Developing and integrating cultural competence into nursing education curricula: a qualitative grounded theory approach

Abstract

The changing demographic UK population in terms of cultural, racial and ethnic mix demands mental health nurses to be educated in ways that will enable them to provide care that is both efficient and culturally appropriate to the diverse population they will serve. However, reported studies indicate that professional nurses, particularly mental health nurses, are not ready to meet the challenges posed by an increasingly culturally diverse society. These have raised questions about the undergraduate nursing education's readiness to develop a mental health work force that is capable of delivering effective mental health services to a multicultural population. The aim of the study was to explore and gain an understanding of cultural competence education from the perspectives of the key participants involved in the undergraduate mental health nursing education within the UK context, and to use the findings to develop a conceptual framework of developing cultural competence. Qualitative grounded theory approach was the method of inquiry used to collect and analyse interview data from the experiences and views of senior lecturers, third year mental health student nurses, clinical sign-off mentors and student mentors within the universities that offer pre-registration mental health nurse training in the West Midlands Region. Analysis of the research findings resulted in an emergent conceptual framework that explains how cultural competence is developed in the undergraduate mental health nursing curriculum in terms of content, processes, strategies, actions and approaches that are considered effective. The findings of this study revealed a degree of consistency between the views of the current study participants and what the literature describes as frameworks for developing cultural competence. The main theoretical constructs emerging from the study fit into a cultural competence frameworks encompassing awareness, knowledge and skills. Whilst some of the themes and theoretical constructs emerging from the results of the interview data were generally consistent with those indicated in the cultural competence literature, there were some other themes that emerged from the study participants on what was required within the curriculum in order to educate student nurses in ways that will enable them to work effectively and culturally appropriately with clients from diverse cultural backgrounds. The additional bridging theoretical construct included ‘conscious of the dynamics and discourse of intercultural education’ which was a result of the differing ideological views about current curricula and how issues of cultural competence could best be addressed within the curricula. The strategies of ‘engagement of local experts to assist in teaching cultural competence specific areas’ and ‘creating educational activities that challenge stereotypes, prejudice, discrimination and religious intolerance’ also expands the current literature by providing evidence to support some of the conceptualisations regarding some of the educational intervention strategies to cultural competence. This study is significant as it represents the first attempt to develop a conceptual framework of developing cultural competence within the UK context based on the perspectives of those directly experiencing the undergraduate mental health nursing education, using qualitative grounded theory approaches. Exploring and developing the conceptual framework from the perspectives of the neglected silent voices of the key participants who are directly involved in the undergraduate nurse training within the UK context, contributes to the existing research in this area and provides a view not currently presented in the nursing literature.