Constructivism in cultural competence education

Mechanisms Driving Postgraduate Health and Social Science Students' Cultural Competence: An Integrated Systematic Review

PURPOSE

The COVID-19 pandemic revealed a global urgency to address health care provision disparities, which have largely been influenced by systematic racism in federal and state policies. The World Health Organization recommends educational institutions train clinicians in cultural competence (CC); however, the mechanisms and interacting social structures that influence individuals to achieve CC have received little attention. This review investigates how postgraduate health and social science education approaches CC and how it accomplishes (or not) its goals.

METHOD

The authors used critical realism and Whittemore and Knafl's methods to conduct a systematic integrated review. Seven databases (MEDLINE, CINAHL, PsycINFO, Scopus, PubMed, Web of Science, and ERIC) were searched from 2000 to 2020 for original research studies. Inclusion criteria were: the use of the term "cultural competence" and/or any one of Campinha-Bacote's 5 CC factors, being about postgraduate health and/or social science students, and being about a postgraduate curriculum or a component of it. Thematic analysis was used to reveal the mechanisms and interacting social structures underlying CC.

RESULTS

Thirty-two studies were included and 2 approaches to CC (themes) were identified. The first theme was professionalized pedagogy, which had 2 subthemes: othering and labeling. The second theme was becoming culturally competent, which had 2 subthemes: a safe CC teaching environment and social interactions that cultivate reflexivity.

CONCLUSIONS

CC conceptualizations in postgraduate health and social science education tend to view cultural differences as a problem and CC skills as a way to mitigate differences to enhance patient care. However, this generates a focus on the other, rather than a focus on the self. Future research should explore the extent to which insight, cognitive flexibility, and reflexivity, taught in safe teaching environments, are associated with increasing students' cultural safety, cultural humility, and CC.

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

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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.

Does diversity go beyond sex and gender? Gender as social category of diversity training in health profession education - a scoping review

Background: Sex and gender are social categories of diversity. Diversity can be perceived with an intersectional framework as it demonstrates the intersecting categories that might contribute to oppression, inequality, power and privilege. This article focused on what aspects were considered in diversity training programmes for health professions and the role of sex/gender in this context. Method: This scoping review focuses on the social categories mentioned in diversity education of health professionals. Articles on diversity training for health professionals were searched for in the Web of Science database using the keywords gender, diversity, training, education and health professions. Twelve articles were finally included in this review. Thematic analysis was employed to summarise information deduced from articles. Findings: Gaps in the aspects included in diversity training were identified. Findings show that culture was mostly discussed, whereas sex/gender and lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) were focused on only to a minor extent. Cultural diversity training includes self-reflection on one's own culture, whereas a comparable tool for sex/gender and LGBTQI is missing. Additionally, other social categories of diversity, such as disability or age, are largely absent. Conclusion: Diversity should be incorporated in its full breadth in health profession education and not fragmented. Additionally, other social categories such as gender might benefit from including self-reflection on these categories in addition to reflecting on the role of power and privilege in order to increase self-awareness for diversity. In this way, othering of the population might be prevented and healthcare can be improved for all.

3D rendering as a tool for cardiac anatomy learning in medical students

Introduction: Teaching cardiac anatomy, due to its complexity, is a constant challenge for professors and students. This situation has led to the creation of new pedagogical strategies, including the use of 3D rendering, to improve learning.Objective: To assess the impact of 3D rendering as a digital instrument on cardiac anatomy learning.Materials and methods: An experimental study was carried out with two groups of students from a medical program randomly selected. Each group consisted of 40 students; one was the control group (3HB) and the other, the study group (3HA). Both groups attended lectures and practices in the dissection hall of the university, that is, they received training using the traditional methodology. The control group received training using the traditional methodology, as well as instruction using anatomy atlas texts, while the 3HA group received training using the 3D Heart-tomy software, a three-dimensional virtual instrument.Results: Theoretical and practical tests were analyzed, and an opinion survey was conducted, which allowed finding that the students of the 3HA group had better academic performance in the theoretical test than the control group.Conclusion: Didactic and digital 3D media facilitate the understanding of the location of the anatomical structure, and works as a pedagogical tool, although it does not replace practices in the dissection hall.

The Critical Research Evaluation Tool (CRET): A Teaching and Learning Tool to Evaluate Research for Cultural Competence

The aim of this study was to present the Critical Research Evaluation Tool (CRET) which teaches evaluation of the researchers' worldview, applicability to multicultural populations, and ethics surrounding potential harms to communities. To provide best cultural care nurses' need to understand how historical/social/political experiences impact health and also influence research. The Student using the CRET reported receiving a strong foundation in research fundamentals, gaining a better understanding of critical frameworks in research, and learning more about themselves and reflecting on their own privileges and biases. The CRET provides nursing students and nursing faculty with a tool for examining diversity and ultimately decreasing health disparity.

Reshaping curricula: Culture and mental health in undergraduate health degrees

Australia is a country rich in cultural diversity, with Indigenous Australians having specific cultural values and a variety of spoken languages. In addition, the increasing number of people from migrant and refugee backgrounds requires that health professionals be able to communicate effectively with people from a wide range of cultural backgrounds. This is particularly relevant when undertaking a mental health assessment, because members of diverse communities often face the dual vulnerability of marginalization and stigmatization. This paper reports on the development and evaluation of a virtual teaching and learning resource that prepares health students to be culturally competent in mental health assessment. Four online interprofessional learning journeys were developed. Evaluation of the learning resources was conducted across three participating Australian universities. Quantitative evaluation involved pre- and post-testing using an empathy scale, the Mental Health Nursing Clinical Confidence Scale, and the Cultural Competence Questionnaire informed by the theory of planned behaviour. Qualitative data from focus group interviews explored participants' experiences of using the guided learning journey. Participants reported changes from pretest to post-test in their empathy and attitudes towards culturally and linguistically diverse consumers with significant positive changes in cultural competence, empathy, and attitudes. There was strong satisfaction with the learning materials, indicating that participants valued this 'real world' learning experience. Results require cautious interpretation, given recruitment difficulties in the evaluation phase. However, these learning journeys appear to have potential to be an effective way to challenge attitudes and perceptions, as well as increase cultural competence towards culturally and linguistically diverse consumers.

Evaluating an Online Family Assessment Activity: A Focus on Diversity and Health Promotion

PROBLEM

A lack of exposure to diverse families and family interactions created a need to identify effective teaching strategies that emphasized diversity and health promotion in a Registered Nurse to Bachelor of Science in Nursing online transition course.

METHODS

A family assessment activity was designed to emphasize diversity and health promotion utilizing the Family Health Systems approach to family assessment and Healthy People 2020 as a framework for family health promotion. The activity was evaluated through faculty observation and student feedback, which is discussed in the article.

FINDINGS

Evaluation data indicated that students believed the activity provided a safe environment to practice assessment skills for working with diverse families, pushed them out of their comfort zones, enhanced their awareness of the need for health promotion, extended their definition of diversity, increased their cultural knowledge, expanded their personal perspectives on families, and provided them with a broader scope of nursing practice in the community.

CONCLUSIONS

Using constructivist strategies that emphasize active learning and the use of cinema to teach family assessment results in increased awareness of diversity and increased knowledge of opportunities for health promotion in families. Smith Jones.

A virtual caravan--A metaphor for home-internationalization through social media: A qualitative content analysis

BACKGROUND

An internationalized curriculum in nursing education was created in response to the rise of globalization and the need to provide nursing care to people of diverse cultures. Through technology, internationalization at home can facilitate intercultural experiences for more nursing students.

OBJECTIVES

The aim of this study is to explore and describe how a virtual course in intercultural communication between students of two universities, through internationalization at home, can support the development of cultural competence.

DESIGN

Qualitative research

PARTICIPANTS

Junior year nursing students

METHOD

Qualitative content analysis of transcribed written and oral presentations during a course on intercultural communication.

RESULTS

Four major themes, which are not mutually exclusive, were identified.

CONCLUSION

Through this intercultural experience, without leaving home, students uncovered their cultural selves and others based on their own reflective understanding and collaborative discourse with each other and the use of social media for communication. Through experiential intercultural encounters beyond textbook and online materials, they learned to appreciate each other as people with cultural differences yet with much in common, and to recognize their assumptions and the value of subtleties and nuances. They were able to explore solutions within an unfamiliar context through their own efforts and with the support of peers and teachers. This led to a deeper understanding of cultural sensitivity and competence.

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

OBJECTIVES

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

DESIGN

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

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSIONS

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

Teaching population health and community-based care across diverse clinical experiences: integration of conceptual pillars and constructivist learning

Nursing programs are challenged to prepare future nurses to provide care and affect determinants of health for individuals and populations. This article advances a pedagogical model for clinical education that builds concepts related to both population-level care and direct care in the community through a contextual learning approach. Because the conceptual pillars and hybrid constructivist approach allow for conceptual learning consistency across experiences, the model expands programmatic capacity to use diverse community clinical sites that accept only small numbers of students. The concept-based and hybrid constructivist learning approach is expected to contribute to the development of broad intellectual skills and lifelong learning. The pillar concepts include determinants of health and nursing care of population aggregates; direct care, based on evidence and best practices; appreciation of lived experience of health and illness; public health nursing roles and relationship to ethical and professional formation; and multidisciplinary collaboration.

Nursing Students in a Global Learning Environment

Purpose: Two tools were created to help international students to better understand culture by becoming more astute observers of nonverbal behaviors, particularly behaviors depicting emotions among Norwegian students. Design/Method: The two tools were a trilingual list of words illustrating emotions and an exercise with images to practice verbalizing their observations of emotional expression. Findings: Students compared the subdued behaviors of Norwegians to the Israelis’ very vivid behaviors. The intense emotional expression of Israelis influenced their interpretations. By making comparisons and through the experiences with Israelis, they learned more about culture and their own emotional expression. Discussions and Conclusions: Creative strategies can contribute to students understanding and reflection of patients in a different culture. Implications for Practice: Encouraging students to grasp the nuances of emotional expression is part of understanding a different culture. Students, like faculty, learn that self-exploration is an evolving process that requires checking out one’s assumptions and interpretations.

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.

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.

Imagined anatomy and other lessons from learner verification interviews with Mexican immigrant women

OBJECTIVE

To identify clearer, learner-preferred, educational approaches for aspects of cervical cancer education found to be difficult to understand for low-literacy, Mexican, immigrant women.

SETTING

Kansas City, Kansas; Garden City, Kansas; San Antonio, Texas.

PARTICIPANTS

Forty-five Mexican immigrant women in the United States for 5 years or less, ninth grade education or less, and predominantly Spanish speaking.

METHODS

Interviews were conducted to evaluate preference and best comprehension among options for specific cervical cancer educational elements, including reproductive system terminology, the purpose of Pap tests and meaning of results, Human Papilloma Virus (HPV), and illustrations of anatomy and Pap procedure.

RESULTS

We identified terminology, translation, content, and illustrations preferred by participants and areas of inadequate existing knowledge needed for comprehension of concepts being taught. Analogies, illustrations, and introduction of medical terms in conjunction with equivalent common Spanish terms were effective ways of building bridges from existing knowledge to new knowledge. Participants desired detailed information and shared new information with others

CONCLUSION

We learned the importance of assessing patients' existing body knowledge. The detail desired by participants challenged common simplification approaches to teaching low-literacy learners. Participant willingness to share information challenged ideas of cultural taboo. Results provide evidence for more effective delivery of women's health education and call for further research on best approaches to teaching low-literacy learners.

Teaching cultural competency through a pharmacy skills and applications course series

OBJECTIVE

To incorporate cultural competency in a Pharmacy Skills and Application course series and assess the level of cultural competency in students who did and did not complete the courses.

DESIGN

The course series focused on cultural competency throughout the PharmD curriculum and included such activities as self-reflection, lecture, diversity service-learning, case studies, and discussion.

ASSESSMENT

The Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised (IAPCC-R) was used to measure cultural competence in 2 cohorts: the last class preceding implementation of the new course series and the first class after its implementation. Overall scores between the 2 cohorts were not significantly different; however, 2 subscale scores were significantly higher among students who completed the course series: cultural skills (p = 0.021) and cultural encounters (p = 0.048).

CONCLUSIONS

The Pharmacy Skills and Application course series appears to improve some aspects of cultural competence in pharmacy students, but may not be sufficient to elicit change in all areas.