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A critical study of cultural competence in nursing curricula

Dissertation
Author: Marie E. Seneque
Abstract:
The growing cultural diversity in the United States necessitates that nurses be prepared to give culturally competent care. Studies in nursing curriculum emphasize the need for culturally congruent care, but research is limited on the implications of this recommendation for the training of nurses. Curriculum and instructional planners need input from faculty in order to integrate this information into nursing training. This qualitative case study was designed to investigate nursing faculty understanding of cultural competence and their perceptions of what constitute the critical elements necessary for a culturally competent nursing curriculum. The Campinha-Bacote model of cultural competence was used as a theoretical framework for typological analysis. Data for analysis included semistructured interviews of 9 faculty members from schools of nursing in the southeastern region of the United States, analysis of students' evaluation and assessment forms pertaining to cultural competence, and review of archival online curricula from some schools of nursing. Patterns within the data were compared to the model, nonexamples were identified, and relationships and generalizations followed the analysis. Findings suggested that faculty had awareness and knowledge of cultural competence, and although all participants agreed that student nurses should be taught cultural competence, current assessments fail to adequately emphasize this aspect of nursing practice. This research contributes to the literature and social change by informing leadership about the type of personnel, curricula, and instructional improvements needed to address cultural competence in schools of nursing and preparing culturally competent clinicians for the future.

TABLE OF CONTENTS LIST OF TABLES .......................................................................................................... v CHAPTER 1: INTRODUCTION .................................................................................... 1 Cultural Demographics .................................................................................................... 1 Cultural Competence in Health Care ................................................................................ 1 Nursing Education and Faculty Competence .................................................................... 3 Nursing Curriculum ......................................................................................................... 6 Statement of the Problem ................................................................................................. 7 Nature of the Study .......................................................................................................... 8 Research Questions ......................................................................................................... 9 Conceptual Framework .................................................................................................... 9 Purpose of the Study ...................................................................................................... 13 Definition of Terms ....................................................................................................... 14 Limitations .................................................................................................................... 15 Assumptions .................................................................................................................. 15 Significance of the Study ............................................................................................... 15 Summary ....................................................................................................................... 17 CHAPTER 2: LITERATURE REVIEW ........................................................................ 19 Cultural Competence ..................................................................................................... 20 Faculty Competence in the Nurse Educator Role ........................................................... 24 Nursing Curriculum ....................................................................................................... 28 Summary ....................................................................................................................... 33 CHAPTER 3: METHODOLOGY……………………………………………………….34 Introduction ……………………………………………………………………………...34 Qualitative Research ...................................................................................................... 35 Research Design ............................................................................................................ 36 Participants .................................................................................................................. 377 Sampling Size ............................................................................................................... 38 Data Collection .............................................................................................................. 39 Document Analysis ....................................................................................................... 42 Data Analysis ................................................................................................................ 42 Coding …………………………………………………………………………………...43 Ethical Considerations ................................................................................................... 43 Credibility ............................................................................................................... 44 Dependability .......................................................................................................... 44 Transferability ......................................................................................................... 45 Conformability ........................................................................................................ 45 Researcher Responsibility ............................................................................................. 45 Summary ....................................................................................................................... 46

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CHAPTER 4: FINDINGS.............................................................................................. 46 Introduction .................................................................................................................. 46 Data Collection and Management ................................................................................. 47 Evidence of Quality ....................................................................................................... 52 Researcher Bias ………………………………………………………………………….53 Data Analysis ……………………………………………………………………………53 Research Findings ……………………………………………………………………….57 Research Questions………………………………………………………………………63 Research Question1 ................................................................................................. 64 Research Question 2 ................................................................................................ 68 Research Question 3 ................................................................................................. 72 Discrepant Data ............................................................................................................. 76 Document Analysis ....................................................................................................... 78 Archival Materials ......................................................................................................... 79 Summary ...................................................................................................................... 79

CHAPTER 5: SUMMARY, CONCLUSION, AND RECOMMENDATIONS ………..81 Introduction .................................................................................................................. 81 Interpretation of Findings ............................................................................................. 83 Summary of Findings .................................................................................................... 87 Implication for Social Change ....................................................................................... 90 Recommendation for Action ......................................................................................... 91 Recommendations for Further Study ............................................................................. 95 Reflection ..................................................................................................................... 96 Conclusion .................................................................................................................... 97

REFERENCES ………………………………………………………………………….98 APPENDIX A: DEMOGRAPHIC QUESTIONNAIRE ............................................... 103 APPENDIX B: INTERVIEW SCHEDULE ................................................................. 105

APPENDIX C: CONSENT FORM ……………………………………………………106

APPENDIX D: ADDITIONAL QUESTIONS………………………………………...107

APPENDIX E: INTERRATER CODING INSTRUCTION…………………………...108

APPENDIX F: INTERVIEW TRANSCRIPTS………………………………………..110

CURRICULUM VITAE……………………………………………………………….138

v LIST OF TABLES

Table 1………………………………………………………………………………….38

Table 2………………………………………………………………………………….55

Table 3………………………………………………………………………………….64

CHAPTER 1: INTRODUCTION Cultural Demographics According to the U.S. Census (2002), more than 31% of the population is ethnic minorities. By 2020, ethnic minorities will constitute approximately 50% of the entire U.S. population (U.S. Department of Health and Human Services [DHHS], 2001). To respond to this demographic change in the United States, health-care professionals must embrace the challenge of providing culturally competent care. Yet, despite 20 years of discussion, health-care professionals are still unclear about what it really means to be culturally competent. Ethnic minorities are understandably keen to sustain their identity, values, and belief system and want to be recognized in a bicultural, pluralistic, and multicultural manner (Butcher, 2000). Leininger(1999), a leading transcultural nurse specialist, noted that in order to meet the health-care needs of an increasingly diverse population, schools of nursing needed to ―teach modules or specific units‖ ( p. 15) related to cultural health in the curricula. Nurses need to be cognizant of their clients‘ cultural beliefs and values regarding health and sickness. A culturally competent curriculum must include issues of cultural awareness, cultural knowledge, cultural encounters, cultural skills, and most importantly cultural desire. This study was conducted to fill the gap in the literature on the critical elements of cultural competence in nursing curricula. Cultural Competence in Health Care Without culturally competent assessment skills, clinical nurses cannot give culturally congruent care. As a result, patients and their families may suffer from adverse

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physical and emotional outcomes (Jeffreys, 2005b). Culturally congruent care involves rendering beneficial and meaningful care that fits the client‘s traditions, beliefs, and values (Jeffreys, 206). To enable the delivery of such care, nurses need to be taught cultural competence. Cultural competence is the ―process in which the health care professional continuously strives to achieve the ability and availability to effectively work within the cultural context of a client (individual, family, community)‖ (Campinha- Bacote, 2003, p. 23). According to Campinha-Bacote (2002), cultural competence is an ongoing learning process that consists of five interrelated constructs: cultural awareness, cultural knowledge, cultural skills, cultural desire, and cultural encounters. Campinha- Bacote (2002) also reported that cultural competence is not an isolated event and is not static. Jeffreys (2006) described cultural competence as a ―multidimensional learning process that integrates transcultural skills in all three dimensions (cognitive, practical, and effective) and aims to achieve culturally congruent care‖ (p. 31). Cultural competence cannot be achieved by attending a single workshop. Cultural competence is a journey that is dynamic and involves above all the desire to be engaged. In December 2000, the Office of Minority Health (OMH) presented the National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards), which were a ―collective set of mandates, guidelines, and recommendations intended to inform, guide, and facilitate required and recommended practices related to culturally and linguistically appropriate health services‖ (DHHS, 2000, p. 5). The final report from the OMH emphasized the importance of pursuing the development of innovative activities that help implement, measure, and assess cultural and linguistic competence in health-care organizations and among healthcare professionals. Responding

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to the increasing need for a national consensus on what cultural and linguistic competence means in health care, the OMH, under the auspices of the DHHS began to focus on policy and research concerning the practice of culturally competent care. The activities recommended by the OMH (2000) include developing core cultural competencies for health-care professionals at all levels of education, supporting efforts to diversify the health-care professional workforce, and developing curriculum standards and evaluative tools for cultural competency training. Cultural knowledge involves the vast variety of health perceptions, trust of the health care system, traditional versus folk medicine, and spirituality. According to Campinha-Bacote (1998), cultural knowledge is the process of obtaining information about the worldviews of different cultural groups and their degree of acculturation. Issues of health literacy and the reality of health disparity need exploring. Patients‘ history taking and physical assessment involve a different insight and need cultural skill when dealing with diverse populations. These are essential topics that need to be included in a culturally competent nursing curriculum. Nursing Education and Faculty Competence To be prepared for the complexities and challenges of providing care to a culturally diverse population, nursing students need to be given the appropriate knowledge in nursing schools. Schmidtlein and Berrdahl (2005) noted, ―Institutions have had to become responsive to a wider range of economic interests and to a more diverse pattern of ethnic and cultural backgrounds and aspirations‖ (p. 76). According to Jeffreys (2006), the goal of achieving culturally congruent care is through the process of learning and teaching cultural competence.

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The dilemma for nursing programs is the lack of expert faculty to teach culturally competent care (Ryan, Carlton, & Ali, 2000). As the client base becomes increasingly multicultural, nursing faculty in some regions of the United States remain predominantly composed of Caucasian, middle class women who have been immersed in the Anglo- Saxon way of interacting and teaching with the knowledge and belief of a predominantly Western caring system. The core components of most nursing curricula include didactic content of disease management, health promotion and prevention, health-care policy, pharmacology, physical assessment, and leadership skills. Cultural immersion is usually only offered as an elective course. One of the challenges for educating nurses about cultural competence is that faculty, unlike the general population, are composed almost entirely of Caucasian women (Pacquiao, 1995; Trossman, 1998). In addition, nursing and nursing education have traditionally been very Eurocentric, with a strong emphasis on individualism, time- orientation, linearity, and independence (Crow, 1993). Learning to value ethnic diversity involves appreciating how variations in culture and background may affect health care and acknowledging and responding to an individual‘s culture in its broadest sense, which requires health-care professionals to learn the skills to negotiate effective communication, to have a heightened awareness of one‘s own attitudes, and to have a sensitivity to issues of stereotyping, prejudice, and racism. Two studies have addressed this crucial deficit. Grossman et al. (1998) surveyed deans and directors of schools of nursing in Florida, a culturally diverse state, and found that schools lacked awareness, knowledge, and sensitivity toward cultural differences and similarities. Ryan et al. (2000) examined the preparatory education and abilities of faculty

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in the area of culturally competent care. Surveys were sent to 610 nurses with at least a baccalaureate degree; only 217 responded, for a return of 36%. The deans from eighty schools reported no faculty prepared formally in this field of study. Only one third of the schools reported offering faculty development programs in transcultural care. The data indicate a serious shortage of faculty prepared in the area of culturally appropriate nursing care. DeSantis (1999), Leininger (1995), and Campinha-Bacote (1998) reported cultural competence takes time to develop. Cultural competence is not acquired in a 1- or 2-day workshop, nor is it likely to develop in just a few years. Nurse educators can lay the foundation by attempting to instill certain attitudes and encouraging the development of certain characteristics in future nurses to enhance their abilities to understand and later practice culturally competent care. The first exposure to the preferred health practices of diverse clientele should occur in the educational setting. Although faculty in schools of nursing recognize the need to incorporate content about culture and culturally appropriate care in their syllabi, they may be teaching only general knowledge about various cultures, which often leads to generalizations. Cultural generalities are rarely applicable to all individuals within a culture (Dreher & MacNaughton, 2002). General knowledge often leads to stereotyping and labeling culturally diverse clients as ―uncooperative, noncompliant, and resistive‖ (Eliason & Macy, 1992, p. 14) to a health-care regimen. Campinha-Bacote and Padgette (1995) noted ―Non-compliance can be considered the failure of health care providers to make available culturally relevant care‖ (p. 31). Conversely, according to Leininger (1989), improving nurses‘ specific knowledge about culture may lead to providing care that is congruent with clients‘ cultural beliefs and values. The best teaching strategy for

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teaching nursing students‘ specific cultural knowledge faculty is affective learning Affective learning is a learning dimension that emphasizes attitudes, values, and beliefs. It is credited in developing professional values and attitudes. Students are individuals with unique personal ways of knowing and learning. Although a majority of nursing students are nontraditional and have shifted both in age and in experiential backgrounds, many nursing programs still employ the conventional pedagogical framework. Nursing Curriculum Banks (1994) noted that while curricular programs attempt to increase the body of knowledge about different ethnic, cultural, and gender groups, student-oriented programs are intended to increase the academic achievement of these groups. Banks explained socially oriented programs should encompass not only programs to restructure and desecrate schools, but programs designed to increase all kinds of contact among the races, encouraging minority teachers, antibias programs, and cultural and racial tolerance. Multicultural education was never intended as a simplistic add-on to the curriculum, although that has become its fate (Banks, 1994; Nieto, 1995). Rather, as posited by Banks (1994) and Nieto (1995), multicultural education is inclusive, complex, and a way of understanding others through a critical assessment of personal, social, historical, and political histories and must include not only what people learn, but how people learn, think, feel, interact, and believe. The starting place to rectify the gap between cultural knowledge and culturally sensitive care is by making sure nursing curricula truly reflect cultural differences from a wide spectrum of racial and ethnic populations. The U.S. National Advisory Council on Nurse Education and Practice issued a national agenda in 2000 that addressed the

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significance of cultural competence. The optimal strategy is to introduce student nurses to preferred health practices of diverse populations in the educational arena. Although most nursing programs and faculty recognize the importance of incorporating culturally appropriate care, assessment, and diversity awareness in the curricula, the best methods are still in dispute. Present curricula may contain accurate cultural terminology, but often lack the qualities that enable students to understand the health-care needs of different cultures. Factors such as gender, age, disability, socioeconomic status, and literacy are essential dimensions of cultural competence. All these components are necessary in a culturally competent curriculum. As discussed by (Benbassat & Baumal, 2004), and Spiro (1992), the decision-making process of curricular reform as cited by nursing faculty includes an emphasis on when content is taught or concentrated during the program. Statement of the Problem Most faculty members who are responsible for curriculum planning and implementation agree there needs to be a culturally competent curriculum, but the critical elements that constitute a culturally competent nursing curriculum are still debatable. A deficit of culturally competent care exists, specifically from nurses (Cooper-Brathwaite, 2005; Narayanasamy, 2003). As schools of nursing are the gateway to preparing future nurses to be aware, knowledgeable, and skilled to manage culturally diverse clientele, this introduction to culturally congruent care should be the start of their journey towards cultural competence. Nursing students are not graduating to work at the bedside as culturally competent clinicians and are ill equipped to care for clients of other cultures (Andrews, 1999; Lester, 1998). Van Ryn (2002) reported there is increasing evidence that

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the lack of culturally competent care is partly responsible for the disparities so evident in health care. Infusion of cultural competence instruction in nursing education is one way to rectify the problem (Smedley, Stith, & Nelson, 2002). As there is a lack of research on cultural competence in nursing curricula, this study was to provide information on the critical elements of cultural competence in nursing curricula examined. Nature of the Study Every nurse practicing in a clinical setting should be culturally competent to work with the diverse clients of the 21st century. Ruth-Sahd (2003) noted nursing faculty need to recognize and include a wide variety of cultural values and beliefs in their curriculum. This study examined faculty understanding and knowledge of cultural competence, what faculty perceived to be critical elements of a culturally competent nursing curriculum, and what faculty viewed to be barriers and facilitating factors to bring about the changes. A comprehensive review of the literature indicated student nurses are not being prepared in nursing school to master the complex nuances of culture, sickness, and health. Platt and Platt (1998) explained the influence of health-care providers on positive health outcomes, and believed that understanding patients‘ values, concerns, and beliefs greatly influences the outcomes. Fields et al. (2004) expressed that better recovery, improved healing, fewer malpractice suits, and fewer litigations have been linked to competent care. In this study, documents, archival records, and interviews were used (Yin, 1994). Documents can be anything germane to the research. Archival materials will include documents related to policies that have brought about change or have been barriers in the educational setting or nursing curriculum.

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Research Questions The following questions guided this research: 1. What is the faculty understanding and knowledge level of cultural competence? 2. What elements do faculty consider essential in a culturally competent curricula? 3. What barriers or facilitating factors exist within nursing education to thwart a culturally competent nursing curriculum? Conceptual Framework Education has been widely recognized as a mechanism for social reform and the notion of social reform through education requires the active engagement of the learner (Freire, 1985). In any education setting, the plan for content and objectives of the program is in the form of a curriculum. As reported by Iwasiw, Goldenberg, and Andrusyszyn (2005), curriculum is ―characterized by interaction, cooperation, change, and possibly conflict‖ (p. 2). Very often, the curriculum is molded in accordance with the educators‘ individual and collective values and beliefs about education, teaching, and learning. Conventional Pedagogy Conventional pedagogy, the preferred approach in nursing education, has been criticized as representing teacher authoritarianism and student oppression. Diekelmann and Diekelmann (1999) described pedagogy as ―the nature of knowledge and learning, specifically how knowledge is produced, reproduced, transformed, and experienced in situations created by faculty and students‖ (p. 104). Authoritarianism and oppression are

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not new to the nursing profession. Conventional pedagogy has been blamed for both the perpetuation of oppression and the deficiencies of learners in nursing education (Harden, 1996; Scarry, 1999). The realization that there is a definite need for change occurred when nursing education was assessed by nursing leaders as being deficient in preparing nurses for contemporary nursing. Consequently, a curriculum revolution was demanded (Moccia, 1990; National League for Nursing, 2003). The need for change was met with conflict because fundamental to the change was the relationships and roles for teachers and students (Schreiber & Banister, 2002), which meant a major overhaul in nursing education with substantive changes in curriculum. Critical pedagogy is deemed more appropriate for present day nursing education and cultural competence infusion. Conflict Theory Weber, a renowned sociologist, stressed the role of human beings as agents of social interpretation and rational understanding (Morrison, 1995). Cultural influences and identities become important depending on context. Cultures are embedded in every conflict because conflicts arise from human relationships. People are all capable of bringing about social change by their actions. Change brings about conflict, but when engaged in constructive conflict there is a great chance in the development of human potential. Conflict practices based on conflict theory can be as useful for people wanting to change the status quo as for people wishing for things to remain the same. Conflict does not necessarily involve hostility, but those capable of bringing about change often shy away from doing so and managing, reducing, and resolving conflict are deterred because of the power struggles. Although entrenched policies and curriculum models are barriers

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that nursing faculty are reluctant to confront, when all parties strive to maximize the benefits that inevitably come from change, the conflict benefits everyone. Spencer (1898) reported conflict is a natural progression to social evolution. Change Theory Some authors maintain that change in nursing education has been slow with little evidence indicating any true change has taken place (Bellack, 2004; Romyn, 2001). The main conflict is that most faculty members have resisted calling for alternative pedagogies despite the changes in student demographics and contemporary content such as the urgent need for cultural competence. Diller and Moule (2004) noted that due to the demographic shift in the United States, cultural competence ―may one day reach a status comparable to computer literacy‖ (p. 13). According to Lewin (1951), the first step in bringing about change is to change the status quo. Changing behaviors in the schools of nursing has been perceived as slow. Therefore, to change the status quo, nursing leaders are required to motivate, build trust, and bring to the faculty‘s attention the need for change. By so doing, the faculty will recognize the status quo is no longer beneficial to the process of education. By removing the anxieties for change and increasing motivation, defensiveness and resistance are minimized. Cultural Competence The concept of cultural competence is often misunderstood in nursing. The approach used in nursing to assess competence is the end point of knowledge and skill demonstrated and observed to reaching the required standard of competence. Cultural competence is far more complex than just regurgitating information or mimicking a skill. Campinha-Bacote also noted cultural competence is an ongoing learning process that

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consists of five interrelated constructs: cultural awareness, cultural knowledge, cultural skills, cultural desire, and cultural encounters. Campinha-Bacote (1994) defined cultural competence as a process rather than an end point. Campinha-Bacote‘s model of cultural competence is the basic framework for the proposed study because it contains the critical elements of cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. These elements should be reflected in the undergraduate nursing curriculum as the foundations and subsequent steps on the journey toward cultural competence. To avoid imposing one‘s own beliefs and values on clients, Campinha-Bacote cited the importance of awareness that involves the self-examination and exploration of one‘s own culture and its influence on one‘s thinking and behavior. Campinha-Bacote (1998) reported cultural knowledge as the process through which health-care providers collect information about the worldviews of different cultural groups. Being able to obtain correct information about a client‘s cultural beliefs and practices concerning health and sickness involves great skill. Cultural skill is ―the ability to collect relevant data regarding the client‘s health history and presenting problem, as well as accurately performing a physical assessment‖ (Campinha-Bacote, 1998, p. 26). For effective communication that brings about the trust so needed for a successful health outcome, Campinha-Bacote (1998) noted cultural encounters are necessary to avoid and negate stereotypes and generalizations. Cultural encounter ―is the process which encourages health care providers to directly engage with clients from diverse cultural backgrounds‖ (Campinha-Bacote, 1998, p. 39). It is not enough for health-care providers to be politically correct in the workplace because of policies and organizational

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strategy. Health-care providers must truly want to care for clients of other cultures. This cultural desire is ―the motivation to ‗want to‘ engage in the process of cultural competence‖ (Campinha-Bacote, 1999, p. 205). These elements, when understood and practiced, together form the complex process that is cultural competence. Only by understanding the faculty perceptions of cultural competence can nursing faculty affect the conflict of using alternative pedagogies, such as critical pedagogy. Purpose of the Study Stake (2000) explained the purpose of a study is not to represent the world, but to represent the case at hand. The purpose of this study was to investigate faculty perceptions of the necessary elements in a culturally competent curriculum in nursing programs. The nature of a culturally competent nursing curriculum is to enhance the nurse-patient relationship and interaction and to provide effective, sensitive, and quality care. Despite numerous studies on cultural competence in the health-care arena since the 1980s, there exists a lack of investigation into the necessary elements of cultural competence in nursing curricula. A major challenge is the inclusion of necessary elements of cultural competence in the nursing curriculum. The proposed research study will hopefully lead to a better understanding of the curricular changes needed pertaining to the inclusion of critical elements of cultural competence. The findings resulting from the study, when shared with nurse educators, might affect curricular changes and start nursing students on their journey toward cultural competence.

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Definition of Terms Cultural competence: A set of congruent behaviors, attitudes, and policies that comes together in a system, in an agency, or among professionals and enables the system, the agency, or those professionals to work effectively in cross-cultural situations (Cross et al., 1989; Isaacs & Benjamin, 1991). Culturally and Linguistically Appropriate Services (CLAS): Services primarily directed at health-care organizations to encourage them to use 14 standards to make their practices more culturally and linguistically accessible. Culturally congruent care: Health care given to fit a client‘s beliefs, values, traditions, and lifestyle (Jeffreys, 2006). Culture: The learned values, attitudes, behaviors, and shared symbols most embraced in a person‘s daily life, passed down from previous generations (Leininger, 1997). Curriculum: Any program of activities, subjects, or courses prescribed to be studied in a school system (Wikipedia, 2007). Diversity: Understanding, respecting, and accepting individual differences and uniqueness along the dimensions of gender, age, race, ethnicity, physical abilities, religious beliefs, socioeconomic status, sexual orientation, and nationality (NIGP, 2001). Office of Minority Health (OMH): Established in 1986 by the U.S. Department of Health and Human Services, the OMH advises the Secretary and the Office of Public Health and Science on public health program activities affecting American Indians and Alaska Natives, Asian Americans, Blacks/African Americans, Hispanics/Latinos, Native Hawaiians, and other Pacific Islanders. The mission of the OMH is to improve and

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protect the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities (OMH, DHHS, 2005). Perception: The process of attaining awareness and understanding of sensory information and of how events are observed and interpreted (McGinn, 1995). Limitations The limitations of research establish the boundaries of the area of study. The study was conducted only within the schools of nursing in North Carolina, and excluded academic administrators. No attempt will be made during the study to compare faculty with each other. The sample size will not be large enough to represent the majority of nursing education practices across the nation, state, or region. Extremes will have to be viewed in regards to the small sample size. Assumptions The study will be based on two assumptions. The first assumption will be that due to the changing demographics of the United States, there is a need to transform nursing education to teach nurses care that will reflect culturally competent awareness, knowledge, and skills. The second assumption will be that faculty will recognize the critical elements necessary in a culturally competent curriculum. It is imperative that nursing faculty identify and implement culturally competent nursing education. Significance of the Study As a result of changing demographics in the patients‘ population, the nursing profession faces numerous challenges in preparing future nurses to understand and respect the changing patient-care environment. Nurses of the 21st century need to be prepared to provide culturally congruent care. Rhoades (2007) assessed a cultural

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competence curriculum prepared by the University of Iowa, one of the very few in the country. Focus groups of nursing students found the curriculum to be a ―very useful self examination or assessment tool‖ (Rhoades, 2007, p. 14). Several theories exist regarding the necessity of cultural competence in nursing care. Lindsey et al. (2003) developed an educational theory regarded as an innovative approach to social action. Lindsey et al.‘s (2003) theory is especially necessary for redesigning the teaching and learning paradigm in schools of nursing. Campinha-Bacote‘s (1999) model is comprehensive and applicable to clinical, education, and research areas. Nurse educators can incorporate Campinha-Bacote‘s (1999) model in their teaching. By including and explaining its various constructs (cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire), nurse educators can teach nursing students the culturally competent nursing practices that are so vital to taking care of patients in the 21st century. MacAvoy and Lippman (2001) and Campinha-Bacote (2002) reported that Campinha-Bacote‘s (1999) model demonstrated validity in clinical practice aimed at developing cultural competence in nurses. Nursing education and nursing curricula need to include culturally competent education because the lack of culturally competent knowledge has been linked with health-care disparity and adverse outcomes in patient care (Anderson et al., 2003). The changing ways of health-care delivery have led to a critical need for a curriculum that embodies culturally competent content throughout the educational process. Evidence regarding the best method to competently educate new nurses has yet to be determined (Campihna-Bacote, 2006; Grant & Letzring, 2003).

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Summary Cultural competence is an ongoing process along the continuum and is constantly changing with new knowledge and encounters. Care is then adapted to meet clients‘ needs in accordance with their cultural beliefs. Edge (2002) reported competency is ―the ability to function effectively and to appreciate the gifts of those who look different than we are. Cultural competency is the skill that enables us to embrace diversity‖ ( p. 83). Ruth-Sahd (2003) posited nurse educators believe in the traditional, linear, rational, and scientific way of thinking and knowing and noted nurse educators need to recognize and include a wide variety of ways of knowing cultural beliefs and values in their curriculum. ―In order to respect and understand the diverse patients‘ population, nurses need to be culturally sensitive‖ (Ruth-Sahd, 2003, p.114). The proposed study will examine faculty perceptions of cultural competence and the necessary elements that constitute a culturally competent nursing curriculum. The guiding conceptual framework will be Campinha-Bacote‘s (1999) model of cultural competence. The research study was based primarily on the qualitative paradigm using the inquiry process to further understand a particular phenomenon in context. Qualitative research is appropriate whenever the need arises to understand ―a social or human problem based on a complex, holistic picture formed with words reporting detailed views of informants‖ (Creswell, 1984, p. 2). Qualitative methods will be used to design the procedures and to analyze the findings to make recommendations for future research and intervention. The research questions listed are a roadmap to guide the researcher during individual interviews. Chapter 2 contained a review of the literature on cultural competence, nursing education, nursing curricula, nursing faculty knowledge of cultural

Full document contains 150 pages
Abstract: The growing cultural diversity in the United States necessitates that nurses be prepared to give culturally competent care. Studies in nursing curriculum emphasize the need for culturally congruent care, but research is limited on the implications of this recommendation for the training of nurses. Curriculum and instructional planners need input from faculty in order to integrate this information into nursing training. This qualitative case study was designed to investigate nursing faculty understanding of cultural competence and their perceptions of what constitute the critical elements necessary for a culturally competent nursing curriculum. The Campinha-Bacote model of cultural competence was used as a theoretical framework for typological analysis. Data for analysis included semistructured interviews of 9 faculty members from schools of nursing in the southeastern region of the United States, analysis of students' evaluation and assessment forms pertaining to cultural competence, and review of archival online curricula from some schools of nursing. Patterns within the data were compared to the model, nonexamples were identified, and relationships and generalizations followed the analysis. Findings suggested that faculty had awareness and knowledge of cultural competence, and although all participants agreed that student nurses should be taught cultural competence, current assessments fail to adequately emphasize this aspect of nursing practice. This research contributes to the literature and social change by informing leadership about the type of personnel, curricula, and instructional improvements needed to address cultural competence in schools of nursing and preparing culturally competent clinicians for the future.