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.

Cuidados enfermeros para el abordaje de la salud comunitaria en población indígena de la Amazonia peruana / Nursing care to address community health of the indigenous population in the Peruvian Amazon

La comunidad nativa Shonori la componen familias asháninkas de la Amazonia peruana. Este trabajo aborda la salud comunitaria mediante una valoración y plan de cuidados de enfermería basado en el modelo de competencia cultural de Purnell y la taxonomía estandarizada enfermera (NANDA, NIC, NOC). La valoración se sustenta en 12 dominios relacionados con la herencia y ecología biocultural, comunicación, roles y organización familiar, conductas de riesgo, nutrición, embarazo, rituales de muerte y espiritualidad y prácticas y proveedores de cuidados de salud. Se detecta como diagnóstico una «salud deficiente de la comunidad relacionada con recursos insuficientes y manifestada por problemas de salud padecidos por la comunidad». Los criterios de resultados esperados en el plan de cuidados son: competencia social, estado de salud de la comunidad y control del riesgo social relacionado con las enfermedades transmisibles. Las intervenciones consisten en fomentar la salud comunitaria, analizar e identificar la situación de salud y riesgos, y controlar y proteger de enfermedades transmisibles y de riesgos ambientales. Intervenciones de la red pública de abastecimiento de agua y subvenciones para el apoyo agrícola y a las viviendas permitieron disminuir vectores, sufragar gastos del abastecimiento de agua segura y comprar alimentos para mejorar la nutrición infantil. El uso de la medicina tradicional fue potenciado y se desarrollaron campañas de salud y educación sexual en coordinación con el sistema oficial de salud. Se hizo un seguimiento durante 40 días, que corroboró la mejora de la salud comunitaria y la necesidad de un abordaje grupal con todos los actores

The native community Shonori is made up of Ashaninka families of the Peruvian Amazon. This paper addresses community health through an assessment and nursing care plan based on the Purnell cultural competency model and the standardized nurse taxonomy (NANDA, NIC, NOC). The assessment is based on 12 domains related to inheritance and biocultural ecology, communication, roles and family organization, risk behaviours, nutrition, pregnancy, death and spirituality rituals, and health care providers and practices. A diagnosis of «Poor health of the community r /t insufficient resources m/b health problems suffered by the community» is detected. The expected results criteria in the care plan are: social competence, community health status and control of social risk related to communicable diseases. The interventions consist of promoting community health, analyzing and identifying the health situation and risks, and controlling and protecting from communicable diseases and environmental risks. Interventions of the public water supply network and subsidies for agricultural and housing support, allowed vectors to be reduced, costs of safe water supply to be covered, and food to be bought to improve child nutrition. The use of traditional medicine was enhanced and health and sexual education campaigns were carried out in coordination with the official health system. A follow-up was carried out for 40 days, corroborating the improvement of community health, and the need for a group approach with all actors

Two-Spirit Identity and Indigenous Conceptualization of Gender and Sexuality: Implications for Nursing Practice.

The word Two-Spirit is an umbrella term that is used to describe Indigenous peoples who are diverse in terms of their sexual orientation and gender identity, though community-specific definitions and roles for gender and sexual orientation are more extensive and varied. While the terminology of Two-Spirit is recent in its development, Indigenous conceptualizations of diverse gender identities, roles, and sexual orientations have existed since time immemorial and provide important insights into how cultural safety can be incorporated into caring practices. The purpose of this article is to introduce readers to the term Two-Spirit and to provide a broad overview of Indigenous conceptualizations of gender, sexuality, and spirit, to address implications for the nursing profession, and to outline potential applications of this knowledge in practice.

[Community health and interculturality]. / Santé communautaire et interculturalité.

An interventional research study in public health was carried out with populations originating from sub-Saharan Africa living in France. With the aim of acting on health inequalities through health education, the researchers focused notably on the links between intercultural relationships and the improvement of health promotion actions.

El factor migratorio como determinante de salud: una intervención transcultural desde la Enfermería del Trabajo / The migratory factor as a determinant of health: A transcultural occupational health nursing intervention

Se presenta un caso clínico de Enfermería del Trabajo en el que la trabajadora manifiesta una sintomatología derivada del estrés generado por el cambio de residencia, además del conjunto de los factores relacionados con este hecho provocados por motivos laborales. Dada la adecuación de la teoría de la diversidad y de la universalidad de los cuidados de Leininger respecto al caso, la valoración de enfermería se realiza siguiendo su modelo del sol naciente (modelo Sunrise). Tras la valoración, se determina que los factores asociados al hecho migratorio son el desencadenante de los síntomas referidos, y se elabora un plan de cuidados con seguimiento por contacto telefónico mensual y nueva evaluación a los 3meses. El abordaje desde una perspectiva holística contenedora de elementos sociales y culturales junto a la utilización de un lenguaje estandarizado enfermero resultan ser de gran importancia en casos como el presentado (AU)

We present a clinical case in occupational health nursing where the worker was showing symptoms of stress caused by a change of residence and related factors at work. A nursing assessment was made following Leininger's theory of Care Diversity and Universality and Sunrise Model, considered suitable for the case. After the assessment, it was determined that the factors associated with the migratory event triggered the reported symptoms, and a care plan was drawn up with monthly telephone contact follow-up and reassessment at 3months. A holistic approach containing social and cultural elements, together with the use of standardised nurse language are very useful in cases such as the one presented (AU)

La aplicación del modelo de competencia cultural en la experiencia del cuidado en profesionales de Enfermería de Atención Primaria / Application of the cultural competence model in the experience of care in nursing professionals Primary Care

Objetivo: Conocer las experiencias y percepciones de los profesionales de enfermería en la prestación de cuidados y promoción de la salud, a mujeres pertenecientes a colectivos en riesgo de vulnerabilidad social, aplicando el modelo de competencia cultural de Purnell. Diseño: Estudio cualitativo fenomenológico. Emplazamiento: Departamento de Salud de Elda. Participantes: Veintidós profesionales voluntarios de Atención Primaria. Método: Entrevistas semiestructuradas y grupos focales con grabación y análisis de contenido, de acuerdo con la teoría del modelo de competencia cultural. Resultados: Los factores socioculturales influyen en la relación entre profesionales y usuarias del sistema. El racismo sutil y los prejuicios históricos crean situaciones incómodas y de desconfianza. La barrera idiomática dificulta no solo la comunicación, sino también el seguimiento y control del proceso salud-enfermedad. El aspecto físico y los estereotipos son condicionantes para los profesionales de Atención Primaria. Aunque se percibe que se hace un mal uso de los servicios sanitarios, se escuchan discursos con signo de cambios. Los aspectos espirituales relacionados con las creencias religiosas solo se tienen en cuenta en el caso de mujeres musulmanas, no siendo considerados como algo importante en el caso de mujeres gitanas o rumanas. Conclusiones: Para ofrecer cuidados de calidad, culturalmente congruentes y competentes, es preciso desarrollar programas de formación en competencia cultural para profesionales, con el fin de dar a conocer la cultura del otro, y trabajar sin ideas preconcebidas y etnocentristas; ya que cuanto mayor es el conocimiento del grupo cultural al que se atiende, mejor es la calidad de los cuidados prestados (AU)

Objective: To know the experiences and perceptions of nurses in providing care and health promotion, women belonging to groups at risk of social vulnerability, applying the model of cultural competence Purnell. Design: Phenomenological qualitative study. Location: Department of Health Elda. Participants: A total of 22 primary care professional volunteers. Method: Semi-structured interviews and focus groups with recording and content analysis, according to the theory model of cultural competence. Results: Socio-cultural factors influence the relationship between professionals and users of the system. The subtle racism and historical prejudices create uncomfortable situations and mistrust. The language barrier makes it difficult not only communication, but also the monitoring and control of the health-disease process. The physical appearance and stereotypes are determining factors for primary care professionals. Although perceived misuse of health services are also talking about changes. The spiritual aspects of religious beliefs alone are taken into account in the case of Muslim women, not being considered as important in the case of Gypsy women and Romanian women. Conclusions: To provide quality care, consistent and culturally competent, it is necessary to develop training programs for professionals in cultural competence, to know the culture of other, and work without preconceived ideas, and ethnocentric; since the greater the knowledge of the cultural group being served, the better the quality of care provided (AU)

O movimento de mulheres piauienses para obter sua formação profissional como enfermeiras 1959-1973 / El movimiento de las mujeres de Piauí em aras de su formación como enfermeras 1959-1973 / The movement of Piaui women for their professional education as nurses 1959-1973

O estudo objetivou descrever a luta de mulheres piauienses por sua formação como enfermeiras em outros estados do Brasil. Tratase de uma pesquisa histórico- social produzida a partir de fontes orais e secundárias. Os dados foram analisados à luz dos conceitos de espaço social, campo, capital, poder simbólico, luta e violência simbólica de Pierre Bourdieu. Os resultados apontam as lutas simbólicas no processo de formação profissional dessas piauienses, em sua maioria, em universidades na região nordeste. Ao realizarem o curso de enfermagem fora do Estado, essas jovens tiveram um conjunto de conhecimentos incorporados, que aliados à diversidade de culturas favoreceram o ganho de capital científico e cultural. Conclui-se que as lutas desenvolvidas por essas mulheres resultaram em ganhos simbólicos e sociais, além da incorporação do habitus profissional. O estudo contribuirá para a história da enfermagem, na construção de novos registros, além de abrir portas para a realização de novas pesquisas sobre a temática (AU)

El estudio tuvo como objetivo describir la lucha de las mujeres Piauí para su formación como enfermeras en otros estados de Brasil. Se trata de una investigación histórico-social producida a partir de fuentes orales y secundarias. Los datos se analizaron de acuerdo a los conceptos de espacio social, campo, el capital, el poder simbólico, la lucha y la violencia simbólica de Pierre Bourdieu. Los resultados muestran las luchas simbólicas en el proceso de formación de éstos mujeres piauienses, en su mayoría en las universidades en el noreste. En la realización del programa de enfermería fuera del estado, estos jóvenes tenían un conjunto de conocimientos incorporados, lo que combinado con la diversidad de culturas favoreció el capital científico y cultural de ganancia. En conclusión, las luchas que estas mujeres resultaron en ganancias simbólicas y sociales así como la incorporación de habitus profesional. El estudio contribuirá a la historia de la enfermería en la construcción de nuevos registros, y abrir las puertas a nuevas investigaciones sobre el tema (AU)

The study aimed to describe the struggle of Piauí women for their training as nurses in other Brazilian states. It is a social-historical research produced from oral and secondary sources. Data were analyzed according to the concepts of social space, field, capital, symbolic power, struggle and symbolic violence of Pierre Bourdieu. The results show the symbolic struggles in the training process of these women do Piauí, mostly at universities in the Northeast. When conducting the nursing course outside the state, these young people had a set of embedded knowledge, which combined with the diversity of cultures promoted the gain scientific and cultural capital. In conclusion, the fights undertaken by these women resulted in symbolic and social gains as well the incorporation of professional habitus. The study will contribute to the history of nursing in the construction of new records, and open doors to new research on the subject (AU)

El cuidado espiritual: una propuesta con base en las prácticas tradicionales de una comunidad indígena Nahua / Cuidado espirituais: proposta com base nas práticas tradicionais de uma comunidade Nahua / Spiritual Care: a traditional practices based proposal from nahua Indian Community

El presente artículo se genera a partir de los resultados de la investigación "Prácticas de cuidado tradicional y espiritual en una comunidad indígena nahua" (García, 2015; García Piña, Cardoso Gómez, Serrano Sánchez & Ostiguín Meléndez, 2015), donde se identificaron elementos de carácter espiritual como recurso para el afrontamiento del proceso salud-enfermedad y muerte. Dichos resultados se complementaron con un análisis documental. Objetivo: Reivindicar las estrategias de cuidado en el contexto social, cultural e histórico, de la comunidad estudiada, con la finalidad contribuir a mejorar la práctica del cuidado de enfermería en el contexto mexicano. Método: Análisis documental teórico-inductivo. Resultados: Las comunidades se van construyendo a partir de objetivos y fines comunes, y son éstas mismas quienes generan respuestas a los procesos de salud-enfermedad y muerte desde su perspectiva particular. Conclusiones: La enfermería tiene como función primordial rescatar las respuestas que las personas generan individual y colectivamente, para afrontar situaciones de la vida; y permitir que el cuidado sea un ejercicio de retroalimentación mutua (AU)

This paper outlines the findings from research named "Traditional and spiritual care practices in a Nahua, indigenous community" (García, 2015; García Piña, Cardoso Gómez, Serrano Sánchez & Ostiguín Meléndez, 2015), in which spirituality elements were identified as coping strategies for the health-diseasedeath processes. Those results were complemented with a documental review. Objective: to claim on the caring strategies, on a specific social, cultural and historical context, that promotes the improvement of the nursing practice in the Mexican context. Method: theoretical-inductive documentary analysis. Results: communities are built from common goals and objectives, which arise as health-disease-death processes in its own particular perspective. Conclusion: nursing has as one of its main functions, to rescue people's individual and collective response, for coping with every life situation; allowing that care itself, becomes a mutual feedback exercise (AU)

Este artigo tem sua origem no projeto de pesquisa intitulado "Práticas de cuidado espiritual e tradicional em uma comunidade indígena Nahua" (García, 2015; García Piña, Cardoso Gómez, Serrano Sánchez & Ostiguín Meléndez, 2015), no qual elementos de espiritualidade foram identificados como cópias de estratégias para o processo saúde-enfermidade-morte. Os resultados foram complementados com uma revisão documental. Objetivo: reivindicar as estratégias assistenciais, em um contexto social, cultural e histórico específico, que promova a melhoria da prática de enfermagem no contexto mexicano. Método: análise documental teórico-indutiva. Resultados: as comunidades são construí- das a partir de metas e objetivos comuns, que surgem como processos saúde-enfermidade- -morte em sua própria perspectiva particular. Conclusão: a enfermagem tem como uma de suas principais funções, resgatar a resposta individuais e coletivas das pessoas, com o objetivo de lidar com cada situação de vida; Permitindo, desse modo, que o cuidado torne-se uma mútua atividade de feedback (AU)

Las enfermeras ante el cuidado de base cultural. Actividad investigadora en iberoamérica / Nurses facing cultural care: research activity in Latin América

Objetivo. Analizar la actividad investigadora llevada a cabo por enfermeras iberoamericanas sobre los cuidados en salud de base cultural. Metodología. Revisión bibliográfica en la que fueron analizados 27 artículos originales: 14 en español y 13 en portugués, entre los años 1996-2014. Límites de búsqueda: medicina tradicional, cuidados culturales, en las bases de datos CUIDEN y SciELO como hemeroteca virtual. Resultados principales. El tipo de terapia predominante se enmarca dentro del plano natural. Los problemas de salud que se tratan con este tipo de terapias están relacionados principalmente con la mujer y el recién nacido. Asimismo, el rol de la mujer es fundamental como promotora, transmisora y protagonista del mantenimiento de las tradiciones. Conclusión. Es imprescindible que el personal sanitario, principalmente las enfermeras, se involucren en el cuidado cultural del ser humano, aceptando y respaldando estos saberes, no solo por el riesgo que algunos remedios suponen para la salud en caso de su mal uso, sino para poder así prestar unos cuidados congruentes y romper con la barrera cultural, a fin de favorecer la comunicación con el paciente (AU)

Objective. To analyze research activities carried out by Latin American nurses on cultural based healthcare. Methodology. Literature review based on the analysis of 27 original articles, 14 in Spanish and 13 in Portuguese, published between 1996-2014. Search limits: traditional medicine and cultural care in CUIDEN database and SciELO virtual library. Results. The predominant type of therapy discussed falls within the natural plane. Health problems treated are primarily related to women and newborns. Likewise, women’s role is crucial in maintaining tradition, promoting, transmitting and being its undisputable protagonists. Conclusion. It is essential that health professionals, especially nurses, get involved in the cultural care of patients, accepting and supporting this kind of knowledge, not only because of the risks that its misuse may pose, but also to provide consistent care, breaking through cultural barriers and favoring communication with patients (AU)

Validación facial de la escala Nursing Activities Score en tres unidades de cuidado intensivo en Bogotá, Colombia / Facial validation of Nursing Activities Score in three intensive care units in Bogota, Colombia

Introducción: La medición de cargas de trabajo en enfermería es fundamental para objetivizar la relación enfermera-paciente. Se asume que a mayor complejidad de los pacientes, es mayor el tiempo de dedicación de una enfermera a la provisión de cuidados directos Método: Se usará la adaptación transcultural de la escala Nursing Activities Score (NAS) al español, compuesta por 23 ítems que miden tareas clínicas y administrativas de enfermeras en UCI. Se someterá el instrumento a un juicio de expertos usando el método delphi de dos rondas para corroborar la validez de contenido del instrumento. Se aplicará la razón de validez de contenido (RVC) y el índice de validez de contenido (IVC) para establecer la utilidad de cada uno de los ítems. Posteriormente, se aplicará el instrumento a una muestra de profesionales de enfermería de tres unidades de cuidado intensivo polivalentes, aplicando los mismos estadísticos de prueba. Resultados: Se obtuvieron datos de RVC significativos para la mayoría de los ítems, tanto en la ronda de expertos como en el muestreo con profesionales. Aunque hay algunos ítems que no obtuvieron el puntaje mínimo para que se consideren válidos, el índice global IVC en la muestra de expertos y profesionales se considera satisfactorio, por lo que se considera que la escala puede ser válida con modificaciones (AU)

Introduction: The measurement of workloads in nursing is essential to objectify the nurse-patient relationship. It is assumed that the greater complexity of patients, the greater the time commitment of a nurse providing direct care. Method: Cross-cultural adaptation of the scale Nursing Activities Score (NAS) to Spanish, includes 23 items that measure clinical and administrative tasks of nurses in ICU use. The instrument to an expert opinion be submitted using the Delphi method two rounds to corroborate the content validity of the instrument. The ratio of content validity (RVC) and content validity index (CVI) to establish the usefulness of each item will apply. The ratio of content validity (RVC) and content validity index (CVI) to establish the usefulness of each item will apply. Subsequently, the device should be applied to a sample of nursing professionals three polyvalent intensive care units, applying the same statistical test. Results: significant RVC data were obtained for most items, in the round of experts and professionals sampling. Although there are some items that did not obtain the minimum score to be considered valid, the global index IVC in the sample of experts and professionals is considered satisfactory, so the scale is considered to be valid with amendments (AU)

Recruitment of nurses from India and their experiences of an Overseas Nurses Program.

BACKGROUND: Overseas recruitment has been vital to the contribution of staff growth in the National Health Service (NHS). In 2011, high nursing vacancy rates within critical care required that overseas nurses were recruited. The recruited nurses were placed in an Overseas Nurses Program (ONP), a course designed to assist overseas nurses in adapting to the NHS. AIM: To describe the experiences of nurses recruited from India who participated in an ONP. DESIGN: A qualitative, research approach was chosen to gather descriptions of the lived experiences of nurses from India transitioning to London, to work in critical care settings. METHOD: A descriptive qualitative approach was taken using in-depth, semi-structured and audio-taped interviews. They were conducted over a 69-day period (30 November 2012 to 6 February 2013) with 16 nurses from India. The nurses were questioned about challenges, experiences and differences; they were also asked to make suggestions for other nurses undertaking an ONP in the future. Interviews were transcribed verbatim into a formal written style with NVivo10. RESULTS: Eleven females and five males aged 25-33 years who had completed up to four years of university training participated in this study. The themes extracted were autonomy and responsibility, language, culture (food and climate), loneliness and work challenges (ONP and essay writing). Participants identified that they would have benefited if pre-allocated mentors from non-English speaking countries who had previously been through the transition process were available to assist them with their personal and professional integration into a new country. CONCLUSION: Autonomy disparity, language barriers and cultural differences need to be recognised and acknowledged by multi-disciplinary teams, by allowing sufficient time and additional support for non-English nurses undergoing ONPs. RELEVANCE TO CLINICAL PRACTICE: Overseas nurses would benefit from being mentored by another nurse from a similar culture, with a non-English background. It may be feasible for overseas nurses to receive training in cultural competencies to improve disparities.

REVISITING "THE INVISIBLE CULTURE OF THE MULTIRACIAL, MULTIETHNIC INDIVIDUAL: A TRANSCULTURAL IMPERATIVE".

Past and present policies, politics, myths, stereotypes, and societal attitudes influence the lived experience of multiple heritage individuals, often resulting in marginalization, disparities, invisibility, cultural pain, and/or unmet needs. This article offers commentary about the past and present with thought-provoking questions for future direction regarding "The Invisible Culture of the Multiracial, Multiethnic Individual: A Transcultural Imperative." The commentary revisits and reminds readers about the 2001 article on the same topic, quickly brings them to the reality of the present, and challenges nurses and other professionals to dismantle disparities through cultural congruent care that focuses on making the invisible culture visible.

THE INVISIBLE CULTURE OF THE MULTIRACIAL, MULTIETHNIC INDIVIDUAL: A TRANSCULTURAL IMPERATIVE (REPRINT FROM 2001).

The main purpose of this introauctory article is to evoKe professional awareness, spark interest, stimulate thought, and disseminate information concerning multiracial, multiethnic (multiple heritage) individuals within the United States. General background information, terms, definitions, ethno-historical influences, practice implications, and current issues will be highlighted. Areasforfurther exploration will be proposed. Transcultural imperatives urge all nurses and other health care professionals to become active participants in the new cultural evolution of a different, broader worldview that uncovers the "invisible" culture of multiple heritage individuals. The new vision challenges nurse and other health care professionals to embark upon a new journey in the quest for cultural congruent care for all individuals.