STUDENT UNDERSTANDING of CULTURALLY AND ETHICALLY RESPONSIVE CARE: Implications for Nursing Curricula
Cagle, Carolyn Spence, Nursing Education Perspectives
Nursing education programs have a responsibility to develop strategies that improve future nurses' multicultural competence and ethical approaches to caring for populations different than their own. This article describes results of a final exam evaluative process used in an undergraduate class focused on culture and ethics. Ideas for nurse educators who desire increased student responsiveness and accountability for meeting the cultural and ethical needs of clients are offered.
Key Words Baccalaureate Curricula - Cultural Competency - Ethics Competency - Caring Nursing Practice - Ethical Decision Making
Among nursing's strongest professional and ethical values is the need to develop a caring interaction with a client to facilitate that person's health. HOWEVER, caring interactions that meet the ethical principle of beneficence (above all, do good) may be a challenge in cases where the client and nurse are from different ethnic or cultural backgrounds. This is particularly true when cultural values influence the interpretation of caring interactions of both parties.
Culturally competent nursing care is that perceived by clients as demonstrating the ability to accept their cultural beliefs and values (1). Thus, it is incumbent on nursing education programs to develop strategies to improve the cultural competence of future nurses to help them care for and intervene effectively with populations other than their own. Many of the 25 to 30 percent of the population in the United States who are considered minorities experience high rates of chronic disease related to complex economic, sociocultural, and historical factors. Students who understand how these factors contribute to health care disparities and influence access to health care will be better prepared to deliver culturally competent care (2,3).
Despite calls to increase cultural competency in professional preparation programs, only limited attention has been paid to effective ways to incorporate this content into most curricula for the health professions (3,4). For example, while the American Association of Colleges of Nursing specifies relevant core competencies that promise to increase the ability of baccalaureate graduates to provide quality care to culturally diverse populations (5), it relegates decisions on the placement of cultural and ethical content and the development of teaching-learning to nurse faculty (3,6-8). With the BSN curriculum already teeming with "essential" content, the need exists to identify where such content belongs in the curriculum, appropriate content, effective teaching methods, and effective means of evaluation.
This article reports on an attempt by a baccalaureate nursing program in a private university located in the southwestern United States to increase students' cultural competency and ethical knowledge for more caring nursing practice. The means is a 15-week required course focused on cultural understanding and ethical decision making. Student responses to a final exam essay question relating to the course are analyzed.
Review of the Literature Both integrated and separate course offerings can help students acquire the cultural awareness and sensitivity needed to form the basis for cultural competence (5,9-11). Students need both didactic knowledge and practice experience to make the connection between culture and health (1,6,12). Many educators recommend an interdisciplinary approach that helps students function efficiently as members of interdisciplinary health care teams, provides experience in working with others, and allows students to develop a broader understanding of cultural values and ethical dilemmas (7,13). Nursing students also demonstrate improved moral development, critical thinking, and cultural sensitivity if they have worked with other health care professional students in resolving ethical dilemmas (14-15). Such experience may be gained through ethical debates and gaming exercises, effective teaching approaches used by faculty who teach undergraduate ethics (16-20). …