Effectiveness of cultural immersion and culture classes for enhancing nursing students' transcultural self-efficacy

With diversity increasing in the United States, educators are struggling to find the most effective methods to prepare nursing students to care for diverse populations. This study's purpose was to determine the impact of immersion experiences and cultural classes on nursing students' transcultural competence. A pretest-posttest, quasi-experimental design was used. Nursing students completing a 2-week to 3-week immersion experience (n = 14) completed the Transcultural Self-Efficacy Tool online 1 week prior to and immediately following an immersion experience. The control group (n = 25), who were students not participating in an immersion experience, completed the instrument during the same time frame. Students who participated in an immersion experience had significantly higher posttest transcultural self-efficacy scores (p < 0.001). Compared with the control group, the students in the immersion group had significantly higher change scores (p < 0.001). In addition, the number of culture classes completed was not correlated with transcultural self-efficacy scores. Recommendations included encouraging student participation in immersion experiences to enhance transcultural competence.     

Improving the cultural competence of nursing students: results of integrating cultural content in the curriculum and an international immersion experience

The purposes of this study were to evaluate the effect of integrating cultural content (ICC) in an undergraduate nursing curriculum on students' self-perceived cultural competence, and to determine whether a 5-week clinical immersion in international nursing (ICC Plus) had any additional effect on students' self-perceived cultural competence. Cultural competence was measured using a 28-item scale regarding students' self-perceived knowledge, self-awareness, and comfort with skills of cultural competence. Pretest scores from admission into the program were matched with posttest scores obtained just prior to graduation for 32 students, 7 of whom also participated in a 5-week immersion experience in Guatemala. Results, expressed in effect sizes, showed small to moderate gains for the 25 students in the ICC group, and very large gains for the 7 students in the ICC Plus group, related to perceived cultural competence. These results are consistent with the two-phase (cognitive and affective) development of cultural competence proposed by Wells.     

The impact of cultural immersion service learning on BSN graduates: A quasi-experimental evaluation

Aim/ObjectiveThe cultural immersion service-learning model evaluated in this study sought to facilitate cultural consciousness of culturally congruent nursing care among predominantly White nursing students attending a university that was racially and culturally homogeneous.BackgroundEvidence supports the use of cultural immersion service learning during undergraduate nursing programs in developing the skills necessary for effective transcultural healthcare; yet, little is known about its impact beyond the semester of the experience.DesignThis project used a quasi-experimental design to determine if transcultural self-efficacy of BSN graduates among five campuses differed.MethodsOne campus of the five conducted a mandatory cultural immersion service-learning experience during the graduates’ junior year. From a population of 94 BSN graduates of which 30 (32%) graduates participated in the cultural immersion service-learning experience, 53 completed the Transcultural Self-Efficacy Tool. Eighteen (34%) of the graduates who participated in the cultural immersion service-learning experience participated in this study.ResultsThe transcultural self-efficacy was significantly greater in those graduates who participated in the cultural immersion service-learning experience; yet, no difference was found among graduates of the four campuses not offering the experience.ConclusionsThe cultural immersion service-learning experience seems to provide nursing students from racially and ethnically homogeneous communities with an experiential learning context which facilitates the development of transcultural self-efficacy.     

Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review

kokko r. (2011) Journal of Nursing Management 19, 673–682
Future nurses’ cultural competencies: what are their learning experiences during exchange and studies abroad? A systematic literature review Aim This article describes the development of cultural competence among nursing students. The focus is on illuminating the learning experiences of nursing students during their exchange. Background As the world gets smaller, the demand for culturally competent nurses increases. Future nurses need to be open-minded towards international cooperation and willing to develop the quality of care from a cultural point of view. Nursing education in many countries provides an option for students to learn nursing in different cultures while taking part of their studies abroad. Methods A systematic literature search was conducted. Inductive content analysis was applied to the data consisting of empirical studies (n = 7) describing nursing students’ studies abroad. Results The process of developing cultural competence among nursing students on exchange was found to consist of three main themes, namely: (1) an increased cultural knowledge base, (2) personal growth and (3) the impact of exchange experiences on the nursing student’s own practice. Conclusions Studies abroad are a beneficial strategy for the development of future nurses’ cultural competence. Implications for nursing management Nursing is facing a crucial challenge to recruit culturally competent nurses, because an increasing number of patients are from different cultures. Nurses with experiences of studying abroad can offer employers a resource through their preparedness for culturally competent nursing.     

A critical analysis of undergraduate students' cultural immersion experiences

HARROWING J.N., GREGORY D.M., O'SULLIVAN P.S., LEE B. & DOOLITTLE L. (2012) A critical analysis of undergraduate students' cultural immersion experiences. International Nursing Review Purpose: This paper is concerned with the impact of an international health promotion experience on the understanding of culture among university students. Such immersion experiences are often cited as a strategy to prepare nurses for culturally appropriate practice. We describe students' epistemic movements over time with respect to cultural perspectives prior to, during and after a field study in Malawi. Design: Data were collected at three time points from students in undergraduate nursing (n = 14) and non‐nursing (n = 8) programs at a Canadian university. Two essays narrating participants' understanding of culture were submitted by consenting class members. A subgroup of nine participants (four nursing students, five from other disciplines) completed a third narrative following a subsequent field study course in Malawi. Method: Using narrative analysis, themes and structures in the participants' writing were identified and located within a constructivist or essentialist paradigm of cultural understanding. Findings: Overwhelmingly, students' narratives were initially portrayed and informed by an essentialist understanding of culture. Later narratives demonstrated varying degrees of epistemic movement towards more constructivist viewpoints. Narratives that initially exhibited constructivist characteristics tended to display strengthened convictions in that paradigm. Conclusion: We challenge the claim that an international immersion experience immediately transforms participants into cultural experts; our evidence suggests that students experienced existential growth, but their understanding of culture did not change as a result of their brief stay in a different cultural context. Cultural immersion is a phenomenon that requires more critical analysis and systematic investigation to determine how such experiences contribute to learning about culture among nursing students.     

Using an eclectic model to educate students about cultural influences on the nurse-patient relationship

This article describes how the concepts of cultural awareness, cultural sensitivity, and cultural competence are integrated into the nursing curriculum at Lehman College, City University of New York. A culturally diverse student population engaged in lectures, classroom exercises, and clinical experiences in order to learn the ideas and imperatives of cultural diversity in nursing care. The exercises were problem-based learning experiences guided by a university-developed model for teaching students to understand cultural diversity. The model is derived from Leininger's comparative cultural caring model and Paterson and Zderad's humanistic nursing model. By observing differences and similarities among diverse cultures, students learned that the assignment of cultural attributes is an inexact process and should be organized as hints rather than as certainties. Students also learned the importance of integrating cultural awareness, cultural sensitivity, and cultural competence into their nursing care.     

Perceptions of graduating nursing students regarding life experiences that promote culturally competent care.

This article describes a qualitative study that explored the perceptions of graduating students from a northeast baccalaureate nursing program regarding their life experiences with cultural diversity. Thirteen students were interviewed using an interview guide, and interviews were recorded on audiotape. Information obtained included participants' cultural heritage, life experiences before entering a nursing program, educational and clinical experiences in the nursing program, knowledge about cultural competence, and the students' reflections on their ability to provide culturally competent care. Primarily qualitative methods were used to gather and analyze data. This article focuses on one of the major themes that emerged: defining life experiences related to cultural diversity. Data were reanalyzed focusing on this theme, and three life patterns emerged: positive, neutral, and conflicted. These patterns affected the students' interest and desire to provide culturally competent care. Implications for further research and nursing education are discussed.     

“It's not their fault”: Clinical facilitators' experiences supporting English as second language students

BackgroundInternational nursing students in Australia are faced with additional stress and challenges during clinical placements due to language and cultural differences. These factors can significantly impact their learning experience and personal wellbeing.AimThis study aimed to explore the clinical facilitators’ perspectives of the experiences of international nursing students and the potential strategies for improving their learning experiences during clinical placements.MethodsAn exploratory qualitative study was designed. Semistructured interviews with 14 participants were conducted and analysed using thematic analysis.FindingsThe findings were categorised into two categories. (1) Clinical facilitators’ perspectives on the international nursing students’ experiences during the clinical placements, and (2) Clinical facilitators’ perspectives on strategies for improving the learning experience of international nursing students. Category 1 consisted of three themes: (i) Reduce self-confidence when communicating in English, (ii) Lowered perceived self-efficacy, and (iii) Looking for a sense of belonging. Category 2 consisted of five themes: (i) Nurture a supportive environment, (ii) Use validating and understanding communications, (iii) Promote acceptance of the cultural and language diversities, (iv) Use strength-based approaches, and (v) Create opportunities for transcultural socialisation.DiscussionClinical facilitators are well-positioned to support international nursing students to achieve positive learning experiences during clinical placements. More support from the university and hospital may be needed to enable clinical facilitators to effectively implement the identified potential strategies.ConclusionThe study findings provided the background for future research to upskill clinical facilitators and support them to facilitate positive experiences for international nursing students during clinical placements.     

Opening our hearts and minds: the meaning of international clinical nursing electives in the personal and professional lives of nurses

Although international opportunities are the hallmark of nursing education at a large private university, the meaning of participating in such clinical nursing electives has not been described. The purpose of this phenomenological study of nurses was to examine the personal and professional meaning of participating in international clinical nursing electives during their undergraduate nursing studies. Audiotaped interviews were conducted with 20 former nursing students who had had this opportunity. "Opening our hearts and minds" was described by the study's participants, with the following themes: increasing understanding of other cultures and peoples, increasing understanding of global sociopolitical and health issues, increasing the commitment to make a difference, experiencing personal and professional growth, contributing to professional development in the host country, making interpersonal connexions, and developing cultural competence. This study makes an important contribution to the documentation of the meaning of participating in international nursing clinical experiences. Data are being used for long-term curricular planning in the development and refinement of future international clinical nursing electives and to provide outcomes data for professional accreditation. There are broader implications for the movement beyond individual cultural competence to increasing global consciousness and the improvement of global health care.     

Clinical mentors' experiences of their intercultural communication competence in mentoring culturally and linguistically diverse nursing students: A qualitative study

BackgroundIntercultural communication has become increasingly important in nursing due to the cross-border mobility of patients, health professionals and students. Development of cultural competence continues to be a challenge, particularly among professionals such as educators or healthcare providers who work in professions requiring communication across cultural boundaries. Despite challenges in nursing education related to cultural diversity, competence in intercultural communication has been proven to empower students and to help them grow professionally.ObjectivesThe aim of this study was to describe clinical mentors' experiences of their intercultural communication competence in mentoring culturally and linguistically diverse nursing students during completion of their clinical practice.DesignQualitative study design.ParticipantsThe participants were 12 nurses who had previously mentored at least two culturally and linguistically diverse nursing students.MethodsData were collected during spring 2016 using semi-structured interviews of 12 mentors working in specialized nursing care at one hospital located in central Finland. Data were analyzed using deductive-inductive content analysis. The main concepts of the Integrated Model of Intercultural Communication Competence were used during the semi-structured theme interviews and during analysis. These concepts include empathy, motivation, global attitude, intercultural experience and interaction involvement.ResultsMentors stated that empathy motivates them in the development of intercultural communication. Mentors experienced a lack of resources and support from their superiors, which caused psychological and ethical strain and reduced mentors' motivation. Mentors openly admitted that they had experienced fear towards unknown cultures, but that this fear was reduced through positive mentoring experiences and cultural encounters.ConclusionsContinuous education on intercultural communication competence could succeed to further develop clinical mentors' mentoring expertise, which could have the potential to greatly benefit students, patients and staff. Such education could be designed, implemented and measured for its effect in collaboration between health care organizations and higher educational institutions.     

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.     

A comparison of self-reported cultural competency skills among two groups of nursing students: implications for nursing education

This study was designed to examine self-reported cultural competency skills of second-semester junior-level nursing students toward clients from culturally diverse backgrounds. The purpose of this study was to ascertain if the addition of an innovative cultural sensitivity intervention facilitated greater self-perceived cultural competency skills when compared with the traditional method of incorporating cultural diversity into a junior-level clinical course. The Ethnic Competency Skills Assessment Inventory was used to collect data from participants attending a university in an urban midwestern county. Significant differences were noted between the pretest scores and posttest scores. Pretest scores were significantly lower than posttest scores for both groups. Nurse educators must examine further the differences in learning experiences related to cultural diversity that may account for these differences.     

Volunteering in Cambodia

In August 2004, three undergraduate nursing students from the University of Toronto's faculty of nursing travelled to Cambodia to volunteer as student nurses. Being immersed in another culture helped to develop the students' cultural competence, enhance their understanding of primary health care and strengthen clinical skills. Given the growing cultural diversity in Canada, developing s kills in these areas is particularly important. In this article, the author reflects on her experiences in Cambodia and explores the unique value that international placements offer.     

The effects of a reminiscence education program on baccalaureate nursing students' cultural self-efficacy in caring for elders

The increase in our minority elder population has created a need to develop innovative programs that prepares students who are competent in gerontological nursing skills and sensitive to cultural differences. The purpose of this pilot study was to test the effects of a reminiscence education program on BSN students' cultural self-efficacy in caring for elders. An interrupted time series design with a nonequivalent, no-treatment control group was used with 64 nursing students recruited from a northeast university in the United States. The intervention consisted of a two-hour reminiscence education program and a 13 week period in which the experimental group implemented integrative reminiscence with elders during their community health practicum. The eldercare cultural self-efficacy scale was the outcome measure. Results indicated that students receiving the reminiscence education program demonstrated significantly higher levels of eldercare cultural self-efficacy F(1, 62)=5.34, p=0.024 than those not receiving the intervention. Reminiscence education programs implemented as part of clinical practicums may assist to increase nursing students' perceptions of confidence in caring for elders. Implications for nursing education and the care of diverse elders are discussed.     

Assessing outcomes of a study abroad course for nursing students

There is little debate about the importance of preparing nursing graduates to provide culturally sensitive care to an increasingly diverse society. However, it is difficult for nurse educators to fit learning experiences that help students develop cultural competence into already full programs and create mechanisms to evaluate the results. This article describes a study to assess the impact of a study abroad program on developing cultural competence, including cultural awareness, sensitivity, knowledge, and skills. Results from the Cultural Awareness Survey, reflective journals, and interviews illustrate how the study abroad experience influenced the development of components of cultural competence and might influence clinical practice. Results suggest effective teaching strategies to assist students in becoming culturally competent are experiential in nature and include role modeling, reflective activities, and group discussion.     

A case for learning-centered curricula

Nurses must be able to anticipate and manage the care of patients with complex conditions in a rapidly changing, highly technological health care environment. Yet many of today's nursing programs are failing to provide curricula to meet the changing needs of students who will work in that environment. Typical teacher-centered programs are content heavy and focus on what faculty want to teach, not what students need to learn. Learning-centered education shifts the focus from teaching to student learning. Learning-centered programs identify student learning outcomes that are reflective of current nursing practice, use authentic assessment, and provide learning experiences that move students toward the achievement of outcomes. This article describes the major benefits of a learning-centered curriculum, and a model depicts the dynamic relationship among learning experiences, assessment, and student learning outcomes. We also offer suggestions for nursing faculty who are considering the move from teacher-centered to learning-centered curricula.     

Evaluating the influence of cultural competence education on students' transcultural self-efficacy perceptions

Guided by the cultural competence and confidence (CCC) model, the Transcultural Self-Efficacy Tool (TSET) was used to evaluate the influence of cultural competence education on the transcultural self-efficacy (TSE) perceptions of undergraduate nursing students following an integrated approach to cultural competence education. Results continue to support that TSE is influenced by formalized education and other learning experiences. As hypothesized, compared with novice students, advanced students' scores were higher for all subscales in both cross-sectional (n = 147) and longitudinal (n = 36) study designs. Results from analysis of variance and covariance demonstrated that none of the demographic variables predicted change; semester was the sole predictor, lending additional support that (a) the educational interventions throughout the four semesters influenced TSE changes and (b) all students regardless of background benefit (and require) formalized cultural competence education. Implications for nurse educators conclude the article.