and vulnerability. This project demonstrates the need for learning experiences that support advocacy and social responsibility for vulnerable groups.

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.

A comparative analysis of cultural competence in beginning and graduating nursing students

The ethnic proportions of the population in the United States are rapidly changing, with the nation's minority population at approximately 101 million. This is also true for the West Texas region, where locally in a city with 183,000 residents, 43 different languages are spoken suggesting that cultural education needs to be included in nursing program curricula. Therefore, a study was conducted during a period of curriculum revision to determine if the current nursing curriculum at a public university offers enough education and experience for graduating nurses to care for such a diverse population by comparing their perceptions of cultural competence with beginning sophomore nursing students' perceptions. Participants were asked to complete the Cultural Competence Assessment (CCA) tool in order to evaluate perceptions of cultural competence. Upon analysis of the data, perceptions of cultural competence among graduating nursing students were significantly higher (P = .002) than the perceptions of cultural competence among beginning nursing students. These results support that nursing students perceive that they have become culturally competent during their nursing education, leading to implications of the need for continued education relating to this concept, beginning with the first course and continuing throughout the nursing curriculum.

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.

Cultural competence of practicing nurses entering an RN-BSN program

AIM

The aim of this exploratory research was to examine the cultural competence of practicing nurses entering an RN to BSN program.

BACKGROUND

As nonwhite populations increase in the United States, the cultural competence of nurses increases in importance. With 38 percent of baccalaureate nursing students in RN-BSN programs, it is important to examine the cultural competence of this population.

METHOD

Fifty-three RN-BSN students completed the Inventory for Assessing the Process of Cultural Competency Among Healthcare Professionals-Revised (IAPCC-R) upon program entry; 50.9 percent were culturally competent as determined by the tool.

RESULTS

A strong correlation existed between IAPCC-R scores and student age, with students 20 to 30 years old scoring significantly higher than those in the age range of 41 to 50.

CONCLUSION

The findings suggest and invite more extensive research on the success of the systematic nursing education initiatives of current associate degree programs and adherence to NLNAC standards for cultural competence, particularly in the cultural skill construct.

Fostering excellence: development of a course to prepare graduate students for research on migration and health

Canada is an immigrant-receiving nation and many graduate students in nursing and other disciplines pursue immigrant health research. As these students often start with inadequate understanding of the policy, theoretical, and research contexts in which their work should be situated, we became concerned that the theses and dissertations were less sophisticated than were both possible and desirable. This led to development of a PhD-level course titled Migration and Health in the Canadian Context. In this study, we provide an analytic overview including course description, objectives, assignments, and specific class topics. Areas of focus include historical and theoretical considerations; determinants of immigrant health; refugee health; cultural competence and cultural safety; research challenges, approaches, and skills; policy-relevant research; and educational imperatives in the health and related disciplines. Salient research is introduced in each of these classes. While Canada is the main focus, comparative data are provided and there is relevance for nurse-researchers in other immigrant-receiving countries.