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

Objectives Objectives

Background and purpose of the research.

Share findings and lessons learned. Lecturers commitment to teaching cultural Lecturers commitment to teaching cultural

competencies and equality.competencies and equality. Lecturers self efficacy.Lecturers self efficacy. Curriculum management of teaching cultural Curriculum management of teaching cultural

competencies and equality.competencies and equality.

Make recommendations for further inquiry.

Mainstreaming CulturalCompetency and Equality

Training Using Action Research Methodology

As part of an action research project, the As part of an action research project, the school of health made a commitment to school of health made a commitment to promote cultural competence and equality promote cultural competence and equality training across all modules through a policy training across all modules through a policy of mainstreaming. of mainstreaming.

The major aim of mainstreaming is to build The major aim of mainstreaming is to build capacity in curriculum provision, through capacity in curriculum provision, through planned curriculum development and planned curriculum development and embedding cultural competence and embedding cultural competence and equality training to an agreed standard.equality training to an agreed standard.

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.

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

The ASKED Framework

A - awarenessS - skillK - knowledgeE - encountersD - desire

Source: Campinha-Bacote J. Cultural competence in psychiatric nursing:

Study DesignStudy Design

A A case analysiscase analysis of cultural competence and of cultural competence and equality training.equality training.

The evaluation adopted a The evaluation adopted a pluralistic designpluralistic design that includes both quantitative and that includes both quantitative and qualitative strategies and utilising qualitative strategies and utilising participatory methods of data collection participatory methods of data collection through an through an action researchaction research methodology. methodology.

Project included Project included

Questionnaire SurveyQuestionnaire Survey Curriculum mappingCurriculum mapping Self completion AuditSelf completion Audit Focus Group InterviewsFocus Group Interviews

FOCUS

The views and perspectives ofteaching staff, regarding the status

of cultural and equality competence

training in the School of Health

InstrumentInstrument

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

Likert Likert ScaleScale

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

Relative importance Relative importance within the curriculum, within the curriculum,

Feelings of self efficacy, Feelings of self efficacy,

Perceptions of behavior Perceptions of behavior to support delivery, to support delivery,

Perceived ability with Perceived ability with subject management, subject management,

Teaching opportunities.Teaching opportunities.

Respondent Profile Respondent Profile

Respondent ProfileRespondent Profile

Distribution of Respondents by Gender

Male23%

Female77%

Respondent ProfileRespondent Profile

Distribution of Respondents by Teaching Experience

> 5 Years

2-5 Years

<2 Years

Respondent ProfileRespondent Profile

White - British75%

Asian or Asian British - Indian

2%

Black or Black British -

Caribbean4%

Other White background

2%

White - Scottish4%

White - Irish4%

Asian or Asian British - Pakistani

2%

Other Asian background

2%

Other Ethnic background

2%Black or Black

British - African2%

Respondent ProfileRespondent Profile

Distribution of Respondents according to Division

pre-registration nursing and midw ifery

undergraduate studies56%Continuing

development17%

Community Health27%

Results Results

Sense of Sense of Self-EfficacySelf-Efficacy

11: inability to practise equal : inability to practise equal opportunities in opportunities in employment.employment.

2: c2: challenge their personal hallenge their personal and professional biases.and professional biases.

3:3: incorporating a clients incorporating a clients cultural beliefs into cultural beliefs into practice and treatment.practice and treatment.

4: capacity to empathize 4: capacity to empathize with their clients.with their clients.

5:5: understand the biases in understand the biases in assessment tools and assessment tools and diagnostic criteria.diagnostic criteria.

Sense Of Self Efficacy

-100%

-50%

0%

50%

100%

1 2 3 4 5

Self-reported: Promotional Self-reported: Promotional BehavioursBehaviours

1: 1: diffusion modeldiffusion model2:2: de-prioritisation  of de-prioritisation  of

race equalityrace equality3:3: screen books, and screen books, and

other teaching other teaching resources for resources for negative cultural, negative cultural, racial, age and racial, age and gender-stereotypes.   gender-stereotypes.  

44: finding news ways of : finding news ways of teaching equality teaching equality and cultural and cultural competency.   competency.  

5:5: teaching effort.   teaching effort.  

Behaviours that Support Curriculum Delivery

-100%

-50%

0%

50%

100%

1 2 3 4 5

Perceived Ability and Perceived Ability and Comfort With Teaching Comfort With Teaching SkillsSkills

1 cultural beliefs, 1 cultural beliefs, religious practices, religious practices, disabilities and rights of disabilities and rights of my students.   my students.  

2 culturally appropriate 2 culturally appropriate teaching techniques.   teaching techniques.  

3 ability to teach students 3 ability to teach students how to recognise how to recognise oppression and oppression and discrimination and discrimination and promote equality   promote equality  

4 inability to intervene 4 inability to intervene when there is cultural when there is cultural insensitivity, gender bias insensitivity, gender bias or prejudice.  or prejudice.  

   5 lack of training and5 lack of training and confidence.confidence.    

Perceived ability to Subject Manage

-100%

-80%

-60%

-40%

-20%

0%

20%

40%

60%

80%

100%

1 2 3 4 5

Teaching OpportunitiesTeaching Opportunities 1: critically reflect upon their 1: critically reflect upon their

personal and professional personal and professional cultural biases.cultural biases.

2: understand the barriers that 2: understand the barriers that prevent equality of access to prevent equality of access to health care.  .health care.  .

3: understand disease incidence 3: understand disease incidence and prevalence among ethnic and prevalence among ethnic groups.  .groups.  .

4: undertake a culturally based 4: undertake a culturally based health needs assessment.  .health needs assessment.  .

5: directly engage in cross cultural 5: directly engage in cross cultural interactions with clients from interactions with clients from diverse cultural groups.  .diverse cultural groups.  .

6: work with interpreters.  .6: work with interpreters.  .7: learn from others as cultural 7: learn from others as cultural

informants.    .informants.    .

Teaching Opportunities

Statement 1

Statement 2

Statement 3

Statement 4

Statement 5

Statement 6

Statement 7

0 20 40 60 80 100

Headlines…………..Headlines………….. There was a strong sense of public duty to There was a strong sense of public duty to

promote equality and commitment to furnish promote equality and commitment to furnish nurses with the necessary competencies to nurses with the necessary competencies to meet the needs of a diverse society.meet the needs of a diverse society.

An integrated approach to equality, and in An integrated approach to equality, and in particular, race equality was a priority, but particular, race equality was a priority, but less evidence of prioritising the subject above less evidence of prioritising the subject above other course provision.other course provision.

Board self-assurance to manage cultural Board self-assurance to manage cultural competence and equality training- responding competence and equality training- responding well to the daily challenge of preparing nursing well to the daily challenge of preparing nursing and midwifery students to care for multi-ethnic and midwifery students to care for multi-ethnic and multi-cultural populations.and multi-cultural populations.

BarriersBarriers Lack of time in an already “packed curriculum”Lack of time in an already “packed curriculum” Difficult to allocate time to search out new and Difficult to allocate time to search out new and

innovative ways to teach “such a sensitive innovative ways to teach “such a sensitive subject”subject”

Lack of information and knowledge of some Lack of information and knowledge of some cultures and religionscultures and religions

Lack of confidenceLack of confidence Large group for teachingLarge group for teaching Staff attitudes “some staff think it is not Staff attitudes “some staff think it is not

important” important”

Caveats……………..Caveats……………..

The data suggests that prominence may be The data suggests that prominence may be given to equality issues only in so far as given to equality issues only in so far as these emanate from problem based and these emanate from problem based and situated learning.situated learning.

Lecturers’ attributes critical to curriculum Lecturers’ attributes critical to curriculum planning and innovation – commitment, planning and innovation – commitment, ownership, reflection, action.ownership, reflection, action.

Sustained Inquiry: Sustained Inquiry: Key Questions Key Questions

Continuity and Coherence Continuity and Coherence

The methods used to raise equality The methods used to raise equality matters.matters.

Initiatives and techniques being used to Initiatives and techniques being used to raise student awareness of bias in raise student awareness of bias in assessment tools.assessment tools.

Initiatives and techniques being used to Initiatives and techniques being used to promote cultural immersion and insight.promote cultural immersion and insight.

The comparability of training The comparability of training opportunities.opportunities.

How Does High Self-How Does High Self-efficacy Impact on efficacy Impact on Training?Training?

There is a need to establish:There is a need to establish:

Levels of teacher self efficacy using Levels of teacher self efficacy using reliable and valid measurement scales. reliable and valid measurement scales.

Factors contributing to variations in self-Factors contributing to variations in self-efficacy.efficacy.

Correlate with audited behaviours and Correlate with audited behaviours and practices.practices.

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

The actions being taken by teachers :The actions being taken by teachers :

Address racial harassment within educational.Address racial harassment within educational.Premises.Premises.

Help students recognise oppression and.Help students recognise oppression and.Discrimination.Discrimination.

Understanding the cultural beliefs, religious.Understanding the cultural beliefs, religious.Practices, disabilities and rights of students.Practices, disabilities and rights of students.