Preparing nursing students for diverse populations

AIM

To improve undergraduate nursing students and educator intercultural knowledge and competencies by implementing an academic systems change.

BACKGROUND

Many organizations have diversity and inclusion guidelines and initiatives for healthcare providers to consider in determining culturally competent care, which has a direct impact on the care given, received, and overall outcomes.

DESIGN

1. Assess student's mindset at the beginning and the end of an undergraduate nursing course. 2. Ensure diversity and inclusion content was provided to faculty through a continuing education program. 3. Review all undergraduate courses for diversity and inclusion content.

METHODS

The Intercultural Development Inventory®, a 50-item cross-cultural, theory-based assessment tool was used in a pre- and post-test design (n = 61 intervention; n = 56 control) to determine undergraduate nursing student's mindset and assists the student's in developing a personalized Intercultural Development Plan. The effectiveness of faculty diversity and inclusion education was evaluated using a post program evaluation. Curricular blueprinting of all undergraduate nursing courses for diversity and inclusion content was completed.

RESULTS

The results demonstrated a statistically significant difference in the post-test between the intervention and control groups.

CONCLUSION

While evidence is lacking in specificity of how to best implement diversity and inclusion content in curriculum, these results provided some excellent baseline data that can be tracked while continued changes occur.

Measuring Research Mentors' Cultural Diversity Awareness for Race/Ethnicity in STEM: Validity Evidence for a New Scale

Research mentors are reticent to address, and sometimes unaware of how, racial or ethnic differences may influence their mentees' research experiences. Increasing research mentors' cultural diversity awareness (CDA) is one step toward improving mentoring effectiveness, particularly with mentees from underrepresented racial/ethnic groups in science, technology, engineering, and mathematics fields. The indicators of CDA for research mentors are not yet known. Thus, we developed a scale to assess CDA related to race/ethnicity (CDA-R/E) in research mentoring relationships informed by multicultural counseling theory and social cognitive theory. The validation process was guided by classical test theory and item response theory and involved qualitative data, cognitive interviews, and an iterative series of item testing with national samples of mentors and mentees. Confirmatory factor analysis evidenced validity for a three-factor mentor scale assessing attitudes, behavior, and confidence, and a two-factor mentee scale assessing attitudes and behavior. The mentee version captures mentees' perception of the relevance of culturally aware mentoring ("Attitudes") and their perception of the frequency of mentor's culturally aware mentoring behaviors ("Behaviors"). Implications for use of the CDA-R/E scale in practice, such as assessing alignment between mentor and mentee CDA scores, and use in future studies are discussed.

Using internationalization-at-home activities to enhance the cultural awareness of health and social science research students: A mixed-method study

BACKGROUND

Despite healthcare scholars valuing diversity, current cultural awareness training does not address mechanisms that drive societal patterns, that generates cultural insensitivity and reinforces stereotypes of minority groups. The influence of culture on thinking is an important issue because of potential ethnocentric biases on the design, data collection, analysis, and dissemination of research.

OBJECTIVES

Using internationalization-at-home activities to explore the mechanisms that enhance the development of cultural awareness in postgraduate health and social science research students.

DESIGN AND METHODS

A pragmatic critical realist study, qualitatively dominant, using mixed-methods to integrate and analyze qualitative and quantitative data. Data were collected pre- and post-internationalization-at-home activities. Qualitative data were collected from online discussion forums and focus groups, and quantitative data were collected from a pre-test and post-test measure of cultural awareness.

SETTING AND PARTICIPANTS

Eighteen research students in postgraduate health and social science programs from three universities (Australia, Hong Kong, and Sweden) participated in five formal internationalization-at-home webinars and informal international group activities.

RESULTS

Participants reported four mechanisms counteracting structures (i.e., ethnocentric biases) toward the emergence of cultural awareness: 1. awareness of cultural issues motivating people toward achieving a common goal; 2. reflexivity within psychological safety; 3. deliberations that challenge the veracity of individual assumptions; 4. courage coupled with curiosity. When some or all the mechanisms occurred, properties of enhanced cultural awareness emerged, as confirmed by the quantitative data.

CONCLUSIONS

Cultural awareness training should emphasize social relations to allow cultural safety to develop for postgraduate health and social science research students. Without skills revealing unconsciously held ethical values, this study argues that postgraduate health and social science students may inadvertently reconstitute and reinforce in their research the discrimination of underserved groups.

Cultural awareness and competence of pharmacy educators and learners from the perspective of pharmacy students at Qatar University: A mixed-methods approach

BACKGROUND

Since healthcare professional educators and practitioners in Qatar are culturally diverse, the impact of this diversity on the education and training of healthcare students should be evaluated. This study, therefore, aims at examining pharmacy students' perspectives on the level of cultural awareness and competence of pharmacy educators and learners at Qatar University and the influence of cultural diversity on pharmacy education in Qatar.

METHODS

A convergent mixed-methods design was adopted. The Cultural Awareness Scale (CAS) was utilized in the quantitative phase, which was administered on 122 pharmacy students at Qatar University College of Pharmacy (QU CPH), of whom 70 responded. The qualitative phase comprised four focus groups with a total of 23 students. The quantitative and qualitative data were collected concurrently, and the results were integrated.

RESULTS

The findings suggest that the QU CPH is an institution of a culturally diverse community. Educators and students alike are generally culturally aware and sensitive; however, demonstration of a holistic awareness was hindered by a few barriers. This study suggests curricular changes to reinforce cultural competence, cultural inclusiveness, and the preservation of Qatar's cultural identity and values in the educational environment.

CONCLUSIONS

The internationalization of pharmacy education in Qatar has inspired students and educators alike to achieve new dimensions of cultural awareness. To infuse passion and enthusiasm in learning while maintaining Qatar's cultural values and identity, healthcare professional educators, researchers, and policymakers are required to collaborate to promote culturally sensitive pharmacy education.

Psychometric properties of a modified cultural awareness scale for use in higher education within the health and social care fields

BACKGROUND

Cultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields.

METHODS

A modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument.

RESULTS

The results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields.

CONCLUSION

The modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.

Advancing pedagogy of undergraduate nursing students' cultural awareness through internationalization webinars: A qualitative study

In today's world, nurses increasingly care for individuals from different cultures. Because culturally sensitive care can improve patient satisfaction in care, nurses need to develop cultural competence in their practice. To develop cultural competence, one option is to build cultural awareness by exposing students to nursing practices in other cultures through online internationalization-at-home activities. However, little is known about the process of cultural awareness development through internationalization activities. Therefore, this qualitative study aimed to identify the development process of cultural awareness in nursing students, who participated in a series of internationalization-at-home activities. A total of 31 nursing students from Australia, Hong Kong, and Sweden volunteered to participate in student-led learning groups. Groups consisted of two to four students from each university, who engaged in four weekly webinars and online reflections about nursing practice based on a case scenario. Data were collected from participants' ongoing reflective journal entries, and after the webinars ended, from three focus groups. A semi-structured interview guide was used to understand how the internationalization-at-home activities impacted their cultural awareness and knowledge of nursing. Data were analyzed using interpretive description. Following four levels of thematic analysis (i.e., comprehension, synthesis, theorizing, reconceptualization), we identified four themes in the development of cultural awareness: 1) nurturing reciprocity through comparisons of nursing culture; 2) discovering common ethical values of the nursing profession; 3) developing cultural awareness in nursing ideology and practice; and 4) transforming understanding of nursing in the context of their healthcare systems. By the end of the internationalization activities, students appeared to have developed relational skills to facilitate their own inner dialogue about ethical ideals of "self" and "other" in the context of being part of the global nursing community. Future research should develop and assess teaching strategies that can further facilitate the four themes in cultural awareness development.

Predictors of self-perceived cultural responsiveness in entry-level physiotherapy students in Australia and Aotearoa New Zealand

BACKGROUND

Ensuring physiotherapy students are well prepared to work safely and effectively in culturally diverse societies upon graduation is vital. Therefore, determining whether physiotherapy programs are effectively developing the cultural responsiveness of students is essential. This study aimed to evaluate the level of self-perceived cultural responsiveness of entry level physiotherapy students during their training, and explore the factors that might be associated with these levels.

METHODS

A cross sectional study of physiotherapy students from nine universities across Australia and Aotearoa New Zealand was conducted using an online self-administered questionnaire containing three parts: The Cultural Competence Assessment tool, Altemeyer's Dogmatism scale, and the Marlowe-Crowne social desirability scale- short form. Demographic data relating to university, program, and level of study were also collected. Data was analysed using one-way ANOVA, t-tests and multiple regression analysis.

RESULTS

A total of 817 (19% response rate) students participated in this study. Overall, students had a moderate level of self-perceived cultural responsiveness (Mean (SD) = 5.15 (0.67)). Fewer number of weeks of clinical placement attended, lower levels of dogmatism, and greater social desirability were related to greater self-perceived cultural responsiveness. Additionally, fourth year undergraduate students perceived themselves to be less culturally responsive than first and second year students (p < 0.05).

CONCLUSIONS

These results provide educators with knowledge about the level of self-perceived cultural responsiveness in physiotherapy students, and the factors that may need to be assessed and addressed to support the development of culturally responsive practice.

Swedish version of measuring cultural awareness in nursing students: validity and reliability test

Background

Nearly 20 % of the Swedish population is foreign-born. Increased exposure of patients from diverse cultures means there is an urgent need to address their unique requirements and provide optimal health care to a diverse population. Nursing schools thus have an important goal of educating nurses to ensure they are culturally competent. Culturally competent care improves safety and equity for patients. To measure cultural awareness among nursing students in Sweden, the aim of this study was to translate, adapt and test the validity and reliability of the Swedish version of a cultural awareness scale which has not previously been tested.

Methods

A total of 158 nursing students from three universities in Sweden completed the 36-item questionnaire on cultural awareness. Verification of face and content validity and a translation/reverse translation process were first carried out.

Results

The results indicate that one item (no 13) caused weak reliability and validity, and therefore it was removed. The reliability test result (with 35 items) showed Cronbach’s Alpha ranged from 0.60 to 0.87. The Model ChiSq group fit for five factors was 50.44 (31.27–77.06; Df = 5; p < 0.001), and the RMSEA was 0.24 (C.I 95 % = 0.18–0.30).

Conclusion

The findings of the validity and reliability tests revealed that the CAS-scale for the 35 items is valid and reliable for use with Swedish nursing students. However, the CAS should be further tested in larger and more diverse samples of nursing students before being used in different socio-cultural settings.

Development of a Cultural Awareness Scale for Occupational Therapy Students in Latin America: A Qualitative Delphi Study

Cultural awareness is a key issue in healthcare worldwide. Valid and reliable assessments are needed to assess cultural awareness for occupational therapy students. The purpose of this study was to develop a scale to assess cultural awareness for Latin American occupational therapy students. A Delphi design was implemented considering four rounds with experts from four countries. A 30-item scale in Spanish was developed to assess three categories of items: personal, therapeutic strategies and persons' cultures. The experts highlighted local features for professional practice as a key aspect of the scale. Local differences in practice were considered with the profession's traditions and prevailing knowledge across the scale. A participatory strategy and an international group of experts enriched the cultural relevance. A subsequent study of statistical reliability is required (the scale is not presented in an extended version here). Further research should consider the application of the scale and strategies to improve cultural awareness across the curricula. Copyright © 2016 John Wiley & Sons, Ltd.

Translation and evaluation of the Cultural Awareness Scale for Korean nursing students

BACKGROUND

To evaluate the effectiveness of a curriculum for achieving high levels of cultural competence, we need to be able to assess education intended to enhance cultural competency skills. We therefore translated the Cultural Awareness Scale (CAS) into Korean (CAS-K). The purpose of this study was to evaluate the cross-cultural applicability and psychometric properties of the CAS-K, specifically its reliability and validity.

METHODS

A cross-sectional descriptive design was used to conduct the evaluation. A convenience sample of 495 nursing students was recruited from four levels of nursing education within four universities in the city of Daejeon, South Korea.

RESULTS

This study provided beginning evidence of the validity and reliability of the CAS-K and the cross-cultural applicability of the concepts underlying this instrument. Cronbach's alpha ranged between 0.59 and 0.86 (overall 0.89) in the tests of internal consistency. Cultural competency score prediction of the experience of travel abroad (r=0.084) and the perceived need for cultural education (r=0.223) suggested reasonable criterion validity. Five factors with eigenvalues >1.0 were extracted, accounting for 55.58% of the variance; two retained the same items previously identified for the CAS.

CONCLUSION

The CAS-K demonstrated satisfactory validity and reliability in measuring cultural awareness in this sample of Korean nursing students. The revised CAS-K should be tested for its usability in curriculum evaluation and its applicability as a guide for teaching cultural awareness among groups of Korean nursing students.