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Background: Cross-cultural care and antidiscrimination are vital to ethical effective health systems. Nurses require quality educational preparation in cross-cultural care and antidiscrimination. Limited evidence-based research is available to guide teachers. Objectives: To develop, implement and evaluate an evidence-based teaching and learning...

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... alpha level was set at 0.05 significance. These data are presented in Table 4. The TSET cognitive subscale capturing students' perceived confidence (self-efficacy) in performing crosscultural nursing care (knowledge skills) is significantly different between pre-and post-measures, indicating that students considered that they had improved in this domain. ...

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... Critics of cultural competence and multicultural education concur that they do not address the underlying systems of operation (power dynamics and perceiving non-whites as "other") and further validate the assumed inferiority of the marginalized group (Bell, 2020;Garneau et al., 2018;Pon, 2009). Learning about cultural differences is not enough to transform human relations constructed in the context of power or eliminate racial discrimination and inequities (Allen et al., 2013;Iheduru-Anderson & Wahi, 2020). ...
... To support transformative learning building, the racial literacy of faculty and nursing students is essential to converse fluently about race- (Long, 2012;Ndiwane et al., 2014;Rutledge et al., 2008), immersion experiences (Edmonds, 2010), new course designs (Allen et al., 2013;Moffitt & Durnford, 2021;Mohammed et al., 2014), critical antidiscriminatory pedagogy (Garneau et al., 2018), and one-off cultural competence, multicultural education, intercultural communication workshops, or antiracist training (Majda et al., 2021;O'Connor et al., 2019;Valderama-Wallace & Apesoa-Varano, 2020). Iheduru-Anderson and Wahi (2022) cited several theoretical approaches to address racism, specifically ongoing norm-critical skill-building. ...
Article
In the profession of nursing, whiteness continues to be deeply rooted because of the uncritical recognition of the white racial domination evident within the ranks of nursing leadership. White privilege is exerted in its ascendency and policy‐making within the nursing discipline and in the Eurocentric agenda that commands nursing pedagogy. While attention to antiracism has recently increased, antiracism pedagogy in nursing education is nascent. Pedagogical approaches in the nursing profession are essential. Because it encompasses the strategies used to transmit the science in how nurses practice and teach, which has predominantly been informed using a Eurocentric lens. This paper presents a literature review on antiracist pedagogy in nursing education, discussing how nurse educators can integrate antiracism pedagogy in nursing education, highlighting examples presented by the authors. Key terms related to antiracism are reviewed. The resultant themes from the literature review include resistance to antiracist pedagogy, managing emotional responses, and supporting transformative learning using an antiracist approach. The primary implementation of Eurocentric pedagogical approaches whiteness pervasive in nursing education must be uprooted. Antiracist and other antioppressive learning approaches must be embraced to understand the insidiousness of racial inequities and its power in sustaining structural oppression in nursing academia.
... Broad goals, specific objectives, suggested training approaches, and activities required for the improvement of cultural competency of students were developed. Second, a brief literature review was conducted, so researchers could extract and understand cultural care curricula (content, training approaches, structure, materials, timing, and evaluation methods) [7,[21][22][23][24][25][26][27][28][29][30]. Moreover, the literature review showed how to integrate cultural care into nursing educational programs. ...
... Therefore, students can communicate with individuals from other cultures [40,41]. Using a literature review and consultation with academics, Allen et al. (2013) developed the teaching-learning methods and learning objectives for nursing students' cultural care education. The teaching-learning method was modified with experiential learning and role-playing. ...
... Then, they evaluated students' learning through quantitative study using pre and post-test. The study findings supported the effectiveness of this strategy in promoting students' confidence in cultural nursing care [21]. Two meta-analyses revealed that the best way to educate cultural competence was through a variety of educational strategies, including lectures, in-depth, interactive exercises and discussions, case study analysis, genograms, presentation of articles, selected readings and web-based learning and data collection, videos, simulations, role-playing, seminar, in-service-based learning, poster presentations, interview with clients, and development of a measuring tool [26,42]. ...
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Background Due to changing population, culturally diverse clients with different perceptions of illness and health are present in healthcare settings. Therefore, it is increasingly important for nursing students to have high levels of cultural competence in order to meet diverse client needs. A training program is essential to enhance students’ cultural competence. This study aimed to design, implement, and evaluate a cultural care-training program to improve cultural competence of undergraduate nursing students. Methods This exploratory mixed methods study used six steps proposed in the Talbot and Verrinder model to design a training program. In the first step, a conventional qualitative study was conducted and 18 participants were interviewed using purposive sampling. In the second and third steps, literature review and the classic Delphi technique were used for initiation and finalization of the program. The fourth, fifth, and sixth steps were completed by implementing, monitoring, and evaluating the cultural care program (five two-hour sessions) among 73 nursing students using a quasi-experimental design. Finally, effectiveness of program was evaluated through the cultural care inventory before and 1 month after the program. Data were analyzed via SPSS25, independent samples t- test, paired t- test, chi-square test, analysis of covariance, and multivariate linear regression tests. Results A systematic model was used to identify key elements of a cultural care program, including main topics, educational objectives and contents, assignments and activities for students, teaching and evaluation methods. The curricular objectives and educational contents were implemented in five sessions to produce measurable results. The quantitative step showed that nursing students’ cultural competence in the intervention group (184.37 ± 22.43) improved significantly compared with the control group (153.19 ± 20.14) (t = 6.24, p = 0.001) after intervention. Conclusion A cultural care training program can be designed by the model applied in this study in order to improve cultural competence of nursing students. This training program will be effective if students’ learning needs, appropriate assignments, and acceptable teaching methods are addressed. Therefore, nurse educators can design comprehensive training programs to improve nursing students’ cultural competence in different cultures and contexts. This training program is highly efficient because it is applicable in many disciplines of nursing education.
... Generally, the students reported what can be described as a "casual" approach to cultural issues in the classroom, with teachers addressing the topic occasionally during lessons, frequently through examples and case-studies. Use of case-studies to illustrate cultural issues in healthcare programs has been documented in the literature [45,46]; other alternative teaching and learning strategies include international experiences [47], liaison with and participation of service users [48] and classdebate and discussion [44,49], among others. However, teacher-led classroom activities were not the only learning opportunities described by our participants, who acknowledged extracurricular and even extra-academic activities leading to improved cultural knowledge, skills and attitudes. ...
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Introduction European societies are rapidly becoming multicultural. Cultural diversity presents new challenges and opportunities to communities that receive immigrants and migrants, and highlights the need for culturally safe healthcare. Universities share a responsibility to build a fair and equitable society by integrating cultural content in the nursing curricula. This paper aims to analyze European student nurses´ experience of learning cultural competence and of working with patients from diverse cultural backgrounds. Materials and methods A phenomenological approach was selected through a qualitative research method. 7 semi-structured focus groups with 5–7 students took place at the participants’ respective universities in Spain, Belgium, Turkey and Portugal. Results 5 themes and 16 subthemes emerged from thematic analysis. Theme 1, concept of culture/cultural diversity, describes the participants’ concept of culture; ethnocentricity emerged as a frequent element in the students’ discourse. Theme 2, personal awareness, integrates the students’ self-perception of cultural competence and their learning needs. Theme 3, impact of culture, delves on the participants’ perceived impact of cultural on both nursing care and patient outcomes. Theme 4, learning cultural competence, integrates the participants’ learning experiences as part of their nursing curricula, as part of other academic learning opportunities and as part of extra-academic activities. Theme 5, learning cultural competence during practice placements, addresses some important issues including witnessing unequal care, racism, prejudice and conflict, communication and language barriers, tools and resources and positive attitudes and behaviors witnesses or displayed during clinical practice. Conclusion The participants’ perceived level of cultural competence was variable. All the participants agreed that transcultural nursing content should be integrated in the nursing curricula, and suggested different strategies to improve their knowledge, skills and attitudes. It is important to listen to the students and take their opinion into account when designing cultural teaching and learning activities.
... In fact, results from previous research have shown that health disparities between minority and non-minority groups do exist. Cultural and social determinants to health, such as unequal access to care, poverty, racism, failings of intercultural communication, and ineffective interactions between the care provider and the patient, have been identified as some of the factors underlying these [4][5][6][7][8][9][10][11][12]. ...
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Introduction: While European health policies do frequently take into consideration the ideas and experiences of their users, the voices of minority and marginalized communities are not often heard. European healthcare services must address this issue as the number of healthcare users with an MM background increases. Aim: To explore the perspectives of key stakeholders and healthcare users with an MM background on transcultural care in four European countries. Design: Qualitative phenomenological study. Methods: Semi-structured, individual interviews were conducted with stakeholders and MM users. Interviews were translated and transcribed verbatim and were carried out from February to May 2021. Descriptive statistics was used to describe the characteristics of the sample; qualitative data were analyzed thematically following Braun and Clarke's phases, resulting in 6 themes and 18 subthemes. Results: For stakeholders and MM users with long-established residence in their respective countries, cultural differences involve different family and community norms, religious beliefs, lifestyles, and habits. These components are perceived as in tension with healthcare norms and values, and they mediate in two key and related aspects of the relationship between MM users and healthcare providers: accessibility and communication. Conclusions: Communication and access to healthcare are key to MM health service users, and they are the most frequent sources of misunderstanding and conflict between them and healthcare professionals. Impact: It is important to extend the investigation of cultural issues in healthcare to stakeholders and MM users. There is no doubt that healthcare professionals should be trained in cultural competence; however, cultural competence training is not the only area for improvement. There should be a change in paradigm in healthcare services across Europe: from individual to organizational integration of culture and diversity.
... In another study, Tosun and Sinan (2020) similarly report that those who wanted to live abroad had higher intercultural awareness level and unprejudiced. The literature reports that students who go abroad through education programs have a better understanding of cultural differences (Allen et al., 2013;Ö zdemir, 2017;Türker, 2019). More than half of the students in this study received education about intercultural healthcare, and a majority of them were willing to participate in education programs about transcultural healthcare. ...
Article
Background Students who will become health professionals should be educated according to universal standards of providing foreign patients with culturally satisfying health care, free from discrimination. Aim This study aims to identify the relationship of intercultural effectiveness and awareness with xenophobia in undergraduate nursing students and vocational schools of health services students. Method This descriptive study was conducted with undergraduate nursing students (N = 257) and vocational schools of health services students (N = 341) in a region with a high refugee population in Turkey. Data were collected through the “Intercultural Awareness Scale,” the “Intercultural Effectiveness Scale,” and the “Xenophobia Scale.” Results Of all the participants, 70.1% were females, and the mean age was 20.70 ± 2.64 years; 57% of the students were from the vocational school students, and 43% from the undergraduate nursing program. Female students had significantly higher scores in intercultural effectiveness, behavioral flexibility, xenophobia (p = 0.036, p = 0.041, p = 0.001, respectively), interaction relaxation and interactant respect (p < 0.001, p < 0.001), while male students had significantly higher intercultural awareness (p < 0.001). The median intercultural effectiveness score of the students living in the rural area was low (p = 0.044), and the median xenophobia score of the students who lived abroad was significantly lower (p = 0.032). There was a negative correlation between the Intercultural Effectiveness Scale total and Intercultural Awareness and Xenophobia Scale total mean scores (r = –0.085, r = 0.182), and there was a weak, positive correlation between the Intercultural Awareness Scale total mean scores and the Xenophobia Scale mean scores (r = 0.113). Conclusion Intercultural sensitivity is considered to be improved by including course content in the curriculum to improve students' intercultural effectiveness and awareness levels and decrease their xenophobic prejudices.
... Of the eleven studies selected for this review, six used a quasiexperimental design (Amerson, 2010;Jeffreys and Dogan, 2012;Grossman et al., 2012;Allen et al., 2013;Noble et al., 2014;Halter et al., 2015), and four used a mixed-methods approach (Richards and Doorenbos (2016)). Wolfe Kohlbry (2016) In all selected studies, there was a marked risk of selection bias due to the lack of a randomized selection procedure before assignment to intervention groups. ...
... Richards and Doorenbos (2016) used "Benett's Developmental Model of Intercultural Sensitivity (DMIS)" as well as "Deardorff's Process Model of Intercultural Competence (PMIC)" guide their research. Two studies chose to combine a "Social Constructivist Model of Health" with the "Theory of Transcultural Nursing" (Allen et al., 2013) or used the "Interpretative Pedagogy Theory", which mentions the "Theory of Planned Behavior" (Muir-Cochrane, 2018). Noble et al. (2014) used "Campinha-Bacote's Model of Cultural Competence" in their quasi-experimental study. ...
... Halter et al. (2015) were similarly conservative in their teaching approaches and interventions, including lectures with participation, reflective papers, cultural competence readings and journal clubs. Allen et al. (2013) used class debates and case scenarios to raise students' cultural competence. Tutorials and lectures were combined with practicums in their labs. ...
Article
Aim This study aimed to synthesize the findings of studies evaluating educational programs providing curricular transcultural nursing education. Backgrounds Nursing care education about cultural diversity and experience with taking care of patients from different cultures and special populations are significant factors that could likely influence cultural competence. The effect of transcultural nursing education given to nursing students has been investigated by different researchers and different methods. Addressing the effects of transcultural nursing education on nursing students’ cultural awareness, knowledge and attitudes can contribute to future transcultural nursing education activities and the creation of training content. Design This study was a methodological systematic review study. Methods Methodological quality was assessed following the PRISMA guidelines. PubMed, Science Direct, APA PsycArticles, OVID, EBSCO, and Web of Science databases were searched from 2010 to 2020. The following keywords were used: “Transcultural nursing”, “education”, “curriculum”, “course”, “effectiveness”, “cultural competence”, “knowledge”, “skills”, “attitudes”, and “nursing students”. Studies published in peer-reviewed journals in English using both experimental and quasi-experimental designs were included. Results Total of 11 research papers, (n=1375) nursing students’ outputs were included in this review. Cultural competence interventions/programs were provided as part of the core theoretical courses or as elective courses. Different durations and types of teaching methods included debates, discussions, case scenarios, practicums, simulation, international learning projects, experiential learning, storytelling, and traditional teaching lectures. In ten studies, an increase in the level of culture-related competences was reported as statistically significant (p<0.05). Conclusions Limited studies have generally proven the effectiveness of transcultural nursing education provided to nursing students. Education content, training methods and training periods were not standard in the literature. More comprehensive, valid and reliable measurement tools are needed to evaluate the education provided for nursing students.
... For the academic to engage students in range of play-based learning experiences it is important to consider the scope of play sequenced through the EPR model, as well as associated strategies. Despite nursing academics accepting role-play as a useful tool to promote learning within simulations (Allen et al., 2013), embodiment and projective play are less common, however there is scope to develop these further. ...
... For example, role-play has been used to educate nursing students in an interactive way, trust games to build team relationships, and ice breaker activities, such as nurse bingo, to encourage a playful environment, are included in the top ten list of nursing games(Wilson, 2018). Role-play in nursing simulations is accepted and evidenced within the literature, particularly in simulation settings in higher education nursing programs(McAllister et al., 2013;Nilsson, 2010;Reid Searl et al., 2014;Tilbrook, Dwyer, Reid-Searl, & Parson, 2017a) Allen et al. (2013) modified an undergraduate nursing curriculum to include role-play and experiential learning to promote inclusive cross-cultural anti-discriminatory teaching approaches.McAllister et al. (2013) discuss the many creative, fun, imaginative ways simulations can be conducted using role-play approaches including puppet play. Reid utilises interpersonal theory to teach humanistic skills to students through masked education simulation, see for example, Reid-Searl (2014) on the following YouTube link (https://www.youtube.com/watch?v=Ii6RxDD9br8). ...
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The nursing academic, who is responsible for settingthe playful conditions, creates a safe and permissive learning environment,which in turn facilitates the student’s ability to engage in fun exploratorylearning activities. It is hypothesised that the use of a humanistic stancewith playful engagement such as, projective small world play, will facilitateoptimal teaching conditions in the higher education sector.
... It has been suggested that educational interventions on cultural competence improve health care students' cultural competence (Allen et al., 2013;Noble et al., 2014). A variety of educational methods have been used in the interventions, including assigned readings, lectures, documentaries, case-based discussions and international experiences (Kardong-Edgren and Campinha-Bacote, 2008;Kardong-Edgren et al., 2010;Oikarainen et al., 2019). ...
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The objective of this literature review was to identify the current evidence available on the learning of cultural competence among health care students using simulation pedagogy. An integrative literature review was conducted systematically. The CINAHL, PubMed and ERIC databases were searched for articles published between 2009 and 2019, resulting in including 17 articles in the review. The data were analyzed using descriptive synthesis. The participants of most of the studies were nursing students. The used simulation methods included low- and high-fidelity simulations, standardized patients, virtual and video-streamed simulations and role-play. The educational contents involved assessing advanced communication skills or focusing on patients' socioeconomic, cultural and environmental needs in care. The learning outcomes included knowledge of cultural competence, culturally competent communication skills, culturally competent nursing skills, self-awareness of cultural diversity and self-efficacy in diverse cultural situations. A variety of simulation methods has been used in the cultural competence education and produced several learning outcomes, including an improved understanding of cross-cultural communication and encouragement to discuss various culturally bound health issues. Further research is needed to find an effective combination of teaching methods using innovative ways to foster learning cultural competence.
... One project implemented at the University of Washington School of Nursing worked to change the climate of whiteness in academic nursing by providing faculty workshops and teaching not only didactic information about whiteness and IR, but also, how to counter against it in the process of educational delivery [43]. Allen and colleagues [75] made the connection between antidiscriminatory teaching and the teaching of crosscultural and culturally-competent care, and worked to promote an anti-discriminatory and cross-cultural curriculum at their Australian nursing program. Although Hassouneh [76] identified many challenges faced by EM faculty in implementing an anti-racist pedagogy in nursing, if developing and implementing an anti-racist pedagogy is the responsibility of nursing education leadership, this should take the pressure off of individual EM faculty. ...
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Background Unfortunately, racism and discrimination against Ethnic minority (EM) has been globalized, universally infecting industries worldwide, and the field of nursing has not been spared. In the United States (US), overt and institutionalized racism (IR) still permeates the fields of nursing, nursing leadership, and nursing education. Programs to address these disparities, and efforts by nursing professional societies and nursing education policymaking bodies to address racism in the nursing field, specifically with nursing leadership and education, have met with little success. Objective The purpose of this paper is to illustrate the existence and magnitude of racism and its impact on the fields of nursing, nursing leadership, and nursing education, and to make evidence-based recommendations for an agenda for reforming nursing education in the US. Methods A narrative literature review was conducted with a focus on pulling together the strongest evidence on which to base policy recommendations. Results Based on the available literature, we put forth five recommendations aimed at modifying nursing education in the US as a strategy to counter IR in the US in the nursing field. Conclusions Recommendations to address IR in nursing focus on nursing education, and involve implementing programs to address the lack of opportunity for both EM students and faculty in nursing, developing an anti-discriminatory pedagogy, and incorporating diversity initiatives as key performance indicators (KPIs) in the process of approval and accreditation of nursing programs.
... Quality cross-cultural care that explicitly targets structural barriers to health such as discrimination is necessary to achieve health equity. Therefore, cross-cultural and antidiscrimination care, in addition to care targeting the social determinants of health, are expected standards of the nursing profession, and thus should be expected components of undergraduate curricula [17][18][19][20][21][22][23]. ...
... These teaching strategies have also been described in the literature. For example, out of classroom cultural immersion experiences [39,40,59,60], case studies [61], liaison and participation of service users from a diverse cultural background [14], sociocultural activities [27], class debate and discussion [18] and photovoice [62]. Similarly, none of the lecturers were aware of, nor implemented, a specific model or teaching strategy for assisting student learning about caring for patients from different cultures. ...
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Cultural competence is an essential component in providing effective and culturally responsive healthcare services, reducing health inequalities, challenging racism in health care and improving patient safety, satisfaction and health outcomes. It is thus reasonable that undergraduate nursing students can develop cultural competency through education and training. The aim of this paper was to investigate nursing lecturers' perception and experience of teaching cultural competence in four undergraduate nursing programs. A phenomenological approach was selected to illicit nursing lecturers' perception of culture and experience of teaching cultural competence. Semi-struc-tured personal interviews were held with a sample of 24 lecturers from four European universities. The anonymized transcripts were analyzed qualitatively following Braun and Clark's phases for thematic analysis. Six themes and fifteen subthemes emerged from thematic analysis of the transcripts. Cultural competence was not explicitly integrated in the nursing curricula. Instead, the lecturers used mainly examples and case studies to illustrate the theory. The integration of cultural content in the modules was unplanned and not based on a specific model. Nursing programs should be examined to establish how cultural content is integrated in the curricula; clear guidelines and standards for a systematic integration of cultural content in the nursing curriculum should be developed .