Methods of increasing cultural competence in nurses working in clinical practice: A scoping review of literature 2011–2021

Understanding cultural inclusion in alcohol and other drug services in New South Wales, Australia and assessing the acceptability of a cultural inclusion audit

INTRODUCTION

Cultural inclusion and competence are understood at the most basic level to be the practice of considering culture so as to provide effective services to people of different cultural backgrounds. In order to work better with clients from diverse backgrounds, alcohol and other drug (AOD) services need to offer a service that is designed to be accessible to all people, where systems in place operate in a way that considers different cultural needs. This research aimed to assess the extent to which non-government AOD services in New South Wales are positioned to support cultural inclusion as well as to evaluate the acceptability of a cultural inclusion audit across four AOD sites.

METHODS

The research adopted a mixed methods approach comprising of a pre-audit online survey (n = 85) designed to assess AOD services' attitudes and practices towards cultural inclusion, and in-depth interviews that were conducted with nine AOD service staff and four cultural auditors to explore the acceptability of a cultural inclusion audit process.

RESULTS

Findings from the survey indicate cultural inclusion practices are limited. Interview data highlight that while staff are not fully aware of what appropriate cultural inclusions entails, they are receptive to and want a cultural inclusion program.

DISCUSSION AND CONCLUSIONS

The study illustrates the benefits of implementing a cultural inclusion audit process aimed at raising awareness of what cultural inclusion entails. Including a cultural inclusion service audit is likely to enhance AOD service provision to culturally and linguistically diverse groups and thereby improve treatment outcomes.

Nursing students' empathy in response to biological and psychosocial attributions of depression: A vignette-based cross-cultural study

BACKGROUND

Empathy is vital for quality nursing care in acute mental health settings. Although different explanations of mental illnesses shape mental health clinicians' empathy towards people with mental illnesses, it is unclear how such findings translate to the culturally diverse nursing context.

AIM

The study investigated nursing students' empathy towards people with depression and their perceived clinical utility of biological and psychosocial explanations of depression in Australia and Singapore, focusing on two factors of cultural difference: relational mobility and cultural tightness.

DESIGN

We used a cross-sectional research design with a repeated-measures component.

PARTICIPANTS

The sample included 211 nursing students from Australia and Singapore. Participants were predominantly female (81 %), with ages ranging from 18 to 57 years (M = 26.51, SD = 7.61).

METHODS

Participants completed a vignette-based online questionnaire containing measures of empathy, perceived clinical utility, relational mobility, and cultural tightness.

RESULTS

Nursing students' empathy in response to the biological and psychosocial explanations of depression differed in Australia (biological: M = 2.96, SD = 0.89, 95 % CI [2.80, 3.13]; psychosocial: M = 3.56, SD = 0.91, [3.39, 3.73]) but not in Singapore (biological: M = 3.05, SD = 0.91, [2.87, 3.23]; psychosocial: M = 3.25, SD = 0.93, [3.06, 3.43]). Relational mobility mediated cross-cultural variances in empathy, b = -0.16, SE = 0.06, 95 % CI [-0.29, -0.05], and perceptions of clinical utility, b = -0.08, SE = 0.05, [-0.20, -0.00], when depression was explained psychosocially.

CONCLUSIONS

Nursing students' empathy and perceived clinical utility of explanations of depression are shaped differently across cultures in part due to relational mobility and cultural tightness. As such, embedding cultural awareness education in nursing curricula to address any culturally rooted biases towards people with mental illnesses may present a promising avenue to optimise nursing students' empathy towards people with mental illnesses.

Enhancing Nursing Care through Cultural Competence: Focus on the Inupiat Community

INTRODUCTION

This article explores the historical and cultural background of the Inupiat community, highlighting health disparities and emphasizing culturally competent care's role in addressing them.

METHODS

Inupiat health beliefs, communication styles, family dynamics, and dietary habits are examined in relation to Western medical practices within tribal health systems. Strategies for cultural education include curriculum development, simulations, clinical assignments, and partnerships with Inupiat healthcare professionals.

RESULTS

Challenges in providing culturally competent care to the Inupiat community are identified, including barriers in nursing education and legal implications for nursing practice. Strategies for enhancing nursing cultural competency are outlined.

DISCUSSION

This paper advocates integrating cultural competency into nursing practices to improve care for the Inupiat community, focusing on training, education, and policy recommendations. It emphasizes the importance of respecting and integrating Inupiat cultural practices to enhance health outcomes and healthcare experiences.

Re-thinking the Concept of Cultural Competency in Nursing Care of Older Adults

The influx of migrants to Canada has resulted in a shift in the country's demographic landscape. Individuals often interpret and approach health and wellness through the lens of their cultural heritage, which has led to stereotyping behaviors and discriminatory practices, exacerbating the notion of "Othering". Immigrant older adults are likely to experience discrimination in a more dreadful way in the form of societal isolation and marginalization due to the collective systems of power such as ageism, ableism, and racism. This paper results from continuous thought-provoking discussions initiated by the first author (AM) in her doctoral program at the University of Western Ontario for the Philosophy of Nursing Science course, taught and facilitated by the second author (SM). After studying the course materials on "revolutionary science" and reflection on the process of paradigm shift introduced by Thomas Khun and engaging in critical discussions on a range of relevant philosophical concepts such as bio-power, othering, silencing and ignorance, marginalization, oppression, neoliberalism, health equity, and social justice, we have been prompted to rethink the concept of cultural competence in nursing education and healthcare practices, particularly in the context of nursing care of older adults. Therefore, in this paper, we will critique the concept of cultural competency in the context of an anti-racist and anti-oppressive lens and suggest a pivotal response to move towards an inquiry-driven approach based on cultural humility and respect in the nursing care of older adults.

Enhancing nursing students' cultural awareness through Community of Inquiry-guided online 'Internationalization at Home' strategies-An intervention study

AIM

Internationalization at Home (IaH) strategies play an important role in nursing curricula to enhance nursing students' cultural awareness in the globalized world. The Community of Inquiry (CoI) is a theoretical framework for the optimal design of online learning environments to support critical inquiry and discourse among students and teachers. To optimise nursing students' online cultural awareness learning experiences, it was timely to develop online IaH strategies based on a sound theoretical model. This study aimed to examine the effectiveness of CoI-guided online IaH strategies on enhancing the cultural awareness of nursing undergraduates who enrolled in a community nursing course.

DESIGN

This was an interventional pre-test post-test study.

METHOD

One hundred and six nursing undergraduates who enrolled in the course participated in the study. The online IaH strategies were developed focusing on the interactions of teaching presence, cognitive presence and social presence of CoI framework and they were integrated into the course. A previously validated Cultural Awareness Scale was adopted for pre-post evaluation. Higher scores indicate greater cultural awareness.

RESULTS

The results showed that there was a significantly higher total score of cultural awareness of participating students at post-online IaH strategies. To be effective, aligning CoI-guided online IaH strategies with course content, pedagogy and assessment was shown to be significant. The inclusion of technological elements in related strategies was also critical to engage student learning. The positive change on the total score of cultural awareness suggested the effectiveness of the deployed strategies. In this ever-changing educational landscape, it may provide insights to educators regarding considering online IaH strategies with theoretical underpinning for curriculum planning and design.

Culturally Competent Care for Diverse Populations: A Review of Transcultural Nursing Education

Transcultural nursing is a discipline that emphasizes culturally competent care for diverse populations, recognizing the influence of culture on health beliefs, values, practices, and outcomes. It requires nurses to respect cultural differences and similarities, but faces challenges in curriculum design, faculty development, and student assessment. This paper explores transcultural nursing education's current state and future directions, addressing the American Association of Colleges of Nursing essentials for integrating cultural content into nursing curricula, reviewing Madeleine Leininger's transcultural nursing theory, diversity, equity, and inclusion concepts, and discussing the main challenges of transcultural nursing education, including lack of student diversity, training, and resources. Strategies to overcome these challenges include interprofessional collaboration, cultural immersion, and evidence-based practice. The paper concludes with how emergency department nurses should incorporate this into practice.

Towards anti-racist futures: a scoping review exploring educational interventions that address systemic racism in post graduate medical education

Since 2020, brought to the forefront by movements such as Black Lives Matter and Idle No More, it has been widely acknowledged that systemic racism contributes to racially differentiated health outcomes. Health professional educators have been called to address such disparities within healthcare, policy, and practice. To tackle structural racism within healthcare, one avenue that has emerged is the creation of medical education interventions within postgraduate residency medical programming. The objective of this scoping review is to examine the current literature on anti-racist educational interventions, that integrate a systemic or structural view of racism, within postgraduate medical education. Through the identification and analysis of 23 papers, this review identified three major components of interest across medical interventions, including (a) conceptualization, (b) pedagogical issues, and (c) outcomes & evaluation. There were overlapping points of discussion and analysis within each of these components. Conceptualization addressed how researchers conceptualized racism in different ways, the range of curricular content educators chose to challenge racism, and the absence of community's role in curricular development. Pedagogical issues addressed knowledge vs. skills-based teaching, and tensions between one-time workshops and integrative curriculum. Outcomes and evaluation highlighted self-reported Likert scales as dominant types of evaluation, self-evaluation in educational interventions, and misalignments between intervention outcomes and learning objectives. The findings are unique in their in-depth exploration of anti-racist medical interventions within postgraduate medical education programming, specifically in relation to efforts to address systemic and structural racism. The findings contribute a meaningful review of the current state of the field of medical education and generate new conversations about future possibilities for a broader anti-racist health professions curriculum.

Examining Cultural Comfort and Knowledge in Undergraduate Nursing Students After the Implementation of an Online Educational Animation on Providing Care for Muslim Patients

INTRODUCTION

With rapidly growing members of the Islamic faith, health care providers should expect to care for Muslim patients regardless of their chosen specialty. The quality of care provided hinges on their knowledge and understanding of Islam. This study aimed to analyze the influence of an educational animation on undergraduate nursing students' cultural comfort and knowledge concerning the health care needs of Muslims.

METHODS

An educational animation was created addressing the unique health care needs of Muslim patients. Surveys (pre, post, 6 weeks) (n = 658) assessed cultural comfort and knowledge on covered topics.

RESULTS

Student knowledge (pre: 12.4 ± 0.1; post: 14.4 ± 0.2; p < .01) and cultural comfort (pre: 4.0 ± 0.03; post: 4.1 ± 0.03; p < .05) increased after viewing the online educational animation. The increase in knowledge was sustained at 6 weeks. Students recommended additional topics for the future.

DISCUSSION

This study highlights how an innovative educational animation can enhance students' understanding of providing care for Muslim patients, positively impacting patient outcomes.

The Development and Validation of an Intercultural Nursing Educator Profile Using the Delphi Method

INTRODUCTION

Educators require focused training to foster the development of intercultural competence in nurses. Training programs for educators need to be based on a comprehensive profile with a focus on intercultural learning. This study aims to define and validate a profile of the Intercultural Nursing Educator (INE).

METHOD

The Delphi method was used with an iterative, multi-stage process to transform opinions into group consensus. A total of 46 European, African, and American experts from the nursing and intercultural field participated. Inclusion criteria required English at a level of B2, expertise in the field of intercultural competence, experience in teaching intercultural competence in the nursing context, and publications focused on intercultural topics.

RESULTS

The INE profile was developed and all 126 competencies were validated.

DISCUSSION AND CONCLUSION

The profile is freely available on the project website and provides the basis for curricula, training programs and assessment of the required competences.