Elsevier

Nurse Education Today

Volume 32, Issue 7, October 2012, Pages 772-778
Nurse Education Today

Interdisciplinary: Cultural competency and culturally congruent education for millennials in health professions

https://doi.org/10.1016/j.nedt.2012.05.002Get rights and content

Summary

The increasingly diverse multicultural and multigenerational student population in the United States requires that educators at all levels develop cultural knowledge, awareness, and sensitivity to help diverse learners fulfill their potential and to avoid cultural misunderstandings that can become obstacles or barriers to learning. The purpose of this study was to design and implement eclectic, creative, evidence-based interdisciplinary educational activities, along with culturally congruent teaching strategies, within a semester-long university course that promoted positive and culturally competent learning outcomes for culturally diverse, largely millennial students. The interdisciplinary course would prepare health professional students with the requisite knowledge and skills, through transformative learning that produces change agents, to provide culturally congruent and quality team-based care to diverse populations. This was a qualitative and quantitative study, which measured students' level of cultural awareness, competence, and proficiency pre and post the educational intervention. Instruments used for data collection included the Inventory for Assessing The Process of Cultural Competence-Student Version (IAPCC-SV) by Campinha-Bacote, course evaluations, students' feedback, and portfolio reflections. The study was conducted at a private academic institution located in the Mid-Atlantic region and the sample population included inter-professional students (N = 106) from various health professions including nursing, pharmacy, and allied health sciences. Results from the pre- and post-test IAPCC-SV survey revealed that mean scores increased significantly from pre-test (60.8) to post-test (70.6). Thus, students' levels of cultural competency (awareness, knowledge, skills, desire, encounter) improved post-educational intervention, indicating that the teaching methods used in the course might be applied on a larger scale across the university system to cater to the nation's increasingly multi-cultural population.

Introduction

The United States is a country of growing diversity, which demands that individuals and health care systems function in a culturally competent way. The Institute of Medicine (2002) cites that sources of current disparities in culturally competent care include failures in the healthcare system, cultural and linguistic barriers, and a subtle mixture of bias and prejudice during the clinical encounter. The later is compounded by a shortage of minority providers in all sectors of healthcare (nurses, pharmacists, physicians, allied health professions, etc.). A Sullivan Commission report Missing Persons: Minorities in the Health Professions (2004), addressed growing concerns over U.S. health care quality and access for a population that is becoming increasingly diverse in respect to socioeconomics, gender, race, age, ethnicity, culture, abilities, and language. The Commission confirmed the broader perspective of not only increasing minority representation in health professions and providing a multicultural and inter-professional education (IPE) built on the ideals of social justice and civic responsibility, but also delivering of culturally competent care.

Thus, culturally competent health professionals are a necessity in today's health care arena and will play a critical role in reducing health disparities and improving health outcomes. The key to cultural competency and culturally congruent care lies in the ability of health care providers to “craft respectful, reciprocal and responsive effective interactions across diverse cultural parameters” (Barrera et al., 2002, p.103). Teaching future health care professionals about specific cultures has been insufficient because it does not allow for the development of an understanding of cultural competence for application in practice. Therefore, educators should adopt eclectic culturally congruent teaching–learning strategies (Jeffreys, 2006) supported by concepts and theories rather than the traditional rigid approach of memorizing facts in order to understand specific cultures. Furthermore, it is imperative that educators link and bridge cultural self-awareness, knowledge, theory, and communication skills in teaching culturally congruent care for millennial health professionals.

According to Howe and Strauss (2007), the millennial generation is loosely defined as those born after 1982 (also referred to as Generation Y). In the Fall of 2000, the first millennials began to enter college, and it has become imperative to consider some of the defining traits and characteristics of this generation when designing coursework. Millennials, as future health care professionals, are more racially and ethnically diverse than preceding generations. Peter Leyden (in Howe and Nadler, 2010) stated that millennials are “not individualistic risk takers like Boomers, or cynical and disengaged like generation X, but they are civic minded, trust in leaders, and are team oriented” (p.15). Furthermore, Millennials are not follower of trends but starting own trend; not self-absorbed but team oriented and value community services; not rule breakers but rule followers; not aimless but highly directed and achievers (Howe and Nadler, 2010). These characteristics shaped our teaching–learning strategy for these active learners, leading us to design the course in a manner that avoided any assumptions, impositions, or judgments in the introduction and practice of culturally competent care and professionalism.

Accreditation standards across health care professions call for cultural competency education in order to prepare future health care providers to care for increasingly diverse populations effectively and efficiently. For example, for the profession of physical therapy, the Commission on Accreditation of Physical Therapist Education includes the importance of cultural competency throughout curriculum plan, evaluation and content (CAPTE, 2011). The PT Profession Practice Expectations are to “provide culturally competent physical care services to individuals, groups and communities” (p.30); “expressively and receptively communicates in a culturally competent manner with patients/clients, family members, caregivers, practitioners, interdisciplinary team members” (p.31, 5.17); “identify, respect and act with consideration for patients' differences, values” (p.31, 5.18); and “effectively educate others using culturally appropriate teaching methods” (p.31, 5.26). Additionally, The Accreditation Counsel for Pharmacy Education (Guideline 9.1) states that “in developing knowledge, skills, attitudes and values in students, schools must ensure that curriculum addresses patient safety, cultural competence, health literacy, health care disparities, and competencies needed to work as a member of an inter-professional team” (ACPE, 2006, p.15). In general, cultural competence is now a mandate (Office of Minority Health, 2001), and must be measurable (American Association of Colleges of Nursing, 2001).

Section snippets

Literature Review

According to Omeri (2008), the last few decades exhibited “transcultural nursing knowledge development through theory, research, and practice”, even though “there remains a lack of formal, integrated cultural education into nursing” (p.x). Health profession educators and researchers have questioned and evaluated the effectiveness of current educational interventions (workshops, free-standing courses, imaginative literature, cultural immersion programs) that were designed to improve cultural

Purpose

Based on our observations, we began to formulate an experimental course to investigate ways of addressing the elements we found lacking in current health care education. The aim of the study was to design and implement creative, evidence-based interdisciplinary educational activities that promote positive and culturally competent learning outcomes for millennial students. The semester-long elective course, “Culturally Congruent Care for Clinical Health Professions,” would prepare future health

Course Design

The “Culturally Congruent Care for Clinical Health Professions” course is an interdisciplinary elective educational activity that was specifically designed for a variety of inter-professional health science students. It is a three-credit course (three hours per week for 14 weeks) consisting of 2 hours of classroom instruction a week, supplemented by one hour of outside activities (reading materials, DVD segments, field trips/community immersion, interviews, e-learning and online discussion

Methodology

This was a qualitative and quantitative study that measured health professional students' level of cultural awareness, competence and proficiency pre and post intervention over the duration of one semester. Instruments used for data collection included the Inventory for Assessing The Process of Cultural Competence-Student Version (IAPCC-SV) by Campinha-Bacote (2007), course evaluations, student feedback, and portfolio reflections. Eclectic, fun, likable, and customized culturally congruent

Statistical Analysis

Descriptive statistics of the socio-demographic variables were estimated using frequency distributions. In addition, univariate statistics including means, medians, standard deviations, and ranges were estimated for the IAPCC-SV scores at baseline and at the end of the study (pre and post-test). These estimates were further summarized by gender, specialty, race and semester. In order to determine changes in summary IAPCC-SV scores from pre-test to post-test, paired t-tests were conducted. These

Quantitative

Table 1 presents the characteristics of students' population (total number of participants, age, gender, profession and race).

Table 2 summarizes the results of the paired analyses, which evaluated differences in IAPCC-SV scores from pre-test to post-test. As shown, there were statistically significant changes in IAPCC-SV scores before and after the course. More specifically, we observed an improvement in scores from baseline (pre-test) to study end (post-test) overall (Pre-Mean = 60.8; Post Mean = 

Discussion

The intervention was mapped on: Healthy People 2010's (2002) two major goals that require culture-specific care: 1) increase quality and years of healthy life for all by examining “quality of life” and meaning of health and well-being within cultural context, and 2) eliminate health disparities among different segments of the population that necessitate culture specific and competent actions that designed and customized to fit client's cultural values, beliefs, and traditions. It was also

Conclusion

Results of IAPCC-SV showed that because of course participation and inter-professional educational activities, the level of cultural competency among health profession students improved post-educational intervention. Collectively, the five constructs of cultural knowledge, attitudes, desire, encounter, and skills were significantly progressed by students who completed the course. According to students' feedback, engaging in an interdisciplinary course that utilized eclectic and culturally

Acknowledgments

We gratefully appreciate and acknowledge: support and fund presented by our Institution; our students from the College of Pharmacy, Nursing, and Allied Health Sciences for their voluntary participation; and to the Center for Minority Health Services Research (CMHSR) and Dr. Mary K. Maneno for assistance with data analysis. We specifically thank Ms. Joanie Atkinson for her editorial support and manuscript preparation.

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