Educational Strategies Applied to Facilitate Cultural Confidence to Care for a Refugee Population

Saturday, 29 July 2017

Judith Ann Young, DNP
Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, IN, USA


The Institute of Medicine (2011) report entitled “The Future of Nursing: Leading Health, Advancing Change,” challenged academic settings to make curricular change to facilitate student preparation with the provision of culturally sensitive care. Professional nursing practice requires nurse graduates be culturally competent to care for and educate diverse patient populations, and work within multicultural interdisciplinary teams. Patient centered holistic care requires the nurse view care needs through the patient’s perspective, and adapt care delivery according to patient expectation (Campinha-Bacote, 2015). Cultural competence is also key to patient safety due to the potential for misperceptions and misunderstanding of patients, families of diverse cultures (Hamre, 2012). Being knowledgeable of the cultural and social attributes of culturally diverse patient population including values and needs also supports social justice and ethical practice. A nurse makes a moral commitment to care for all patients. Specifically the Code of Ethics for Nurses, Provision one states, “nurses practice with compassion and respect for the inherent dignity, worth and unique attributes of every person” and Provision three, “promotes, advocates for and protects the rights, health and safety of the patient” (ANA, 2015).

The Office of Minority Health (2005) defines culture as “thoughts, communication, actions, and customs” that impact healthcare delivery and management. According to Jeffreys (2006) “Culture is a factor that can make the greatest difference in promoting wellness, preventing illness, restoring health and enhancing quality of life for all individuals” (p.xiii).

One program outcome for a Leadership course is to develop a “culturally sensitive individual who provides holistic individual, family, community, and population-entered nursing care that will improve patient health outcomes.” Educational activities must facilitate the integration of knowledge, skills, and attitudes to achieve program outcomes. The challenge for facilitating student achievement of cultural competency without the international travel and study abroad experiences is real as many cannot afford to “study abroad” and travel to third world countries is risky. It is therefore imperative that culturally sensitive learning opportunities be integrated within course content in the classroom setting. Course internationalization is “a process by which international elements are infused into course content, and international resources are used in course readings and assignments" (Schuerholz-Lehr et al., 2007, p. 70).


The pursuit of meaningful learning activities to facilitate student competency is an important focus. According to Jeffrey’s (2005) “Self-efficacy and skill development can be facilitated through education” (p. 24). An educational strategy such as a case study or problem-based assignment could facilitate experiential learning (Pfeiffer et al., 2013) as well as collaboration and innovative problem-solving skills.

The gap in needed resources challenges nursing faculty to facilitate student achievement of the desired program outcome of cultural sensitivity. Following a literature review, educational strategies were identified and utilized. One educational included an in class activity to facilitate self-awareness of bias and judgment. A caring manner is a fundamental component of the nurse-patient relationship. To build this trusting, caring relationship, the nurse must be self-aware of any judgmental feelings that could impair the development of a therapeutic relationship. Cultural sensitivity supports a non-judgmental viewpoint. A video and guest speakers also presented the refugee story prior to arrival in the United States and the challenges post arrival associated with transitioning into their new home. The unfolding case study facilitated synthesis of knowledge, skills and attitudes needed to provide care to members of a refugee patient population by raising awareness of health beliefs, values and practices of the Burmese culture and how culture affects patient-centered care planning. .

Results:  Student confidence to care for a patient from a diverse culture would be evaluated at two time points, the start and end of the semester utilizing Jeffrey’s Cultural Competence Clinical Evaluation Tool – Student Version (CCCET-SV) and the Transcultural Self-Efficacy Tool. The tools, based on Bandura’s research, evaluate change in an individual’s perceived confidence associated with the cognitive, behavioral and affective domains of cultural competence upon completion of the leadership didactic and clinical courses.

Conclusion:  Professional nursing practice requires culturally competence. Culture impacts healthcare delivery and management and awareness of cultural attributes supports social justice and ethical practice. Multiple evidence based educational strategies applied in the didactic and clinical settings effectively enhanced students’ perceived confidence to care for a diverse patient population.