Measuring Cultural Competency: One-Year Post Immersion Experience in Costa Rica

Measuring Cultural Competency: One-Year Post Immersion Experience in Costa Rica

 

Abstract

Background

According to the United States Census Bureau (USCB), over 37% of the US population is non-white. The Hispanic population grew by 43% and individuals who identify themselves as belonging to two or more races increased by 33% between 2000-2010. Minority residents of the United States are estimated to be as one in three with the population reaching 101 million  (United States Census Bureau (USCB), 2010a; USCB, 2010b & Humes, Jones & Ramerez, 2011). Nurses need to provide culturally competent care for our diverse population. According to the American Association of Colleges of Nursing (2008) it is important to serve our diverse patient populations by facilitating the education of baccalaureate nurses who are culturally competent.

Offering immersion courses have been described in the literature as a method of developing cultural competent nurses. Positive quantitative results have been described in study abroad programs to improve cultural competency and personal growth with undergraduate baccalaureate nursing students (DeDee & Stewart, 2003; Carpenter & Garcia, 2012; Downing, Kowal & Paradies, 2011; Ballestas & Roller, 2013). The short-term study abroad program can foster long-term global engagement in students (Fisher, 2009). Preparing students and faculty to deliver culturally competent care has been described in study abroad programs (Bentley & Ellison, 2007).

However, little is known about the long-term effects of study abroad programs in nursing and more research has been indicated in the literature (Read, 2011; Edmonds, 2012; Kelleher, 2013). This abstract describes the results of a one-year post experience in Costa Rica of baccalaureate nursing students who had an increase in cultural competence scores immediately following the one-week immersion course. The study purpose was to determine if initial competence scores were maintained one year following the experience.

Purpose:

The purpose of this presentation is to determine the effects of a study abroad program on cultural competence one-year post experience compared to immediate post experience. One method of teaching cultural diversity is experiential. Study abroad programs offer students an experience working with individuals from other diverse cultures.

Design

Quantitative comparison design measured cultural competency based on an immersion program utilizing an instrument completed at conclusion of program (N=18) and one-year (N=15) after participating in the one-week program in Costa Rica. The study design was a pre-test post tests one utilizing the instrument: Inventory for Assessing the Process of Cultural Competency among Healthcare Professionals-Revised (IAPCC-R) with permission of the author, J. Campinha-Bacote. The subjects completed the 25 questions Likert scale instrument answering strongly agree (4points), agree (3points), disagree (2 points) and strongly disagree (1 point). The point scale total equals 100 points. The higher score indicates an increase in cultural competency. Cultural proficiency is scored 91-100, culturally competent is scored 75-90, culturally aware is scored 51-74, and culturally incompetence is scored 50-25 (Rollo, 2014). Scores one-month after initial immersion experience in Costa Rica were compared to scores one-year post experience utilizing the same instrument (IAPCC-R). The effectiveness of the initial immersion program has been reported elsewhere (Ballestas & Roller, 2013). IRB was obtained from authors’ university.

Theory

Cultural competency is defined as a “process, not an end point, in which the nurse continuously strives to achieve the ability to work in the cultural context of an individual, family or community from a diverse cultural/ethnic background” (Campinha-Bacote, 1994 pp. 1-2). The framework chosen for this research study was the model: The Process of Cultural Competency in the Delivery of Healthcare Services.This theoretical model follows a fluid process that spans cultural awareness, cultural desire, cultural skill and cultural knowledge. The study fits the theoretical model in unique ways because cultural competency begins during the process of acquiring awareness, knowledge, skill and desire (Campinha-Bacote, 2002).

Results

Demographics for the 15 subjects were an age range of 21-41 years. The mode was 22 years of age (38.9%). Gender was predominately female (93.3%). Race /Ethnicity was self-reported as Black/African American N= 2, (13.3%); Asian, N= 1(6.6%); Caucasian N=8, (53.3%); Hispanic/Latino N=1, (6.6%); and Other N= 3, (20%). The initial immediate post immersion overall increase in total scores from the pre-experience to immediate post Costa Rica study abroad experience was an 89% improvement in cultural competency (Ballestas & Roller, 2013). The mean scores from the immediate post experience t-test (78.83) (Time 1) and the one year post experience t-test (78.80) (Time 2) were similar. Students increased their scores one year post experience to culturally proficient N=2 by 13.3%. Cultural proficient scores decreased; this was because 2 students originally culturally proficient were now scored in the higher category. Three students could not be contacted and thus not included in data. The cultural aware category scores remained unchanged for the N=4 at the year follow up. The initial post experience scores and the one-year post experience scores from the groups were compared using a t-test= .012 There was no significant difference between the students’ (N=18) one-year scores and the one-year after experience scores (N=15). Although some students increased or decreased their score, the group’s overall cultural competency was maintained one-year post immersion course.

Study Limitations

Limitations of this study were its small sample size and that students in this study were primarily seniors in a four-year program and thus may have gained cultural competency from courses completed in the nursing curriculum. Three subjects from Time 1 did not participate in Time 2 data collection because they could not be contacted. The (IAPCC-R) instrument has been reported to be validated and reliable. However, there is now a student version of the instrument available (Rollo, 2014) which may have been more appropriate for the study.

Conclusion

Cultural competency that increased at the conclusion of a study abroad program was maintained one-year post immersion experience for baccalaureate nursing students. Few past research reported have described cultural competency post one-year immersion course outcomes. The comparison of the two groups revealed no significant differences between them. This confirmed that at the post one-year immersion, subjects maintained the gains in cultural competency they achieved by attending a one-week immersion experience in Costa Rica. Nurse educators have a challenge to provide opportunities for nursing students to gain and maintain skills of cultural competence. Assisting nursing students to learn about and provide culturally competent care can be achieved through a short-term immersion program. Culturally based experiences should be available in the curriculum to offer all students the possibility to participate in study abroad courses. This study’s findings although using a small sample indicate further research is needed to measure the effectiveness of the program such as with a control or comparison group.