Abstract
Cultural competence and cultural safety are essential knowledge in contemporary nursing care. Using a three-phase, mixed methods sequential triangulation design, this study examines the extent to which Anglophone Schools of Nursing in Canada have integrated cultural competence and/or cultural safety into the undergraduate nursing curricula. Factors that influence successful integration are identified through the lens of Donabedian’s structure, process, and outcome model. Results suggest that several facilitating factors are present, such as leadership, partnerships and linkages, and educational supports for students. Of particular concern is the lack of policies to recruit and retain Aboriginal faculty, financial resources, and outcome evaluation indicators. A conceptual model of integration is offered to explain how Schools of Nursing function to support the implementation of these concepts into their curriculum. This study provides theoretical and practical implications for initiation and improvement of cultural competence and/or cultural safety integration strategies in Schools of Nursing.
References
Aboriginal Nurses Association of Canada. (2009a). Cultural competence & cultural safety in first nations, Inuit and Métis nursing education: An integrated review of the literature. Retrieved from http://www.anac.on.ca/Documents/Making%20It%20Happen%20Curriculum%20Project/FINALReview ofLiterature.pdfSearch in Google Scholar
Aboriginal Nurses Association of Canada. (2009b). Cultural competence & cultural safety nursing education: A framework for first nations, Inuit and Métis nursing education. Retrieved from http://www.anac.on.ca/Documents/Making%20It%20Happen%20Curriculum%20Project/FINALFRAMEWORK.pdfSearch in Google Scholar
American Association of Colleges of Nurses [AACN]. (2008). The essentials of baccalaureate education for professional nursing practice. Washington, DC: AACN.Search in Google Scholar
Anderson, N. L. R., Calvillo, E. R., & Fongwa, M. N. (2007). Community-based approaches to strengthen cultural competency in nursing education and practice. Journal of Transcultural Nursing,18(Suppl 1), 49S–59S.10.1177/1043659606295567Search in Google Scholar PubMed
Anonson, J. M., Desjarlais, J., Nixon, J., Whiteman, L., & Bird, A. (2008). Strategies to support recruitment and retention of First Nations youth in Baccalaureate nursing programs in Saskatchewan, Canada. Journal of Transcultural Nursing,19(3), 274–283.10.1177/1043659608317095Search in Google Scholar PubMed
Arnold, O., Appleby, L., & Heaton, L. (2008). Incorporating cultural safety in nursing education. Nursing BC,40(2), 14–17.Search in Google Scholar
Association of Universities and Colleges of Canada [AUCC], and National Aboriginal Achievement Foundation [NAAF]. (2011). Moving forward: National working summit on Aboriginal postsecondary education. Ottawa, ON: AUCC.Search in Google Scholar
Barrere, C., Delaney, C., Peterson, D., & Hickey, K. (2010). Primary stroke center education for nurses. The Journal of Nursing Administration, 40(12), 515–521.10.1097/NNA.0b013e3181fc1a05Search in Google Scholar PubMed
Bourque-Bearskin, L. R. (2011). A critical lens on culture in nursing practice. Nursing Ethics, 18(4), 548–559.10.1177/0969733011408048Search in Google Scholar PubMed
Browne, A., Varcoe, C., Smye, V., Reimer-Kirkham, S., Lynam, M. J., & Wong, S. (2009). Cultural safety and the challenges of translating critically oriented knowledge in practice. Nursing Philosophy, 10, 167 – 179.10.1111/j.1466-769X.2009.00406.xSearch in Google Scholar PubMed
Calvillo, E., Clark, L., Ballantyne, J. E., Pacquiao, D., Purnell, L. D., & Villarruel, A. M. (2009). Cultural competency in Baccalaureate nursing education. Journal of Transcultural Nursing, 20(2), 137–145.10.1177/1043659608330354Search in Google Scholar PubMed
Canadian Nurses Association [CNA]. (2010). Promoting cultural competence in nursing. Ottawa, ON: CNA.Search in Google Scholar
Canadian Nurses Association [CNA]. (2004). Promoting cultural competent care. Ottawa, ON: CNA.Search in Google Scholar
Clark, L., Calvillo, E., Cruz, F. D., Fongwa, M., Kools, S., Lowe, J., & Mastel-Smith, B. (2011). Cultural competencies for graduate nursing education. Journal of Professional Nursing, 27(3), 133–139.10.1016/j.profnurs.2011.02.001Search in Google Scholar PubMed
College of Registered Nurses of British Columbia. (2009). Competencies in the context of entry-level registered nurse practice in British Columbia. Retrieved from http://crnbc.ca/Downloads/09w13_Certified Practice Equivalency Assessment Tool RN First Call.docSearch in Google Scholar
Creswell, J. W., & Clark, V. L. (2007). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage.Search in Google Scholar
DeSouza, R. (2008). Wellness for all: The possibilities of cultural safety and cultural competence in New Zealand. Journal of Research in Nursing, 13(2), 125–135.10.1177/1744987108088637Search in Google Scholar
Donabedian, A. (2005). Evaluating the quality of medical care. The Millbank Quarterly, 83(4), 691–729.10.1111/j.1468-0009.2005.00397.xSearch in Google Scholar PubMed PubMed Central
Donabedian, A. (1988). The quality of care: How can it be assessed?JAMA, 260(12), 1743–1748.10.1001/jama.260.12.1743Search in Google Scholar PubMed
Douglas, M. K., Pierce, J. U., Rosenkoetter, M., Pacquiao, D., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., … Purnell, L. (2011). Standards of practice for culturally competent nursing care: 2011 update. Journal of Transcultural Nursing, 22(4), 317–333.10.1177/1043659611412965Search in Google Scholar PubMed
Doutrich, D., Arcus, K., Dekker, L., Spuck, J., & Pollock-Robinson, C. (2012). Cultural safety in New Zealand and the United States: Looking at a way forward together. Journal of Transcultural Nursing, 23(2), 143–150.10.1177/1043659611433873Search in Google Scholar PubMed
Drevdahl, D. J., Canales, M. K., & Dorcy, K. S. (2008). Of goldfish tanks and moonlight tricks: Can cultural competency ameliorate health disparities?Advances in Nursing Science, 31(1), 13–27.10.1097/01.ANS.0000311526.27823.05Search in Google Scholar PubMed
Gozu, A., Beach, M. C., Price, E. G., Gary, T. L., Robinson, K., Palacio, A., … Cooper, L. A. (2007). Self-administered Instruments to Measure Cultural Competence of Health Professionals: A systematic review. Teaching and Learning in Medicine,19(2),180–190.10.1080/10401330701333654Search in Google Scholar PubMed
Hendy, J., & Barlow, J.(2012). The role of the organizational champion in achieving health system change. Social Science & Medicine, 74, 348–355.10.1016/j.socscimed.2011.02.009Search in Google Scholar PubMed
Higginbottom, G. M. A., Richter, M. S., Mogale, R. S., Ortiz, L., Young, S., & Mollel, O. (2011). Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethno-cultural groups: An integrative review of the literature. BMC Nursing, 10(16), 1–11.10.1186/1472-6955-10-16Search in Google Scholar PubMed PubMed Central
Hughes, K. H., & Hood, L. J. (2007). Teaching methods and an outcome tool for measuring cultural sensitivity in undergraduate nursing students. Journal of Transcultural Nursing, 18(1), 57–62.10.1177/1043659606294196Search in Google Scholar PubMed
Hunter, J. L., & Krantz, S. (2010). Constructivism in cultural competence education. Journal of Nursing Education, 49(4), 207–214.10.3928/01484834-20100115-06Search in Google Scholar PubMed
Jeffreys, M. R., & Dogan, E. (2012). Evaluating the influence of cultural competence education on students’ transcultural self-efficacy perceptions. Journal of Transcultural Nursing, 23(2), 188–197.10.1177/1043659611423836Search in Google Scholar PubMed
Johnstone, M. J., & Kanitsaki, O. (2007). An exploration of the notion and nature of the construct of cultural safety and its applicability to the Australian health care context. Journal of Transcultural Nursing, 18(3), 247–256.10.1177/1043659607301304Search in Google Scholar PubMed
Kardong-Edgren, S., & Campinha-Bacote, J. (2008). Cultural competency of graduating US Bachelor of Science nursing students. Contemporary Nurse, 28, 37–44.10.5172/conu.673.28.1-2.37Search in Google Scholar PubMed
Kardong-Edgren, S., Cason, C. L., Walsh Brennan, A. M., Reifsnider, E., Hummel, F., Mancini, M., & Griffin, C. (2010). Cultural competency of graduating BSN nursing students. Nursing Education Research, 31(5), 278–285.Search in Google Scholar
Kennedy, H. P., Fisher, L., Fontaine, D., & Martin-Holland, J. (2008).Evaluating diversity in nursing education: A mixed method study. Journal of Transcultural Nursing, 19(4),363–370.10.1177/1043659608322500Search in Google Scholar PubMed
Kumas-Tan, Z., Beagan, B., Loppie, C., MacLeod, A., & Frank, B. (2007). Measure of cultural competence: Examining hidden assumptions. Academic Medicine, 82(6), 548–557.10.1097/ACM.0b013e3180555a2dSearch in Google Scholar PubMed
Lipson, J. G., & Desantis, L. A. (2007). Current approaches to integrating elements of cultural competence in nursing education. Journal of Transcultural Nursing, 18(Suppl 1), 10S–20S.10.1177/1043659606295498Search in Google Scholar PubMed
Liu, W., Edwards, H., & Courtney, M. (2011). The development and descriptions of an evidence-based case management educational program. Nurse Education Today, 31, e51–e57.10.1016/j.nedt.2010.12.012Search in Google Scholar PubMed
Mahara, M. S., Duncan, S., Whyte, N., & Brown, J. (2011). It takes a community to raise a nurse: Educating for culturally safe practice with Aboriginal Peoples. International Journal of Nursing Education Scholarship, 8(1), 1–12.10.2202/1548-923X.2208Search in Google Scholar
National Aboriginal Achievement Foundation [NAAF]. (2011). Moving forward: National working summit on Aboriginal postsecondary education. Ottawa, ON: NAAF.Search in Google Scholar
National Aboriginal Health Organization [NAHO]. (2008). Cultural competency and safety: A guide for health care administrators, providers and educators. Ottawa, ON: NAHO.Search in Google Scholar
Pacquiao, D. (2007). The relationship between cultural competence education and increasing diversity in nursing schools and practice settings. Journal of Transcultural Nursing, 18(1), 28S–37S.10.1177/1043659606295679Search in Google Scholar PubMed
Patton, M. Q. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.Search in Google Scholar
Ploeg, J., Skelly, J., Rowan, M., Edwards, N., Davies, B., Grinspun, D., … Downey, A.(2010). The role of nursing best practice champions in diffusing guidelines: A mixed methods study. Worldviews on Evidence-Based Nursing, 7(4), 238–251.10.1111/j.1741-6787.2010.00202.xSearch in Google Scholar PubMed
Royal Commission on Aboriginal Peoples. (1996). The Report of the Royal Commission on Aboriginal Peoples. Retrieved from http://www.parl.gc.ca/Content/LOP/ResearchPublications/prb9924-e.htmSearch in Google Scholar
Rutledge, C. M., Garzon, L., Scott, M., & Karlowicz, K.(2004). Using standardized patients to teach and evaluate nurse practitioner students on cultural competency. International Journal of Nursing Education Scholarship,1(1), 1–16.10.2202/1548-923X.1048Search in Google Scholar PubMed
Salant, P., & Dillman, D. A. (1994). How to conduct your own survey. Toronto ON: John Wiley & Sons.Search in Google Scholar
Sargent, S. E., Sedlak, C. A., & Martsolf, D. S. (2005). Cultural competence among nursing students and faculty. Nurse Education Today,25, 214–221.10.1016/j.nedt.2004.12.005Search in Google Scholar PubMed
Sealy, L. J., Burnett, M., & Johnson, G. (2006). Cultural competence of Baccalaureate nursing faculty: Are we up to the task?Journal of Cultural Diversity, 13(3), 131–140.Search in Google Scholar
Siantz, M. L. de L. (2008). Leading change in diversity and cultural competence. Journal of Professional Nursing,24(3), 167–171.10.1016/j.profnurs.2008.01.005Search in Google Scholar PubMed
Tuck, I., Moon, M. W., & Allocca, P. N. (2010). An integrative approach to cultural competence education for advanced practice nurses. Journal of Transcultural Nursing,21(4), 402–409.10.1177/1043659609360716Search in Google Scholar PubMed
Watts, R. J., Cuellar, N. G., & O’Sullivan, A. L. (2008). Developing a blueprint for cultural competence education at Penn. Journal of Professional Nursing, 24(3), 136–142.10.1016/j.profnurs.2008.01.002Search in Google Scholar PubMed
Wepa, D. (2003). An exploration of the experiences of cultural safety educators in New Zealand: An action research approach. Journal of Transcultural Nursing, 14(4), 339–348.10.1177/1043659603257341Search in Google Scholar PubMed
Williams, I. (2011). Organizational readiness for innovation in health care: Some lessons from the recent literature. Health Services Management Research, 24(4), 213–218.10.1258/hsmr.2011.011014Search in Google Scholar PubMed
Woods, M. (2010). Cultural safety and the socioethical nurse. Nursing Ethics, 17(6), 715–725.10.1177/0969733010379296Search in Google Scholar PubMed
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