![[ Visit Client Website ]](images/banner.gif)
The challenge for all educators while facilitating nursing students’ affective domain of learning within the professional nursing role is to transform the nursing student consciousness. It is essential to encourage students to view culturally competent care as recognition and appreciation of the other. Canales and Bowers (2001) suggest that the other is not necessarily defined by a specific ethnicity or culture, but is “all persons, in general, who were viewed as different” (p. 107). The purpose of this exploratory evaluation of student learning is to contribute to the knowledge base of educational strategies for the teaching and learning interactions concentrating on the concept of cultural care.
Different terms are used to describe the concept of cultural care that include cultural competence or confidence and cultural sensitivity (Jeffreys, 2010). Arieli, Friedman, and Hirschfeld (2012) describe the concept of “cultural safety” as creating the conditions where people feel free to explain their identities or cultural beliefs (2012, p. 192). Gregory, Harrowing, Lee, Doolittle, and O’Sullivan (2010) describe the concept of “cultural relativism” as taking into account the individualized and subjective nature in defining culture (2010, p. 7). Carpenter and Garcia (2012) explored student affective dimensions about culture while studying abroad and suggest the concept of cultural awareness is the understanding of cultural and environmental influences in health. Harrowing, Gregory, O’ Sullivan, Lee, and Doolittle (2012) analyzed cultural immersion experiences of nursing students and suggest that cultural care requires engagement with another culture to expand the worldview and deepen the understanding of the “cultural other” (2012, p. 500). Fisher (2014) associated cultural awareness with the developing professional role of the student nurse.
The purpose of this exploratory evaluation of student learning is to assess changes in student perceptions and their reflective self-learning in the affective domain about care of another during a population health clinical experience. This preliminary exploration of findings is significant as a discussion for nurse educators to strategize integration of cultural concepts into curricular plans as well as exploring the aesthetic knowledge development in the nursing care of another. Chinn and Kramer (2015) suggest the foundation of aesthetic knowledge development for the student nurse calls for the internal reflection about situations and experiences.
The Transcultural Self-Efficacy Tool (TSET) developed by Jeffreys (2010) is an 83 item measure with three subscales reflecting knowledge development and confidence in the cognitive, practical, and affective domains. The TSET has supported reliability internal consistency with Cronbach’s alpha 0.92-0.98 (Jeffreys & Dogan, 2010). Criterion related validity suggests that Self-Efficacy Strength is influenced by cultural care experiences and changes over time; nursing students more often score higher in their affective dimensions of competence and more often score lower in their cognitive dimensions of competence; students as “novice learners” generally score lower as compared to “advanced learners” such as experienced practicing nurses (Jeffreys, 2010, p. 76). Student data of TSET scores assessing Self-Efficacy Strength (SES) are currently measured at the end of each semester of coursework as program outcome data within the educational setting to evaluate changes in score over time indicative of development of cultural competence and confidence following the Model to Guide Cultural Competence Education (Jeffreys, 2010, p. 47).
The population that the senior pre-licensure nursing student is working with is elementary school-aged children with physical or developmental special needs. The setting is an adaptive physical education program utilizing equine-assisted therapy in a farm barn environment (Beaming, 2015). The purpose of this presentation is to explore student cultural care Self-Efficacy Strength (SES) evidenced by reflective journal writing and changes in Transcultural Self-Efficacy Tool (TSET, Jeffreys, 2010) scores in the cognitive, practical, and affective domains of learning following volunteer experiences in children’s adaptive physical education programs during population health clinical coursework in a pre-licensure baccalaureate program.
For this exploration of Self Efficacy Strength and assessment of transformational learning, selected student TSET items are evaluated in the cognitive, practical, and affective domains to see change in scores before and after the clinical educational program. The specific items to be explored and evaluated are: Item 19 in the cognitive domain growth and development, Item 39 in the practical domain world view/philosophy of life, and Item 55 in the affective domain you are aware of your own biases and limitations (Jeffreys, 2010).
To supplement the evaluation of the student progressive learning about cultural competence and to provide evidence of affective domain of learning about care of the other, student reflective narratives in clinical logs are reviewed for evidence of multi-perspectival awareness of learning to explore and examine evidence of the transformational educative process. Two primary themes and learning outcomes in this pre-licensure program are Patient Centered Care and Teamwork and Collaboration. Student reflective writings are explored for evidence of “thinking about the complexity” within the situation as suggested by Ironside (2005, p. 447). Further evidence in the student reflective writings are examined and explored for evidence of the student’s individualized understanding of their learning, their enhanced self-awareness, their acceptance of the unique needs of the other, and their appreciation and discernment of differences and challenges in the population that they have served during their clinical encounter within another culture.
Evidence of achieving the Patient Centered Care outcome is student writing about respect and advocacy for another, identification of barriers for the population, and explanations of learning communication strategies for the specific population. Evidence of achieving the Teamwork and Collaboration outcome is student writing about professional interactions with multi-disciplinary health care workers and personnel in the clinical environment, writing about respect for other team member’s contribution within group interactions, the development of shared knowledge in the team delivery of interventions, and acceptance of feedback or critique in interpersonal relationships of the learning environment. Additionally, the pre-licensure student reflective writings are examined and explored for evidence of roles of the developing professional role in advocacy and outreach for the specific population’s unmet health needs and health challenges.
Learning Activity One: The learner will be able to describe changes in Self-Efficacy Strength (SES) in selected pre-licensure nursing students following student participation in a population based clinical educational program. The clinical setting is an adaptive physical education program in a barn/farm location and students are working closely in a multidisciplinary situation with children living with varying degrees of autism spectrum disorders.
Learning Activity Two: The learner will be able to describe changes in the affective domain of Self-Efficacy Strength (SES) in selected pre-licensure nursing students following student participation in a clinical program as evidenced by student reflective narratives illustrating new learning. Discussion of findings will examine and relate transformational knowledge development during the nursing student’s journey learning about care of another, the many different contexts of culture, and multi-perspectival situational thinking.
This exploratory evaluation of student learning of cultural care contributes to knowledge of teaching and learning strategies for the pre-licensure nursing student as well as providing program evaluation in progress achieving and documenting program outcomes. Discussion of changes in Self-Efficacy Strength (SES) as evidenced with TSET scores on selected items within the subscales of the cognitive, practical, and effective domain includes the opportunity for participants to appraise the analysis of scores. Discussion with nurse educators and nurse researcher participants in this educational program about the reflective narratives promotes the clarification of subjective data interpretation processes and provides alternative explanations for changes in student beliefs about culture, acceptance and appreciation of another, and recognition of self-learning.