Perceptions of culturally competent practice behaviour by newly qualified nurses Item Type Thesis Authors Wray, Jane Rights <a rel="license" href="http://creativecommons.org/licenses/ by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by- nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http:// creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>. Download date 26/09/2021 21:25:44 Link to Item http://hdl.handle.net/10454/16040 University of Bradford eThesis This thesis is hosted in Bradford Scholars – The University of Bradford Open Access repository. Visit the repository for full metadata or to contact the repository team © University of Bradford. This work is licenced for reuse under a Creative Commons Licence. Perceptions of culturally competent practice behaviour by newly qualified nurses Jane WRAY Submitted for the degree of PhD Faculty of Health Sciences University of Bradford 2017 i Abstract Jane Wray Perceptions of culturally competent practice behaviour by newly qualified nurses Keywords Cultural Competence, Newly Qualified Nurses, Nursing Behaviour, Nursing Practice, Transition Background: The nursing workforce needs to be adequately prepared to deliver care to an increasingly diverse patient population in the United Kingdom (UK). The Nursing and Midwifery Council (NMC) expects newly qualified nurses (NQNs) to deliver culturally sensitive and respectful care. Aim: The study aimed to explore NQNs’ perceptions of culturally competent practice during the first 9 months post qualification. Methods: A qualitative longitudinal study was conducted with a volunteer sample of 14 NQNs recruited from 3 Higher Education Institutions in the north of England. Data was collected using directed reflections (at 2-3 and 5- 6 months) and semi-structured interviews (at 8-9 months) and analysed using a phenomenological approach informed by symbolic interactionism. Results: Perceptions of culturally competent nursing practice were associated with core concepts such as individualised patient care, compassionate and respectful care, respecting individual differences, ii professionalism and patient trust. Specific behaviours were associated with verbal and non-verbal communication, care planning and diversity-specific adjustments. Discussion: Self-perceived competence and confidence in caring for, and interacting with, patients from diverse backgrounds developed and changed throughout the transition period with experience and interaction opportunities. An ability to reflect upon and learn from novel experiences, plus an enabling ward culture and environment which responded positively to nurses seeking advice and support was important. Conclusion: Educational preparation may have enabled NQNs’ opportunities to develop some but not necessarily all of the skills and behaviours required to demonstrate culturally competent practice. During transition, supported development and professional socialisation can assist in enhancing competence and confidence. iii Acknowledgements I would like to express my thanks to the large number of people whose assistance have been invaluable to me whilst completing this PhD. First, I would like to acknowledge the support and guidance given to me by my PhD supervisors, Professor Uduak Archibong and Dr Sean Walton. Their advice and endless encouragement has motivated me throughout to continue writing and complete this work. To paraphrase a quote by Alexandra K Trenfor; you showed me where to look, but you didn’t tell me what to see. I am also grateful for the additional support of colleagues and peers in the School of Health and Social Work at the University of Hull especially my dear friend, Jo Aspland and my mentor Professor Roger Watson. Also, the Postgraduate Research Student group in the Faculty of Life Sciences at Bradford University, my Action Learning Set (Jae, Jane and Saudat thanks for listening to me) and the patient and carer advisory group. I would also like to thank all the newly qualified nurses who participated in the study for giving me their time and allowing me to intrude upon their lives. Finally, this work would not have been completed without the endless patience of Ian, William, my family and friends. You encouraged me to achieve this and offered support when I most needed it. I will repay your kindness in full. iv Table of contents Abstract .....................................................................................................................................ii Acknowledgements .................................................................................................................. iv Table of contents ...................................................................................................................... v Chapter 1: Introduction to the study ....................................................................................... 1 1.1 Introduction ................................................................................................................... 1 1.2 Study aim and objectives ............................................................................................... 2 1.3 Personal statement – Why cultural competence?......................................................... 3 1.4 Thesis structure .............................................................................................................. 5 1.5 Conclusion ...................................................................................................................... 7 Chapter 2: Study context ......................................................................................................... 8 2.1 Introduction ................................................................................................................... 8 2.2 Health inequalities and the organisational context of care ........................................... 8 2.3 Anti-discrimination legislation and healthcare services .............................................. 12 2.3.1 Healthcare organisations and their response to anti-discrimination legislation .. 18 2.3.2 Organisational equalities and cultural competence ............................................. 22 2.4 NQNs and professional standards................................................................................ 25 2.4.1 Professional standards and cultural competence ................................................. 27 2.5 Understanding cultural competence ........................................................................... 28 2.5.1 Core concepts of cultural competence ................................................................. 36 2.5.2 CCPB and educational preparation ....................................................................... 47 2.6 Understanding the transition period ........................................................................... 49 2.6.1 Support and the NQN in transition ....................................................................... 50 2.6.2 Socialisation during transition .............................................................................. 54 2.6.3 NQNs and the ‘journey’ of transition .................................................................... 57 2.7 Conclusion .................................................................................................................... 63 Chapter 3: The Literature review ........................................................................................... 65 3.1 Introduction ................................................................................................................. 65 3.2 The literature review methods .................................................................................... 65 3.3 Key themes ................................................................................................................... 78 3.3.1 Experience and length of years in practice ........................................................... 79 3.3.2 Education and training .......................................................................................... 80 3.3.3 Skills, behaviours and competencies .................................................................... 82 3.4 Conclusion and identification of key gaps in the evidence base ................................. 86 Chapter 4: Study philosophy, methodology and design ........................................................ 89 v 4.1 Introduction ................................................................................................................. 89 4.2 Study aim and research questions ............................................................................... 89 4.3 Philosophical positioning ............................................................................................. 92 4.4 Reflexivity within this study ......................................................................................... 98 4.5 Methodology and theoretical framework ................................................................. 105 4.5.1 Symbolic interactionism ...................................................................................... 107 4.5.2 The Developmental Model of Intercultural Sensitivity (DMIS) ........................... 116 4.6 Study design ............................................................................................................... 123 4.6.1 Study sample