Journal of Practical & Professional Nursing Category: Clinical Type: Review Article
Promoting Understanding of Cultural Competence through a Transformative International Mentoring Program
- Sharon Elizabeth Metcalfe1*
- 1 School Of Nursing, Western Carolina University, North Carolina, United States
*Corresponding Author:Sharon Elizabeth Metcalfe
School Of Nursing, Western Carolina University, North Carolina, United States
Received Date: Jun 20, 2019 Accepted Date: Jun 27, 2019 Published Date: Jul 04, 2019
INTERNATIONAL EDUCATIONAL EXPERIENCES AND CULTURAL LEARNING
Long T found that nursing schools must now contain curriculum that includes cultural competence training which goes beyond traditional teaching strategies in the classroom . Lectures and readings that were educational mainstays of the past alone are no longer sufficient to prepare nursing students for a global health care which requires knowledge of the diversity of patient’s needs and cultural preferences. Study abroad opportunities allow novice students to engage in active learning and critical reflection regarding their individualized patient care experiences. These opportunities allow once in a lifetime experiences for students to reflect on both the similarities and the differences they witness in healthcare within a different country from their own .
CULTURAL COMPETENCE NURSING MODEL AND TRANSFORMATIVE LEARNING THEORY AND INTERNATIONAL NURSING EXPERIENCES
The theoretical framework of Mezirow’s transformative learning may be used as the underpinning of the foundation for nursing educators to embrace international learning . Mezirow’s classic theory is used to describe how people develop and use critical self-reflection to consider their beliefs and experiences, and change their own unique perspectives of the world and its people over time . Mezirow believed that a person would change their world view of both people and a situation when facing a “disorienting dilemma”, which is an experience that doesn’t fit into the person’s current beliefs about the world. Brown and Schmidt found that reflection is a critical component in nursing education to understanding global cultures and people as it develops critical thinking and social awareness that are necessary in providing culturally competence in delivery of care .
Students often discover that international travel experiences in which they learn to care for a population of patients that are different and unique from one’s own is a transformative experience that enriches their world perspective and increases their knowledge base of cultural nursing care . Walters et al., conducted a study in which six short-term international study abroad programs were assessed through students’ reflections through journaling with cultural experiences with people in Haiti . Reflection scores were found to be highest for journaling and supported the use of Mezirow’s transformative learning theory for supporting the educational benefits of study abroad programs. Brown and Boateng found that study abroad programs have significant benefits such as promoting cultural understanding and acknowledging the differences in healthcare settings, policies and practices . Bamber found that pedagogical approaches such as utilizing international service learning opportunities with students helps to develop and cultivate a cosmopolitan orientation to the world and healthcare . Cosmopolitanism is considered the acquisition of becoming other-wise for gaining cultural awareness and cultural competence.
INTERNATIONAL TRANSFORMATIVE MENTORING PROGRAM
Development of international program
Based upon the clinical nursing research findings that have been evident in the nursing literature, an international transformative educational pediatric program and collaboration was initiated in 2007. The program has been in existence for twelve years and has engaged over 120 nursing students in learning and understanding cultural competence of children and families of both socialized and capitalized health care systems through care of pediatric patients in the United Kingdom and the United States. This program is presented each academic year, and students from the United States travel to the United Kingdom over Spring Break, and students from the United Kingdom travel to the United States during the winter break for their clinical education.
Mentoring program development
Curriculum goal of transformative knowledge of cultural competence
Pediatric cultural patients and mentoring of nursing care
To understand the living conditions and cultural venues of both countries, student tours are arranged to view local and regional sites. The purpose of these activities is to align the curriculum goal of understanding the culture of the pediatric patients and their families in the environment in which the children reside. These activities allow a better understanding towards meeting the goal of cultural appreciation for a culture that is different than the one of the visiting students in their home countries. These tours comprise tours to medical and nursing museums, citywide tours of both host cities, and day long excursions to view the housing and schools in which children and their families reside. Students from the United Kingdom that participate in the mentoring program in the United States additionally visit the Native American community through touring the museum, visiting local hospital community agencies such as mental health and diabetes clinics, and partake in home visits with public health nurses to understand family life. These students also travel to the countryside and participate in the regional clinic for migrant farm workers and their families with the faculty from the United States. Both groups of students have especially enjoyed these special opportunities to more fully understand the culture of the children and families that they are learning to care for with their nursing mentor. It is a once in a lifetime experience.
Clinical nursing mentors and student global presentations
These course requirements are required for both groups of students from the United States and the United Kingdom. Topics such as childhood obesity, diabetes, respiratory illnesses, issues surrounding vaccination of childhood illnesses, mental health issues, and autism found prevalent in pediatric care worldwide are presented to their peers in the host country. Presentations are made to audiences in both countries at the local children’s hospital, and are prepared for a twenty-minute length. Students prepare their own Power Point presentation and rehearse with their peers at a pre-course trip seminar prior to the overseas excursion. In many years, the students have presented to clinical nursing administrators from throughout each of the wards of the hospitals, as well as interprofessional providers such as physicians, nutritionists, child life therapists, physical therapists, mental health providers, and palliative care specialists.
International faculty involvement
Narrative reflective journaling for transformative development
Students from the United States are amazed to learn that in the United Kingdom, pediatric wards consist of long rows of beds, with the children being cared for side by side with families able to visit with one another throughout their child’s hospital stay. Student nurses from the United Kingdom often reflect upon the seemingly isolation of solitary rooms in which pediatric units are designed to care for children within the United States. Both groups of students are surprised to learn that patients in the United Kingdom participate in the National Health Trust which pays for their hospitalization, and children in the United States must private pay, use insurance, or be placed on Medicaid for fees for service. Students from the United States are additionally interested in learning that nurse’s wear bright orange medications beware vests in the United Kingdom to help prevent interruptions and ensure safe administration of medication to children on the wards. Likewise, students from the United Kingdom are generally in dismay when they observe nurses administering medications in the children’s rooms with a medication cart that is based upon a computer cart for documentation. Lastly, students from the United Kingdom are surprised to learn that when a child is hospitalized at the Native American hospital on the reservation, often the entire extended family comes and stays in the room with the child and the nuclear family until the child returns home. These interesting examples of students’ cultural awareness for both nursing care of pediatric patients and their families helps them to grow and mature in having an increased understanding of both the culture of nursing and the culture of the country they are visiting.
Reflective essays and cultural presentations
Transformative daily debriefing sessions
DISCUSSION OF MERITS OF INTERNATIONAL TRANSFORMATIVE MENTORING PROGRAM
Students that have participated in this international clinical mentoring program have been able to utilize the Purnell Model for Cultural Competence to assess their overall understanding of meeting the learning objectives of understanding a pediatric patient and their family’s culture in another country . Each student has utilized the conceptual model’s wheel and twelve facets of cultural life to help them to prepare their journals, their evening debriefing presentations, and their formal presentations that they share with their peers from another country. The use of this model and its application to provision of nursing care has been specially designed for ease with nursing students, and the students base their observational and written journal assignments on the merits of the cultural competence model. Students have additionally been able to compare the Purnell Model for Cultural Competence with the Jeffreys Cultural Competence and Confidence Model with assessing their pediatric patients and nursing care [3,12]. Using this additional conceptual model, nursing students have been able to analyze their patients and their culture by assessing the patient’s cultural values, beliefs, traditional practices and lifestyles. The Jeffrey’s Cultural Competence and Confidence Model has become one of the most well-known conceptual models for learning to care for patients in a global society with an understanding of cultural competence . Both renown models are utilized by nursing educators around the world, and the university and clinical nursing faculty for this international clinical mentoring program have found them to be successful in providing guidance and understanding for both undergraduate and graduate nursing students.
Both university schools of nursing and pediatric hospitals have also been enriched by the years of valuable experiences and professional collegial friendships that have developed. It is hoped that this program review will both interest and encourage other schools of nursing and pediatric hospitals to inquire and initiate programs of this nature. These programs are invaluable to student learning with the many aspects of cultural awareness and an understanding of cultural competence in the delivery of holistic nursing care. Transformative adventures such as these help students to prepare for their future as nurses and the responsibility of caring for a variety of cultures of pediatric patients within a global society.
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Citation:Metcalfe SE (2019) Promoting Understanding of Cultural Competence through a Transformative International Mentoring Program. J Pract Prof Nurs 3: 012.
Copyright: © 2019 Sharon Elizabeth Metcalfe, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.