Inclusive pedagogy in online simulation-based learning in undergraduate nursing education: A scoping review

BACKGROUND

Equality, diversity and inclusion initiatives seek to embed the concept of inclusive pedagogy to promote inclusive educational environments. However, no evidence synthesis exists which examines whether and how the concept of inclusive pedagogy is addressed in online simulation-based learning in the undergraduate nursing education literature.

AIMS

To map the evidence regarding the adoption of inclusive pedagogy in online simulation-based learning in undergraduate nursing education.

DESIGN

A scoping review.

METHODS

Data were extracted, synthesized and presented in narrative and table format.

DATA SOURCES

A systematic search of five databases and five sources of grey literature was conducted to search literature published between 1st January 2010 to 1st June 2022.

RESULTS

Thirty-eight papers published between 2011 and 2022 were included. The results are presented under three identified themes: (1) Learner diversity; (2) Theoretical frameworks promoting equality, diversity and inclusion in online simulation and (3) Online simulation feedback.

CONCLUSION

Inclusive pedagogy has not been considered or embedded in its entirety in online simulation in undergraduate nursing education literature.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Utilizing an inclusive pedagogy framework may prove advantageous in generating inclusive teaching approaches to support all students.

IMPACT

This review will interest educators and managers that wish to incorporate equality, diversity and inclusion initiatives in nursing education.

REPORTING METHOD

This scoping review has adhered to the EQUATOR guidelines: the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Do We Make a Difference? The Effect of a Doctor of Physical Therapy Program Curriculum on Student Cultural Competence

INTRODUCTION

Doctor of Physical Therapy (DPT) education programs have been charged with developing a culturally competent health care workforce to better meet the needs of diverse communities and reduce health inequities. The purpose of this longitudinal, quasi-experimental educational intervention study was to examine the effects of an integrated DPT program curriculum on student cultural competence at a public, midsize, midwestern university.

REVIEW OF LITERATURE

There is an abundance of research on conceptual models and frameworks for the development of cultural competence within health care education with many studies relying on self-perception to measure outcomes. Using the Model of Interculturalization as a theoretical framework, this study explored the development of cultural competence among DPT students using the Intercultural Development Inventory (IDI).

SUBJECTS

A purposeful convenience sample of DPT students ( n = 177) was used.

METHODS

The IDI was administered to 3 student cohorts. One cohort had data at 4 different time points, including upon entry into the program (baseline) and at the end of the first, second, and third year. Two cohorts had data for 2 time points. IDI Developmental Orientation (DO) and Orientation Gap (OG) scores were used to measure cultural competence and accuracy of self-perception of cultural competence. Data analysis was performed using descriptive statistics, independent and dependent sample t -tests, and analysis of variances.

RESULTS

There were no differences between the cohorts. There were statistically significant improvements in both cultural competence (DO scores) and accuracy of self-perception of cultural competence (OG scores) for 2 cohorts. However, significant change only occurred during year 1. No other differences across time for any of the cohorts were significant.

DISCUSSION AND CONCLUSION

Findings can be leveraged and incorporated into recommendations for curricular revision and program reform targeting cultural competence development among DPT students.

Standardized patients' experience of participating in medical students' education: a qualitative content analysis

BACKGROUND

Standardized patients are considered a significant educational method in medical sciences and have been successfully employed for many years. This study was conducted with the aim of explaining the experience of standardized patients participating in the education of medical student.

METHOD

A qualitative content analysis approach was used. This study was conducted at Standardized Patient Center, Tehran University of Medical Sciences, Tehran, Iran, May to February 2022. Fifteen standard patients were selected through purposive sampling with maximum variation. Semi-structured, in-depth, face-to-face interviews were conducted with standard patients. The average duration of the interviews was 60 to 90 min. Data were transcribed and analyzed using the Graneheim and Lundman approach.

RESULTS

A passport for the future and duality of feelings were the two main themes identified in this study with six subthemes. One of the main themes was passport for the future with subthemes creative, participation in educating future generation, reflection and another theme was duality of feeling with subthemes feeling of value, guilty conscience, and fear of judgment by others.

CONCLUSION

The participants expressed having mixed feelings about their role as standard patients. They felt conflicted because they were compensated for their participation, which made them worry about being judged by others and feel guilty about taking the fee. Therefore, it is recommended to conduct further studies in this area.

Improving self-efficacy in behavioral health through interprofessional education

ABSTRACT

Interprofessional education (IPE) is important in preparing health profession students to practice in a workforce dependent on teamwork and collaboration. Many health profession students graduate without ever having active shared learning experiences in the academic setting. Opportunities for students to participate in activities that promote self-efficacy in competencies related to interprofessional collaborative practice are essential. The purpose of the project was to assess health profession students' perception of self-efficacy related to the core competencies of IPE. The project used a pre/post quantitative survey research design comprising a sample of students enrolled in clinical practicums in behavioral health care settings. Using standardized patients, students participated in timed simulated encounters. Participants ( n = 36) completed the 16-item Interprofessional Education Collaborative Competency Self-Assessment Tool on conclusion of the learning activity. Survey responses were scored on a 5-point Likert-type scale, with high scores indicating a stronger level of agreement of perceived self-efficacy. On the postsurvey, most items were rated as "agree" or "strongly agree." Item means ranged from 4.64 to 4.81. A positive association was found between students' self-efficacy and the utilization of standardized patients within an interprofessional experiential learning activity. The intervention contributed to improving self-efficacy in interprofessional competencies related to collaborative interaction and values.

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

AIM

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

An Exploration of Diversity, Equity, Inclusion, and Antiracism in Standardized Patient Simulations

A trending topic in pharmacy education is the importance of educating and exposing student pharmacists to topics of diversity, equity, inclusion, and antiracism (DEIA). Incorporation of diverse patient populations is one emerging learning opportunity for students in the DEIA space. This commentary presents the findings of seven pharmacy programs reporting similarities and differences in standardized patient (SP) recruitment and training, and their use in DEIA simulation learning activities. Common barriers of DEIA-centric SP activities in pharmacy programs were also identified and included recruitment of diverse SPs, lack of faculty knowledge for implementation of DEIA-focused simulations, and emotional protection of SPs involved. While no best practices or standardized processes exist, the authors provide suggestions for addressing barriers, and make a call to action for further research to determine best practices related to recruitment, training, and utilization of diverse SPs in simulation activities in pharmacy education.

From a learning opportunity to a conscious multidimensional change: a metasynthesis of transcultural learning experiences among nursing students

BACKGROUND

Several educational activities in nursing schools worldwide have been implemented to promote transcultural nursing and cultural competence. Despite the diversity of their experiences and outcomes, the available evidence has not been systematically reviewed and reinterpreted. This study aimed to review and reinterpret all rigorous qualitative evidence available, providing an opportunity to understand how students learn transcultural nursing and assisting faculties, researchers, managers, and practitioners in designing new interventions to improve transcultural training.

METHODS

A meta-synthesis was conducted to review and integrate qualitative studies of these phenomena. English, Spanish and Portuguese articles were searched in Pubmed and Scopus databases. Only peer-reviewed journals in which qualitative approaches were used were included. Quality was assessed using the CASP qualitative version checklist. The metasynthesis technique proposed by Noblit and Hare was used to analyse the data.

RESULTS

Twenty-nine studies were included in the analysis. Most studies used phenomenological approaches that were conducted in Australia and the United States of America, with international internships being the most popular learning method. The data revealed one central theme, "From learning opportunity to conscious multidimensional change," and six subthemes. The transcultural nursing learning experience is not a simple or linear process. Instead, it appears to be a complex process formed by the interaction between a) self-awareness, b) reflective thinking, c) Cultural Encounters, d) cultural skills, e) Cultural Desire, and f) Cultural Knowledge.

CONCLUSIONS

Transcultural nursing learning is a multifaceted process that arises from specific learning opportunities. This process is still to evolving. Therefore, specific educational strategies should be implemented to encourage attitudinal change and promote reflective thinking.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A virtual training program for improving cultural competence among academic nurse educators

BACKGROUND

Everyday, nursing students interact with culturally diverse clients. Nursing education recognizes that cultural competence is a necessary outcome of nursing programs. Nurse educators expect all nursing students to provide culturally congruent care to multicultural clients. Therefore, nurse educators must be culturally competent in order to prepare culturally competent nursing students for clinical practice. This study aimed to evaluate the effect of virtual training program on the cultural competence of academic nurse educators.

METHODS

This randomized controlled study included nurse educators working in six nursing schools affiliated with medical universities of Kerman province in southeastern Iran. Sixty-nine nurse educators were randomly assigned to the intervention (n = 35) and control (n = 34) groups. The training program consisted of three 2-hour sessions for a month. Cultural Diversity Questionnaire for Nurse Educators Revised (CDQNE-R) was used to evaluate the cultural competence of educators before and one month after the virtual training program.

RESULTS

Both the intervention (3.29 ± 0.58) and control (3.24 ± 0.58) groups demonstrated a similar level of cultural competence before the training program (t = 0.05, p = 0.95). After the training, the intervention group showed a significant increase in cultural competence (3.80 ± 0.7) compared to the control group (3.23 ± 0.67). This improvement resulted in culturally competent participants becoming culturally proficient, as evidenced by a large effect size (t = -4.76, p = 0.001).

CONCLUSION

The virtual training program had a positive impact on the cultural competence of nurse educators. Given the importance of cultural competence in nursing education, continuing education programs that focus on strengthening the cultural competence of nurse educators should be prioritized. The experiences gained from implementing virtual training programs can serve as a valuable resource for nurse educators seeking to enhance their cultural competence.

Enhancing Cross-Cultural Competence of Medical and Healthcare Students with the Use of Simulated Patients-A Systematic Review

Increasing cultural and linguistic diversities of populations have created a challenge for medical educators to provide authentic learning experiences fostering cross-cultural understanding and interprofessional attitudes of students. Simulations with actors portraying patients (commonly referred to as simulated patients) are effective learning modalities to teach students to provide culturally competent care and influence the quality of patient-centered care. The aim of this systematic review was to identify and synthesize available evidence on the use of simulations with simulated patients as a learning intervention to teach cultural competence to the students of healthcare professions. The PubMed, Medline Complete, and CINAHL databases were searched for articles, which resulted in 27 papers being included in the review. Results revealed that engaging students in cross-cultural interactions with patients increases their level of cultural competence, confidence, and learning satisfaction, and therefore, simulations with simulated patients can serve as a powerful reinforcement of cross-cultural education.

Teaching cultural competence to undergraduate pharmacy students using vignettes (case scenarios) as an innovative teaching intervention

OBJECTIVE

Cultural competence is instrumental in reducing health equities. Addressing cultural competence at higher education level in healthcare students lays a solid cultural competence foundation for professional practice. The use of vignettes as a teaching intervention was effective because it allowed the use of role-modelling in real-life situations.The study aimed to enhance cultural competence in undergraduate pharmacy students using a self-directed online interactive cultural competence module embedded with three vignettes (case scenarios).

METHOD

This study was an exploratory longitudinal mixed method (survey and written feedback) study and used a convenience sample of 90 pharmacy students at an Australian University. Students' self-perceived transcultural self-efficacy was evaluated pre- and post-intervention using Jeffreys' Transcultural Self-Efficacy Tool (TSET) which is a validated outcome measure.

KEY FINDINGS

Vignettes were effective in teaching cultural competence as shown by significant (P < 0.0005) changes pre- to post-intervention in cognitive, practical and affective domains scores using TSET. The affective domain had the least positive mean score change. There was no significant association between any of the demographic factors such as age, gender or birthplace/parents' birthplace and changes in any of the three domains. Cronbach's alpha of >0.90 in all domains confirmed the test's internal consistency and reliability.

CONCLUSIONS

The findings were indicative of the students' positive receptivity to learning cultural competence and that they had a well-developed understanding of cultural competence. Further research is needed to determine why most cultural competence teaching methods produce little or no meaningful change in enhancing the affective domain.

The Perception of Nurses about Migrants after the COVID-19 Pandemic: Close Contact Improves the Relationship

Nurses have faced during the COVID-19 pandemic a tough professional situation in which they have had to work in a resource-limited context and with a high probability of COVID-19 transmission. In today's multicultural societies, care for immigrant patients is also included. In our study, we have delved into the perception of hospital nurses towards migrant people in the context of the COVID-19 pandemic. We used a qualitative methodology with a phenomenological approach. Semi-structured interviews were conducted with 16 nurses. Seven categories emerged and were distributed in the three blocks of the interviews: (a) perception before the pandemic: prejudices make a mark and communication problems; (b) perception after the pandemic: prejudices weaken and communication worsens; and (c) how to improve care: improve communication, more nurses, and no need for training. The approach in the interpersonal relationship between nurses and patients during the pandemic has improved health care. Proposals arise to overcome the language barrier such as the incorporation of intercultural translators-mediators and professionals of foreign origin. There is a lack of awareness of the need for training in cultural competence on the part of the nurses in the study.

Nursing Students' Self-Efficacy in Immigrant Health

BACKGROUND

The United States has the largest, most diverse immigrant population. Nurses will care for immigrant clients in all areas of nursing practice.

PURPOSE

The purpose of this study was to determine nursing students' self-efficacy in working with immigrant clients following a service-learning experience.

METHODS

A pre-/posttest descriptive study was used to measure students' self-efficacy in cultural aspects of screening, providing health education, and assisting with health care access prior to and after a voluntary service-learning experience at a resettlement agency.

RESULTS

Statistical significance was found in overall scale score and in all 19 individual items except 2 related to working with (P = .21) and communicating with (P = .49) the health care team. Overall, pretest and posttest results revealed that students' self-efficacy working with immigrant clients was improved.

CONCLUSION

Collaborating with an immigrant resettlement program to provide a structured immigrant health learning experience for prelicensure nursing students can improve self-efficacy in working with immigrant clients.

Improving Cultural Competence and Self-Efficacy Among Postgraduate Nursing Students: Results of an Online Cultural Care Training Program

INTRODUCTION

Since nurses and nursing students interact with culturally diverse clients in health care settings, training programs are required to improve cultural competence and self-efficacy among them. This study aimed to investigate the effect of an online cultural care training program on cultural competence and self-efficacy among postgraduate nursing students.

METHODS

The present interventional study used random sampling to allocate 80 postgraduate nursing students into the intervention and control groups. Cultural care training program was held for the intervention group.

RESULTS

No significant difference in cultural competence and self-efficacy scores was found between the intervention and control groups in the pretest. However, the intervention group scored higher in terms of cultural competence and self-efficacy after the intervention.

DISCUSSION

Given cultural diversity and prevalence of medical tourism, nursing instructors need to pay special attention to cultural care education at all academic levels.

Using a model to design, implement, and evaluate a training program for improving cultural competence among undergraduate nursing students: a mixed methods study

BACKGROUND

Due to changing population, culturally diverse clients with different perceptions of illness and health are present in healthcare settings. Therefore, it is increasingly important for nursing students to have high levels of cultural competence in order to meet diverse client needs. A training program is essential to enhance students' cultural competence. This study aimed to design, implement, and evaluate a cultural care-training program to improve cultural competence of undergraduate nursing students.

METHODS

This exploratory mixed methods study used six steps proposed in the Talbot and Verrinder model to design a training program. In the first step, a conventional qualitative study was conducted and 18 participants were interviewed using purposive sampling. In the second and third steps, literature review and the classic Delphi technique were used for initiation and finalization of the program. The fourth, fifth, and sixth steps were completed by implementing, monitoring, and evaluating the cultural care program (five two-hour sessions) among 73 nursing students using a quasi-experimental design. Finally, effectiveness of program was evaluated through the cultural care inventory before and 1 month after the program. Data were analyzed via SPSS25, independent samples t- test, paired t- test, chi-square test, analysis of covariance, and multivariate linear regression tests.

RESULTS

A systematic model was used to identify key elements of a cultural care program, including main topics, educational objectives and contents, assignments and activities for students, teaching and evaluation methods. The curricular objectives and educational contents were implemented in five sessions to produce measurable results. The quantitative step showed that nursing students' cultural competence in the intervention group (184.37 ± 22.43) improved significantly compared with the control group (153.19 ± 20.14) (t = 6.24, p = 0.001) after intervention.

CONCLUSION

A cultural care training program can be designed by the model applied in this study in order to improve cultural competence of nursing students. This training program will be effective if students' learning needs, appropriate assignments, and acceptable teaching methods are addressed. Therefore, nurse educators can design comprehensive training programs to improve nursing students' cultural competence in different cultures and contexts. This training program is highly efficient because it is applicable in many disciplines of nursing education.

The Role of Standardized Patient Programs in Promoting Equity, Diversity, and Inclusion: A Narrative Review

PURPOSE

Integrating equity, diversity, and inclusion (EDI) in curricula for training health professionals is a frequent institutional goal. The use of standardized (or simulated) patient programs (SPPs) to support EDI in health sciences training is not well described. Here the authors present a theoretical model based on a synthesis of the literature for using SPPs in EDI training, along with a narrative review of the available literature.

METHOD

The authors searched PubMed, Scopus, Science Direct, and Google Scholar databases for studies published between January 2000 and October 2019 describing the use of SPPs to support EDI in health sciences education. Studies were included if they described standardized patient (SP) education involving EDI and reported empiric data about its design, delivery, or effectiveness. The authors conducted a narrative review and provided a synthesis of the available literature, identifying key themes.

RESULTS

Out of 117 studies identified, 17 met the inclusion criteria. Most studies (53%; n = 9) focused on cultural competence; many focused on communication with diverse patients (29%; n = 5) or health inequity (18%; n = 3). Studies employed portrayal of diversity (71%; n = 12) or learning objectives supported by diversity (29%; n = 5) as approaches to EDI relevant to SP training. Three primary themes emerged: improving cultural competence, effective communication with diverse patients, and highlighting health inequalities.

CONCLUSIONS

This review outlines approaches to EDI-based SPPs, with the perspectives and priorities of institutional approaches in mind. SP education around specific EDI issues is reported; however, programmatic approaches to EDI by SPPs are lacking. More research is needed to provide further evidence for the challenges, effectiveness, and outcomes of developing and implementing EDI-based SPPs in health sciences education.

A Systematic Review of Global Health Assessment for Education in Healthcare Professions

Objective:

Methods:

Results:

Conclusions:

Cultural adaptation and validation of the Transcultural Self-Efficacy Tool for use with undergraduate nursing students in Spain

BACKGROUND

The provision of culturally competent care helps reduce healthcare inequalities. There is a positive association between the cultural competence of nursing professionals and patient satisfaction, and also between nurses' self-efficacy and patients' adherence to treatment. While training in this respect is important, the self-assessment of skills should also be addressed.

AIMS

To produce a culturally-validated Spanish-language version of the Transcultural Self-Efficacy Tool (TSET) for use in undergraduate nursing studies, and to evaluate its implementation within the Spanish educational system.

METHODS

This cultural adaptation and psychometric validation study was carried out with student nurses from two universities. International standards were followed for the translation and cultural adaptation of the questionnaire. All students completed the questionnaire twice, the second time 14 days after the first. Those who took the Transcultural Care course at the University of Málaga also completed the questionnaire a third time, after concluding this study subject. The reliability, discriminatory capacity, stability and sensitivity to change of the questionnaire were tested and confirmed, and a confirmatory factor analysis was performed.

RESULTS

A total of 286 students took part in this study. Overall, the TSET obtained a reliability score of 0.978, according to Cronbach's alpha test. In relation to nationality of origin, the discriminatory capacity of the questionnaire was -1.067 (-1815 a -0,320) = 0.005. Stability, assessed at 14 days using the intraclass correlation coefficient, was 0.901 (0.873 a 0.923) <0.001. The before-after sensitivity to change for those who took the Transcultural Care course was 1.820 (1558 a 2083) <0.001.

CONCLUSIONS

This Spanish-language version of the TSET is culturally suitable for the educational context of undergraduate nursing students in Spain, and its psychometric validation was performed with satisfactory results.

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

AIM

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

BACKGROUNDS

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

DESIGN

This study was a methodological systematic review study.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Cultural competence learning of the health care students using simulation pedagogy: An integrative review

The objective of this literature review was to identify the current evidence available on the learning of cultural competence among health care students using simulation pedagogy. An integrative literature review was conducted systematically. The CINAHL, PubMed and ERIC databases were searched for articles published between 2009 and 2019, resulting in including 17 articles in the review. The data were analyzed using descriptive synthesis. The participants of most of the studies were nursing students. The used simulation methods included low- and high-fidelity simulations, standardized patients, virtual and video-streamed simulations and role-play. The educational contents involved assessing advanced communication skills or focusing on patients' socioeconomic, cultural and environmental needs in care. The learning outcomes included knowledge of cultural competence, culturally competent communication skills, culturally competent nursing skills, self-awareness of cultural diversity and self-efficacy in diverse cultural situations. A variety of simulation methods has been used in the cultural competence education and produced several learning outcomes, including an improved understanding of cross-cultural communication and encouragement to discuss various culturally bound health issues. Further research is needed to find an effective combination of teaching methods using innovative ways to foster learning cultural competence.

Cultural competence among pre-graduate nursing students, new graduate nurses, nurse mentors, and registered nurses: A comparative descriptive study

BACKGROUND

Achieving and improving cultural competence in nursing is an ongoing process, beginning in the student period and continuing through the professional career.

OBJECTIVES

The present study aims to compare pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors in Taiwan in terms of their respective levels of cultural competence, and to determine associated influencing factors.

DESIGN

A comparative cross-sectional study.

SETTINGS

Three universities and three hospitals (one regional hospital and two teaching hospitals) in Taiwan.

PARTICIPANTS

A total of 756 nurses/students (103 pre-graduate nurses, 321 newly graduated nurses, 101 registered nurses, and 231 nurse mentors).

METHODS

The Cultural Competence Scale for Pre-Graduated Students to Licensed Professionals was used to measure the cultural competence level. One-way analysis of variance and hierarchical regression analysis were used for statistical analysis.

RESULTS

For overall cultural competence and the subscales of knowledge, awareness, and skills, the pre-graduate students scored lower than the other three groups. Experience of caring for patients from diverse cultures and countries significantly influenced the cultural competence of all four groups. Ability to speak fluent English and receiving cultural competence education during nursing education only significantly influenced the cultural competence of the pre-graduate and new graduate nurses. Current job position and primary practice setting significantly influenced the cultural competence of the registered nurses and nurse mentors.

CONCLUSION

Pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors have differing levels of cultural competence and differing influencing factors. Cultural competence education that accords with the influencing factors for each nursing position would continuously cultivate nursing staff's cultural competence.

The influence of the oncology-focused transgender-simulated patient simulation on nursing students' cultural competence development

BACKGROUND

Disparities experienced by transgender patients, especially in cancer care, leads to poorer outcomes and overall health. Simulation, using transgender simulated patients (SPs) with a focus on cancer care can be an effective way to foster cultural competence nursing education.

METHODS

Guided by the National League for Nursing (NLN)/Jeffries Simulation Theory and Cultural Competence and Confidence Model, this grant funded pretest (n = 48) and posttest (n = 41) comparison group, quasi-experimental study aimed to understand changes in students' transcultural self-efficacy (TSE) following the transgender-simulated patient simulation (TSPS) focusing on an oncological emergency management. Developed by following recommended guidelines and standards, the TSPS had content validity review and pilot testing. It aimed to improve students' knowledge, skills, and attitudes with regard to providing culturally congruent nursing care. The statistical methods included paired sample t-tests, independent t-tests, and correlation analyses.

RESULTS

Students who participated in the TSPS intervention had significantly higher posttest TSE scores (P < .05).

DISCUSSION

SP methodology can be an effective way to foster cultural congruence in nursing care. The findings contribute to the importance of continuous efforts for the inclusion of lesbian, gay, bisexual, transgender, queer (LGBTQ) topic in nursing education to enhance culturally congruent care.

The Development of Chinese Version of Transcultural Nursing Self-Efficiency Scale: Using Rasch Model Analysis

Introduction: With the huge advances of globalization and urbanization, the nursing services in China are meeting the challenge of varied culture-specific needs in practices. Tools to measure transcultural sensitivity thus has great value in promoting transcultural nursing practices. Method: The Chinese version of Transcultural Nursing Self-Efficacy Scale (TSET-CV) was translated and validated with a sample of 2,346 nurses in China. Utilizing the analytical framework of the rating scale model, each item of the three subscales, namely the cognitive, practical, and effect subscale, was analyzed in terms of item analysis, item fitting, difficulty, reliability, item function, and validity. Results: The analysis suggested that 5-point Likert-type scale was more suitable than the 10-point Likert-type scale originally used. Item 27 and Item 79 showed deficient properties, which was deleted in the TSET-CV. The most accurate ranges measured by the TSET-CV matched the range of the distribution of the subjects' ability. Discussion: Unlike the classical test theory, the rating scale model based on the Rasch's model can provide sample-independent psychometric properties of items. The revised TSET-CV has great potential in diagnosing deficiency among nursing student in transcultural self-efficiency, which can promote the development of corresponding education strategies.

Transgender Standardized Patient Simulation: Management of an Oncological Emergency

Introduction: This article describes the development process of Transgender Standardized Patient Simulation (TSPS) as an innovative cultural competence education and its pilot testing as part of the students' program of study. The multidimensional education strategy, TSPS, aimed to improve students' knowledge, skills, attitudes, and confidence in providing culturally sensitive care to a transgender patient experiencing an oncological emergency. Methodology: The design of the TSPS followed the cultural competence and confidence model and international simulation guidelines. Content validity of the TSPS was established. As our usual simulation assessment survey, the adapted simulation effectiveness tool-modified was used to evaluate if the TSPS met with students' learning need. Results: Participants (n = 32) strongly agreed that the TSPS met with their learning expectations and needs and improved their ability to provide culturally sensitive care. Discussion: Training and practice in this area is much needed and well-received by nursing students and faculty.