Transcultural nursing clinical education: A systematic review of the literature since 2005 with recommendations for international immersion clinical courses.

摘要

This systematic review sought evidence for the effectiveness of cultural competence pedagogy approaches in professional nursing education. The objective was to rank the findings from literature published since 2005, evaluating the effectiveness of educational strategies for cultural competence of undergraduate baccalaureate nursing students. The research question was posed in the PICO format: Population/Intervention/Comparison/Outcomes): Among undergraduate baccalaureate nursing students (population), are international immersion clinical experiences of greater than two weeks (intervention), compared to current cultural competency education approaches (comparison) more effective in fostering acquisition of cultural competency (outcomes)? The measure of student acquisition of cultural competence consisted of three characteristics identified by Cavillo et al., 2009: 1) increased self-awareness of their own values, attitudes, beliefs and behavior that compose their culture, 2) increased skill in assessment and communication with persons from other cultures, and 3) ability to provide an assessment of transcultural differences (outcomes). The systematic search resulted in a sample of 37 published sources, including systematic reviews, descriptive studies, case study design, and expert opinion articles. Using predetermined criteria from SIGN (2010), I evaluated the strength of the evidence as excellent (A), good (B), fair (C), or poor (D). Findings demonstrated that international immersions provided optimal experiences to develop cultural competence alone, but more effective when combined with other strategies. The findings of this analysis of the published literature suggest there is some evidence supporting the effectiveness of international immersion experiences in increasing student self-awareness, cross-cultural communication and assessment skills, and ability to assess cultural differences. Outcomes of international experiences and cultural encounters were cognitive, affective, and adaptive growth. These outcomes included growth in self awareness; recognition of ethnocentrism; and negotiating and living as a minority person. The evaluation measures described in the literature were consistently student self perception rather than observed development of the student's cultural competence. Recommendations for increasing cultural competency nursing include strategies that are cumulative across the curriculum, such as theories and models, clinical applications in assignments, care plans, simulation and post conferences, and systems level assignments. Recommendations for further research included evaluating both student self-perception and patients' perceptions of cultural competency in nursing care.