- Email: [email protected]
A project to increase educator cultural competence in mentoring at-risk nursing students
Teaching and Learning in Nursing (2015) xx, xxx–xxx
www.jtln.org
A Project to Increase Educator Cultural Competence in Mentoring At-Risk Nursing Students1,2 Debra K. Gibbs DNP, RN a,⁎, Alicia L. Culleiton DNP, RN, CNE b, 3 a b
Angelina College, P.O. Box 1768, Lufkin, TX, United States, 75902 Duquesne University School of Nursing, 600 Forbes Avenue, 531 Fisher Hall, Pittsburgh, PA, United States, 15282 KEYWORDS: Cultural competence Mentoring Nursing education
Abstract The purpose of this pilot project was to enhance faculty cultural competency in mentoring diverse students. The project was based upon Dr. Campinha-Bacote's Process of Cultural Competence in the Delivery of Healthcare Services model. A pretest–posttest design measured educator cultural competency in mentoring using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals for Mentoring (IAPCC-M). Fisher's analysis revealed a statistically significant increase in educator cultural competency with a two-tailed P value of 0.0011. © 2015 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Texas joins the nation in facing a critical registered nurse shortage, and nursing programs have been challenged to increase graduates fourfold by 2020 (Texas Team, 2009). To meet the challenges of a continued nursing shortage, the retention of students enrolled in schools of nursing is essential (Williams, 2010). Although there are no national attrition rate statistics, racial/ethnic minority students have higher rates of attrition than do their peers in nursing programs (Bednarz, Schim, & Doorenbos, 2010). Educators that are open to diversity and provide culturally sensitive learning opportunities that is respectful of the differences of others will improve the retention of students (Bednarz et al., 2010; Dewald, 2012). One way to enhance cultural 1 Grant/Financial: There has been no significant financial support for this work that could have influenced its outcome. 2 This article has been previously submitted to Teaching and Learning in Nursing; this is the revised manuscript for publication and is not under consideration for publication elsewhere. ⁎ Corresponding author. Tel.: + 1 936 633 4507; fax: +1 936 633 5241. E-mail addresses: [email protected] (D.K. Gibbs), [email protected] (A.L. Culleiton) 3 Tel.: +1 412 396 6547.
congruence is to increase the cultural competency of nurse educators and nursing students throughout all aspects of nursing programs (Jeffreys, 2010). The question guiding this faculty enrichment project is “For associate degree nursing faculty, what is the effect of computer-based modular education on cultural competency in mentoring the at-risk nursing student?”
1. Background The ongoing nursing shortage intensifies the urgency to increase the retention of students currently enrolled in nursing programs. Enrollment has increased for all demographic groups in nursing programs; however, completion rates persistently remain low (Baum, Ma, & Payea, 2013). The highest attrition typically occurs within the first year of a nursing program (Chen & Voyles, 2013; Williams, 2010). Research describes factors including age, gender, English as a second language (ESL) or additional language, employment status, critical thinking skills, personality, self-efficacy, and academic engagement/support as key to academic performance (Pitt, Powis, Levett-Jones, & Hunter, 2012).
http://dx.doi.org/10.1016/j.teln.2016.01.003 1557-3087/© 2015 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
2 The early identification of the at-risk student enhances the potential of student success intervention(s) (Harding, 2012; Jeffreys, 2014). A critical shortage of nursing educators presents multiple challenges because traditional and nontraditional students enter nursing school often underprepared. These students may exhibit poor test taking and study skills and may lack an understanding of the rigors of nursing school (Fuller, 2013; Hanover Research, 2011; Pitt et al., 2012). The nurse educator often has advanced degrees; however, they may lack formal preparation or the skills needed for the many facets of the nurse educator role (Schoening, 2013; Zungolo, 2004). Little research exists on the cultural competency of nursing faculty. The nurse educator must possess cultural competence as they interact with cultural diversity and role model culturally sensitive behaviors (Montenery, Jones, Perry, Ross, & Zoucha, 2013). A role responsibility of the faculty at one associate degree nursing program is to provide support to nursing students. Data collected from interviews with faculty suggested that they were uncomfortable with mentoring at-risk students. In addition, the nurse educators expressed feeling insecure in their knowledge of bridges, barriers, and success strategies for the ESL student. The need for early identification of the at-risk student and enhancement of educator cultural competency in mentoring the student at-risk for course or program failure was the impetus for this pilot faculty enrichment project.
D.K. Gibbs, A.L. Culleiton cultural competency as they interact with cultural diversity and role model culturally sensitive behaviors (Montenery et al., 2013). Campinha-Bacote's model of cultural competence in health care delivery is a model that can be used to provide a framework for the development and implementation of cultural competence (Campinha-Bacote, 2010). The multifaceted role of the nurse educator includes teaching, role modeling, and the provision of culturally appropriate care. It is imperative that nurse educators develop cultural competency, cultural sensitivity, and cultural assessment skills to best serve the diverse student population of today. According to Meier (2013), mentoring is a process where a seasoned or more skilled person serves as an advisor, role model, teacher, and/or counselor to a person with less experience or skills for the purpose of personal and/or professional development. The success of at-risk nursing students is dependent upon the use of mentoring in combination with teaching–learning strategies that facilitate student confidence and critical thinking (Corrigan-Magaldi, Colalillo, & Molloy, 2014). Engaging the student in a trusting relationship with an advisor or mentor and early intervention is effective in the enhancement of student retention and improving academic outcomes (Zhang et al., 2014). Faculty workshops and enrichment projects are recommended as a strategy to enhance educator cultural competency and provide mentoring skills needed for the at-risk student (Dudas, 2011; Greenberg, 2013; Harris et al., 2014; Scheele, Pruitt, Johnson, & Xu, 2011; Wilson, Sanner, & McAllister, 2010).
2. Literature Review To meet the health care needs of a diverse population, educators must recruit, retain, and graduate diverse nursing students (Harris, Rosenberg, & O'Rourke, 2014). Early identification and early intervention for the at-risk or nontraditional student is critical to the possibility of maximizing student success interventions and improving academic outcomes (Harding, 2012; Jeffreys, 2014; Zhang, Fei, Quddus, & Davis, 2014). The highest attrition typically occurs within the first year of nursing and often in the first semester (Chen & Voyles, 2013; Williams, 2010). Cultural competency is an imperative for nursing students and nurse educators. Campinha-Bacote (2007) defined cultural competence as “the ongoing process in which the healthcare professional continually strives to achieve the ability and availability to work effectively within the cultural context of the patient (individual, family, community)” (p. 15). A vast amount of literature describes cultural competency of nursing students; however, little research exists on cultural competency of the nurse educator who role model and teach this essential nursing concept. Today's classroom of culturally, academically, linguistically, and generationally diverse students presents the nurse educator with ongoing challenges (Bednarz et al., 2010; Jeffreys, 2014; Loyola, 2010). The nurse educator must possess
3. Methods 3.1. Purpose The purpose of this pilot faculty enrichment project was to enhance faculty cultural competency in mentoring students who are at-risk for course or program failure through a series of four educational modules via the college computer learning management system. The project aims included the enhancement of faculty cultural competence, heighten awareness of personal cultural biases and assumptions, and increase knowledge of barriers and bridges to success of at-risk nursing students.
3.2. Design A pretest–posttest design was used to evaluate faculty development following this pilot faculty enrichment project. The project was implemented in a associate degree nursing (ADN) program in east Texas during the fall semester 2014.
3.3. Sample A convenience sample of ADN nurse educators that teach all levels in the nursing program and the student success specialist
Mentoring at-risk students Table 1
3
Module 1: Cultural Competency.
The process of cultural competence in the delivery of healthcare services constructs 1. Cultural desire • Self-motivation or genuine passion and commitment to engage in the cultural competence process • Respect individual differences and build upon similarities 2. Cultural awareness • Exploration of one's personal values, biases, and prejudices • Always a risk of imposing personal cultural values during an encounter 3. Cultural knowledge • Process of discovering other cultures and various world views • Cultures are continually evolving 4. Cultural skill • The ability to collect relevant cultural data in a sensitive manner • Needed to serve today's diverse and changing population 5. Cultural encounter • A direct interaction occurring with a person from a culturally diverse background • Essentially every encounter is a cultural encounter • Requires self-awareness (Campinha-Bacote, 2007).
was recruited for participation in this enrichment project. Sixteen faculty volunteered to participate, which included 15 females and 1 male (n = 16). No further inclusion criteria were specified. The education modules were available for all faculty to review, regardless of participation in the project.
3.4. Protection of Human Subjects Before project implementation, the investigator verbally introduced the nurse educators to the project. After a clear project overview was provided that included the purpose, goal, and aims, participants were given a consent form to read, discuss, and sign. The participants were asked to complete the consent, demographic, and pretests. The nurse educators could choose to withdraw from the project at any time. The administrative assistant collected project-sensitive material that were then locked in a filing cabinet within the investigator's secure office.
3.5. Instruments Dr. Campinha-Bacote's Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals for Mentoring (IAPCC-M), a 9-item self-assessment instrument was used to measure the level of cultural competency as it relates to the mentoring process (Transcultural C.A.R.E. Associates, 2014). The IAPCC-M was adapted from the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals - Revised (IAPCC-R) that was validated through psychometric testing (Fitzgerald, Cronin, & Campinha-Bacote, 2009). The tool has also been used in nursing to measure nurse educator cultural competency in mentoring (Greenberg, 2013; Wilson et al., 2010). In the study by Wilson et al. (2010), the internal consistency reliability of the IAPCC in a sample of health science faculty was considered high (α = 0.86 pretest
and 0.81 posttest). The tool measures the five cultural constructs of cultural desire, cultural awareness, cultural knowledge, cultural skill, and cultural encounters using a 4-point Likert scale to reflect the response categories of strongly agree = 4 points, agree = 3 points, disagree = 2 points, and strongly disagree = 1 point. Total scores range from 9 to 36 and are indicative of whether faculty are operating at a level of cultural proficiency. Scores from 29 to 33 suggests that the participant is culturally competent, scores from 19 to 28 suggests the participant is culturally aware, and scores ranging 9–18 are suggestive of operating at the culturally incompetent level of cultural competence. In addition, faculty participants who viewed the enrichment modules then completed a project satisfaction survey developed by the project coordinator. The survey used a 4-point Likert scale to reflect the category responses of strongly agree = 4 points, agree = 3 points, disagree = 2 points, and strongly disagree = 1 point. The satisfaction survey included the following: 1. The material covered in the modules will help me fulfill my role responsibility as an at-risk student mentor. 2. The modules were presented over an appropriate time frame. 3. The information presented in the modules met my learning needs. 4. I feel more confident in my role as an ESL/diverse student support person. 5. Overall, I am satisfied with the program.
Additional open-ended questions include the following: 6. What material presented in the learning modules did you find to be most helpful? 7. What recommendation(s) do you have to improve future modules?
The administrative assistant transcribed the responses to ensure anonymity of educator feedback.
4
D.K. Gibbs, A.L. Culleiton
3.6. Procedures Four computer-based, audio-enhanced PowerPoint enrichment modules were developed to deliver the content for this project. Faculty-focused enrichment projects, workshops, and activities that provide learning opportunities that are culturally sensitive were found within the literature to increase cultural competency (Greenberg, 2013; Wilson et al., 2010). In addition, teaching–learning strategies that facilitate different learning styles within the classroom and small group environments increase student success (Bednarz et al., 2010; Harris et al., 2014). The nurse educators had a 6-week time frame to complete the PowerPoint modules. The focus of each module was as follows: • Module #1: Strategies to increase cultural competence • Module #2: Identifying the at-risk student and strategies to promote academic success • Module #3: ESL students barriers and bridges to success • Module #4: Strategies to increase student success.
The IAPCC-M was administered as a pretest/posttest and a postproject satisfaction survey created by the project investigator.
3.7. Module 1 Module 1 defined cultural competence as “the ongoing process in which the healthcare professional continually strives to achieve the ability and availability to work effectively within the cultural context of the patient (individual, family, community)” (Campinha-Bacote, 2007, p. 15). The model of cultural competence by Dr. Campinha-Bacote was presented and provides the theoretical underpinning for this project. According to Campinha-Bacote (2007), the Process of Cultural Competence in the Delivery of Healthcare Services model consists of five constructs that include cultural desire, cultural awareness, cultural knowledge, cultural skill, and cultural encounter (see Table 1). The nurse educators were encouraged to reflect, explore, and complete a self-examination of personal cultural awareness. Nurse educators must develop cultural assessment skills to best serve the diverse student population.
strengths, and weaknesses to enhance the likelihood of success (Jeffreys, 2014). Today's classroom is often multicultural, multiethnic, and multigenerational (Billings & Halstead, 2012). Integration of retention strategies and the use of culturally conscious mentoring throughout the educational process promotes student success (Bednarz et al., 2010; Jeffreys, 2014; Loyola, 2010). The module also stressed the importance of obtaining certified nurse educator as a way to demonstrate professionalism and expertise in the role of nurse educator (National League for Nursing, 2014).
3.9. Module 3 Module 3 focused on ESL student barriers and bridges to success. The literature describes four need areas that include language, culture, academic, and personal challenges (Billings & Halstead, 2012; Hansen & Beaver, 2012; Olson, 2012). Language difficulties are universally mentioned as a primary concern for ESL students and faculty (Billings & Halstead, 2012; Hansen & Beaver, 2012; Olson, 2012). According to the literature, it takes 2 to 3 years to attain basic English interpersonal communications skills and up to 5 to 7 years to acquire the more formal, academic language required for college success (Hansen & Beaver, 2012; Olson, 2012). Both students and faculty may not recognize the need for additional English language training because many ESL students are proficient in basic English communication (Hansen & Beaver, 2012). Bridges to success discussed include peer and faculty support. According to Olson (2012), students that establish a peer relationship with someone that shares the same language, values, and cultural experiences tend to have greater success. The nurse educator can play a key role in the success of the ESL student “by addressing the language issue effectively, but also by increasing their own cultural awareness, sensitivity, and competence” (Olson, 2012, p. 31). As faculty value diversity, respect cultural differences, and adapt teaching or learning styles that complement the various needs of diverse students, bridges to success can be created or strengthened. The classroom provides a perfect environment for nurse educators to teach, role model, and facilitate cultural competence (Billings & Halstead, 2012; Campinha-Bacote, 2010).
3.10. Module 4 3.8. Module 2 Module 2 focused on identifying the at-risk nursing student and strategies for improving student success. The at-risk, diverse, or nontraditional student can be defined as 25 years or older, commutes to school, male, a member of an ethnic or racial minority group, speaks English as a second or additional language, has dependent children, obtained a general equivalency diploma, and/or has required previous remedial coursework (Jeffreys, 2007). This module discussed early identification of the at-risk student by proactively assessing and addressing student needs,
Module four focused on success strategies for the diverse or at-risk nursing student. Various instructional strategies were discussed (see Table 2). The nurse educator tailors the mentoring or coaching experience to the particular student and situation, helping the student overcome anxiety so that their best practice can be demonstrated (Benner, Sutphen, Leonard, & Day, 2010). Coaching and providing feedback can be challenging for educators. Choosing the appropriate questions and strategies are paramount to the student/faculty relationship. Becoming skilled in conducting an assessment in a culturally sensitive manner that acknowledges different
Mentoring at-risk students Table 2
Module 4: Strategies for Success.
5 Table 3
Faculty Participant Demographics.
Strategies for success for diverse or at-risk nursing students Avoid slang and complex language Appropriate use of visual aids Consistent, clear instruction Appropriate time allotted for processing/responding Timely feedback Supportive guidance:
• • • •
Study, test taking, and note-taking skills Prioritization Language development Time management
Tailor coaching/mentoring to the student and/or situation Culturally sensitive student assessment Tailor teaching strategies considering:
• • • • • •
Learner diversity Various learning styles Amount of time available Room size Equipment available Number of students
Student engagement
• Use of technology • Simulated experiences • Unfolding case studies (Bednarz et al., 2010; Benner et al., 2010; Billings & Halstead, 2012; Campinha-Bacote, 2007; Fuller, 2013).
cultures and ethnicities is a skill the professional nurse educator seeks to master (Campinha-Bacote, 2007). In addition, the cognitive load theory was briefly reviewed, and faculty were encouraged to consider the cognitive load with regard to the ESL student and their ability to successfully process information into working memory.
3.11. Demographics The faculty demographic data that were collected addressed gender, age, marital status, highest level of education obtained, ethnicity, cultural competence continuing education, and continuing education with regard to mentoring and/or advising (see Table 3). This diverse group (n = 16) is comprised of 25% ethnic minority background and includes one male educator. The majority of nurse educators have not completed previous continuing education with regard to cultural competence and mentoring/advising.
4. Results The project included a convenience sample of 16 nurse educators (n = 16). Because of the small sample size, Fisher's analysis was used to test the null hypothesis that the probability of increasing cultural competency is the same whether one participated in the faculty enrichment project. Fisher's analysis was used to examine the educator's level of cultural competence as a group, comparing pre- and postproject item responses on the IAPCC-M survey. The
Gender Age
Marital status
Highest level education
Ethnicity
Cultural competence continuing education Mentoring/Advising continuing education
Demographic data
(n = 16)
%
Male Female 26–34 35–54 55–64 65 and over Single, never married Married with children Divorced Widowed Bachelor degree Masters degree Doctoral degree Asian African American Hispanic White; non-Hispanic Yes No Yes No
1 15 2 9 4 1 1 11 3 1 1 13 2 1 2 1 12 4 12 6 10
6 94 13 56 25 6 6 69 19 6 6 81 13 6 13 6 75 25 75 38 62
percentage of faculty who were culturally incompetent, culturally aware, culturally competent, and culturally proficient was measured pre- and postproject.
5. Summary of Findings The IAPCC-M was used to evaluate the effectiveness of the project in enhancing faculty cultural competence, which is instrumental in mentoring at-risk nursing students. This measurement tool uses four levels of cultural competence scores ranging from culturally incompetent, culturally aware, culturally competent, to culturally proficient. For analysis purposes, the levels of cultural competence were dichotomized to culturally incompetent/culturally aware and culturally competent/culturally proficient. Data collected preproject was compared to postproject results. Fisher's analysis indicates the association between the two groups, and the project outcomes are considered statistically significant with a two-tailed P value equal to 0.0011 (see Table 4). Preproject, no faculty self-assessed themselves as culturally proficient. The majority of faculty (81%) were culturally aware, and 19% were culturally competent preproject. Postproject, 31% of faculty evaluated themselves as culturally proficient, 50% were culturally competent, and 19% were considered culturally aware (see Table 5). Faculty responses to the project satisfaction survey revealed that all faculty agreed or strongly agreed that the material within the modules is helpful in fulfilling their role as an at-risk student mentor. The remaining survey responses included appropriateness of the time frame the project was presented, project information met faculty's learning needs, increased confidence in faculty role as ESL student support person, and overall project satisfaction. Analysis of the
6
D.K. Gibbs, A.L. Culleiton Table 4
IAPCC-M Results. Pretest total (n = 16)
Posttest total (n = 16)
Results
Level of cultural competence
Number of educators
Percentage of educators (%)
Number of educators
Percentage of educators (%)
Two-tailed P value
Culturally incompetent/culturally aware Culturally competent/culturally proficient
13 3
81% 19%
3 13
19% 81%
0.0011
Summary: Fisher's analysis indicates a significant difference between the groups and outcomes preproject versus postproject.
faculty responses to these items on the tool revealed that 81– 94% strongly agreed or agreed and 6–19% responded as they neither disagreed or agreed. In addition, faculty were presented with an opportunity to provide feedback regarding the material they felt most helpful and what recommendations they would suggest for future learning opportunities. The comments provided by faculty were collected and analyzed with 44% of faculty providing no additional feedback. Faculty responded that the material in the learning modules they found most helpful included suggestions for handling barriers and strategies to assist at-risk students, perceived improved ability to mentor students postproject, and faculty must want to be culturally competent. A few key faculty recommendations to improve future modules included having less photos, adding more links to resources, and dividing future projects into shorter modules.
6. Discussion Classroom and clinical arenas provide a rich environment for nursing faculty to teach and role model cultural competency; however, today's multicultural, multiethnic, and multigenerational student population presents ongoing challenges. Prior to participation in this pilot faculty enrichment project, over 60% of the participants denied having continuing education regarding cultural competency and were culturally aware in the provision of mentoring support to at-risk nursing students. According to CampinhaBacote (2007), the first step toward becoming culturally aware involves the identification of one's personal cultural biases, prejudices, and assumptions that we embrace regarding those persons different from ourselves. The faculty were encouraged to reflect consciously and deliberately on the biases or isms that may lead to the imposition of one's personal cultural values on another during an encounter. Cultural desire is the self-motivation that propels a person to “want to” and not “have to” engage in the cultural competence Table 5
process (Campinha-Bacote, 2007). The pivotal point on the journey toward cultural competency is cultural desire. A challenge the nurse educator faces is to determine specific student barriers to success and employ innovative teaching strategies as a bridge to optimize student performance. The nurse educator that values diversity, respects cultural differences, and adapts teaching strategies that complement the various needs of diverse students can create or strengthen bridges for promoting student success. Early identification of at-risk students is the initial step to augment student success interventions. Proactive strategies are initiated prior to academic difficulty or role conflicts whereby each student is encouraged to perform at his or her best. Early faculty involvement is especially important for the at-risk student who often does not initiate adaptive and/or help-seeking behaviors. Upon completion of this project, nurse educators reported higher levels of cultural competence in mentoring at-risk nursing students. The results of this project support the importance of continuing education that helps the educator on the journey toward cultural competence in mentoring at-risk nursing students.
7. Limitations Several limitations should be considered when interpreting the findings of this project. The project was based on a small number of nurse educator participants and selfreported data of their perceptions; therefore, it is recommended that the project be replicated at larger nursing schools with greater numbers of faculty. In addition, project implementation and timing of postproject testing and evaluation may be considered as limitations. The project was implemented the last 8 weeks of the semester; therefore, early identification and proactive strategies for success were initiated late rather than early in the semester. The early identification of at-risk students enhances the possibility of student success interventions.
Group Summary Level of Cultural Competence (n = 16).
n = 16Culturally incompetent (9–18 points)
Culturally aware (19–28 points)
Culturally competent (29–33 points)
Culturally proficient (34–36 points)
Preproject Postproject
81% (13) 19 % (3)
19% (3) 50 % (8)
31% (5)
Summary: The majority (81%) of faculty were culturally aware preproject. Upon project completion, 50% of faculty were culturally competent and 31% culturally proficient.
Mentoring at-risk students In addition, postproject testing and qualitative evaluation was completed following the final faculty meeting of the semester. The meeting was lengthy and included discussion of several topics that were debated. The time frame and nature of the meeting may have resulted in fewer faculty completing the qualitative portion of the project evaluation. One educator mentioned a need to pick her children up from school. Another faculty participant stated, “I just cannot think! I am exhausted and am ready to start Christmas break.” Lastly, this diverse group of nurse educator participants in this ADN program are 25% minority and include a male. The at-risk student population of this program ranges from 25% to 40%; therefore, the results of this study may not be generalized to other programs.
8. Conclusion In conclusion, cultural competency is a lifelong journey the nurse is continually striving to achieve. A pivotal point in the process of cultural competency is cultural desire. An individual must be personally motivated to engage in the process of cultural competence, and it is important for the nurse educator to reflect on their personal cultural competency knowledge, cultural awareness skills, and comfort in assessing and mentoring the diverse or at-risk student. As the student population of today becomes increasingly diverse and academically at risk, faculty education in cultural competency and mentoring is essential. The IAPCC-M assessment tool provided a lens to interpret the impact of this nurse educator enrichment project on the development of cultural competency in mentoring the at-risk nursing student. The faculty participants in the project self-reported significantly improved cultural competency in mentoring at-risk students. In addition, faculty participants reported an increased confidence and knowledge in their role as an at-risk nursing student mentor. Implementing the project in the last half of the semester did not provide the faculty with time to identify the at-risk student, implement strategies for success early, and had little to no influence on student retention/attrition. Based upon the total scores from the IAPCC-M and the faculty's project evaluation, computer-based learning modules are an effective approach to provide additional knowledge and evidence-based teaching strategies educators can use in classroom, clinical, and small group environments to enhance success of the at-risk nursing student. Meeting the learning needs of the diverse students increases the likelihood of their academic success and possible workforce entry.
References Baum, S., Ma, J., & Payea, K. (2013). Education pays 2013: The benefits of higher education for individuals and society. Retrieved from http:// trends.collegeboard.org/sites/default/files/education-pays-2013-fullreport.pdf.
7 Bednarz, H., Schim, S., & Doorenbos, A. (2010). Cultural diversity in nursing education: Perils, pitfalls, and pearls. Journal of Nursing Education, 49(5), 253−260, http://dx.doi.org/10.3928/0148483420100115-02. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass. Billings, D. M., & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty, 4th ed. St. Louis, MO: Elsevier. Campinha-Bacote, J. (2007). The process of cultural competence in the delivery of healthcare services: The journey continues, 5th ed. Cincinnati, OH: Transcultural C.A.R.E. Associates. Campinha-Bacote, J. (2010). A culturally conscious model of mentoring. Nurse Educator, 35(3), 130−135, http://dx.doi.org/10.1097/ NNE.0b013e3181d950bf. Chen, S., & Voyles, D. (2013). HESI admission assessment scores: Predicting student success. Journal of Professional Nursing, 29(5), S32−S37, http://dx.doi.org/10.1016/j.profnurs.2012.06.008. Corrigan-Magaldi, M., Colalillo, G., & Molloy, J. (2014). Faculty-facilitated remediation: A model to transform at-risk students. Nurse Educator, 39(4), 155−157, http://dx.doi.org/10.1097/NNE.0000000000000043. Dewald, R. J. (2012). Teaching strategies that promote a culturally sensitive nursing education. Nursing Education Perspectives, 33(6), 410−412, http://dx.doi.org/10.5480/1536-5026-33.6.410. Dudas, K. (2011). Strategies to improve NCLEX® style testing in students who speak English as an additional language. The Online Journal of Cultural Competence in Nursing and Healthcare, 1(2), 14−23. Fitzgerald, E. M., Cronin, S. N., & Campinha-Bacote, J. (2009). Psychometric testing of the inventory for assessing the process of cultural competence among healthcare professionals - student version (IAPCC-SV©). Journal of Theory Construction and Testing, 13(2), 64−68. Fuller, B. (2013). Evidence-based instructional strategies: Facilitating linguistically diverse nursing student learning. Nurse Educator, 38(3), 118−121, http://dx.doi.org/10.1097/NNE. 0b013e31828dc2c3. Greenberg, N. E. (2013). A project to increase faculty's cultural competence in mentoring English as a second language nursing students. Teaching and Learning in Nursing, 8(4), 128−135, http://dx.doi.org/10.1016/ j.teln.2013.07.003. Hanover Research (2011). Improving student retention and graduation rates. Retrieved from Hanover Research http://www.mybrcc.edu/ intranet/attachments/article/110/Improving%20Student%20Retention %20and%20Graduation%20Rates.pdf. Hansen, E., & Beaver, S. (2012). Faculty support for ESL nursing students: Action plan for success. Nursing Education Perspectives, 33(4), 246−250, http://dx.doi.org/10.5480/1536-5026-33.4.246. Harding, M. (2012). Efficacy of supplemental instruction to enhance student success. Teaching and Learning in Nursing, 7(1), 27−31, http:// dx.doi.org/10.1016/j.teln.2011.07.002. Harris, R. C., Rosenberg, L., & O'Rourke, M. E. (2014). Addressing the challenges of nursing student attrition., 53(1), 31−37, http://dx.doi.org/ 10.3928/01484834-20131218-03. Jeffreys, M. R. (2007). Tracking students through program entry, progression, graduation, and licensure: Assessing undergraduate nursing student retention and success. Nurse Education Today, 7(5), 406−419, http://dx.doi.org/10.1016/j.nedt.2006.07.003. Jeffreys, M. R. (2010). Teaching cultural competence in nursing and health care: Inquiry, action, and innovation, 2nd ed. New York, NY: Springer. Jeffreys, M. R. (2014). Student retention and success: Optimizing outcomes through holistic competence and proactive inclusive enrichment. Teaching and Learning in Nursing, 9(4), 164−170, http://dx.doi.org/ 10.1016/j.teln.2014.05.003. Loyola, S. (2010). Evidence-based teaching guidelines: Transforming knowledge into practice for better outcomes in healthcare. Critical Care Nursing Quarterly, 33(1), 19−32, http://dx.doi.org/10.1097/ CNQ.0b013e3181c8e309. Meier, S. R. (2013). Concept analysis of mentoring. Advances in Neonatal Care, 13(5), 341−345, http://dx.doi.org/10.1097/ANC.0b013e3182a14ca4.
8 Montenery, S. M., Jones, A. D., Perry, N., Ross, D., & Zoucha, R. (2013). Cultural competence in nursing faculty: A journey, not a destination. Journal of Professional Nursing, 29(6), e51−e57, http://dx.doi.org/ 10.1016/j.profnurs.2013.09.003. National League for Nursing (2014). Certified nurse educator (CNE) 2014 candidate handbook. Retrieved from National League for Nursing http:// www.nln.org/certification/handbook/cne.pdf. Olson, M. A. (2012). English-as-a-second language (ESL) nursing student success: A critical review of the literature. Journal of Cultural Diversity, 19(1), 26−32. Pitt, V., Powis, D., Levett-Jones, T., & Hunter, S. (2012). Factors influencing nursing students' academic and clinical performance and attrition: An integrative literature review. Nurse Education Today, 32(8), 903−913, http://dx.doi.org/10.1016/j.nedt.2012.04.011. Scheele, T. H., Pruitt, R., Johnson, A., & Xu, Y. (2011). What do we know about educating Asian ESL nursing students?: A literature review. Nursing Education Perspectives, 32(4), 244−249. Schoening, A. M. (2013). From bedside to classroom: The nurse educator transition model. Nursing Education Perspectives, 34(3), 167−172, http://dx.doi.org/10.5480/1536-5026-34.3.167.
D.K. Gibbs, A.L. Culleiton Texas Team (2009). Texas nursing: Our future depends on it. A strategic plan for the state of Texas to meet nursing workforce needs of 2013. Retrieved from Texas Department of State Health Services http://www. dshs.state.tx.us/chs/cnws/texasteam/texasstrategy.pdf. Transcultural C.A.R.E. Associates (2014). Inventory for assessing the process of cultural competence among healthcare professionals in mentoring (IAPCC-M©). Retrieved from Transcultural C.A.R.E. Associates http://transculturalcare.net/iapcc-m.htm. Williams, M. G. (2010). Attrition and retention in the nursing major: Understanding persistence in beginning nursing students. Nursing Education Perspectives, 31(6), 362−367. Wilson, A. H., Sanner, S., & McAllister, L. E. (2010). A longitudinal study of cultural competence among health science faculty. Journal of Cultural Diversity, 17(2), 68−72. Zhang, Y., Fei, Q., Quddus, M., & Davis, C. (2014). An examination of the impact of early intervention on learning outcomes of at-risk students. Research in Higher Education, 26, 1−12. Zungolo, E. (2004). Faculty preparation: Is clinical specialization a benefit or a deterrent to quality nursing education? The Journal of Continuing Education in Nursing, 35(1), 19−23.
www.jtln.org
A Project to Increase Educator Cultural Competence in Mentoring At-Risk Nursing Students1,2 Debra K. Gibbs DNP, RN a,⁎, Alicia L. Culleiton DNP, RN, CNE b, 3 a b
Angelina College, P.O. Box 1768, Lufkin, TX, United States, 75902 Duquesne University School of Nursing, 600 Forbes Avenue, 531 Fisher Hall, Pittsburgh, PA, United States, 15282 KEYWORDS: Cultural competence Mentoring Nursing education
Abstract The purpose of this pilot project was to enhance faculty cultural competency in mentoring diverse students. The project was based upon Dr. Campinha-Bacote's Process of Cultural Competence in the Delivery of Healthcare Services model. A pretest–posttest design measured educator cultural competency in mentoring using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals for Mentoring (IAPCC-M). Fisher's analysis revealed a statistically significant increase in educator cultural competency with a two-tailed P value of 0.0011. © 2015 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Texas joins the nation in facing a critical registered nurse shortage, and nursing programs have been challenged to increase graduates fourfold by 2020 (Texas Team, 2009). To meet the challenges of a continued nursing shortage, the retention of students enrolled in schools of nursing is essential (Williams, 2010). Although there are no national attrition rate statistics, racial/ethnic minority students have higher rates of attrition than do their peers in nursing programs (Bednarz, Schim, & Doorenbos, 2010). Educators that are open to diversity and provide culturally sensitive learning opportunities that is respectful of the differences of others will improve the retention of students (Bednarz et al., 2010; Dewald, 2012). One way to enhance cultural 1 Grant/Financial: There has been no significant financial support for this work that could have influenced its outcome. 2 This article has been previously submitted to Teaching and Learning in Nursing; this is the revised manuscript for publication and is not under consideration for publication elsewhere. ⁎ Corresponding author. Tel.: + 1 936 633 4507; fax: +1 936 633 5241. E-mail addresses: [email protected] (D.K. Gibbs), [email protected] (A.L. Culleiton) 3 Tel.: +1 412 396 6547.
congruence is to increase the cultural competency of nurse educators and nursing students throughout all aspects of nursing programs (Jeffreys, 2010). The question guiding this faculty enrichment project is “For associate degree nursing faculty, what is the effect of computer-based modular education on cultural competency in mentoring the at-risk nursing student?”
1. Background The ongoing nursing shortage intensifies the urgency to increase the retention of students currently enrolled in nursing programs. Enrollment has increased for all demographic groups in nursing programs; however, completion rates persistently remain low (Baum, Ma, & Payea, 2013). The highest attrition typically occurs within the first year of a nursing program (Chen & Voyles, 2013; Williams, 2010). Research describes factors including age, gender, English as a second language (ESL) or additional language, employment status, critical thinking skills, personality, self-efficacy, and academic engagement/support as key to academic performance (Pitt, Powis, Levett-Jones, & Hunter, 2012).
http://dx.doi.org/10.1016/j.teln.2016.01.003 1557-3087/© 2015 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
2 The early identification of the at-risk student enhances the potential of student success intervention(s) (Harding, 2012; Jeffreys, 2014). A critical shortage of nursing educators presents multiple challenges because traditional and nontraditional students enter nursing school often underprepared. These students may exhibit poor test taking and study skills and may lack an understanding of the rigors of nursing school (Fuller, 2013; Hanover Research, 2011; Pitt et al., 2012). The nurse educator often has advanced degrees; however, they may lack formal preparation or the skills needed for the many facets of the nurse educator role (Schoening, 2013; Zungolo, 2004). Little research exists on the cultural competency of nursing faculty. The nurse educator must possess cultural competence as they interact with cultural diversity and role model culturally sensitive behaviors (Montenery, Jones, Perry, Ross, & Zoucha, 2013). A role responsibility of the faculty at one associate degree nursing program is to provide support to nursing students. Data collected from interviews with faculty suggested that they were uncomfortable with mentoring at-risk students. In addition, the nurse educators expressed feeling insecure in their knowledge of bridges, barriers, and success strategies for the ESL student. The need for early identification of the at-risk student and enhancement of educator cultural competency in mentoring the student at-risk for course or program failure was the impetus for this pilot faculty enrichment project.
D.K. Gibbs, A.L. Culleiton cultural competency as they interact with cultural diversity and role model culturally sensitive behaviors (Montenery et al., 2013). Campinha-Bacote's model of cultural competence in health care delivery is a model that can be used to provide a framework for the development and implementation of cultural competence (Campinha-Bacote, 2010). The multifaceted role of the nurse educator includes teaching, role modeling, and the provision of culturally appropriate care. It is imperative that nurse educators develop cultural competency, cultural sensitivity, and cultural assessment skills to best serve the diverse student population of today. According to Meier (2013), mentoring is a process where a seasoned or more skilled person serves as an advisor, role model, teacher, and/or counselor to a person with less experience or skills for the purpose of personal and/or professional development. The success of at-risk nursing students is dependent upon the use of mentoring in combination with teaching–learning strategies that facilitate student confidence and critical thinking (Corrigan-Magaldi, Colalillo, & Molloy, 2014). Engaging the student in a trusting relationship with an advisor or mentor and early intervention is effective in the enhancement of student retention and improving academic outcomes (Zhang et al., 2014). Faculty workshops and enrichment projects are recommended as a strategy to enhance educator cultural competency and provide mentoring skills needed for the at-risk student (Dudas, 2011; Greenberg, 2013; Harris et al., 2014; Scheele, Pruitt, Johnson, & Xu, 2011; Wilson, Sanner, & McAllister, 2010).
2. Literature Review To meet the health care needs of a diverse population, educators must recruit, retain, and graduate diverse nursing students (Harris, Rosenberg, & O'Rourke, 2014). Early identification and early intervention for the at-risk or nontraditional student is critical to the possibility of maximizing student success interventions and improving academic outcomes (Harding, 2012; Jeffreys, 2014; Zhang, Fei, Quddus, & Davis, 2014). The highest attrition typically occurs within the first year of nursing and often in the first semester (Chen & Voyles, 2013; Williams, 2010). Cultural competency is an imperative for nursing students and nurse educators. Campinha-Bacote (2007) defined cultural competence as “the ongoing process in which the healthcare professional continually strives to achieve the ability and availability to work effectively within the cultural context of the patient (individual, family, community)” (p. 15). A vast amount of literature describes cultural competency of nursing students; however, little research exists on cultural competency of the nurse educator who role model and teach this essential nursing concept. Today's classroom of culturally, academically, linguistically, and generationally diverse students presents the nurse educator with ongoing challenges (Bednarz et al., 2010; Jeffreys, 2014; Loyola, 2010). The nurse educator must possess
3. Methods 3.1. Purpose The purpose of this pilot faculty enrichment project was to enhance faculty cultural competency in mentoring students who are at-risk for course or program failure through a series of four educational modules via the college computer learning management system. The project aims included the enhancement of faculty cultural competence, heighten awareness of personal cultural biases and assumptions, and increase knowledge of barriers and bridges to success of at-risk nursing students.
3.2. Design A pretest–posttest design was used to evaluate faculty development following this pilot faculty enrichment project. The project was implemented in a associate degree nursing (ADN) program in east Texas during the fall semester 2014.
3.3. Sample A convenience sample of ADN nurse educators that teach all levels in the nursing program and the student success specialist
Mentoring at-risk students Table 1
3
Module 1: Cultural Competency.
The process of cultural competence in the delivery of healthcare services constructs 1. Cultural desire • Self-motivation or genuine passion and commitment to engage in the cultural competence process • Respect individual differences and build upon similarities 2. Cultural awareness • Exploration of one's personal values, biases, and prejudices • Always a risk of imposing personal cultural values during an encounter 3. Cultural knowledge • Process of discovering other cultures and various world views • Cultures are continually evolving 4. Cultural skill • The ability to collect relevant cultural data in a sensitive manner • Needed to serve today's diverse and changing population 5. Cultural encounter • A direct interaction occurring with a person from a culturally diverse background • Essentially every encounter is a cultural encounter • Requires self-awareness (Campinha-Bacote, 2007).
was recruited for participation in this enrichment project. Sixteen faculty volunteered to participate, which included 15 females and 1 male (n = 16). No further inclusion criteria were specified. The education modules were available for all faculty to review, regardless of participation in the project.
3.4. Protection of Human Subjects Before project implementation, the investigator verbally introduced the nurse educators to the project. After a clear project overview was provided that included the purpose, goal, and aims, participants were given a consent form to read, discuss, and sign. The participants were asked to complete the consent, demographic, and pretests. The nurse educators could choose to withdraw from the project at any time. The administrative assistant collected project-sensitive material that were then locked in a filing cabinet within the investigator's secure office.
3.5. Instruments Dr. Campinha-Bacote's Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals for Mentoring (IAPCC-M), a 9-item self-assessment instrument was used to measure the level of cultural competency as it relates to the mentoring process (Transcultural C.A.R.E. Associates, 2014). The IAPCC-M was adapted from the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals - Revised (IAPCC-R) that was validated through psychometric testing (Fitzgerald, Cronin, & Campinha-Bacote, 2009). The tool has also been used in nursing to measure nurse educator cultural competency in mentoring (Greenberg, 2013; Wilson et al., 2010). In the study by Wilson et al. (2010), the internal consistency reliability of the IAPCC in a sample of health science faculty was considered high (α = 0.86 pretest
and 0.81 posttest). The tool measures the five cultural constructs of cultural desire, cultural awareness, cultural knowledge, cultural skill, and cultural encounters using a 4-point Likert scale to reflect the response categories of strongly agree = 4 points, agree = 3 points, disagree = 2 points, and strongly disagree = 1 point. Total scores range from 9 to 36 and are indicative of whether faculty are operating at a level of cultural proficiency. Scores from 29 to 33 suggests that the participant is culturally competent, scores from 19 to 28 suggests the participant is culturally aware, and scores ranging 9–18 are suggestive of operating at the culturally incompetent level of cultural competence. In addition, faculty participants who viewed the enrichment modules then completed a project satisfaction survey developed by the project coordinator. The survey used a 4-point Likert scale to reflect the category responses of strongly agree = 4 points, agree = 3 points, disagree = 2 points, and strongly disagree = 1 point. The satisfaction survey included the following: 1. The material covered in the modules will help me fulfill my role responsibility as an at-risk student mentor. 2. The modules were presented over an appropriate time frame. 3. The information presented in the modules met my learning needs. 4. I feel more confident in my role as an ESL/diverse student support person. 5. Overall, I am satisfied with the program.
Additional open-ended questions include the following: 6. What material presented in the learning modules did you find to be most helpful? 7. What recommendation(s) do you have to improve future modules?
The administrative assistant transcribed the responses to ensure anonymity of educator feedback.
4
D.K. Gibbs, A.L. Culleiton
3.6. Procedures Four computer-based, audio-enhanced PowerPoint enrichment modules were developed to deliver the content for this project. Faculty-focused enrichment projects, workshops, and activities that provide learning opportunities that are culturally sensitive were found within the literature to increase cultural competency (Greenberg, 2013; Wilson et al., 2010). In addition, teaching–learning strategies that facilitate different learning styles within the classroom and small group environments increase student success (Bednarz et al., 2010; Harris et al., 2014). The nurse educators had a 6-week time frame to complete the PowerPoint modules. The focus of each module was as follows: • Module #1: Strategies to increase cultural competence • Module #2: Identifying the at-risk student and strategies to promote academic success • Module #3: ESL students barriers and bridges to success • Module #4: Strategies to increase student success.
The IAPCC-M was administered as a pretest/posttest and a postproject satisfaction survey created by the project investigator.
3.7. Module 1 Module 1 defined cultural competence as “the ongoing process in which the healthcare professional continually strives to achieve the ability and availability to work effectively within the cultural context of the patient (individual, family, community)” (Campinha-Bacote, 2007, p. 15). The model of cultural competence by Dr. Campinha-Bacote was presented and provides the theoretical underpinning for this project. According to Campinha-Bacote (2007), the Process of Cultural Competence in the Delivery of Healthcare Services model consists of five constructs that include cultural desire, cultural awareness, cultural knowledge, cultural skill, and cultural encounter (see Table 1). The nurse educators were encouraged to reflect, explore, and complete a self-examination of personal cultural awareness. Nurse educators must develop cultural assessment skills to best serve the diverse student population.
strengths, and weaknesses to enhance the likelihood of success (Jeffreys, 2014). Today's classroom is often multicultural, multiethnic, and multigenerational (Billings & Halstead, 2012). Integration of retention strategies and the use of culturally conscious mentoring throughout the educational process promotes student success (Bednarz et al., 2010; Jeffreys, 2014; Loyola, 2010). The module also stressed the importance of obtaining certified nurse educator as a way to demonstrate professionalism and expertise in the role of nurse educator (National League for Nursing, 2014).
3.9. Module 3 Module 3 focused on ESL student barriers and bridges to success. The literature describes four need areas that include language, culture, academic, and personal challenges (Billings & Halstead, 2012; Hansen & Beaver, 2012; Olson, 2012). Language difficulties are universally mentioned as a primary concern for ESL students and faculty (Billings & Halstead, 2012; Hansen & Beaver, 2012; Olson, 2012). According to the literature, it takes 2 to 3 years to attain basic English interpersonal communications skills and up to 5 to 7 years to acquire the more formal, academic language required for college success (Hansen & Beaver, 2012; Olson, 2012). Both students and faculty may not recognize the need for additional English language training because many ESL students are proficient in basic English communication (Hansen & Beaver, 2012). Bridges to success discussed include peer and faculty support. According to Olson (2012), students that establish a peer relationship with someone that shares the same language, values, and cultural experiences tend to have greater success. The nurse educator can play a key role in the success of the ESL student “by addressing the language issue effectively, but also by increasing their own cultural awareness, sensitivity, and competence” (Olson, 2012, p. 31). As faculty value diversity, respect cultural differences, and adapt teaching or learning styles that complement the various needs of diverse students, bridges to success can be created or strengthened. The classroom provides a perfect environment for nurse educators to teach, role model, and facilitate cultural competence (Billings & Halstead, 2012; Campinha-Bacote, 2010).
3.10. Module 4 3.8. Module 2 Module 2 focused on identifying the at-risk nursing student and strategies for improving student success. The at-risk, diverse, or nontraditional student can be defined as 25 years or older, commutes to school, male, a member of an ethnic or racial minority group, speaks English as a second or additional language, has dependent children, obtained a general equivalency diploma, and/or has required previous remedial coursework (Jeffreys, 2007). This module discussed early identification of the at-risk student by proactively assessing and addressing student needs,
Module four focused on success strategies for the diverse or at-risk nursing student. Various instructional strategies were discussed (see Table 2). The nurse educator tailors the mentoring or coaching experience to the particular student and situation, helping the student overcome anxiety so that their best practice can be demonstrated (Benner, Sutphen, Leonard, & Day, 2010). Coaching and providing feedback can be challenging for educators. Choosing the appropriate questions and strategies are paramount to the student/faculty relationship. Becoming skilled in conducting an assessment in a culturally sensitive manner that acknowledges different
Mentoring at-risk students Table 2
Module 4: Strategies for Success.
5 Table 3
Faculty Participant Demographics.
Strategies for success for diverse or at-risk nursing students Avoid slang and complex language Appropriate use of visual aids Consistent, clear instruction Appropriate time allotted for processing/responding Timely feedback Supportive guidance:
• • • •
Study, test taking, and note-taking skills Prioritization Language development Time management
Tailor coaching/mentoring to the student and/or situation Culturally sensitive student assessment Tailor teaching strategies considering:
• • • • • •
Learner diversity Various learning styles Amount of time available Room size Equipment available Number of students
Student engagement
• Use of technology • Simulated experiences • Unfolding case studies (Bednarz et al., 2010; Benner et al., 2010; Billings & Halstead, 2012; Campinha-Bacote, 2007; Fuller, 2013).
cultures and ethnicities is a skill the professional nurse educator seeks to master (Campinha-Bacote, 2007). In addition, the cognitive load theory was briefly reviewed, and faculty were encouraged to consider the cognitive load with regard to the ESL student and their ability to successfully process information into working memory.
3.11. Demographics The faculty demographic data that were collected addressed gender, age, marital status, highest level of education obtained, ethnicity, cultural competence continuing education, and continuing education with regard to mentoring and/or advising (see Table 3). This diverse group (n = 16) is comprised of 25% ethnic minority background and includes one male educator. The majority of nurse educators have not completed previous continuing education with regard to cultural competence and mentoring/advising.
4. Results The project included a convenience sample of 16 nurse educators (n = 16). Because of the small sample size, Fisher's analysis was used to test the null hypothesis that the probability of increasing cultural competency is the same whether one participated in the faculty enrichment project. Fisher's analysis was used to examine the educator's level of cultural competence as a group, comparing pre- and postproject item responses on the IAPCC-M survey. The
Gender Age
Marital status
Highest level education
Ethnicity
Cultural competence continuing education Mentoring/Advising continuing education
Demographic data
(n = 16)
%
Male Female 26–34 35–54 55–64 65 and over Single, never married Married with children Divorced Widowed Bachelor degree Masters degree Doctoral degree Asian African American Hispanic White; non-Hispanic Yes No Yes No
1 15 2 9 4 1 1 11 3 1 1 13 2 1 2 1 12 4 12 6 10
6 94 13 56 25 6 6 69 19 6 6 81 13 6 13 6 75 25 75 38 62
percentage of faculty who were culturally incompetent, culturally aware, culturally competent, and culturally proficient was measured pre- and postproject.
5. Summary of Findings The IAPCC-M was used to evaluate the effectiveness of the project in enhancing faculty cultural competence, which is instrumental in mentoring at-risk nursing students. This measurement tool uses four levels of cultural competence scores ranging from culturally incompetent, culturally aware, culturally competent, to culturally proficient. For analysis purposes, the levels of cultural competence were dichotomized to culturally incompetent/culturally aware and culturally competent/culturally proficient. Data collected preproject was compared to postproject results. Fisher's analysis indicates the association between the two groups, and the project outcomes are considered statistically significant with a two-tailed P value equal to 0.0011 (see Table 4). Preproject, no faculty self-assessed themselves as culturally proficient. The majority of faculty (81%) were culturally aware, and 19% were culturally competent preproject. Postproject, 31% of faculty evaluated themselves as culturally proficient, 50% were culturally competent, and 19% were considered culturally aware (see Table 5). Faculty responses to the project satisfaction survey revealed that all faculty agreed or strongly agreed that the material within the modules is helpful in fulfilling their role as an at-risk student mentor. The remaining survey responses included appropriateness of the time frame the project was presented, project information met faculty's learning needs, increased confidence in faculty role as ESL student support person, and overall project satisfaction. Analysis of the
6
D.K. Gibbs, A.L. Culleiton Table 4
IAPCC-M Results. Pretest total (n = 16)
Posttest total (n = 16)
Results
Level of cultural competence
Number of educators
Percentage of educators (%)
Number of educators
Percentage of educators (%)
Two-tailed P value
Culturally incompetent/culturally aware Culturally competent/culturally proficient
13 3
81% 19%
3 13
19% 81%
0.0011
Summary: Fisher's analysis indicates a significant difference between the groups and outcomes preproject versus postproject.
faculty responses to these items on the tool revealed that 81– 94% strongly agreed or agreed and 6–19% responded as they neither disagreed or agreed. In addition, faculty were presented with an opportunity to provide feedback regarding the material they felt most helpful and what recommendations they would suggest for future learning opportunities. The comments provided by faculty were collected and analyzed with 44% of faculty providing no additional feedback. Faculty responded that the material in the learning modules they found most helpful included suggestions for handling barriers and strategies to assist at-risk students, perceived improved ability to mentor students postproject, and faculty must want to be culturally competent. A few key faculty recommendations to improve future modules included having less photos, adding more links to resources, and dividing future projects into shorter modules.
6. Discussion Classroom and clinical arenas provide a rich environment for nursing faculty to teach and role model cultural competency; however, today's multicultural, multiethnic, and multigenerational student population presents ongoing challenges. Prior to participation in this pilot faculty enrichment project, over 60% of the participants denied having continuing education regarding cultural competency and were culturally aware in the provision of mentoring support to at-risk nursing students. According to CampinhaBacote (2007), the first step toward becoming culturally aware involves the identification of one's personal cultural biases, prejudices, and assumptions that we embrace regarding those persons different from ourselves. The faculty were encouraged to reflect consciously and deliberately on the biases or isms that may lead to the imposition of one's personal cultural values on another during an encounter. Cultural desire is the self-motivation that propels a person to “want to” and not “have to” engage in the cultural competence Table 5
process (Campinha-Bacote, 2007). The pivotal point on the journey toward cultural competency is cultural desire. A challenge the nurse educator faces is to determine specific student barriers to success and employ innovative teaching strategies as a bridge to optimize student performance. The nurse educator that values diversity, respects cultural differences, and adapts teaching strategies that complement the various needs of diverse students can create or strengthen bridges for promoting student success. Early identification of at-risk students is the initial step to augment student success interventions. Proactive strategies are initiated prior to academic difficulty or role conflicts whereby each student is encouraged to perform at his or her best. Early faculty involvement is especially important for the at-risk student who often does not initiate adaptive and/or help-seeking behaviors. Upon completion of this project, nurse educators reported higher levels of cultural competence in mentoring at-risk nursing students. The results of this project support the importance of continuing education that helps the educator on the journey toward cultural competence in mentoring at-risk nursing students.
7. Limitations Several limitations should be considered when interpreting the findings of this project. The project was based on a small number of nurse educator participants and selfreported data of their perceptions; therefore, it is recommended that the project be replicated at larger nursing schools with greater numbers of faculty. In addition, project implementation and timing of postproject testing and evaluation may be considered as limitations. The project was implemented the last 8 weeks of the semester; therefore, early identification and proactive strategies for success were initiated late rather than early in the semester. The early identification of at-risk students enhances the possibility of student success interventions.
Group Summary Level of Cultural Competence (n = 16).
n = 16Culturally incompetent (9–18 points)
Culturally aware (19–28 points)
Culturally competent (29–33 points)
Culturally proficient (34–36 points)
Preproject Postproject
81% (13) 19 % (3)
19% (3) 50 % (8)
31% (5)
Summary: The majority (81%) of faculty were culturally aware preproject. Upon project completion, 50% of faculty were culturally competent and 31% culturally proficient.
Mentoring at-risk students In addition, postproject testing and qualitative evaluation was completed following the final faculty meeting of the semester. The meeting was lengthy and included discussion of several topics that were debated. The time frame and nature of the meeting may have resulted in fewer faculty completing the qualitative portion of the project evaluation. One educator mentioned a need to pick her children up from school. Another faculty participant stated, “I just cannot think! I am exhausted and am ready to start Christmas break.” Lastly, this diverse group of nurse educator participants in this ADN program are 25% minority and include a male. The at-risk student population of this program ranges from 25% to 40%; therefore, the results of this study may not be generalized to other programs.
8. Conclusion In conclusion, cultural competency is a lifelong journey the nurse is continually striving to achieve. A pivotal point in the process of cultural competency is cultural desire. An individual must be personally motivated to engage in the process of cultural competence, and it is important for the nurse educator to reflect on their personal cultural competency knowledge, cultural awareness skills, and comfort in assessing and mentoring the diverse or at-risk student. As the student population of today becomes increasingly diverse and academically at risk, faculty education in cultural competency and mentoring is essential. The IAPCC-M assessment tool provided a lens to interpret the impact of this nurse educator enrichment project on the development of cultural competency in mentoring the at-risk nursing student. The faculty participants in the project self-reported significantly improved cultural competency in mentoring at-risk students. In addition, faculty participants reported an increased confidence and knowledge in their role as an at-risk nursing student mentor. Implementing the project in the last half of the semester did not provide the faculty with time to identify the at-risk student, implement strategies for success early, and had little to no influence on student retention/attrition. Based upon the total scores from the IAPCC-M and the faculty's project evaluation, computer-based learning modules are an effective approach to provide additional knowledge and evidence-based teaching strategies educators can use in classroom, clinical, and small group environments to enhance success of the at-risk nursing student. Meeting the learning needs of the diverse students increases the likelihood of their academic success and possible workforce entry.
References Baum, S., Ma, J., & Payea, K. (2013). Education pays 2013: The benefits of higher education for individuals and society. Retrieved from http:// trends.collegeboard.org/sites/default/files/education-pays-2013-fullreport.pdf.
7 Bednarz, H., Schim, S., & Doorenbos, A. (2010). Cultural diversity in nursing education: Perils, pitfalls, and pearls. Journal of Nursing Education, 49(5), 253−260, http://dx.doi.org/10.3928/0148483420100115-02. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass. Billings, D. M., & Halstead, J. A. (2012). Teaching in nursing: A guide for faculty, 4th ed. St. Louis, MO: Elsevier. Campinha-Bacote, J. (2007). The process of cultural competence in the delivery of healthcare services: The journey continues, 5th ed. Cincinnati, OH: Transcultural C.A.R.E. Associates. Campinha-Bacote, J. (2010). A culturally conscious model of mentoring. Nurse Educator, 35(3), 130−135, http://dx.doi.org/10.1097/ NNE.0b013e3181d950bf. Chen, S., & Voyles, D. (2013). HESI admission assessment scores: Predicting student success. Journal of Professional Nursing, 29(5), S32−S37, http://dx.doi.org/10.1016/j.profnurs.2012.06.008. Corrigan-Magaldi, M., Colalillo, G., & Molloy, J. (2014). Faculty-facilitated remediation: A model to transform at-risk students. Nurse Educator, 39(4), 155−157, http://dx.doi.org/10.1097/NNE.0000000000000043. Dewald, R. J. (2012). Teaching strategies that promote a culturally sensitive nursing education. Nursing Education Perspectives, 33(6), 410−412, http://dx.doi.org/10.5480/1536-5026-33.6.410. Dudas, K. (2011). Strategies to improve NCLEX® style testing in students who speak English as an additional language. The Online Journal of Cultural Competence in Nursing and Healthcare, 1(2), 14−23. Fitzgerald, E. M., Cronin, S. N., & Campinha-Bacote, J. (2009). Psychometric testing of the inventory for assessing the process of cultural competence among healthcare professionals - student version (IAPCC-SV©). Journal of Theory Construction and Testing, 13(2), 64−68. Fuller, B. (2013). Evidence-based instructional strategies: Facilitating linguistically diverse nursing student learning. Nurse Educator, 38(3), 118−121, http://dx.doi.org/10.1097/NNE. 0b013e31828dc2c3. Greenberg, N. E. (2013). A project to increase faculty's cultural competence in mentoring English as a second language nursing students. Teaching and Learning in Nursing, 8(4), 128−135, http://dx.doi.org/10.1016/ j.teln.2013.07.003. Hanover Research (2011). Improving student retention and graduation rates. Retrieved from Hanover Research http://www.mybrcc.edu/ intranet/attachments/article/110/Improving%20Student%20Retention %20and%20Graduation%20Rates.pdf. Hansen, E., & Beaver, S. (2012). Faculty support for ESL nursing students: Action plan for success. Nursing Education Perspectives, 33(4), 246−250, http://dx.doi.org/10.5480/1536-5026-33.4.246. Harding, M. (2012). Efficacy of supplemental instruction to enhance student success. Teaching and Learning in Nursing, 7(1), 27−31, http:// dx.doi.org/10.1016/j.teln.2011.07.002. Harris, R. C., Rosenberg, L., & O'Rourke, M. E. (2014). Addressing the challenges of nursing student attrition., 53(1), 31−37, http://dx.doi.org/ 10.3928/01484834-20131218-03. Jeffreys, M. R. (2007). Tracking students through program entry, progression, graduation, and licensure: Assessing undergraduate nursing student retention and success. Nurse Education Today, 7(5), 406−419, http://dx.doi.org/10.1016/j.nedt.2006.07.003. Jeffreys, M. R. (2010). Teaching cultural competence in nursing and health care: Inquiry, action, and innovation, 2nd ed. New York, NY: Springer. Jeffreys, M. R. (2014). Student retention and success: Optimizing outcomes through holistic competence and proactive inclusive enrichment. Teaching and Learning in Nursing, 9(4), 164−170, http://dx.doi.org/ 10.1016/j.teln.2014.05.003. Loyola, S. (2010). Evidence-based teaching guidelines: Transforming knowledge into practice for better outcomes in healthcare. Critical Care Nursing Quarterly, 33(1), 19−32, http://dx.doi.org/10.1097/ CNQ.0b013e3181c8e309. Meier, S. R. (2013). Concept analysis of mentoring. Advances in Neonatal Care, 13(5), 341−345, http://dx.doi.org/10.1097/ANC.0b013e3182a14ca4.
8 Montenery, S. M., Jones, A. D., Perry, N., Ross, D., & Zoucha, R. (2013). Cultural competence in nursing faculty: A journey, not a destination. Journal of Professional Nursing, 29(6), e51−e57, http://dx.doi.org/ 10.1016/j.profnurs.2013.09.003. National League for Nursing (2014). Certified nurse educator (CNE) 2014 candidate handbook. Retrieved from National League for Nursing http:// www.nln.org/certification/handbook/cne.pdf. Olson, M. A. (2012). English-as-a-second language (ESL) nursing student success: A critical review of the literature. Journal of Cultural Diversity, 19(1), 26−32. Pitt, V., Powis, D., Levett-Jones, T., & Hunter, S. (2012). Factors influencing nursing students' academic and clinical performance and attrition: An integrative literature review. Nurse Education Today, 32(8), 903−913, http://dx.doi.org/10.1016/j.nedt.2012.04.011. Scheele, T. H., Pruitt, R., Johnson, A., & Xu, Y. (2011). What do we know about educating Asian ESL nursing students?: A literature review. Nursing Education Perspectives, 32(4), 244−249. Schoening, A. M. (2013). From bedside to classroom: The nurse educator transition model. Nursing Education Perspectives, 34(3), 167−172, http://dx.doi.org/10.5480/1536-5026-34.3.167.
D.K. Gibbs, A.L. Culleiton Texas Team (2009). Texas nursing: Our future depends on it. A strategic plan for the state of Texas to meet nursing workforce needs of 2013. Retrieved from Texas Department of State Health Services http://www. dshs.state.tx.us/chs/cnws/texasteam/texasstrategy.pdf. Transcultural C.A.R.E. Associates (2014). Inventory for assessing the process of cultural competence among healthcare professionals in mentoring (IAPCC-M©). Retrieved from Transcultural C.A.R.E. Associates http://transculturalcare.net/iapcc-m.htm. Williams, M. G. (2010). Attrition and retention in the nursing major: Understanding persistence in beginning nursing students. Nursing Education Perspectives, 31(6), 362−367. Wilson, A. H., Sanner, S., & McAllister, L. E. (2010). A longitudinal study of cultural competence among health science faculty. Journal of Cultural Diversity, 17(2), 68−72. Zhang, Y., Fei, Q., Quddus, M., & Davis, C. (2014). An examination of the impact of early intervention on learning outcomes of at-risk students. Research in Higher Education, 26, 1−12. Zungolo, E. (2004). Faculty preparation: Is clinical specialization a benefit or a deterrent to quality nursing education? The Journal of Continuing Education in Nursing, 35(1), 19−23.