Culture is an important and essential concept in nursing education necessary to provide safe, quality nursing care.1,2 As nurses are called to care for more diverse populations, nursing faculty members often struggle to find effective ways to teach nursing students about culture and cultural competence. Although there are a variety of teaching strategies used to teach culture, clinical experiences have yielded the most favorable results.3 Furthermore, immersion experiences have been shown to have a positive impact on cultural competence, but they require a time commitment and may not be financially feasible for many schools of nursing.4 A study by Lonneman5 explored 6 strategies, including journaling, reflection, and interviewing, to increase cultural competence in second-degree nursing students and found positive results. In an effort to create an interactive cultural opportunity for baccalaureate nursing students, the author created a unique clinical experience by "matching" nursing with international students located on the same college campus. The purpose of this article is to describe this creative, inexpensive approach to providing a cultural clinical experience for nursing students using resources on one's very own campus.
This clinical experience was guided by the Process of Cultural Competence in the Delivery of Healthcare Services by Campinha-Bacote, which describes cultural competence as a process rather than a state of being. The 5 concepts included in the theory include cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.6
The Cultural Experience
The cultural experience took place at a public Midwestern university in a junior-level community health nursing course. Although this was standard educational practice, institutional review board approval was obtained. As a component of the clinical portion of the course, students were required to participate in a cultural community experience with the goals of reviewing the relationship between culture and health, identifying how cultural values and beliefs relate to health activities, and outlining why nurses should be concerned with cultural competence.
Although the assignment had existed for several years, past cultural experiences were focused on students spending time immersed in 1 cultural group, such as Hutterites, Native Americans, and refugees. In an attempt to develop a creative new approach to learning about culture, the author, who was responsible for 1 group of 8 students, began by exploring resources within the university. The university had an active Office of International Affairs and a population of more than 670 international students from 79 countries. Unfortunately, few nursing students had the experience of interacting with international students on their own campus.
The author initially contacted the Office of International Affairs and spoke with an international student advisor about the idea of matching nursing students with international students to allow both individuals to learn more about each other's culture. The international student advisor sent an e-mail to inquire about students' potential interest in participating in this experience. As a result, the 8 nursing students were matched with 8 international students from 7 different countries, including Saudi Arabia, Russia, Vietnam, Sri Lanka, Nigeria, India, and China. E-mail addresses were provided to the nursing students, and they were instructed to contact their matched student to arrange a meeting.
Students could meet either individually with their matched student or with other students as part of a larger group. They were required to spend a minimum of 3 hours together, all at 1 time or divided into multiple meeting times. Suggested activities included going for coffee, exercising, shopping, or doing another activity together. Students were reminded to be respectful of the questions asked, particularly the ones that may be more sensitive and to emphasize that the purpose of the experience was for both students to have the opportunity to learn about each other's culture, not only for the nursing student to complete an assignment.
To meet the goals of the clinical experience, the corresponding assignment included aspects of assessment and reflection, demonstrating Campinha-Bacote's concept of cultural awareness and cultural knowledge.6 Before the meeting, the nursing students completed an initial assessment of the background of the cultural group and a reflective journal identifying their thoughts and feelings, any existing prejudices, their concerns about the experience, and their expectations of it. During the meeting, nursing students were given an outline of topics to discuss, including cultural considerations regarding communication, nutrition, spirituality/religion, and health care practices. They also were encouraged to ask additional questions as appropriate. Although they did not complete a physical assessment, students partially demonstrated Campinha-Bacote's concept of cultural skill and cultural encounters.6 After the meeting, the nursing students completed another reflective journal by responding to prompting statements about their thoughts and feelings during the experience. In addition, they participated in a 1-hour postconference about the experience with their peers and the author.
Student Evaluation of Experience
Students who participated in the postconference expressed that they enjoyed the experience and learned more about another culture than they expected, particularly those who met in a larger group because they were able to interact with multiple students and learn more about more than 1 culture. Many students also stated they were now friends on social media, and several expressed an interest in continuing their new friendships. One student commented, "I never thought I would learn this much about another culture in such a short amount of time." Another commented, "This provided a great learning opportunity for both of us[horizontal ellipsis]this is the reason why were able to talk and ask any questions of each other during the 3 hours. We found each other's cultures very interesting that we didn't run out of questions to ask." Although the experience was required for nursing students, their desire to spend more time with members of other cultural groups after the experience demonstrates Campinha-Bacote's concept of cultural desire.6
Lessons Learned
As with any experience done for the first time, the author learned a few lessons to improve the assignment for next time. First, it may be more beneficial to require meetings throughout the semester versus 1 time only as this may give students the opportunity to establish an ongoing relationship and become more comfortable with each other. Second, considering ways to increase the involvement of the international students may make this a more mutually beneficial assignment. Because the nursing students were required to complete the corresponding assignment, they may have been more motivated; however, because it was volunteer only for international students, there may have been less incentive to take the opportunity to learn more about culture through the experience. Collaborating with the Office of International Affairs was essential. Finally, basic safety issues related to meeting a stranger should be discussed. During the postconference, 1 female student shared that she met individually with her matched male student. Rather than meeting at a public location, she picked him up and spent time at a private residence. While nothing negative happened, it was a good reminder to discuss general safety rules when arranging meetings.
Student comments supported the value of this cultural experience. Many nursing students had preconceived notions about specific cultures before participating and were surprised with the information they learned during the experience.
Conclusions
This unique educational approach contributes to the literature about teaching strategies that are useful in teaching cultural competence. Faculty members who struggle to find creative ways to teach students about culture with limited resources may consider using this approach. Creating an engaging cultural experience may be no further than in one's own "campus-yard."
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