Developing, Implementing, and Evaluating Cultural Competency and Equality IN Nurse Training : What A

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Developing, Implementing, and EvaluatingCultural
Competency and Equality IN Nurse Training What
Are We Learning?

• Results From an Action Research Project to
  Mainstream Cultural Competencies and Equality
  Training in the Nurse Curriculum

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Objectives

• Background and purpose of the research.
• Share findings and lessons learned.
• Lecturers commitment to teaching cultural
  competencies and equality.
• Lecturers self efficacy.
• Curriculum management of teaching cultural
  competencies and equality.
• Make recommendations for further inquiry.

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Mainstreaming CulturalCompetency and Equality
Training Using Action Research Methodology

• As part of an action research project, the school
  of health made a commitment to promote cultural
  competence and equality training across all
  modules through a policy of mainstreaming.
• The major aim of mainstreaming is to build
  capacity in curriculum provision, through planned
  curriculum development and embedding cultural
  competence and equality training to an agreed
  standard.

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Our Vision

• The ability to provide care to patients with
  diverse values, beliefs and behaviours including
  tailoring delivery of care to meet patients
  social, cultural, and linguistic needs.
• The ultimate goal is a health care system and
  workforce that can deliver the highest quality of
  care to every patient, regardless of race,
  ethnicity, cultural background, or English
  proficiency.
• The commonwealth fund. New York, NY, 2002.

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Rationale for Culturally Competent Health Care

• Responding to demographic changes
• Eliminating disparities in the health status of
  people of diverse racial, ethnic, cultural
  backgrounds
• Improving the quality of services outcomes
• Meeting legislative, regulatory, accreditation
  mandates
• Gaining a competitive edge in the marketplace
• Decreasing the likelihood of liability/malpractice
  claims

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The ASKED Framework

• A - awareness
• S - skill
• K - knowledge
• E - encounters
• D - desire
• Source Campinha-Bacote J. Cultural competence in
  psychiatric nursing

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Study Design

• A case analysis of cultural competence and
  equality training.
• The evaluation adopted a pluralistic design that
  includes both quantitative and qualitative
  strategies and utilising participatory methods of
  data collection through an action research
  methodology.

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Project included

• Questionnaire Survey
• Curriculum mapping
• Self completion Audit
• Focus Group Interviews

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FOCUS

• The views and perspectives of
• teaching staff, regarding the status of
• cultural and equality competence training
• in the School of Health

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Instrument

• On-line questionnaire consisting of five sections
  and 26 items.

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Likert Scale

• On-line questionnaire consisting of five sections
  and 26 items.
• Relative importance within the curriculum,
• Feelings of self efficacy,
• Perceptions of behavior to support delivery,
• Perceived ability with subject management,
• Teaching opportunities.

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Respondent Profile
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Respondent Profile
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Respondent Profile
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Respondent Profile
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Respondent Profile
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Results
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Sense of Self-Efficacy

• 1 inability to practise equal opportunities in
  employment.
• 2 challenge their personal and professional
  biases.
• 3 incorporating a clients cultural beliefs into
  practice and treatment.
• 4 capacity to empathize with their clients.
• 5 understand the biases in assessment tools and
  diagnostic criteria.

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Self-reported Promotional Behaviours

• 1 diffusion model
• 2 de-prioritisation  of race equality
• 3 screen books, and other teaching resources for
  negative cultural, racial, age and
  gender-stereotypes.  
• 4 finding news ways of teaching equality and
  cultural competency.  
• 5 teaching effort.  

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Perceived Ability and Comfort With Teaching Skills

• 1 cultural beliefs, religious practices,
  disabilities and rights of my students.  
• 2 culturally appropriate teaching techniques.  
  
• 3 ability to teach students how to recognise
  oppression and discrimination and promote
  equality  
• 4 inability to intervene when there is cultural
  insensitivity, gender bias or prejudice.  
•   5 lack of training and confidence.  

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Teaching Opportunities

• 1 critically reflect upon their personal and
  professional cultural biases.
• 2 understand the barriers that prevent equality
  of access to health care.  .
• 3 understand disease incidence and prevalence
  among ethnic groups.  .
• 4 undertake a culturally based health needs
  assessment.  .
• 5 directly engage in cross cultural interactions
  with clients from diverse cultural groups.  .
• 6 work with interpreters.  .
• 7 learn from others as cultural informants.    .

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Headlines..

• There was a strong sense of public duty to
  promote equality and commitment to furnish nurses
  with the necessary competencies to meet the needs
  of a diverse society.
• An integrated approach to equality, and in
  particular, race equality was a priority, but
  less evidence of prioritising the subject above
  other course provision.
• Board self-assurance to manage cultural
  competence and equality training- responding well
  to the daily challenge of preparing nursing and
  midwifery students to care for multi-ethnic and
  multi-cultural populations.

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Barriers

• Lack of time in an already packed curriculum
• Difficult to allocate time to search out new and
  innovative ways to teach such a sensitive
  subject
• Lack of information and knowledge of some
  cultures and religions
• Lack of confidence
• Large group for teaching
• Staff attitudes some staff think it is not
  important

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Caveats..

• The data suggests that prominence may be given to
  equality issues only in so far as these emanate
  from problem based and situated learning.
• Lecturers attributes critical to curriculum
  planning and innovation commitment, ownership,
  reflection, action.

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Sustained Inquiry Key Questions
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Continuity and Coherence

• The methods used to raise equality matters.
• Initiatives and techniques being used to raise
  student awareness of bias in assessment tools.
• Initiatives and techniques being used to promote
  cultural immersion and insight.
• The comparability of training opportunities.

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How Does High Self-efficacy Impact on Training?

• There is a need to establish
• Levels of teacher self efficacy using reliable
  and valid measurement scales.
• Factors contributing to variations in
  self-efficacy.
• Correlate with audited behaviours and practices.

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The Positive Actions of Teachers Should Be
Treated As a Resource, Audited and Models of Good
Practice Established.

• The actions being taken by teachers
• Address racial harassment within educational.
• Premises.
• Help students recognise oppression and.
• Discrimination.
• Understanding the cultural beliefs, religious.
• Practices, disabilities and rights of students.