Continuing the cultural competency journey through exploration of knowledge, attitudes, and skills with advanced practice psychiatric nursing students: an exemplar

Numerous training and education programs have evolved to address culturally competent health care delivery. This article describes an exemplar educational approach used to teach cultural competency to beginning graduate psychiatric mental health nursing students. Using interactive strategies delivered within the 4 phases of the curriculum, the approach has been shown to facilitate students' ongoing journey to cultural competence. Building on baccalaureate nursing competencies, the course addresses attitudes, knowledge, skills, and cultural humility to strengthen cultural self-assessment, cross-cultural clinical practice expertise, and the use of culturally appropriate research for graduate students.     

Culturally Congruent Care in Radiology Nursing

The United States' diversity is growing, making it difficult for nurses to meet the needs of patients from a wide range of cultures, belief systems, and groups. Nursing is not new to providing culturally competent care; however, the profession's demographic shift has made it a priority. Improving nurses' cultural competency can lead to increased access to health care and, as a result, better health outcomes. Nurses in all specialties work with people from all walks of life, which necessitates that they have the knowledge and skills necessary to care in a culturally appropriate manner. Radiology nurses, in particular, influence care in a variety of settings and provide care to people of all ages and acuities, making the commitment to fostering culturally congruent practice even more critical. Nurses can begin this process by critically reflecting on their own biases as well as the concepts of cultural humility, competence, and competemility.     

The development of an online diversity and inclusion community: Promoting a culture of inclusion within a college of nursing

Societal demographics are rapidly changing and driving the need to develop a culturally aware and sensitive nursing workforce. Nursing faculty are essential to transform academic and healthcare settings into culturally responsive environments. Yet, there isn't a “one size fits all” plan for faculty to foster diversity and inclusion (D&I) within academic nursing. For instance, cultural humility best practices in academia are limited as D&I interventions historically focus on cultural competency. Cultivating cultural humility exceeds developing cultural competency. Cultural humility incorporates elements of self-reflection/critique (acknowledging assumptions and beliefs), learning from others (listening and being open), and partnership-building (gaining appreciation and respect), all of which encompasses a life-long process. The purpose of this paper is to outline the development of an online D&I communication platform for a college of nursing. We present lessons learned and helpful recommendations for others promoting culturally responsive educational environments. This work is important as limited literature exists outlining the development of online communication platforms where faculty, students, and staff can foster cultural humility. Adopting cultural humility into the fabric of the college of nursing can lead to open communication, a greater understanding of one another, and an opportunity to improve relationships with diverse individuals and patient populations.     

Enabling nursing students to become culturally competent – a documentary analysis of curricula in all Swedish nursing programs

Research has shown that majority of nurses feel that they lack relevant knowledge about immigrant’s cultural backgrounds, and therefore, feel incompetent in providing these patients with good care. Last year alone, 4520 nursing students graduated from nursing schools throughout Sweden. Later on, they will meet and treat people from diverse cultural backgrounds and consequently, it is crucial that their educational training prepares them for their future work in a multiethnic society. The aim of this study was to investigate whether the nursing curricula in Sweden’s nursing schools provide students with the necessary tools for becoming culturally competent. The present study was based on two main questions: (i) Do the present educational plans and courses provide nursing students with the opportunity to become culturally competent? (ii) How do the contents of the educational plans match the contents of the course plans? The study was conducted using a quantitative documentary analysis, where the authors analysed the curricula of 26 nursing schools in Sweden and then compared them to the theoretical frame of reference ‘The Process of Cultural Competence in the Delivery of Healthcare Services’, a model written by Campinha‐Bacote. The results showed that 69% (18/26) had included the concept of culture in their educational plans, whereas 77% (20/26) had included this in their courses. In all, 15% (78) from a total of 504 curricula had included the concept of culture in some way or another. However, the analysis found that only three schools provided students with specific training on the topic. Conclusively, the results showed that nursing students were not prepared for their work in a multiethnic society and nursing education in Sweden has failed to implement existing research into the nursing curricula.     

Cultural Competence in the Master's Curriculum—A Course Exemplar

Multiple teaching–learning strategies such as the online cultural self-assessment, clinical case scenario, critiques of multicultural skill vignettes, and the cultural assessment of the clinical agency helped move nurse practitioner students along the continuum to becoming culturally competent practitioners. Ongoing integration of cultural content in course curricula is necessary to prepare health care providers to meet the challenge of caring for a more diverse society. These students acknowledged this challenge and worked at conquering the cultural divide, making gains and adjustments in the areas of cultural knowledge, skills, and attitudes. There is a gap that exists between those who have been trained recently as it relates to providing culturally sensitive care and those who have not had integrated cultural content in their educational preparation. This will continue to be a challenge for educators, clinical institutions, and governmental agencies. The goal is to ensure that the implementation and integration of cultural competence concepts are not academic exercises but should serve as opportunities to reduce the gap that presently exists.     

Learning about Culturally Humble Care of Sexual and Gender Minority Patients

Each day, nurses care for patients from diverse cultures and backgrounds, including those who self-identify as lesbian, gay, bisexual, transgender, or queer. To facilitate productive health partnerships, nurses need to be aware of a patient's sexual orientation, gender identity, and expression. Prelicensure nursing students employed cultural humility with the use of a video and a guided discussion. The purpose of this article is to describe teaching strategies that can be used by other nurse educators.     

Interdisciplinary: Cultural competency and culturally congruent education for millennials in health professions

The increasingly diverse multicultural and multigenerational student population in the United States requires that educators at all levels develop cultural knowledge, awareness, and sensitivity to help diverse learners fulfill their potential and to avoid cultural misunderstandings that can become obstacles or barriers to learning. The purpose of this study was to design and implement eclectic, creative, evidence-based interdisciplinary educational activities, along with culturally congruent teaching strategies, within a semester-long university course that promoted positive and culturally competent learning outcomes for culturally diverse, largely millennial students. The interdisciplinary course would prepare health professional students with the requisite knowledge and skills, through transformative learning that produces change agents, to provide culturally congruent and quality team-based care to diverse populations. This was a qualitative and quantitative study, which measured students' level of cultural awareness, competence, and proficiency pre and post the educational intervention. Instruments used for data collection included the Inventory for Assessing The Process of Cultural Competence-Student Version (IAPCC-SV) by Campinha-Bacote, course evaluations, students' feedback, and portfolio reflections. The study was conducted at a private academic institution located in the Mid-Atlantic region and the sample population included inter-professional students (N=106) from various health professions including nursing, pharmacy, and allied health sciences. Results from the pre- and post-test IAPCC-SV survey revealed that mean scores increased significantly from pre-test (60.8) to post-test (70.6). Thus, students' levels of cultural competency (awareness, knowledge, skills, desire, encounter) improved post-educational intervention, indicating that the teaching methods used in the course might be applied on a larger scale across the university system to cater to the nation's increasingly multi-cultural population.     

Barriers and facilitators of care for diverse patients: Nurse leader perspectives and nurse manager implications

Objective

To examine chief nurse executives’ perspectives on: (1) the provision of culturally and linguistically appropriate services in hospitals and (2) to identify barriers and facilitators associated with the implementation of culturally and linguistically appropriate services.

Background

Hospitals continue to face challenges providing care to diverse patients. The uptake of standards related to culturally and linguistically appropriate services into clinical practice is sluggish, despite potential benefits, including reducing health disparities, patient errors, readmissions and improving patient experiences.

Method

A qualitative study with chief nurse executives from one eastern United States (US). Data were analysed using content analysis.

Results

Seven themes emerged: (1) lack of awareness of resources for health care organisations; (2) constrained cultural competency training; (3) suboptimal resources (cost and time); (4) mutual understanding; (5) limited workplace diversity; (6) community outreach programmes; and (7) the management of unvoiced patient expectations.

Conclusions

As the American population diversifies, providing culturally and linguistically appropriate services remains a priority for nurse leaders. Being aware and utilizing the resources, policies and best practices available for the implementation of culturally and linguistically appropriate services can assist nursing managers in reaching their goals of providing high quality care to diverse populations.

Implications for Nursing Management

Nurse managers are key in aligning the unit's resources with organisational goals related to the provision of culturally and linguistically appropriate services by providing the operational leadership to eliminate barriers and to enhance the uptake of best practices related to culturally and linguistically appropriate services.     

Changes in weight bias after simulation in pre-license baccalaureate nursing students

AimThe purpose of this study was to evaluate weight bias in baccalaureate nursing students before and after introduction to a communication tool and simulation experience.MethodsA single group pretest-posttest parallel convergent mixed-methods design was used. First semester baccalaureate nursing students within one school of nursing were the participants. The survey included the Fat-Phobia Scale, the Beliefs About Obese Persons scale, and open-ended questions. Findings were triangulated under the Theory of Cultural Humility.ResultsStatistically significant changes were found in elements of both scales and qualitative analysis uncovered an overall planned change in approach when working with patients with obesity. Students’ attitudes trended towards positive attributes, individualized patient-centered care, and cultural humility.DiscussionPurposeful education on communication in addition to diverse patient scenarios in simulation may be effective tools to increase cultural humility and decrease bias in nursing students.     

Developing a culturally competent health care workforce in Japan: implications for education

In recent years, the population of foreign nationals and individuals from diverse cultural, racial, ethnic, and linguistic populations has consistently increased in Japan. An apparent failure by the health care workforce to deliver culturally congruent health care services has resulted in dissatisfaction with the health care system on the part of foreign nationals and increased potential for negative health care outcomes. Primary hindrances to the development of a culturally competent health care workforce include limited exposure to foreigners, cultural factors, and language difficulties. Recommendations are proposed for strategic educational actions to address these obstacles and develop in Japan a culturally competent health care workforce.     

Reducing barriers to interprofessional training: Promoting interprofessional cultural competence

The need to train health professionals who can work across disciplines is essential for effective, competent, and culturally sensitive health care delivery. By its very nature, the provision of health service requires communication and coordination between practitioners. However, preparation for interdisciplinary practice within the health care setting is rare. The authors argue that the primary reason students are not trained across disciplines is related to the diverse cultural structures that guide and moderate health education environments. It is further argued that this profession specific “cultural frame” must be addressed if there is any hope of having interprofessional education accepted as a valued and fully integrated dimension of our curriculum. Each health discipline possess its own professional culture that shapes the educational experience; determines curriculum content, core values, customs, dress, salience of symbols, the meaning, attribution, and etiology of symptoms; as well as defines what constitutes health, wellness and treatment success. Most importantly, professional culture defines the means for distributing power; determines how training should proceed within the clinical setting; and the level and nature of inter-profession communication, resolution of conflicts and management of relationships between team members and constituents. It might be said that one factor limiting interdisciplinary training is profession-centrism. If we are to achieve effective and fully integrated interdisciplinary education, we must decrease profession-centrism by crafting curriculum that promotes interprofessional cultural competence. The article explores how to promote interprofessional cultural competence within the health education setting.     

Integrating cultural values, beliefs, and customs into pregnancy and postpartum care: lessons learned from a Hawaiian public health nursing project

Determining the elements of culturally competent health care is an important goal for nurses. This goal is particularly integral in efforts to design better preventive health care strategies for pregnant and postpartum women from multiple cultural and ethnic backgrounds. Learning about the values, beliefs, and customs surrounding health among the targeted groups is essential, but integrating this knowledge into the actual health care services delivery system is more difficult. The success of a prenatal and postpartum program developed for native Hawaiian, Filipino, and Japanese women in Hawaii has been attributed to the attention on training, direct care giving, and program monitoring participation by local cultural and ethnic healers and neighborhood leaders living in the community, with coordination by public health nurses. This article profiles central design elements with examples of specific interventions used in the Malama Na Wahine or Caring for Pregnant Women program to illustrate a unique approach to the delivery of culturally competent care.     

Improving socially constructed cross‐cultural communication in aged care homes: A critical perspective

Cultural diversity between residents and staff is significant in aged care homes in many developed nations in the context of international migration. This diversity can be a challenge to achieving effective cross‐cultural communication. The aim of this study was to critically examine how staff and residents initiated effective cross‐cultural communication and social cohesion that enabled positive changes to occur. A critical hermeneutic analysis underpinned by Giddens’ Structuration Theory was applied to the study. Data were collected by interviews with residents or their family and by focus groups with staff in four aged care homes in Australia. Findings reveal that residents and staff are capable of restructuring communication via a partnership approach. They can also work in collaboration to develop communication resources. When staff demonstrate cultural humility, they empower residents from culturally and linguistically diverse backgrounds to engage in effective communication. Findings also suggest that workforce interventions are required to improve residents’ experiences in cross‐cultural care. This study challenges aged care homes to establish policies, criteria and procedures in cross‐cultural communication. There is also the challenge to provide ongoing education and training for staff to improve their cross‐cultural communication capabilities.     

Design and evaluation of interprofessional cross-cultural communication sessions

Abstract

The 2013 National Standards for Culturally and Linguistically Appropriate Services (CLAS) call for healthcare professionals to provide quality care and services that are responsive to diverse cultural health beliefs and practices. Accreditation organizations for health professional programs require their curriculum to adequately prepare future practitioners for serving culturally and linguistically diverse populations. Another common curricular need of health professional programs is interprofessional education (IPE). This study presents data that evaluates two IPE culturally competent communication sessions designed for pharmacy and nursing students. Teams of nursing and pharmacy students (n?=?160) engaged in case studies focused on developing cross-cultural communication skills, using the LEARN model. Quantitative survey data collected pre-test and post-test measured cultural competency (including subscales of perceived skills, perceived knowledge, confidence in encounter, and attitude) and knowledge related to culturally competent communication. Univariate ANOVA results indicate that actual knowledge as measured by the test and all four Clinical Cultural Competency Questionnaire (CCCQ) subscales significantly increased after the IPE sessions. Pharmacy students scored higher than nursing students on the knowledge pre-test, and nursing students had a more positive attitude at pre-test. The IPE sessions effectively addressed all learning outcomes and will continue in future course offerings. Using cross-cultural communication as a thematic area for IPE program development resulted in educational benefits for the students. To further strengthen nursing and pharmacy students’ interprofessional practice, additional IPE opportunities are to be explored.     

Effects of a cultural competence education programme on clinical nurses: A randomised controlled trial

BackgroundThe cultural competence education programme for health professionals aimed to ensure that all people receive effective health care, particularly those from culturally diverse backgrounds.ObjectivesThe purpose of this study was to investigate the effect of a cultural competence educational course on nurses' self-assessment of their cultural competence.DesignA single-blind, randomised control trial design was employed.Participants and settingsEligible nurses were recruited from a northern Taiwan medical centre with 2089 beds.MethodsA permuted block of four was used to randomly assign participants to the experimental (n = 47) and control groups (n = 50). The educational course comprised four units and was conducted once weekly for four weeks, with each session lasting 3 h.ResultsA significant group-time interaction was identified regarding self-learning cultural ability, verifying the education intervention's effect on self-learning cultural ability after a two-month intervention. In addition, a significant main effect over time was discovered for total cultural competence; there was no significant interaction effect.ConclusionsThe study provided evidence that an educational programme effectively improved cultural competence in clinical nurses. The results provide a reference for health care providers to design in-service cultural competence education for improving quality of care.