IN JANUARY 2008, health care students from three universities--nurse practitioner students, baccalaureate nursing students, and medical students--formed a medical brigade that ventured into the rural and isolated villages of the mountainous western Honduras state of Intibuca. The goal was twofold. Students wished to perform a community service by bringing a mobile medical clinic to largely inaccessible areas and to engage with people from a culture very different from their own, thereby increasing their cultural competence.
As the population of the United States becomes increasingly diverse, health care providers must learn to care for and communicate effectively with people from a variety of cultural backgrounds. To understand and respond to the needs of culturally diverse patients, health care providers must possess the skills and insight to overcome barriers in language and differences in beliefs, values, and customs. According to the 2002
Institute of Medicine report Unequal Treatment (Smedley, Stith, & Nelson, 2003), all current and future health care workers should be given cross-cultural training.
International learning experiences are cited as effective ways for students to increase their cultural competence (Evanston & Zust, 2004; Kollar & Ailinger, 2002; St. Clair & McKenry, 1999; Walsh & DeJoseph, 2002). The purpose of this study was to investigate the value of an international service-learning experience from the perspective of the student participants, using both quantitative and qualitative research methods to document the effect of the experience on cultural competence.
Theoretical Framework The Culturally Congruent Care model by Schim, Doorenbos, Benkert, and Miller (2007) guided this research. The model provides a logical synthesis of the complex concepts that together result in culturally competent care and provides a framework on which to base provider education and evaluation. Based on the work of theorists in cultural competence, particularly Leininger (1988), it processes existing theories in a new way. The model suggests that the goal of culturally congruent care is achieved by the appropriate interconnection of various pieces of a puzzle.
The four pieces of cultural congruence that progressively lead to cultural competence are cultural diversity, cultural awareness, cultural sensitivity, and cultural competence. Essentially, cultural diversity is attained by exposure to people of different cultural backgrounds. Cultural awareness implies a cognitive knowledge of various cultures, while cultural sensitivity synthesizes knowledge into a deeper understanding that results in a change in attitude about oneself and others, openness to cultural learning, and a desire to engage in cross-cultural experiences. Cultural competence takes the pieces of cultural diversity, cultural awareness, and cultural sensitivity and uses them to demonstrate certain behaviors in clinical practice, such as learning about the cultures represented in the community and adapting care to meet the cultural needs of the community. The 3-D puzzle model looks at how these pieces fit together on the provider level, interact with pieces on the client level, and together form the desired outcome of culturally congruent care. (See Figure.)
The value of this model is in identifying not just that cultural competence exists, but also which specific components of competence are present in the provider. The model is used to interpret the data collected in this study, both quantitative and qualitative, and to evaluate the effectiveness of the specific international learning experience studied in this project.
Review of the Literature International learning experiences for nursing students were recommended as a means of acquiring greater cultural understanding and sensitivity as early as the 1980s. Lindquist (1984) and Meleis (1985) agreed that international nursing experiences could help students care for the subcultures they would encounter in the diversifying face of the American population and urged those involved in international nursing experiences to contribute to the literature on the subject. …