Development of an Unfolding Case Study to Promote Student Cultural Confidence

The Nursing Code of Ethics outlines the social responsibility and professional values of nurses. Specifically Provision 1 states – “nurses practice with compassion and respect for the inherent dignity, worth and unique attributes of every person” while provision 3 states – “nurses promote, advocate for and protect the rights, health and safety of the patient” (ANA, 2015). Currently, globalization has resulted in increased diversity of the population in the United States. As a result, nurse professionals must be educated to address the unique care needs of people from nation states other than their own to provide safe, quality care (Mill et al., 2010; Wilson et al., 2012). Nurse professionals must also act as leader-managers when caring for diverse populations to provide individual, family, community and population centered nursing care. In order to achieve holistic care, nurses must be culturally competent to view care needs through the patient’s perspective, and adapt care delivery according to each patient’s expectation (Campinha-Bacote, 2011). The American Association of Colleges of Nursing reports that cultural competence reduces misunderstanding of patient, family, and multicultural healthcare provider communications (Hamre, 2012). A culturally competent nurse professional who is knowledgeable of the cultural and social attributes of diverse patient populations avoids the misperceptions, assumes a non-judgmental attitude, and develops a respect for difference. Nurses who make a moral commitment to the provision of care that is equitable to all (Comer et al., 2013) support ethical practice.

Whereas culture refers to communication patterns, thought processes, behaviors, traditions, values and philosophy (Arbour, et al., 2015), cultural competence includes awareness and understanding of the impact of culture upon health (Douglas, et al., 2014). 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). Jeffreys also suggests confidence is the precursor to the development of cultural competence.

One Midwest University who has committed to internationalizing the curriculum by promoting relationships between diverse cultures, understands that globalization includes awareness of the influences of political, economic, culture and social dimensions resulting from the changing demographics of local communities. Globalization has led to the resettlement of multiple diverse populations in the surrounding community. The Burmese refugee population, specifically the Chin ethnic group, represents the newest arrivals and the least known.

Faculty in the academic setting and educators in healthcare organizations face the challenging task of preparing nurse professionals to provide culturally competent care to clients served in surrounding communities. Both face the challenge of facilitating achievement of cultural competence without international travel or study abroad experiences. Faculty conducted a literature review and discovered that there are limited available resources in the form of real life case study materials. A case study is an active learning strategy that promotes collaboration and problem solving through experiential learning (Pfeiffer et al., 2013). Therefore, a task force was formed with the goal of developing an unfolding case study through collaboration. The task force was comprised of a university faculty member and staff from a clinical partner serving the Burmese refugee population, specifically the Chin ethnic group. The staff included an educator, clinical nurse specialist, Burmese nurse and physician, a case manager and an interpreter. Over the course of a semester, an unfolding case study prototype was designed. Constructivist pedagogy directed development of the unfolding case study. The Constructivist philosophy implies the learner engages in the learning process by working collaboratively, is self- directed, utilizes prior learning, and constructs new knowledge through reflection (Hmelo-Silver, Chernobilsky & Jordan, 2008). The goal of the case study was to promote cultural awareness, and facilitate development of the knowledge, skills and attitudes required to care for the Chin population. The unfolding case study scenario focused upon a Burmese male refugee from the Chin ethnic group, seeking medical care for a gastric complaint in the emergency room.

Jeffreys’s Cultural Competence and Confidence Model provided the theoretical framework for the project. Jeffreys describes Transcultural Self-Efficacy (TSE) as the extent to which students are confident in their ability to communicate and interact effectively in a transcultural setting. This confidence, according to Jeffreys explains the motivation students need to acquire to develop skills within three domains including cognitive, practical and affective. Skill in the three domains is realized when students demonstrate care that is culturally appropriate and congruent. Evaluation of student confidence relied on two instruments from Jeffreys’ toolkit.

The unfolding case study and an overview of the beliefs, values and healthcare practices of the Chin ethnic group will be the focus of the presentation. Recommendations for healthcare providers will be provided and the evaluative findings over several semesters presented.