Measuring Changes in Cultural Awareness, Sensitivity, and Behaviors Among Online Graduate Nursing Students

Friday, 28 July 2017

Janet A. Levey, PhD, MSN, BSN
Nursing, Concordia University Wisconsin, Mequon, WI, USA

Purpose: Cultural competency is embedded at the graduate level to prepare nurses for advanced roles in nursing education and practice (Clark et al., 2011). Nurse educators employ several learning opportunities for graduate students to develop a higher level of cultural awareness, sensitivity, and behaviors. Some graduate online cultural diversity courses use blogging, recorded lectures, synchronous classrooms, social media, video conferencing, and short-term immersion experiences (Arbour, Kaspar, & Teall, 2015). However, short-term immersion experiences may be a burden on students related to cost, family commitments, and use of vacation work benefits (Sagar, 2014). The purpose of this presentation is to describe the effect of an online graduate cultural diversity course on transforming nursing students’ perceptions towards cultural awareness, sensitivity, behaviors, and course learning objectives over a 16-week time period. The primary investigator (PI) created a graduate online course using innovative teaching strategies as an alternative to the university’s hybrid course requiring short-term travel. Leininger’s Transcultural Nursing Theory served as the theoretical framework for the study.

Methods: A longitudinal design was used to measure the impact of an online graduate course on students’ perceptions towards the attributes of cultural competency and course learning objectives at baseline and upon course completion. An additional aim was to identify effective teaching strategies used to teach cultural competency and skills during a16-week educational experience. The research questions included: (1) What is the effect of a 16-week online cultural diversity course on nursing students’ perceptions of cultural awareness, sensitivity, and behaviors?; (2) What is the effect of a 16-week online cultural diversity course on nursing student behaviors and course learning objectives?; (3) Which online teaching strategy was the most effective for teaching cultural diversity content and skills?; and (4) What is the relationship between teaching strategies and students’ perceptions of achieving course learning objectives?

Participants in the study were students in the graduate nurse educator or nurse practitioner programs at a Midwestern University who registered for the online cultural diversity course. The study was approved by the university’s instructional review board and launched in August 2015 and data collection for this phase of the study will end in December 2016. Participants received a survey invitation and reminder emails two weeks prior to the official course start date. The emails explained data would be collected over two points in time and was not related to a grade. No incentive was provided for participating and consent was implied when participants linked to the survey. Qualtrics Survey Software provided the portal in which to collect and store password secured data for the PI. Participants provided their unique student identification number to link survey responses. After grades were submitted, the class received the same survey invitations and reminder emails, minus demographic survey. G*Power determined a sample size of 34 achieved adequate power (effect size = 0.5; alpha = .05).

The Cultural Competence Assessment (CCA) instrument was used to measure perceptions of cultural awareness, sensitivity, and behaviors. Permission was received to use the CCA and demographic survey for research purposes. The CCA instrument has a test-retest reliability index of .89. The CCA has two subscales: Cultural Awareness and Sensitivity [CAS] (11-items; reliability index .75) and Cultural Competence Behaviors [CCB] (14-items, reliability index .91). Participants rated their level of agreement on the CAS and CCB using a 7-point Likert scale (strongly agree to strongly disagree). The CAS and CCB is scored using a range of 1 to 7 per item. A higher score indicates a greater level of cultural awareness, cultural sensitivity, and cultural competence behaviors. The second part of the survey contained items specific to course learning objectives (CLO) in which the stem was formatted in first-person (7-items), similar to the CCA. Face and content validity were established before the start of the study. A higher score indicates a greater level of culturally competent behaviors as related to the course objectives.

Results: The study is currently in progress and findings will be presented during the poster presentation. Descriptive statistics will describe the sample characteristics and identify the pedagogical approach most effective when teaching cultural diversity online. Cultural awareness, sensitivity, and behaviors mean scores will be compared using a paired t test statistic at baseline and course completion. Pearson correlation will examine the relationships between teaching strategies and students’ perceptions of achieving course learning objectives. Anecdotal student feedback and comments will be shared with the audience.

Conclusions: Findings from this study might provide nurse educators with insight on engaging teaching strategies to connect online graduate students to cultural awareness, sensitivity, and behaviors. Examining the relationships between course learning objectives and student behaviors can offer an opportunity for educators to evaluate if course outcomes are congruent with student behaviors and make appropriate course revisions. Measuring the desired online course outcomes for the cultural attributes of awareness, sensitivity, and behaviors of future nurse educators and nurse practitioners is important to ensure we are preparing our graduates for complex settings. Phase II of the study will compare perceptions over three points in time for participants and will be disseminated at a later date.