FGC affects at least 200 million women worldwide. Due to increasing transmigration, care of women with FGC has become a national and global public health and human rights issue. The United States (US) is one of the Western countries that has a large number of women who underwent or are at risk to undergo FGC. Based on the US Population Reference Bureau (PRB) report in Feb 2013, there were more than 507,000 females with different migration statuses that were subjected to some form of FGC. Around 55% of these women were between 15 to 49 years old. Accordingly, it is important to consider this group of women as a vulnerable population in our healthcare system as it is usually associated with the existence of health disparities. Immigrant women, and more specifically pregnant, who underwent FGC are more at risk for health disparities when compared to their non- immigrant counterparts.
Statement of the Problem:
Caring for immigrant women with FGC, especially those who are pregnant, is a key challenge in the American healthcare context. The challenge occurs as a result of a lack of standardized clinical guideline that sustains the cultural and clinical aspects for immigrant women with FGC. This void marginalizes this vulnerable group of women from accessing and utilizing the current healthcare and more specifically perinatal services. Thus, the increased risk of poorer health status among these women impacts negatively on their quality of life. This affects the image of the US healthcare in general and the perinatal health services in particular.
Justifications of the Current Challenge:
A review of the literature indicated that the following issues challenge care of immigrant women who have undergone FGC.
- Cultural Gap. Lack of understanding the cultural and social aspects behind FGC performance creates a cultural distance between the healthcare providers and immigrant women.
- Clinical Gap. There is a clinical gap regarding how to manage the complications that occur as a result of FGC. The current clinical management is focusing on preventing and managing the complications that occur in the severest type of FGC (Type III) or infibulation.
- Lack of Trust. Women and their partner's concern about the increasing the performance rate of C-sections among women with FGC, particularly among women who have Type III, in U.S.
- Lack of effective-Therapeutic commination. Misunderstanding the different cultural and ethnic backgrounds may block effective therapeutic communication between American healthcare providers and immigrant women and their partners. Such lack of an effective communication generates ethnocentrism, discrimination, stereotyping, cultural blindness, and cultural imposition.
Scope & Purpose:
International studies highlight the need for an educational tool that raises the healthcare providers’ awareness about various aspects that concern FGC. The purpose of this presentation is to test the efficacy of the FGC digital e-book as a learning and educational tool to improve the level of knowledge, attitude, and self-efficacy among undergraduate nursing students when caring for women who have undergone FGC.
Significance of this Topic in Nursing Profession
A growing body of evidence from different western countries such as Norway, Sweden, USA, UK, and Spain, indicates the existence of significant gaps in training providers, as well as gaps in general knowledge about caring for women who underwent FGC, despite the availability of existing care protocols in most of these countries. Therefore, there is a need to examine the impact of the FGC-digital eBook on nurses who provide perinatal care within American system. Targeting nurses in general and nursing students in specific is ideal to exemplify the foundation of holistic care in FGC and perinatal healthcare context. These individuals are ideal primary care providers because the ‘cornerstones’ of their practice model include continuity of care partnership with birthing families, and informed parental choice.
Methods & Evaluation:
A pre-post test quasi-experimental design was conducted with a convenience sample of undergraduate nursing students at Binghamton University. The FGC knowledge scale has 14 close-ended questions with a total score ranges from 14 to 42; 14 indicate the lowest score and 42 indicate the highest. The attitude scale is 5 points Likert scale that measures the participant’s attitudes regarding 13 statements of different aspects of FGC. The FGC self-efficacy scale has 14 close-ended questions; the total scale score ranges from 14 to 42; while 14 indicate the lowest score, and 42 indicate the highest.
Findings:
The preliminary data indicated that the FGC digital e-Book has a positive impact on the level of FGC knowledge, attitude, and self-efficacy among undergraduate nursing students.
Discussion:
FGC is a complex socio-cultural phenomenon that has various health and clinical controversies, which interfere with the concept of holistic care in the nursing profession. Therefore, assessing and exploring the level of knowledge, attitude, and self-efficacy provided deeper insights about the clinical and cultural aspects of FGC that focus on the holistic care. Further, optimal heath care must be based on effective communication, cultural sensitivity, and trusting relationship to create a delicate balance that puts the women’s best interest in the forefront.
The FGC Digital eBook is an electronic learning tool that covered the clinical, cultural, social, and ethical aspects of FGC. It can easily accessed by any personal laptop, smartphone, iPad, or tablet. This eBook emphasized the self-reflective learning strategy, which enhanced the student’s effective learning-engagement, where the participants set, achieved, and monitored their progress through the course.
The eBook covered all clinical controversies that concern FGC in a professional and engaging way. Indeed, it represented the social aspects at different historical periods and within different cultural contexts. Such information assisted the undergraduate nursing students in increasing their level of knowledge, considering the appropriate attitudes and the self-efficacy skills that are needed to provide a competent clinical and socio-cultural care for this group of women.