Nursing Education and Cultural Knowledge, Understanding, Cultural Sensitivity, and Cultural Skills

What Is Cultural Knowledge In Nursing Education, Cultural Understanding, Cultural Sensitivity, and Cultural Skills In Nursing Education, Cultural Competence In Nursing Education.

What Is Cultural Knowledge In Nursing Education

    Cultural knowledge is the attainment of
factual information about different cultural groups. Having cultural knowledge
is important for faculty and students in the classroom and in clinical areas.
Faculty can plan assignments for students to assess their own cultural
knowledge. There are a variety of conceptual models and frameworks that faculty
can use to assist students in acquiring cultural knowledge.

   For example, Giger
and Davidhizar (2008) developed a transcultural assessment model that includes
five components: communication, time, space, health beliefs and practices, and
environment. Such a model can help students learn about themselves and other
individuals by using these components as a framework for assessment, as well as
for special assignments and points of reference in less formal conversations. 

    Additional models designed for nursing are Leininger’s (1993) Cultural Care
Theory; Purnell and Paulanka’s (2008) model for cultural competence; and
Campinha Bacote’s (1999) model, The Process for Cultural Competence and
Delivery of Healthcare Services, which incorporates cultural knowledge,
awareness, skill, desire, and encounters. 

    As knowledge is shared, and as
students seek to learn new knowledge about specific cultural groups, faculty
can ensure that students have knowledge of the concept of heterogeneity (e.g.,
variety, diversity, and differences in subgroups) as contrasted with the
concept of homogeneity (sameness). 

    Although there is a tendency to classify
individuals within an ethnic group as one group, the truth is that there are
“multiple culturally similar” but not culturally homogeneous ethnic subgroups”
(Aponte, 2009). An understanding of the differences must be manifested through
the manner in which questions are phrased. The underlying point is to not make
assumptions; in making cultural assessments faculty should ask open ended
questions rather than direct questions. 

Cultural Understanding, Cultural Sensitivity, and Cultural
Skills In Nursing Education

    Cultural understanding is the recognition that
there are multiple perspectives, multiple truths, multiple solutions, and
multiple ways of knowing. In other words, students develop insights and learn
that “one culture does not fit all.” To assess students’ cultural
understanding, faculty should plan activities that have the potential for
students to demonstrate an understanding of different cultures. 

    In addition to
clinical practice, students can actively engage in discussion groups, for
example, through case studies, vignettes, role playing, essay writing,
responses to questions, panel discussions, and games. 

    A student who has an
appropriate cultural understanding will recognize when values, beliefs, and
practices of individuals are not compromised. As with other attributes of
cultural competence, measurement for understanding can be sought through self assessment,
tests, feedback from essays and other written assignments, role playing, and
engagement in games. 

    Cultural sensitivity develops as faculty and students come
to appreciate, respect, and value cultural differences. Because cultural
sensitivity is not easily developed through classroom learning activities,
using clinical exchange experiences in a different part of the city or in
different areas within the United States is an effective strategy. 

    Here,
students have an opportunity to establish personal relationships with people
who are from socioeconomic classes or cultural groups that are not the same as
theirs. As a follow up to these experiences, faculty can provide leading
questions or points that will help students feel comfortable engaging in
conversations. 

    Cultural skill relates to effective performance, for example, in
communicating with others. Skill development in the area of communication can
be enhanced through the use of interviews and visual media, the latter of which
can be shown in segments and as time permits for discussion and evaluation of
the effectiveness and ineffectiveness of the communication or interview
techniques. 

    Faculty can provide feedback following role plays, small-group
exercises, discussions of case presentation, as well as permit students to self-assess.
Evidence of skill development will be exhibited when beliefs, values, and
practices are integrated into plans, when communication is effective, and when
appropriate assessments and interventions are made. Cultural competence is by
nature a skill evidenced through skill sets.

Cultural Competence In Nursing Education

    Because faculty are role models and
cultural agents, they must possess necessary knowledge, skills, and attitudes
to facilitate inclusive teaching and guide students to provide culturally
competent care. It is equally important for faculty and students to have an
awareness and understanding of their personal beliefs and how these may affect
teaching and learning and patient care. 

    Nunez (2000) describes cultural competence
as the capacity to function effectively as an individual and an organization
within the context of the cultural beliefs, behaviors, and needs presented by
consumers in their communities. 

    Purnell and Paulanka (2008) defined cultural
competence as developing an awareness of one’s own existence, thoughts, and
environments without letting it influence others from different backgrounds;
demonstrating awareness and understanding of the patient’s cultural background;
respecting and accepting cultural differences and similarities; and providing
congruent care by adapting it to the patient’s cultural health care beliefs,
values, and norms. 

    Campinha Bacote, Yahie, and Langenkamp (1996) defined
cultural competence as “a process, not an end point, in which the nurse
continuously strives to achieve the ability to effectively work within the
cultural context of an individual, family, or community from a diverse cultural
and ethnic background”. 

    This implies that one continuously strives
to achieve. Therefore it can be considered to be developmental as well as a
journey. In addition to these definitions, cultural competence has been
described as existing on a continuum. Each provides a beginning point for
faculty as they direct efforts to facilitate cultural competence understanding
among students. 

    Burchum (2002) identified eight attributes of cultural
competence: cultural awareness, cultural knowledge, cultural understanding,
cultural sensitivity, cultural interaction, cultural skill, cultural
competence, and cultural proficiency. Likewise, Lister (1999) identified seven
terms classified as a taxonomy: 

(1) cultural awareness

(2) cultural knowledge

(3) cultural understanding

(4) cultural sensitivity

(5) cultural interaction

(6) cultural skill

(7) cultural competence

    Wells (2000) proposed a model of
cultural competence that incorporates two phases: cognitive and affective. The
cognitive phase involves acquiring knowledge whereas the affective phase
relates to changes in attitudes and behaviors. 

    Both of these are considered to
be developmental. In viewing the concept on a continuum, there is progression
from lack of or limited knowledge to cultural knowledge and then awareness. 

    Characteristics of the affective phase are the development of cultural
sensitivity, cultural competence, and cultural proficiency. The components of
cultural competence are similar in each of these models. Preparing a culturally
competent graduate is a goal of all nursing programs. 

    To achieve this goal,
instruction and activities should be directed toward the meanings, development
of cultural confidence, attributes, assessment, instructional strategies,
resources, and evaluation.