The purpose of this program evaluation study was to assess the impact of an international clinical practicum experience on the cultural competence of undergraduate nursing students enrolled in an approved Community and Public Health Nursing Practicum course in a baccalaureate nursing program at a large Midwestern university in the United States. The research question for this study was “In undergraduate baccalaureate nursing students, how does an international immersion experience compared to traditional practicum experience affect cultural competency?”
CCC is imperative as increasing globalization has direct and indirect impacts on healthcare (Loftin, Hartin, & Branson, 2013). CCC plays a clear role in improving quality and patient outcomes (IOM, 2003). Minority populations are underrepresented in the general workforce and in healthcare, limiting opportunities for cultural exchange (Loftin et al., 2013) and contributing to ethnocentric perceptions of cultural superiority among healthcare providers. These provider prejudices often contribute to furthering health disparities (IOM, 2003). Changing attitudes and behaviors is essential and may be best accomplished during early phases of professional education (Shaya & Gbarayor, 2006). The precursor to any educational strategy design requires an evaluation of the student’s baselines knowledge, skills, attitudes, strengths, and limitations for providing culturally competent care (CCC) (Jeffries, 2003). Global immersion experiences are still in their infancy in the academic setting being studied and to date, no formal evaluation of such programs has been completed.
Four dimensions of CCC - affective, attitudinal, cognitive, and behavioral - have been identified for incorporation into nursing education via didactic, practical, and research methodologies (Rew, Becker, Cookston, Khosropour & Martinez, 2003). In 2008, the American Association of Colleges of Nursing (AACN) defined characteristics for cultural competence in undergraduate students and advised nursing faculty to prepare graduates for culturally competent practice (Loftin, Hartin, Branson, & Reyes, 2013). In an integrated review, 11 tools, which measure CCC, were assessed to determine the common characteristics, psychometric properties, and concepts of competency (Loftin et al., 2013).. Four tools, specific to nursing, were identified. The only tool to address all three characteristics of CCC identified by AACN was the Transcultural Self Evaluation Tool (TSET) (Loftin et al., 2013).
Methods:
Assessment of the impact of an international community practicum immersion experience on the cultural competency in pre-licensure students enrolled in the fall semester 2018 Community and Public Health Nursing Practicum course was completed using the Cultural Competence Evaluation Tool – Student Version (CCCET-SV) (Jeffreys, 2010). The CCCET-SV tool is an 83-item questionnaire, with demonstrated reliability and validity, adapted from the TSET. Prior to data collection, study approval was granted by the university’s institutional review board. Students completed the CCCET-SV prior to and following their clinical practicum experience. Students who participated in the traditional and immersion international community practicum experience were invited to complete the evaluation tool in order to measure and compare levels of cultural competence. The CCCET-SV was administered during face-to-face classroom time. Descriptive statistics will be used to report aggregate findings and themes will be identified based on the responses to the following stem: Describe the most impactful learning experience related cultural competency from your Community and Public Health Nursing Practicum.
Results:
Baseline data collection occurred in fall 2018. Data analysis is currently underway and will be completed in early 2019. The full study is slated for completion by May 2019.
Conclusion:
There is little evidence in the literature regarding the impact of immersion experiences when compared with traditional clinical practicums. In order to evaluate educational strategies we need to know the student’s knowledge, skills, attitudes, strengths, and limitations at baseline and at the conclusion of their program. Global immersion experiences are still in their infancy at the institution understudy and to date, no formal evaluation of these programs has been completed. Spring 2018 was the first time an international clinical practicum experience was offered as part of the Community and Public Health Nursing Practicum. Findings from my project will be used to optimize educational experiences for undergraduate nursing students and improve outcomes for future patients under their care. Additionally, documentation of benefits will be helpful to secure continued funding for these programs. Most important, cultural awareness and understanding will help eliminate biases when providing care and reduce health care disparities.