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Caring for Refugees: Measuring Cultural Competence in Nursing

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Title: Caring for Refugees: Measuring Cultural Competence in Nursing


1
Caring for Refugees Measuring Cultural
Competence in Nursing
Andrea Addington RN, EdD
2
Objectives Cultural competence in nursing
education
  • I. Define Cultural competence
  • II. Describe rationale for cultural competence
  • III. Review of literature regarding teaching
    techniques
  • IV. Analyze research on measuring cultural
    competence

3
Culturally Congruent Care
  • Culturally-based care knowledge, acts, and
    decisions used in sensitive and knowledgeable
    ways to appropriately and meaningfully fit the
    cultural values, beliefs, and lifeways of clients
    for their health and well-being, or to prevent
    illness, disabilities, or death (Leininger
    McFarland, 2006, p. 15).

4
Cultural Competence
  • Is a multidimensional learning process that
    integrates transcultural skills in all three
    dimensions (cognitive, practical, and affective),
    involves transcultural self- efficacy
    (confidence) as a major influencing factor, and
    aims to achieve culturally congruent care
    (Jeffries, 2007, p.29).

5
Rationale
  • The Institute of Medicine has reported that
    bias, prejudice, and stereotyping on the part of
    healthcare providers may contribute to
    differences in care (Institute of Medicine
    (IOM), 2002, p.1).

6
  • The US population is becoming increasingly
    diverse, and requires healthcare professionals to
    be educated in culturally competent care.
    (Davidhizar Giger, 2001).

7
Rationale
  • The National League for Nursing Accrediting
    Commission (NLNAC, Inc. in 2008) has standards
    that require cultural competency in practice as
    well as standards for nursing schools to include
    cultural diversity concepts in the curriculum.

8
Leininger Theory Culture Care Diversity and
Universality Theory
  • Cultural values beliefs and practices
  • Not ethnocentric
  • Individualistic vs. stereotypical
  • May cause conflict, stress, and racial bias
    (incompetence)
  • Self reflection

9
Review of the literature
  • Canales and Bowers (2001) described a lack of
    progress in teaching and evaluating cultural
    competence (p. 102).
  • Few studies have used tools to measure effects on
    student learning

10
Experiences to enhance CC
  • food, field trips, interviews, music (Hughes
    Hood, 2007)
  • international immersion experiences (Caffrey,
    Neander, Markle, Stewart, 2005)
  • exchange programs within the United States to
    areas with different cultures- immersion
    (Huttlinger Keating, 1991)
  • experiences of ethnic activities such as pow-wows
    and cultural festivals (Wendler Struthers,
    2002)
  • interviews (Flood, 2007)
  • caring for persons of a different culture in
    clinical settings (Lundberg, Backstrom, Widen,
    2005, Addington, 2010).
  • Classroom-theory, journals, games, cultural
    content

11
Literature Review
  • Doutrich and Storey (2004)
  • 13 nursing students
  • Partnered with public health nurses for 16 weeks
  • Used Capina-Bacotes Cultural Competency
    Assessment tool
  • Significant increase in mean scores

12
  • Caffrey, Neander, Markle, and Stewart's (2005)
  • Two groups of students compared Both groups
    showed an increase in cultural competence
  • Classroom learning does have an effect
  • 5-week international immersion provided better
    learning experience, higher change in mean scores

13
Griswald, et al. (2006)
  • Evaluated medical students
  • Two days of interactions with refugee clients in
    a clinic
  • Demonstrated a gain in cultural competency
    knowledge and communication skills

14
How do we teach CC?
  • Knowledge-books, research, lecture
  • Experience-clinical
  • Theory of change

15
Barriers to change (beliefs)
  • Fear?other culture?Stems from family beliefs,
    political beliefs, peers, religious beliefs
  • Fear?can cause anger, distrust
  • What is the fear of another culture?
  • Dont understand, loss of control

16
Steps to Cultural competence
  • Get rid of fear-takes away barriers to change
  • In healthcare, this takes openness, willingness
  • Change beliefs
  • Meeting someone from another culture
  • Cultural assessment
  • Self assessment
  • Ability to communicate-translators

17
Being immersed in another culture appears to
develop changes in ethnocentric thinking as well
as provide a basis for cultural knowledge that is
not attainable by classroom alone.

18
Research Questions
  • At the conclusion of a community health rotation,
    do nursing students who worked with refugee
    clients, as compared to those students who did
    not work with refugee clients, have an increased
    level of cultural competence as measured by the
    Caffrey Cultural Assessment Tool?
  • Is there a significant difference in cultural
    competence in all students after taking a
    Community Health course?
  • Is there a significant difference between
    nursing students self perceived level of
    cultural competence after working with refugee
    clients than before working with refugee clients?
  • What is the relationship between demographic
    factors and nursing students' level of self
    perceived cultural competence?

19
Design
  • This study was a two group pretest posttest
    quasi-experimental design to compare students in
    the Community Health Refugee group (CHR) and
    students in the Community Health group (CH).

20
Instrument
  • The tool to assess the students cultural
    competence was the Caffrey Cultural Competence in
    Healthcare Scale (CCCHS). It has 28 items using a
    5 point Likert scale.

21
Instrument
  • How comfortable are you in interacting socially
    with members of a cultural group other than your
    own?
  • In general, how would you evaluate your comfort
    level in caring for clients from a culture other
    than your own?
  • How knowledgeable are you about the healthcare
    beliefs of a cultural group other than your own?

22
Sample
  • Sampling was a random sample to divide students
    into two groups the students enrolled in the
    Community Health clinical group assigned to
    refugee clients (CHR), and the control group
    students enrolled in the Community Health course
    who did not take care of refugee clients (CH).

23
Delimitations
  • The study was done with a group of nursing
    students from a small Midwestern Catholic Health
    Sciences College. The results may not be
    generalized to all colleges with nursing schools.
    The students were enrolled in the BSN Community
    Health course.

24
Limitations
  • Sample size- 20 students, refugee group only 6
  • Assessment tool-perceptions of their cultural
    competency skills and attitudes.
  • The researcher is a faculty member

25
Significance of the Study
  • Not only are nurses, physicians, other
    healthcare providers, and institutions ethically
    and morally obligated to provide the best
    culturally congruent care possible, but they are
    also legally mandated to do so (Jeffries, 2006.
    p. xiv).

26
  • Learning cultural competent skills may result in
    decrease in health disparities
  • Nurse educators understanding of student
    perceptions
  • Curriculum implications

27
Population and setting
  • Private college
  • BSN nursing students taking the Community Health
    course
  • Refugee Center
  • Two groups of students
  • CHR- working with refugee clients
  • CH-working with clients from the Visiting Nurse
    Services

28
Data Analysis
  • The demographic data and the Caffrey Cultural
    Competence in Healthcare Scale (CCCHS) was
    analyzed using summary, descriptive, and
    inferential statistics.
  • Inferential included t-tests and ANOVA

29
Interventions
  • In addition to students working with refugee
    clients to increase cultural competence, the
    following were used as teaching tools in the
    classroom and clinical setting
  • Heritage self assessment
  • Client cultural assessment
  • Journals

30
Chapter 4 Results Demographic
  • Worked with refugee client
  • Status in nursing program
  • Gender
  • Age
  • Ethnic heritage
  • Religious background
  • English primary language
  • Previous time out of country
  • Fluency in second language
  • Contact with other cultural group
  • Work history as RN in years
  • Contact with clients from another culture
  • Contact with health care workers from another
    culture
  • Fluency in second language
  • Contact with other cultural group
  • Work history as RN in years
  • Contact with clients from another culture
  • Contact with health care workers from another
    culture

31
Contact with clients from another culture
  • . Only 10 (n2) of the students had a moderate
    or great amount of contact with clients from
    another culture, with 90 (n18) categorized as
    only little or some contact.

32
Contact with healthcare workers from another
culture
  • . Most students (70, n16) had minimal amount
    of contact with health care workers from another
    culture. Four students (20) had a moderate to
    great deal of contact.

33
Descriptive statistics for CCCHS
Cultural competence level of comfort, knowledge,
and awareness in providing care to persons from
cultures other than their own Pretest scores
56-108 Posttest 64- 116 Highest gain 32
points Lowest gain loss of 14 points 14 students
showed a gain
34
Question scores
  • Question 10 How comfortable are you / would you
    be in working with a translator in a healthcare
    setting? (82 total points)
  • Question 16 How knowledgeable are you about
    another cultures beliefs and practices related
    to organ donation? (44)

35
High scores gt70, average 3.5/5 per student
  • Question 19 Awareness of own limitations
    providing culturally competent care.
  • Question 20 Comfort in advocating for clients of
    another culture with other healthcare
    providers.
  • Question 21 General evaluation of comfort level
    in caring for clients from another culture.
  • Question 23 Comfort in working with
    another member of healthcare team from
    another culture.
  • Question 25 Interest in working with culturally
    diverse staff.

36
Scores 2.5 average per student(out of 5) Lower
scores
  • How knowledgeable are you about the healthcare
    beliefs of a cultural group other than your own?
  • How knowledgeable are you about the health care
    practices of a cultural group other than your own?

37
Inferential statistics
  • Hypothesis one was students working with refugee
    clients will have an increased level of self
    perceived attitudes, skills and knowledge of
    cultural competence after they worked with
    refugee clients than students who did not work
    with refugee clients.

38
ANOVA
  • CHR pretest mean 2.79, posttest 3.13
  • CH pretest mean 2.77, postest 2.99
  • CHR Difference .33
  • CH Difference .22
  • Posttest ANOVA (F 1,18 .236, p .632)
  • Null accepted-not statistically significant

39
T-test refugee status
  • (t .486, df 18, p .633)
  • Null accepted
  • So between the 2 groups of students, did not see
    statistically significant differences in scores
  • I believe that with a larger sample size, it
    would have shown significant differences

40
Outcomes t-test
41
Change is possible!
  • We have more in common as humans than difference,
  • but none of us is more human than another
  • Maya Angelou

42
  • Working with refugees stretched me to reach
    beyond my comfort zone. Coming from a small
    town, I had never had contact with another
    culture. I am so glad I had this experience I
    may otherwise never have had. Nursing student
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