Cultural competence of undergraduate student nurses: a multicenter study.

OBJECTIVE: to evaluate the level of cultural competence of an undergraduate nursing students' population from four European higher education institutions. METHOD: a total of 168 nursing students from four different countries were included in our study. The study methodology involved a cross-sectional assessment of cultural competence among undergraduate nursing students from four European universities. Data collection included sociodemographic variables, as well as the following validated tools: the Intercultural Sensitivity Scale, the Cultural Competence Assessment Tool (student version) and the Cultural Awareness Scale. RESULTS: our results indicated that students demonstrated a high level of intercultural sensitivity but a moderate level of cultural competence and cultural awareness. Variations existed among students from different countries, suggesting potential differences in educational approaches. Despite expectations that higher-level students would exhibit greater cultural competence, no significant differences were found by year of study, indicating a lack of effective integration of cultural competence into nursing curricula. CONCLUSION: nurse educators should consider the students' cultural competence before designing related study programmes. Training programmes related to cultural competence should include elements which have been associated with enhanced cultural competence, including language skills, cultural encounter, and opportunities for internationalisation.

Cultural competence of undergraduate student nurses: a multicenter study / Competencia cultural de estudiantes de pregrado en enfermería: estudio multicéntrico / Competência cultural de estudantes de graduação em enfermagem: um estudo multicêntrico

Objective: to evaluate the level of cultural competence of an undergraduate nursing students' population from four European higher education institutions. Method: a total of 168 nursing students from four different countries were included in our study. The study methodology involved a cross-sectional assessment of cultural competence among undergraduate nursing students from four European universities. Data collection included sociodemographic variables, as well as the following validated tools: the Intercultural Sensitivity Scale, the Cultural Competence Assessment Tool (student version) and the Cultural Awareness Scale. Results: our results indicated that students demonstrated a high level of intercultural sensitivity but a moderate level of cultural competence and cultural awareness. Variations existed among students from different countries, suggesting potential differences in educational approaches. Despite expectations that higher-level students would exhibit greater cultural competence, no significant differences were found by year of study, indicating a lack of effective integration of cultural competence into nursing curricula. Conclusion: nurse educators should consider the students' cultural competence before designing related study programmes. Training programmes related to cultural competence should include elements which have been associated with enhanced cultural competence, including language skills, cultural encounter, and opportunities for internationalisation.

Objetivo: evaluar el nivel de competencia cultural de una población de estudiantes de pregrado en enfermería de cuatro instituciones europeas de educación superior. Método: en nuestro estudio se incluyeron en total 168 estudiantes de enfermería de cuatro países diferentes. La metodología de estudio implicó una evaluación transversal de la competencia cultural de los estudiantes de pregrado en enfermería de cuatro universidades europeas. La recolección de datos incluyó variables sociodemográficas y las siguientes herramientas validadas: la Escala de Sensibilidad Intercultural, la Herramienta de Evaluación de la Competencia Cultural (versión para estudiantes) y la Escala de Conciencia Cultural. Resultados: los estudiantes demostraron un alto nivel de sensibilidad intercultural pero un nivel moderado de competencia y conciencia cultural. Hubo variaciones entre los estudiantes de diferentes países, lo que sugiere posibles diferencias en los enfoques educativos. A pesar de que se esperaba que los estudiantes de educación superior tuvieran mayor competencia cultural, no se encontraron diferencias significativas por año de estudio, lo que indica que la competencia cultural no se incluye de forma efectiva en los planes de estudio de las carreras de pregrado en enfermería. Conclusión: los educadores de enfermería deben considerar la competencia cultural de los estudiantes antes de diseñar programas de estudio relacionados con la misma. Los programas de formación relacionados con la competencia cultural deben incluir elementos que se hayan asociado con una mayor competencia cultural, eso incluye habilidades lingüísticas, encuentros culturales y oportunidades de internacionalización.

Objetivo: avaliar o nível de competência cultural de uma população de estudantes de graduação em enfermagem de quatro instituições europeias de ensino superior. Método: um total de 168 estudantes de enfermagem de quatro países diferentes foram incluídos em nosso estudo. A metodologia do estudo envolveu uma avaliação transversal da competência cultural entre estudantes de graduação em enfermagem de quatro universidades europeias. A coleta de dados incluiu variáveis sociodemográficas, bem como as seguintes ferramentas validadas: Escala de Sensibilidade Intercultural, Ferramenta de Avaliação de Competência Cultural (versão do aluno) e Escala de Consciência Cultural. Resultados: nossos resultados indicaram que os alunos demonstraram um alto nível de sensibilidade intercultural, mas um nível moderado de competência e consciência cultural. Houve variações entre os alunos de diferentes países, o que sugere possíveis diferenças nas abordagens educacionais. Apesar das expectativas de que os alunos de nível superior apresentariam maior competência cultural, não foram encontradas diferenças significativas por ano de estudo, indicando uma falta de integração eficaz da competência cultural nos currículos de enfermagem. Conclusão: os educadores de enfermagem devem considerar a competência cultural dos alunos antes de elaborar programas de estudo relacionados. Os programas de treinamento relacionados à competência cultural devem incluir elementos que tenham sido associados a uma maior competência cultural, incluindo habilidades linguísticas, encontros culturais e oportunidades de internacionalização.

Migrant and ethnic minority nurses' experience of working in European health services: a qualitative study.

OBJECTIVE: To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. METHOD: A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark's stages after qualitative data had been verbatim transcribed, translated into English, and analyzed. RESULTS: Four themes and 4 subthemes emerged from thematic analysis of the transcripts. CONCLUSION: Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them.

Qualified Nurses' Perceptions of Cultural Competence and Experiences of Caring for Culturally Diverse Patients: A Qualitative Study in Four European Countries.

BACKGROUND: European nurses are expected to provide appropriate care for patients from diverse cultural backgrounds. However, there is limited knowledge and understanding of this process. The aim of this study was to analyse the perceptions of culture and experiences of caring for patients from diverse cultural backgrounds of a purposive sample of qualified nurses from four European countries, namely Belgium, Portugal, Spain and Turkey. METHODS: A qualitative phenomenological approach was selected in order to understand complex phenomena through the participants' lived experiences, meanings and perspectives. Individual interviews and focus groups took place with 28 staff nurses and 11 nurse managers from four European countries. The sociodemographic and cultural characteristics of the sample were described and analysed using descriptive statistics. Qualitative data were transcribed verbatim, translated into English and analysed following Braun and Clark's phases for thematic analysis. RESULTS: Five themes and twelve subthemes emerged from thematic analysis of the transcripts. The themes included: (1) relevance of culture for nursing; (2) culture in the healthcare service; (3) qualities of the healthcare professionals; (4) challenges to culturally competent care; (5) becoming a culturally competent nurse. CONCLUSIONS: There are challenges to the delivery of culturally congruent care, namely language and communication difficulties, prejudices and stereotyping in the health service, a tendency for ethnocentrism, a lack of education and training in cultural competence and a lack of support from the health service to facilitate new ways of acting.

Migrant and ethnic minority nurses' experience of working in European health services: a qualitative study / Experiência de enfermeiros migrantes e de minorias étnicas em trabalho em serviços de saúde europeus: estudo qualitativo / Experiencia de trabajo de enfermeras inmigrantes y de minorías étnicas en los servicios de salud europeos: un estudio cualitativo

ABSTRACT Objective: To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. Method: A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark's stages after qualitative data had been verbatim transcribed, translated into English, and analyzed Results: Four themes and 4 subthemes emerged from thematic analysis of the transcripts. Conclusion: Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them.

RESUMO Objetivo: Analisar a percepção da cultura e experiência de trabalho em serviços de saúde europeus de uma amostra intencional de enfermeiros qualificados migrantes e de minorias étnicas que moram atualmente na Bélgica, Portugal, Espanha e Turquia. Método: Optou-se pelo método fenomenológico qualitativo. Realizaram-se entrevistas individuais com 8 enfermeiros qualificados migrantes e de minorias étnicas que moram atualmente em quatro países europeus. A análise temática foi realizada por meio das etapas de Braun e Clark após os dados qualitativos terem sido transcritos na íntegra, traduzidos para o inglês e analisados. Resultados: Quatro temas e 4 subtemas emergiram da análise temática das transcrições. Conclusão: Enfermeiros migrantes e de minorias étnicas que trabalham na União Europeia vivenciam e testemunham discriminação e preconceito de pacientes e colegas devido a diferenças culturais. Os serviços de saúde europeus devem acompanhar de perto e combater a discriminação e o preconceito contra os trabalhadores e pacientes migrantes e de minorias étnicas, e tomar iniciativas para os reduzir e, em seguida, erradicá-los.

RESUMEN Objetivo: Analizar la percepción de la cultura y la experiencia de trabajar en los servicios de salud europeos de una muestra intencional de enfermeros calificados de minorías étnicas y migrantes que actualmente viven en Bélgica, Portugal, España y Turquía. Método: Se decidió utilizar un método cualitativo fenomenológico. Se realizaron entrevistas individuales con 8 enfermeros calificados inmigrantes y de minorías étnicas que actualmente viven en cuatro países europeos. El análisis temático se realizó utilizando las etapas de Braun y Clark después de que los datos cualitativos fueran transcritos palabra por palabra, traducidos al inglés y analizados. Resultados: Del análisis temático de las transcripciones surgieron 4 temas y 4 subtemas. Conclusión: Los enfermeros de minorías étnicas y migrantes que trabajan en la Unión Europea experimentan y son testigos de la discriminación y de los prejuicios de los pacientes y colegas sobre la base de la diferencia cultural. Los servicios de salud europeos deben monitorear de cerca y abordar la discriminación y los prejuicios hacia el personal y los pacientes de minorías étnicas y migrantes, y tomar iniciativas para reducirlos y, eventualmente, erradicarlos.

Nursing students' experience of learning cultural competence.

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.

Nursing Lecturers' Perception and Experience of Teaching Cultural Competence: A European Qualitative Study.

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-structured 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.

Measuring invisible nursing interventions: Development and validation of Perception of Invisible Nursing Care-Hospitalisation questionnaire (PINC-H) in cancer patients.

Visible nursing work is usually associated with formal work and physician-delegated tasks which are protocolised and usually well documented. Nevertheless, nurses carry out many actions and display specific attitudes and behaviours which, despite contributing to the well-being, recovery of patients and satisfaction with the attention received, are not as visible. Previous studies have been conducted in order to define 'invisible nursing interventions', but no quantitative instruments focused on measuring invisible nursing interventions have been found in the literature. PURPOSE: To test the psychometric properties of the Perception of Invisible Nursing Care-Hospitalisation (PINC-H) questionnaire. METHODS: Cross-sectional survey design. A self-administered questionnaire was completed by 381 participants recruited consecutively after discharge from a Spanish hospital. Data were collected from 2012 to 2020. RESULTS: Three factors were identified from exploratory factor analysis, namely 'Caring for the person', 'Caring for the environment and the family' and 'Caring presence'. Criterion Validity Coefficient was highly significant (p < 0.001) with values ranging between 0.63 and 0.71. Cronbach's alpha was 0.96. Test-retest reliability was estimated in a subsample of 187 participants; in all the items, correlation coefficients were highly significant (p < 0.001) and within range (0.532-0.811) with a mean value of 0.680. Also, correlations between each dimension and the complete questionnaire indicated good temporal stability between measurements. CONCLUSIONS: The instrument had satisfactory validity and reliability. PINC-H can contribute to highlight nursing interventions and behaviours which are often unseen and, thus, less valued. We argue that PINC-H will also be useful to evaluate the quality of invisible nursing care to oncology inpatients.

Association between adherence to the Mediterranean diet and the prevalence of cardiovascular risk factors.

OBJECTIVE: to determine the prevalence of cardiovascular risk factors in a cohort of workers and to quantify its association with compliance with the Mediterranean diet follow-up. METHOD: a cross-sectional descriptive study was carried out on a cohort of 23,729 workers. Clinical data from annual medical examinations and the Mediterranean Diet Adherence Screener were used to assess adherence to the Mediterranean diet. RESULTS: 51.3% of the participants showed good adherence to the Mediterranean diet. The multivariate analysis showed an inverse and significant association between the follow-up of the Mediterranean diet and the prevalence of abdominal obesity (Odds Ratio = 0.64, 95% CI 0.56; 0.73), dyslipidemia (Odds Ratio = 0.55, 95% CI 0.42; 0.73), and metabolic syndrome (Odds Ratio = 0.76, 95% CI 0.67; 0.86). CONCLUSIONS: our results suggest that the Mediterranean diet is potentially effective in promoting cardiovascular health. Implementing the interventions promoting the Mediterranean diet in the working population seems justified.

The Teaching and Learning Cultural Competence in a Multicultural Environment (CCMEn) Model.

BACKGROUND: Within the European higher education context, students and lecturers are encouraged to engage in teaching and learning activities abroad. This frequently involves using a second language and being exposed to students and lecturers from culturally different backgrounds. OBJECTIVE: To design a model for teaching and learning cultural competence in a multicultural environment (CCMEn). DESIGN: Theory development from empirical experience, research, and scholarly works. METHOD: This model was developed based on our experience of teaching and learning cultural competence in a multicultural environment in a nursing education context; it rests on three pillars, namely, Coyle's Content and Language Integrated Learning educational approach, the concept of social and emotional learning, as defined by the Collaborative for Academic, Social and Emotional Learning, and the existing literature surrounding teaching and learning cultural competence in higher education. RESULTS: The CCMEn model is intended to guide the process of teaching and learning cultural competence in a multicultural environment through the use of a second language and has been adapted from existing educational approaches and theory. CONCLUSION: Teaching and learning in multilingual and multicultural contexts in Europe is becoming more common. Students who learn alongside students and teachers from different cultural backgrounds need to be supported from an academic, linguistic and socioemotional perspective. We believe that the CCMEn model can serve as a guide to enhancing student learning in this context.

Association between adherence to the Mediterranean diet and the prevalence of cardiovascular risk factors / Associação entre adesão à dieta mediterrânea e prevalência de fatores de risco cardiovascular / Asociación entre la adherencia a la dieta mediterránea y la prevalencia de factores de riesgo cardiovascular

Objective: to determine the prevalence of cardiovascular risk factors in a cohort of workers and to quantify its association with compliance with the Mediterranean diet follow-up. Method: a cross-sectional descriptive study was carried out on a cohort of 23,729 workers. Clinical data from annual medical examinations and the Mediterranean Diet Adherence Screener were used to assess adherence to the Mediterranean diet. Results: 51.3% of the participants showed good adherence to the Mediterranean diet. The multivariate analysis showed an inverse and significant association between the follow-up of the Mediterranean diet and the prevalence of abdominal obesity (Odds Ratio = 0.64, 95% CI 0.56; 0.73), dyslipidemia (Odds Ratio = 0.55, 95% CI 0.42; 0.73), and metabolic syndrome (Odds Ratio = 0.76, 95% CI 0.67; 0.86). Conclusions: our results suggest that the Mediterranean diet is potentially effective in promoting cardiovascular health. Implementing the interventions promoting the Mediterranean diet in the working population seems justified.

Objetivo: determinar a prevalência de fatores de risco cardiovascular em uma coorte de trabalhadores e quantificar sua associação com o monitoramento da dieta mediterrânea. Método: estudo descritivo transversal, realizado em uma coorte de 23.729 trabalhadores. Dados clínicos dos exames médicos anuais e a Mediterranean Diet Adherence Screener foram usados para avaliar a adesão à dieta mediterrânea. Resultados: 51,3% dos participantes apresentaram boa adesão à dieta mediterrânea. A análise multivariada mostrou associação inversa e significativa entre o acompanhamento da dieta mediterrânea e a prevalência de obesidade abdominal (Odds Ratio = 0,64, IC 95% 0,56, 0,73), dislipidemia (Odds Ratio = 0,55, IC 95% 0,42, 0,73) e de síndrome metabólica (Odds Ratio = 0,76, IC 95% 0,67, 0,86). Conclusões: nossos resultados sugerem que a dieta mediterrânea é potencialmente eficaz na promoção da saúde cardiovascular. A implementação de intervenções que promovem a dieta mediterrânea na população trabalhadora parece justificada.

Objetivo: determinar la prevalencia de factores de riesgo cardiovascular en una cohorte de trabajadores y cuantificar su asociación con el seguimiento de la dieta mediterránea. Método: se llevó a cabo un estudio descriptivo transversal sobre una cohorte de 23.729 trabajadores. Se utilizaron los datos clínicos procedentes de los exámenes médicos anuales y el Mediterranean Diet Adherence Screener para evaluar la adherencia a la dieta mediterránea. Resultados: el 51,3% de los participantes presentó una buena adherencia a la dieta mediterránea. El análisis multivariante evidenció una asociación inversa y significativa entre el seguimiento de la dieta mediterránea y la prevalencia de obesidad abdominal (Odds Ratio = 0,64, IC 95% 0,56; 0,73), dislipidemia (Odds Ratio = 0,55, IC 95% 0,42; 0,73) y de síndrome metabólico (Odds Ratio = 0,76, IC 95% 0,67; 0,86). Conclusión: nuestros resultados sugieren que la dieta mediterránea es potencialmente eficaz en la promoción de la salud cardiovascular. Parece justificada la implementación de intervenciones que promuevan la dieta mediterránea en la población trabajadora.