Building Cultural Competence In Undergraduate Nursing Students

By JoAnn D. Long, PhD, RN, NEA-BC

Living in the wake of the global pandemic, images of war, political extremism, incivility, and protest call attention to our need as human beings for greater compassion, respect, and understanding of human and cultural diversity. But what does it look like to be culturally competent?

Cultural competence is understood to be a professional duty in the nursepatient relationship and has long been recognized as an ethical standard of practice in multiple disciplines (ANA, 2021; NASW, 2017). Teaching strategies and curricula which foster tolerance, respect, critical self-reflection, awareness of values, and which empower nurses to act as agents of social justice in the nurse patient relationship are needed (ANA, 2022, Gradellini, et al., 2021). In this project, we sought to design an RN to BSN course to help registered nurses returning to school to practice the skills needed for greater cultural competence. We chose to do so by using a broad, multi-disciplinary and theological lens through which to help nurses critically think about human diversity. Students, in dialogue with assigned reading, forum discussions, cultural interviews, and a movie critique of the Disney favorite Babe , engage with one another and several multi-disciplinary conversation partners (Leninger, 1967; Hofstede, et al, 2010; Noonan, 1995; Nouwen, 2000; Volf, 2005). Exploration of diverse cultures, gender roles, values, and beliefs take place while students steadily contemplate the idea of their own “belovedness” and that of others using a theological lens (Nouwen, 2000).

Teaching strategies and curricula which foster tolerance, respect, critical self-reflection, awareness of values, and which empower nurses to act as agents of social justice in the nurse patient relationship are needed.

The course begins and ends with student assessment of their own level of cultural competence using (with permission) Georgetown’s Maternal Child Health (MCHC) (ncc.georgetown.edu) Cultural Competency assessment. The Cultural Competency section of the MCHC prompts users to consider their level of knowledge and skills in the following eight areas of cultural competence:

1. The influence of conscious and unconscious (implicit) biases and assumptions has on individuals and organizations;

2. How linguistic competence requires organizational and provider capacity to respond effectively to the health literacy needs of populations served;

3. How ability, age, class, race, sex, gender identity, and sexual orientation impact health;

4. How multiple social and cultural disparities influence health and access to health care services;

5. The impact of culturally competent health care practices on individual’s access to health services, participation in health promotion and prevention programs, adherence to treatment plans, and overall health outcomes;

6. Conduct personal and/or organizational self-assessments regarding cultural competence;

7. Assess, without making assumptions, the strengths and weaknesses of individuals based on sensitivity to and respect for their diverse backgrounds; and

8. Incorporate an understanding and appreciation of differences in experiences and perspectives into professional behaviors and attitudes while maintaining awareness of the potential for implicit bias (Humphries, et al, 2015). We evaluated RN to BSN self-reported scores on the MCH Cultural Competency online measure (from beginning to the end of the eight-week course) during 2020 – 2021. We found RN to BSN student knowledge-skills scores improved significantly in all eight of the areas reflecting cultural competency (Long, 2022).

Two assignments especially seemed significant to student growth.

CULTURAL INTERVIEW

The Cultural Interview assignment provides students with the opportunity to practice while learning. Students set up an interview with a co-worker or friend with a distinctively different culture than their own and preferably away from work. Students craft their own set of interview questions. During the interview they record their observations and are asked to pay close attention to the use of their senses to describe the environment, sights, sounds, and smells experienced during the interview. Afterwards, students record how they practiced respectful communication while interacting with one whose culture, beliefs, behaviors, and background may be different from one’s own. Moreover, they also incorporate aspects of the course reading into the interview write-up while reflecting on how such experiences may foster greater multicultural understanding when caring for diverse people and populations. Many note the process as “eye-opening,” and one which required a step outside of their comfort zone; yet was worthwhile.

Reading theologian Henri Nouwen’s short book Life of the Beloved underpins the course and is frequently noted by students as a particularly thought-provoking and positive experience.

ASSIGNED READING

Reading theologian Henri Nouwen’s short book Life of the Beloved underpins the course and is frequently noted by students as a particularly thought-provoking and positive experience. The following comments from an open-forum, end of course “take-away” shed light on how the reading has impacted their thinking about themselves and their cultural competence:

Moving forward. . . I aim to approach each patient with an open mind, empathy, and a willingness to learn from their unique cultural perspective.

“Reading Life of the Beloved helped me to realize there is beauty despite all the hardship life has thrown. It also made me think that any brokenness can help you shine a little brighter. If we do not understand ourselves, it can be difficult to understand others, so it is important to have good selfawareness when providing care to others. From now on I plan to always have an open mind when it comes to providing patient care and understand things more from the patient’s point of view rather than my own.”

“Moving forward. . . I aim to approach each patient with an open mind, empathy, and a willingness to learn from their unique cultural perspective. By incorporating cultural humility into my practice and being mindful of differences, I hope to provide more effective and culturally competent care to all patients, ensuring that their individual needs and values are respected.”

One size may not fit all educational settings when teaching cultural competence. However, the use of a broad, multi-disciplinary approach and a theological lens may prompt registered nurses’ self-reflection on their own belovedness and that of the diverse patients for whom they care. Perhaps learning to lean into the practice of compassion, respect, and understanding towards oneself and others with whom we are different is what it looks like to be culturally competent.

JoAnn D. Long, PhD, RN, NEA-BC is a professor and the director of nursing research and development at Lubbock Christian University.

REFERENCES

ANA Scope and Standards of Practice (2021). https:// www.nursingworld.org/practice-policy/scope-ofpractice/.

ANA Position Statements (2022). The Nurse’s Role and Responsibility in Unveiling and Dismantling Racism in Nursing. https://www.nursingworld.org/ practice-policy/nursing- excellence/official-positionstatements/.

Georgetown University National Center for Cultural Competence, Maternal Child Health Assessment Cultural Competency, Section 7 https://www. mchnavigator.org/assessment/

Gradellini, C., Gómez-Cantarino, S., DominguezIsabel, P., Molina-Gallego, B., Mecugni, D., & UgarteGurrutxaga, M. I. (2021). Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review. Frontiers in psychology 12, 682920. https://doi.org/10.3389/fpsyg.2021.682920.

Hofsted, G., Hofsted, J. G., & Minkov, M. (2010). Organizations Software of the Mind: Intercultural Cooperation and Its Importance for Survival. McGraw Hill: New York.

Humphries, B. P., Couse, L. J., Sonnemneier, R. M., Kurtz, A., Russell, S. M., & Antal, P. (2015). Transforming LEND Leadership Training Curriculum through the Maternal Child Health Leadership Competencies. Maternal Child Health Journal, 19, 300-307.

Leninger, M. (1967). The Culture Concept and its Relevance to Nursing. Journal of Nursing Education pp. 27 – 37.

Long, J.D. (2022). “Broadening the Lens: Effectiveness of a Multi-Disciplinary Approach to Teaching Cultural Competence in RN-BSN Students.” Oral Presentation, Sigma Theta Tau International Research Congress, July 21, 2022, Edinburg, Scotland.

National Association of Social Workers (2017). Code of Ethics. https://www.socialworkers.org/About/ Ethics/Code-of-Ethics/Code-of-Ethics-English. Nouwen, H. J.M. (2000). Life of the Beloved: Spiritual Living in a Secular World. Crossroads: New York. Volf, M. (2005). Free of Charge: Giving and Forgiving in a Culture Stripped of Grace. Zondervan: Grand Rapids: MI.