Cultural Competency Classes and Their Impact on Their Nursing Care

Type: Research Paper

Subject: Pharmacology & Nursing Care

Subject area: Nursing

Education Level: Undergraduate/College

Length: 8 pages

Referencing style: APA

Preferred English: US English

Spacing Option: Double

Title: Cultural Competency Classes and their Impact on their Nursing Care

Instructions: apa 7th edition – student assignment paper format title page introduction / background methods results discussion discussion section also includes: interpretations of the results section - the results should not include your opinions - those go here! next steps in research should be discussion of limitations in the literature potential applications to practice now. references appendix – literature review matrix only articles included in the results section – minimum of 5 there are no page minimums or limits to this paper submit to canvas in .pdf or .docx 1 point of extra credit will be given if you submit a paper copy for grading on or before the due date/time

Focus: the main purpose of the paper is to find research articles that address the picot question ,does cultural competency classes improve nursing care at the bedside? and help back up their claims.

Structure: Important notes: hello, it is for my research methods class, its an evidence based paper and i have already picked out the sources that my teacher has approved and i have written an intro and background, if it doesnt fit in with what you would like to say , feel free to change it.

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Cultural Competency Classes and Their Impact on Their Nursing Care

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Cultural Competency Classes and Their Impact on Their Nursing Care

The American Association of College of Nursing underscores the significance of incorporating cultural competence content in today’s nursing curricular. According to Roller & Ballestas (2017), cultural competence classes are necessary because of the United States’ changing demographic profile.  Based on the 2010 U.S. Census Bureau statistics, 37% of the United States population was non-white by 2010. Between 2000 and 2010, the United States recorded a 43% growth in the Hispanic population and a 33% growth in individuals belonging to two or more races (Roller & Ballestas, 2017). Accordingly, among three American residents, one belongs to the racial/ethnic groups, and the number is expected to rise to 101million individuals.  Since the United States is increasingly becoming a culturally diverse country, enhancing undergraduate students’ access to immersion courses is vital to boosting their cultural competency levels. The immersion courses are beneficial to both the undergraduate baccalaureate nursing students and faculty because they improve their cultural competency and personal growth.

 Although many university programs incorporate courses to enhance student’s cultural competence, many feel inadequately prepared to offer their service in a culturally diverse environment.  Stough-Hunter,  Guinan, & Hart(2016) consider this statement troubling because the United States population is increasingly becoming diverse requiring nursing programs to prepare graduate nurses to serve these patients. Debiasi & Selleck (2017) substantiate that graduate nurses require culturally appropriate skills to provide culturally competent care to the diverse American population. The authors further state that primary care nursing practitioners work with diverse patient’s population in underserved areas. These patients have unique social, economic, and cultural needs that healthcare workers should consider when providing care. As nurses’ scope of practice widens, it is necessary to enhance their cultural competence ability to offer care that reflects their population’s diversity.

 Cultural Competence is a significant aspect of client care. It influences the establishment of rapport with the client, making accurate diagnoses, and comprehending illness and health from the patient’s perspective and language. Given the importance of cultural competence skills in the United States healthcare system, my PICOT Question is: Does cultural competency classes improve nursing care at the bedside? 

Methods

The articles for the literature review were sourced from online databases, including EBSCOhost and Proquest. I only included articles between 2016 and 2021 were included. The keywords used to search for the articles were Diversity, Cultural Competence, Nursing Education Programs, Nursing Students, Primary Care, and Nurse Practitioners. The search strategy resulted in five articles being relevant to my inclusion criteria and PICOT question.

Results

Cultural competency is a continuous process that enhances nurses’ ability to offer their services in a multi-cultural environment.  Nurses take care of communities, families, and individuals from distinct ethnic/cultural backgrounds. Therefore, cultural competence is an important aspect of care delivery. Serving the global community requires nursing students to provide competent and safe care to a diverse patient population.  For this reason, Accrediting bodies like the American Association of College of Nurses require a baccalaureate curriculum to integrate culture in their courses while including standards to measure students’ cultural competence (Knecht et al., 2018).  Nursing students remain underprepared to meet the care of the diverse patient population.

Approximately 40% of the United States populations are ethnic minorities.  Hispanics account for about 17% to 20% of this population, followed by African Americans (13%). Other ethnic minority groups, including American Indian, Asian, and Middle Eastern, Pacific Islanders, and other races also make up the American population (Knecht et al., 2018). Between 2009 and 2013, about 15% of the American population identified itself as foreign-born, with 33% speaking other languages than English (Knecht et al., 2018). The American population is also religiously diverse. Most Americans consider themselves Christians (75%), while the remaining identify themselves as Hindus, Muslims, Buddhists, or Judaism (Knecht et al., 2018). Therefore, nursing students should be culturally prepared to care for individuals from distinct religious and cultural backgrounds.

According to Debiasi & Selleck (2017), primary care nurse practitioners are stationed in diverse communities. The communities are underserved despite their unique social, economic, and cultural needs. Nurses working in these communities should be competent to meet the diverse needs of these patient populations. However, Knecht et al. (2018) note that both graduate and baccalaureate-prepared nurses are ill-prepared to offer culturally-appropriate care to an increasingly diverse patient population. The situation worsens by classroom education about individuals’ beliefs and values, promoting generalization and populations’ stereotype. Therefore, primary care nurses working in diverse communities need to be adequately prepared to address their client’s social, cultural, and economic needs.

The nursing program can use various strategies like nurses’ international experience, cultural-tailored communication training, and appropriate teaching strategies to enhance their student’s cultural competency skills. Roller & Ballestas (2017) analyzes a study comparing nursing students studying cultural content in the classroom environment and those studying abroad program on cultural sensitivity and awareness in Guatemala. According to the study findings, students engaging in the immersion program scored higher on cultural sensitivity, cultural awareness, cultural competence, and cultural efficacy than their peers not studying abroad. The findings demonstrate the importance of international experience in enhancing nurses’ cultural competency. Culturally tailored communication is another strategy to boost nurses’ cultural competency. Parker, Fang, & Bradlyn (2020) maintain that healthcare provider training is crucial to overcoming the disparities that characterize healthcare access because the training’s focus is on cultural competence.  Cultural competence training positively affects intermediate outcomes like provider behaviors, attitudes, knowledge, and clinical measures. 

Accordingly, teaching strategies like critical reflection, immersion experiences, standardized patient simulation, and clinical experiences effectively boosts student’s confidence, knowledge, and awareness while interacting with clients from diverse ethnic backgrounds.  According to Stough-Hunter, Guinan, & Hart (2016), the lecture method improves students’ knowledge but not their cultural competence, while group discussion methods improve ideas exchanges and students’ knowledge and attitudes.  However, group discussions do not result in a permanent change in student’s behavior. Clinical experiences with individuals from diverse cultures enhance students’ confidence and comfort in care. Additionally, racial and ethnically diverse guest lecturers provide students with significant insights into caring for patients from diverse backgrounds (Stough-Hunter,  Guinan,  & Hart, 2016). Also, partnering between community members and the education sectors provides individuals with a platform to speak about their unique cultural experiences with their healthcare workers. Immersion abroad for one semester or one week reduces students’ anxiety when engaging with individuals from new cultures (Stough-Hunter,  Guinan,  & Hart, 2018). The experience also improves student’s second language skills. Furthermore, immersion enhances cultural flexibility, sensitivity, self-awareness, and averting of stereotyping. Knecht et al.(2018) support immersion abroad claiming that student nurses’ exposure to various encounters compels them to examine their beliefs and values and critically reflect about their experience. Additionally, international experience compels students to approach diverse perspectives, complexity, and uncertainty through others’ worldviews or eyes. Through critical reflection, student nurses become aware of the experiences of individuals from diverse backgrounds. Thus, cultural encounters form the basis for developing cultural competence.

Discussion

The minority groups in the United States receive poor care quality than their white counterparts. As a result, mortality and morbidity rates are higher in racial/ethnic minority groups than whites. Parker, Fang, & Bradlyn(2020) note that 20 years after the Institute of Medicine 2000 report, healthcare disparities in accessing quality and safe care have improved. However, healthcare disparities between Whites and Blacks persist, and healthcare provider training can help overcome these disparities.  The training purpose is to enhance providers’ cultural competence to enhance their competence in meeting diverse patients’ linguistic, cultural, and social needs.

  Studying abroad programs boosts students’ cultural competence. These programs allow nursing students to interact with individuals from different cultures. The experience enhances their confidence and comfort in providing healthcare to the diverse patient populations by being immersed in their culture. Accordingly, studying abroad exposes students to multiple perspectives and experiences that allow them to discover uncertainty in caring for diverse patient population.  Furthermore, international experience promotes student nurses understanding of their client’s worldviews through trusting and open relationships and some level of immersion. 

Nursing faculty should adopt teaching strategies that enhance their students’ cultural competence. Many students claim that they are inadequately prepared to provide care to a diverse patient population. Therefore, the faculty should use teaching strategies like immersion experiences, standardized patient simulations, and clinical experiences because they boost students’ confidence in working with diverse patient populations.

Limitations in the Literature

Although the articles provide significant insights into the importance of cultural competence in meeting the diverse patient population’s linguistic, cultural, and social needs of, the articles’ study methods had various limitations. For instance, Debiasi & Selleck(2017) conducted a study whose objective was to use training to enhance nurses’ practitioners’ ability to offer culturally competent care. The authors utilized a mixed-methods design to meet the study objective. However, the study had various limitations. For instance, the study was carried out for more than ten weeks. However, such a study requires a significant amount of time to allow nurse practitioners to make practice changes to assess if the practice changes are permanent. Additionally, the sample size was too small to generalize the study findings. For instance, the number of nurse practitioners was 13, a number too small to generalize the study findings. Therefore, future studies should consider more participants and a longer study time. Another limitation of the study was that both the nurse practitioner and the client participants did not disclose their names in their completed surveys. Accordingly, the study used different clients in the pre-and-post training, limiting data analysis. Despite these weaknesses, future studies can use it as a pilot study to conduct lengthier and larger research.

Roller & Ballestas (2017) also conducted a study to determine the study abroad program’s impact on cultural competence after one year compared to immediately after the experience. The study utilized a quantitative comparison design to measure cultural competency. Additionally, the study utilized instruments that students filled after the program’s conclusion. The study comprised 33 students (18 whose study abroad program’s impact was measured immediately after the experience and 15 students, one year after the study abroad program). However, the study had multiple limitations. For instance, the smaller sample size limits the generalizability of the study findings to the whole population. The study also lacked a control group because one year after the international experience, individuals’ life experiences or continuation with nursing program courses could influence the participant’s cultural competency.  Researchers should consider these limitations in their future studies to understand immersion experiences’ effectiveness in promoting student nurses’ cultural competence.

 Parker, Fang,  & Bradlyn (2020) aimed to assess a culturally tailored communication training effectiveness in improving cultural competence among diverse care management teams. The study participants comprised three care management teams. The team was made of 15 registered pharmacists, 14 registered nurses, and seven non-clinical support staff who participated in the self-assessment and training program. However, the study had multiple limitations. For instance, the study sample is small, and the findings are not generalizable. Therefore, it is not possible to know whether a training program affects healthcare workers’ cultural competence. Some participants may have provided biased answers because of their concerns about their perceived social norms or social desirability because of self-assessment. Additionally, the researchers’ limited the training program’s impact on cultural competence to self-report. They failed to consider other influences on cultural competence like clinical parameters or patient experiences, which should be considered in future studies.

 Knecht et al. (2018) utilized a convergent mixed-method study to examine the impact of students’ participation in a culturally diverse and embedded service-learning program on their cultural competence development.  Focus group interviews and IAPCC-SV (The Inventory for Assessing the Process of Cultural Competence among Health Care Professionals-Student Version) helped collect and analyze the data.  Various limitations characterized the study. For instance, the study participants were selected from a single undergraduate female nursing program, limiting the study findings’ generalizability.

Stough-Hunter,  Guinan,  & Hart(2016) examined cultural competence levels among students before and after taking courses on cultural competence and diversity. The researchers used a 20-item survey to measure 226 students’ cultural competences levels between 2012 and 2015. The researchers differentiated the score after and before taking the courses, and there were significant improvements in student’s cultural competence levels after the courses. However, the study findings were limited by a lack of control group’s pre/post-test data. Additionally, different professors taught cultural competence and diversity courses. Thus, the researchers did not consider the professors’ different teaching strategies when measuring students’ level of cultural competency. A longitudinal aspect is missing in the research despite it being important. Cultural competence is a continuous rather than a static process requiring longitudinal research. However, the study provides significant insights into the importance of teaching strategies in enhancing student nurses’ cultural competence level.

Potential Applications to Practice Now

Despite the article studies’ small study sample size, they provided vital information regarding the significance of cultural competence in enhancing care delivery. For instance, the United States’ population is increasingly becoming diverse, and healthcare providers should be competent to cater to patients’ diverse needs, especially those from distinct cultural backgrounds. However, student nurses are inadequately prepared to care for patients from these backgrounds despite cultural competence being essential skills to build rapport with clients, correctly diagnose and treat patients. For this reason, the articles provide appropriate strategies that the nurse faculty should consider to enhance their students’ level of cultural competency. Some of these strategies include critical reflection, immersion experiences, standardized patient simulation, and clinical experiences. Additionally, inviting guest speakers from diverse backgrounds and partnering with the community boosts student’s level of cultural competence. Through these strategies, individuals interact with diverse individuals, respect diverse viewpoints, and examine issues from the client’s worldview or culture.  Therefore, students’ exposure to culturally-based experiences prepares them to care for an increasingly diverse patient population.

References

Debiasi, L. B., & Selleck, C. S. (2017). Cultural competence training for primary care nurse practitioners: an intervention to increase culturally competent care. Journal of cultural diversity, 24(2), 39-45.

Knecht, J. G., Fontana, J. S., Beth Fischer, R. S. M., Jessie Tetrault, B. S. N., & Katherine Spitz, B. S. N. (2018). An investigation of the development of cultural competence in undergraduate nursing students a mixed methods study. Journal of Community Medicine & Public Health, 4, 1-8.  https://doi.org/10.29011/2577-2228 /100044

Parker, M., Fang, X., & Bradlyn, A. (2020). Costs and effectiveness of a culturally tailored communication training program to increase cultural competence among multi-disciplinary care management teams. BMC health services research, 20(1), 1-7. https://doi.org/10.1186/s12913-020-05662-z

Roller, M. C., & Ballestas, H. C. (2017). Cultural competency: Measuring the sustainability following an immersion program for undergraduate students. Journal of the New York State Nurses Association, 45(1), 21-28.

Stough-Hunter, A., Guinan, J., & Hart, J. P. (2016). A comparison of teaching methods building cultural competency informed by contact theory. Journal of cultural diversity, 23(3), 91-98

Appendix – literature review matrix

Student Name:   ___________Mary Kasozi_____________________

Author / Year	Type of Design &  Level of Evidence		Sample (n=x)	Variables	Data collection tools	Results		Recommendations
Knecht et al/ 2019	A convergent parallel mixed-methods study  Level: 6		n= 58 students	Half participated in DCS that focus on the underserved and the other half attended TCS at visiting nurses' associations weekly to fulfill their community course clinical requirement. While all students participated in post-conference with the assumption of critical reflection, students who participated were afforded the opportunity to critically reflect with the faculty advisor and Sister of Mercy with a background in social work.	The Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version (IAPCC-SV)® (Campinha-Bacote, 2014) was used with permission to measure the cultural competence of students	Results of both qualitative and quantitative data analysis support the use of an embedded service-learning program in undergraduate nursing curriculum. In addition to uncovering themes of enlightenment, competence, and connection, reflecting cultural awareness, knowledge/ skills and desire, this study demonstrated a statistically significant difference in mean scores on the IAPPCC-SV measuring cultural competence between groups.  Students who participated in the embedded service-learning program scored higher when compared to students who participated in more traditional, less diverse clinical experience.   As a result, they may be better prepared to care for the increasingly complex and diverse health care population and as a result may be better positioned to challenge the sociopolitical realities that currently contribute to inequities in health care.		Many publications were located that presented different strategies for the presentation of cultural information to undergraduate nursing students, and many more on service-learning experiences, few presented the student with a synchronous approach.
Roller et al/ 2019	Comparative/Quasi-Experimental Level: 3	n= 18 and then n=15		measured cultural competency based on an immersion program and utilizing an instrument student completed at the conclusion of the program (N = 18) and one year after participating in the program (N = 15)	The Inventory for Assessing the Process of Cultural Competency among Healthcare Professionals-Revised (IAPCC-R), a self-report instrument developed by Campinha-Bacote, was used for the study. This instrument has been widely used in study abroad programs for baccalaureate nursing students		13.3% improvement in the highest category (culturally proficient), and t-test scores of 78.83 post experience and 78.80 one year later were recorded. No significant difference was revealed. The group’s overall cultural competency was maintained one year post immersion course.  Cultural competency that increased at the conclusion of a study abroad program was maintained one year post immersion experience for baccalaureate nursing students.	Continuing to add immersion experiences to curricula to enhance cultural competence. Even though many studies demonstrated an effectiveness of their programs, follow-up at a later time would strengthen their results.
Debiasi et al/ 2017	mixed-methods design  level: 5		n= 13	NPs (n=13) completed a Cultural Competence Assessment pre- and post- training using the Purnell Model for Cultural Competence. Clients completed the Clinicians' Cultural Sensitivity Survey pre- and post- NP training.	Clinicians' Cultural Sensitivity Survey  The client was honest, and the NP provided outstanding care in all areas.  The clientfeared retribution (possible poorer care) if he/ she answered negatively.  The client held the NP in high regard and did not want the NP to get "in trouble."		All of the NPs who completed the cultural competency training said that it was valuable and would be useful to other NPs; however, one suggested that a live training session would be more desirable.	For future studies, it is recommended to include quality control items on the surveys that require the participant to do something to indicate he/she read the item.
Stough-Hunter et al/ 2016	Comparative/Quasi-Experimental Level: 3		n-226 students	Traditional lecture, n=88 research and reporting  n=72 cross conversation partner n=66 then taking a cultural competency survey	Cultural Competency Scale and the composite score of the Miville-Guzman scale		The results indicated that there were no significant differences in racial composition, country of birth and English as primary language across the three teaching methods. However, there was a significant difference in gender by class, with the research and reporting class having more males than the other two classes.	Concludes that further research is needed to develop a standardized definition, model, evaluation instrument, curricula and comparison of various teaching methods for cultural competence.
Parker et al/2020	Comparative/Quasi-Experimental Level: 3		N=17	to assess program effectiveness based on participant responses to a validated cultural competence self-assessment survey 2 weeks before and after the training program	The web-based module, “Touching the Dream: Focus on African American Culture and Health”		Participants’ self-assessments on each of these cultural competence measures was high prior to the training, which may be explained in that 75% of survey respondents indicated they had received prior cultural competence training. This explanation is consistent with the contrasted groups assessment within the CCA psychometric evaluation study, where scores for those that reported receiving training previously were significantly higher than those without prior training	program effectiveness was limited to participant self-report and did not consider other outcomes like patient experience or improvement in clinical parameters.