ABSTRACT Providing culturally appropriate care is an essential nursing competency for new graduates. Multiple curricular approaches are being used to achieve this end. When measured by Campinha-Bacote's Inventory for Assessing the Process of Cultural Competency Among Healthcare Professionals-R[R], graduating students (n = 515) from six different BSN programs scored, on average, in the culturally aware range. These results suggest that no one curricular approach is proving to be more effective than another in achieving essential cultural competency.
Key Words Cultural Competency--Nursing Curricula--Baccalaureate Nursing Students
RESPONDING TO PATIENTS WITH APPROPRIATE CULTURAL SENSITIVITY IS AN ESSENTIAL COMPETENCY FOR NURSES, THE HEALTH CARE PROVIDERS WITH THE MOST PATIENT CONTACT. As demographic patterns in the United States and worldwide shift and as consumers of health care become more diverse, cultural sensitivity has become imperative among all health care providers. * Driven by both increased diversity among consumers of health care and accrediting board maxims, most nursing programs include cultural competency as a program outcome. However, "despite 50 years of transcultural nursing knowledge development through theory, research, and practice, there remains a lack of formal, integrated cultural education into nursing" (Omeri, 2008, p. x). Current curricular approaches include such activities/programs as service-learning projects (Worrell-Carlisle, 2005); cultural immersion abroad (Jones, 2005; Kollar & Ailinger, 2002; Walsh & DeJoseph, 2003; Woods & Atkins, 2006); cultural immersion within other cultures at home (Sloand, Groves, & Brager, 2004); and free-standing cultural courses. * Integration into the curriculum is the most frequently reported curricular methodology for achieving cultural competency as a program outcome (Kardong-Edgren et al., 2005; Lipson & DeSantis, 2007). However, as Brennan and Cotter (2008) report, such an approach is neither robust nor efficient. Their evaluation of student perceptions of cultural competency as implemented within an integrated undergraduate curriculum revealed a heavy didactic emphasis on culture and cultural competency with little clinical application. They also found that the same content and examples were used repeatedly. * Integration of cultural competency learning processes and activities into an undergraduate curriculum too often translates into "implementation by an ad hoc committed few" (Boyle, 2007, p. 2IS). If a strong curricular thread has not been articulated and documented, content and strategies may be lost when the committed few move on or change teaching assignments. Some programs have used content mapping followed by content leveling across the curriculum to improve integration of cultural competency. A recent surge in special themed issues of nursing education journals may indicate that a tipping point has been reached and that nurse educators are searching for evidence-based teaching practices for cultural content. * THIS STUDY begins examination of the evidence by evaluating the program outcomes of six undergraduate nursing programs. Each employed a different curricular methodology for teaching cultural competency. Graduates from each program completed the same standardized inventory to measure cultural competency. This approach to evaluate the outcomes of different curricular methodologies has not been previously reported in the literature. Preliminary study results on first-semester data from four of the six programs were reported by Kardong-Edgren and Campinha-Bacote (2008).
Theoretical Framework Campinha-Bacote's (2003) Cultural Competency Care Model provided the conceptual framework for the study. Campinha-Bacote argues that the key to cultural competency is cultural desire, wanting to, rather than having to, learn and interact with other cultures. This definition is the basis for the other model constructs: cultural awareness, recognition of ethnocentrism and a willingness to learn about other worldviews, cultural similarities, and differences; cultural knowledge, which provides a strong educational base about other cultural beliefs, health practices including incidence and prevalence of diseases, and treatment efficacies; cultural skill, which relates to the opportunity to practice conducting holistic health assessments, including psychosocial assessments; and cultural encounters, necessary to build real-world experience. …