The Influence of Transcultural Humility Simulation Development Activities on the Cultural Competence of Baccalaureate Nursing Students
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University of Wisconsin Milwaukee UWM Digital Commons Theses and Dissertations August 2016 The nflueI nce of Transcultural Humility Simulation Development Activities on the Cultural Competence of Baccalaureate Nursing Students Teresa Hamilton University of Wisconsin-Milwaukee Follow this and additional works at: https://dc.uwm.edu/etd Part of the Adult and Continuing Education and Teaching Commons, Curriculum and Instruction Commons, and the Nursing Commons Recommended Citation Hamilton, Teresa, "The nflueI nce of Transcultural Humility Simulation Development Activities on the Cultural Competence of Baccalaureate Nursing Students" (2016). Theses and Dissertations. 1270. https://dc.uwm.edu/etd/1270 This Dissertation is brought to you for free and open access by UWM Digital Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of UWM Digital Commons. For more information, please contact [email protected]. THE INFLUENCE OF TRANSCULTURAL HUMILITY SIMULATION DEVELOPMENT ACTIVITIES ON THE CULTURAL COMPETENCE OF BACCALAUREATE NURSING STUDENTS by Teresa Hamilton A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing at The University of Wisconsin, Milwaukee August 2016 ABSTRACT THE INFLUENCE OF TRANSCULTURAL HUMILITY SIMULATION DEVELOPMENT ACTIVITIES ON THE CULTURAL COMPETENCE OF BACCALAUREATE NURSING STUDENTS by Teresa Hamilton The University of Wisconsin, Milwaukee Under the Supervision of Professor Karen Morin One way to mitigate health disparities in the provision of nursing care and impact social justice with vulnerable populations is the development of cultural competence. Although addressed in nursing curricula, gaps in how to best address cultural competence remain. A study was undertaken to determine whether participation in a researcher-designed intervention, entitled Transcultural Humility Simulation development, based on components of Campinha-Bacote’s model with an emphasis on “becoming” culturally competent, improved cultural competence in graduating baccalaureate nursing students. A longitudinal, descriptive, quasi-experimental, pretest-posttest comparison group design using embedded mixed methods was used. A total of 57 student participants from one baccalaureate nursing school in the western US were randomly assigned to the intervention group ( n = 22) or the comparison group ( n = 35). All participants completed the Inventory for Assessing the Process of Cultural Competence-Student Version before and after the intervention. Intervention participants also completed three written reflection exercises the day of the workshop. A subgroup of participants in the intervention group ( n = 12) and the comparison group ( n = 8) were interviewed two to three months after graduation. No statistically significant differences were obtained between groups while treating the pretest as a covariate. Participants who identified as more than one race on the demographic survey ii perceived they were more culturally competent than those who identified as one race, F ratio of F(10, 3) = 15.13, p = .02. Analysis of participant reflections during the intervention indicated they anticipated incorporating cultural competence into their practice by shattering preconceived perceptions, constructing innovative insights , improving effective communication , and emerging personal development . Once in practice, they incorporated cultural competence through cultivating nursing-person relationships , providing quality nursing care , serving the patient and family , establishing extraordinary communication and approaching care with humility . This study suggests that bringing attention to cultural competence through participation in Transcultural Humility Simulation Development could raise awareness and foster developmental growth among student participants through transformative learning, epistemic belief change, and double-loop learning. iii © Copyright by Teresa Hamilton, 2016 All Rights Reserved iv Dedicated to Stephan, Luke, Lyndon, Lauren Mother and Dad, And my whole family. Each of you motivated, inspired, and cheered for me. I am grateful. TABLE OF CONTENTS FRONT MATTER Page Abstract ............................................................................................................................... ii Copyright ........................................................................................................................... iv Dedication ............................................................................................................................v Table of Contents ............................................................................................................... vi List of Figures .................................................................................................................... xi List of Tables .................................................................................................................... xii List of Appendices ........................................................................................................... xiii Acknowledgements .......................................................................................................... xiv Chapter Page 1. INTRODUCTION ...........................................................................................................1 Problem Statement ...................................................................................................2 Purpose of the Study ................................................................................................5 Theoretical Framework ............................................................................................6 Research Hypotheses ...............................................................................................7 Research Questions ..................................................................................................8 Theoretical and Operational Definitions ..................................................................9 Cultural Competence ...................................................................................9 Cultural Awareness ..........................................................................9 Cultural Knowledge .........................................................................9 Cultural Skill ..................................................................................10 Cultural Encounters .......................................................................10 Cultural Desire ...............................................................................10 Assumptions ...............................................................................................10 Significance of the Study .......................................................................................11 Nursing Theory ..........................................................................................11 Nursing Research .......................................................................................12 Nursing Practice .........................................................................................12 Nursing Education .....................................................................................13 Health Policy ..............................................................................................14 Chapter 1 Summary ...............................................................................................15 2. REVIEW OF LITERATURE ........................................................................................16 Procedure ...............................................................................................................16 Cultural Competence .............................................................................................17 Concept Analyses.......................................................................................17 Models and Theories ..................................................................................19 Leininger ........................................................................................19 Giger and Davidhizar .....................................................................20 Jeffreys ...........................................................................................21 Campinha-Bacote ...........................................................................22 Assumptions .......................................................................22 Model .................................................................................22 Constructs ..........................................................................26 Cultural Awareness ................................................26 Cultural Knowledge ...............................................26 Cultural Skill ..........................................................27 Cultural Encounters ...............................................27 Cultural Desire .......................................................28 Interrelationships of Constructs .............................28 Empirical Literature Using Campinha-Bacote’s Theory ...............29 IAPCC-R ............................................................................29 IAPCC-SV .........................................................................35 Cultural Competence Summary .................................................................39