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Distance Learning Teaching Strategies in Registered Nurse to Baccalaureate Nurse Programs: Advancing Cultural Competence of Registered Nurses in Providing End-of-Life Care
Teaching and Learning in Nursing 13 (2018) 153–155
Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.jtln.org
Distance Learning Teaching Strategies in Registered Nurse to Baccalaureate Nurse Programs: Advancing Cultural Competence of Registered Nurses in Providing End-of-Life Care1,2,3 Michelle H. Cheshire, Ed.D, MSN, RN ⁎, Haley P. Strickland, Ed.D, MSN, RN 4 The Capstone College of Nursing, University of Alabama, Tuscaloosa, AL 35487, USA
a r t i c l e
i n f o
Article history: Accepted 6 March 2018 Available online xxxx Keywords: Cultural competence End of life RN to BSN Nursing education Teaching learning strategies Scholarly writing
a b s t r a c t In order to prepare nurses to effectively provide holistic nursing care to an increasingly diverse patient population, nurse educators must incorporate cultural care practices into the nursing curricula. Specifically, teaching culturally competent end-of-life care is essential but can pose challenges for distance education programs. The purpose of this article is to identify multiple learning strategies utilized in an online nursing program to teach students how to provide culturally competent end-of-life care. © 2018 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Cultural competence entails the knowledge and awareness to appropriately interact with individuals of varying cultures. Culture is a term that exceeds beyond the categorization of race, ethnicity, or religion. It may also refer to groups of similar age, gender, sexual orientation, income, education, or profession. In today's health care environment, culturally competent health care providers are essential.Culturally competent nursing care consists of the knowledge and attitudes to effectively care for patients in cross-cultural situations.With nurses having the most interaction with patients in many clinical settings, the question is: How do nurses obtain the knowledge to effectively provide culturally competent care? In health care, there is a rapidly changing and ethnically diverse patient population (Diaz, Clarke, & Gatua, 2015; Loftin, Newman, Gilden, Bond, & Dumas, 2013). The United States Census projects that, within the next 20 years, there will be no single majority racial group in the country. The International Council of Nurses (2013), based on the globalization of healthcare, advocates that nurses 1
Acknowledgment of Financial Support. This manuscript content was not funded. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. ⁎ Corresponding author: Tel.: +1 205 348 6318; fax: +1 205 348 5559. E-mail addresses: [email protected] (M.H. Cheshire), [email protected] (H.P. Strickland). 4 Tel.: +1 205 348 2705; fax: +1 205 348 5559. 2 3
should be culturally and linguistically competent to respond effectively to client needs. To provide holistic nursing care, nurse educators must incorporate cultural care practices within the nursing curriculum. The American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing Practice (2008) identifies cultural competence as an essential nursing skill. Regardless of the type of degree program, a goal of nursing faculty is to increase the ability of students to identify, respect, and address the diverse needs of patients (Arbour, Kasper, & Teall, 2015; Repo, Vahlberg, Salminen, Papadopoulos, & Leino-Kilpi, 2017). Nurse educators understand that no single assignment or activity can make a student culturally competent. This is why strategies to incorporate this content should be integrated throughout the curriculum beginning with the first nursing course.Most nursing curricula emphasize increasing knowledge rather than developing culture-specific skills. Strategies for teaching cultural competence in traditional classroom settings are well documented (Denton, Esparza, Fike, Gonzalez, & Lundquist Denton, 2016; Ghaddar, Ronnau, Saladin, & Martinez, 2013; Montenery, Jones, Perry, Ross, & Zoucha, 2013). There is much less published research to support methods for teaching cultural competencies in an online format. This gap in the literature is important to address in light of the growing number of distancebased graduate and undergraduate nursing programs across the United States. Over the past 10 years, the online format for registered nurse-to-bachelor of science in nursing (RN-to-BSN) programs has
https://doi.org/10.1016/j.teln.2018.03.001 1557-3087/© 2018 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
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M.H. Cheshire, H.P. Strickland / Teaching and Learning in Nursing 13 (2018) 153–155
gained popularity. RN-to-BSN online educational programs have seen a dramatic increase in enrollment since the Institute of Medicine (2010) report The future of nursing: Leading Change, Advancing health. This report sets a goal that 80% of all registered nurses would be prepared in bachelor of science in nursing by the year 2020.Asynchronous distance RN-to-BSN education programs challenge faculty to develop innovative strategies to address the essential content related to cultural competence. In most cases,RN-to-BSN students enter the program aware of the concepts related to providing culturally competent nursing care. However, RN students matriculate from a variety of schools where the teaching of cultural content may not be consistent (Riley, Smyer, & York, 2012). They also enter the program with varying levels of clinical experience.RN-to-BSN students have the unique advantage of having clinical experiences where they have cared for patients of various cultural backgrounds and have acquired some knowledge of other cultures in both their prior education and in practice. One particular area where many RN-to-BSN students lack a robust knowledge of cultural sensitivity is end-of-life care.Developing effective teaching strategies requiring students to identify the cultural needs of the dying patient is imperative. The purpose of this article is to identify multiple learning strategies used in anRN-to-BSN program to teach students how to provide culturally competent end-of-life care.
Teaching and Learning Strategies Teaching culturally competent end-of-life care is essential in nursing education because care preferences and death and dying practices vary widely between cultures.Educators understand the importance of having meaningful assignments to broaden students' understanding of differing beliefs and cultural practices, which directly impact end-of-life nursing care.A university in the southeast United States addressed integration of culturally competent end-of-life care into the RN-to-BSN curriculum. The RN-to-BSN program can be completed in three semesters using an online asynchronous platform. It is important to begin the integration of cultural competence in the first semester of the program. The Role Transition Course, taught in the first semester, allows students the opportunity to broaden their understanding of other cultures and how utilization of this knowledge has a direct impact on providing patient care. Multiple teaching strategies have been incorporated into this course to promote cultural competency in endof-life care. Learning objectives are achieved through a cultural competence module, which includes recorded lectures and assigned readings. There are two online lectures that focus on cultural and linguistic competencies specific to various cultures. An additional lecture in the module addresses therapeutic communication with those of varying cultural backgrounds and addressesthe similarities and differences of communication depending on the culture. For example, in many Asian cultures, making eye contact while communicating is seen as disrespectful, whereas in other cultures, it is necessary in order to gain trust.The module objectives specific to end-of-life culture competence are as follows:(a) analyze differences in health benefits held by members of various cultural groups and the application of models for cultural competence; (b) discuss the various types of barriers to communication, including but not limited to cultural barriers; (c) complete a cultural self-assessment; (d) identify the physical, mental, and spiritual needs of patients from different cultures; and (e) identify cultural practices impacting death and dying. The module also contains specific required assignments to teach cultural competence in end-of-life care, including a cultural self-assessment, discussion, scholarly paper, and a written reflection. This module takes students between 3 and 4 weeks to complete.
Approximately 70 RN-to-BSN students complete this module each semester. Cultural Self-Assessment Students are required to complete a cultural self-assessment recommended by the American Nurses Association. Research supports the importance of self-assessment (Alpers & Hanssen, 2014; Heitzler, 2017; Mareno & Hart, 2014). The cultural self-assessment requires students to explore their own cultural background, family origin, and the perceived advantages and disadvantages belonging to their own racial/ethnic group. As part of the self-assessment, students explore their biases and prejudices about their own group and those in other groups. Students are also asked to reflect on the cultural norms specific to end-of-life care in their own culture. This self-assessment is not a graded assignment to honor the privacy of the student. Discussions The module contains a discussion post assignment that requires students to share a clinical experience in which they perceive communication with a patient or caregiver from a different culture positive. They are also required to share an experience where the student perceived that communication was negatively impacted due to cultural barriers. As part of the discussion assignment, students read and respond to peer posts. Students are encouraged to provide suggestions to fellow students on ways to turn perceived negative communication experiences to positive experiences in the future. This allows them to learn from peers about other cultures that they may not have encountered in their practice. Scholarly Paper For the scholarly writing assignment, students are asked to identify a culture, other than their own, and research the culture's practices related specifically to death and dying. This research serves as the basis for the paper. Using writing is an effective way of teaching cultural competence (Slade, Thomas-Conner, & Tsao, 2008). The development of writing skills is an integral part of the nursing curriculum, and faculty should explore and evaluate ways to educate and empower students to use writing assignments to improve their understanding of important topics, such as culturally competent care (Troxler, Vann, & Oermann, 2011).Nursing students, especially those who are already licensed, identify a difference between academic writing style and the type of writing used in nursing practice. For RN-to-BSN students, this evidence is important, and the assignment helps them develop a deeper understanding of the cultural variations in end-of-life care and in death and dying. This writing assignment is more effective than a simple reading assignment focused on transcultural issues. Writing requires the students to synthesize information, which causes them to critically think at a higher level (Troxler et al., 2011).The assignment encourages students to choose a cultural group that they routinely care for in their clinical practice.Students are required to research cultural beliefs and practices related to terminal illness, dying, and death. The paper guidelines require students to compare and contrast these practices with their own culture. They must also address how the knowledge gained will impact future nursing practice. Written Reflection The final assignment in the module utilizes the teaching strategy of reflection.Using the discussion tool in the online course, students are asked to reflect on what they have learned in the cultural competence module and how the new knowledge will impact their clinical
M.H. Cheshire, H.P. Strickland / Teaching and Learning in Nursing 13 (2018) 153–155
practice. Reflection on how to ensure a good death for patients and their families based on the patients' cultural beliefs and practices. In addition to their own reflection, students are responsible for reading and responding to other students posts. This strategy allows the students' knowledge to extend beyond the specific culture they researched. This provides a broader view of multiple cultural beliefs and practices, which may influence the care they provide in the future. Evaluation of Strategies The cultural content for this course has evolved over several semesters. Student feedback is encouraging and indicates that the assignments have effectively expanded the students' knowledge and understanding of various cultures. One student explained: “I have been a nurse for years, and never realized the care I was providing my Hispanic patients, when they were dying, was not culturally sensitive.” Two other student comments indicate that the module had a positive impact based on their reflection assignment feedback: “Culturally sensitive care can make all the difference in a good death for my patients and their families,” and “This writing assignment has transformed my understanding of the Asian culture and increased my confidence when caring for this patient population during end of life care.” Quantitative student feedback from standardized program surveys indicates that student learning outcomes are achieved by completion of these cultural competency assignments. Approximately 85% (n = 96) of students reported that these assignments enhanced their ability to meet the cultural competency course objectives. Conclusion Cultural competence continues to be an essential nursing concept given the increased multicultural patient population. In today's society, all nurse educators realize the importance of teaching cultural competence. Nurse educators in distance programs are faced with unique challenges and must implement innovative teaching strategies that intentionally address cultural care.RN-to-BSN faculty have the opportunity to build on students' previous nursing practice and target more specific issues, such as end-of-life care. The strategies
155
discussed in this article can enable students to develop their cultural competencies.Continued development of cultural competencies when providing end-of-life care is an ongoing process for all nurses and requires lifelong learning.
References Alpers, L. M., & Hanssen, I. (2014). Caring for ethnic minority patients: A mixed method study of nurses' self-assessment of cultural competency. Nurse Education Today, 34(6), 999–1004. American Association of Colleges of Nursing (2008). The essentials of baccalaureate education for professional nursing practice. D.C.: Washington. Arbour, M., Kasper, R., & Teall, A. (2015). Strategies to promote cultural competence in distance education. Journal of Transcultural Nursing, 26(4), 436–440. Denton, J. M., Esparza, S., Fike, D. S., Gonzalez, J., & Lundquist Denton, M. (2016). Improvements in cultural competence through classroom and local cross-cultural service-learning activities. Journal of Physical Therapy Education, 30(2), 6–13. Diaz, C., Clarke, P., & Gatua, M. (2015). Cultural competence in rural nursing education: Arewe there yet? Nursing Education Perspectives, 36(1), 22–26. https://doi.org/10. 5480/12-1066.1. Ghaddar, S., Ronnau, J., Saladin, S., & Martinez, G. (2013). Innovative approaches to promote a culturally competent, diverse health care workforce in an institution serving Hispanic students. Academic Medicine, 88(12), 1870–1876. Heitzler, E. T. (2017). Research: Cultural competence of obstetric and neonatal nurses. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46, 423–433. https://doi.org/ 10.1016/j.jogn.2016.11.015. Institute of Medicine (2010). The future of nursing: Leading change, advancing health. International Council of Nurses (2013). Framework of competencies for cultural and linguistic nursing practice. Geneva: International Council of Nurses. Loftin, C., Newman, S., Gilden, G., Bond, M., & Dumas, B. (2013). Moving toward greater diversity. Journal of Transcultural Nursing, 24(4), 387–396. https://doi.org/10. 1177/1043659613481677. Mareno, N., & Hart, P. L. (2014). Cultural competency among nurses with undergraduate and graduate degrees: Implications for nursing education. Nursing Education Perspectives, 35(2), 83–88. 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. Repo, H., Vahlberg, T., Salminen, L., Papadopoulos, I., & Leino-Kilpi, H. (2017). The cultural competence of graduating nursing students. Journal of Transcultural Nursing, 28(1), 98–107. https://doi.org/10.1177/1043659616632046. Riley, D., Smyer, T., & York, N. (2012). Cultural competence of practicing nurses entering an RN-BSN program. Nursing Education Perspectives, 33(6), 381–385. Slade, D., Thomas-Conner, I., & Tsao, T. (2008). When nursing meets English: Using a pathography to develop nursing students culturally competent selves. Nursing Education Perspectives, 29(3), 151–155. Troxler, H., Vann, J., & Oermann, M. (2011). How baccalaureate nursing programs teach writing. Nursing Forum, 46(4), 280–288.
Contents lists available at ScienceDirect
Teaching and Learning in Nursing journal homepage: www.jtln.org
Distance Learning Teaching Strategies in Registered Nurse to Baccalaureate Nurse Programs: Advancing Cultural Competence of Registered Nurses in Providing End-of-Life Care1,2,3 Michelle H. Cheshire, Ed.D, MSN, RN ⁎, Haley P. Strickland, Ed.D, MSN, RN 4 The Capstone College of Nursing, University of Alabama, Tuscaloosa, AL 35487, USA
a r t i c l e
i n f o
Article history: Accepted 6 March 2018 Available online xxxx Keywords: Cultural competence End of life RN to BSN Nursing education Teaching learning strategies Scholarly writing
a b s t r a c t In order to prepare nurses to effectively provide holistic nursing care to an increasingly diverse patient population, nurse educators must incorporate cultural care practices into the nursing curricula. Specifically, teaching culturally competent end-of-life care is essential but can pose challenges for distance education programs. The purpose of this article is to identify multiple learning strategies utilized in an online nursing program to teach students how to provide culturally competent end-of-life care. © 2018 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
Cultural competence entails the knowledge and awareness to appropriately interact with individuals of varying cultures. Culture is a term that exceeds beyond the categorization of race, ethnicity, or religion. It may also refer to groups of similar age, gender, sexual orientation, income, education, or profession. In today's health care environment, culturally competent health care providers are essential.Culturally competent nursing care consists of the knowledge and attitudes to effectively care for patients in cross-cultural situations.With nurses having the most interaction with patients in many clinical settings, the question is: How do nurses obtain the knowledge to effectively provide culturally competent care? In health care, there is a rapidly changing and ethnically diverse patient population (Diaz, Clarke, & Gatua, 2015; Loftin, Newman, Gilden, Bond, & Dumas, 2013). The United States Census projects that, within the next 20 years, there will be no single majority racial group in the country. The International Council of Nurses (2013), based on the globalization of healthcare, advocates that nurses 1
Acknowledgment of Financial Support. This manuscript content was not funded. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. ⁎ Corresponding author: Tel.: +1 205 348 6318; fax: +1 205 348 5559. E-mail addresses: [email protected] (M.H. Cheshire), [email protected] (H.P. Strickland). 4 Tel.: +1 205 348 2705; fax: +1 205 348 5559. 2 3
should be culturally and linguistically competent to respond effectively to client needs. To provide holistic nursing care, nurse educators must incorporate cultural care practices within the nursing curriculum. The American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing Practice (2008) identifies cultural competence as an essential nursing skill. Regardless of the type of degree program, a goal of nursing faculty is to increase the ability of students to identify, respect, and address the diverse needs of patients (Arbour, Kasper, & Teall, 2015; Repo, Vahlberg, Salminen, Papadopoulos, & Leino-Kilpi, 2017). Nurse educators understand that no single assignment or activity can make a student culturally competent. This is why strategies to incorporate this content should be integrated throughout the curriculum beginning with the first nursing course.Most nursing curricula emphasize increasing knowledge rather than developing culture-specific skills. Strategies for teaching cultural competence in traditional classroom settings are well documented (Denton, Esparza, Fike, Gonzalez, & Lundquist Denton, 2016; Ghaddar, Ronnau, Saladin, & Martinez, 2013; Montenery, Jones, Perry, Ross, & Zoucha, 2013). There is much less published research to support methods for teaching cultural competencies in an online format. This gap in the literature is important to address in light of the growing number of distancebased graduate and undergraduate nursing programs across the United States. Over the past 10 years, the online format for registered nurse-to-bachelor of science in nursing (RN-to-BSN) programs has
https://doi.org/10.1016/j.teln.2018.03.001 1557-3087/© 2018 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.
154
M.H. Cheshire, H.P. Strickland / Teaching and Learning in Nursing 13 (2018) 153–155
gained popularity. RN-to-BSN online educational programs have seen a dramatic increase in enrollment since the Institute of Medicine (2010) report The future of nursing: Leading Change, Advancing health. This report sets a goal that 80% of all registered nurses would be prepared in bachelor of science in nursing by the year 2020.Asynchronous distance RN-to-BSN education programs challenge faculty to develop innovative strategies to address the essential content related to cultural competence. In most cases,RN-to-BSN students enter the program aware of the concepts related to providing culturally competent nursing care. However, RN students matriculate from a variety of schools where the teaching of cultural content may not be consistent (Riley, Smyer, & York, 2012). They also enter the program with varying levels of clinical experience.RN-to-BSN students have the unique advantage of having clinical experiences where they have cared for patients of various cultural backgrounds and have acquired some knowledge of other cultures in both their prior education and in practice. One particular area where many RN-to-BSN students lack a robust knowledge of cultural sensitivity is end-of-life care.Developing effective teaching strategies requiring students to identify the cultural needs of the dying patient is imperative. The purpose of this article is to identify multiple learning strategies used in anRN-to-BSN program to teach students how to provide culturally competent end-of-life care.
Teaching and Learning Strategies Teaching culturally competent end-of-life care is essential in nursing education because care preferences and death and dying practices vary widely between cultures.Educators understand the importance of having meaningful assignments to broaden students' understanding of differing beliefs and cultural practices, which directly impact end-of-life nursing care.A university in the southeast United States addressed integration of culturally competent end-of-life care into the RN-to-BSN curriculum. The RN-to-BSN program can be completed in three semesters using an online asynchronous platform. It is important to begin the integration of cultural competence in the first semester of the program. The Role Transition Course, taught in the first semester, allows students the opportunity to broaden their understanding of other cultures and how utilization of this knowledge has a direct impact on providing patient care. Multiple teaching strategies have been incorporated into this course to promote cultural competency in endof-life care. Learning objectives are achieved through a cultural competence module, which includes recorded lectures and assigned readings. There are two online lectures that focus on cultural and linguistic competencies specific to various cultures. An additional lecture in the module addresses therapeutic communication with those of varying cultural backgrounds and addressesthe similarities and differences of communication depending on the culture. For example, in many Asian cultures, making eye contact while communicating is seen as disrespectful, whereas in other cultures, it is necessary in order to gain trust.The module objectives specific to end-of-life culture competence are as follows:(a) analyze differences in health benefits held by members of various cultural groups and the application of models for cultural competence; (b) discuss the various types of barriers to communication, including but not limited to cultural barriers; (c) complete a cultural self-assessment; (d) identify the physical, mental, and spiritual needs of patients from different cultures; and (e) identify cultural practices impacting death and dying. The module also contains specific required assignments to teach cultural competence in end-of-life care, including a cultural self-assessment, discussion, scholarly paper, and a written reflection. This module takes students between 3 and 4 weeks to complete.
Approximately 70 RN-to-BSN students complete this module each semester. Cultural Self-Assessment Students are required to complete a cultural self-assessment recommended by the American Nurses Association. Research supports the importance of self-assessment (Alpers & Hanssen, 2014; Heitzler, 2017; Mareno & Hart, 2014). The cultural self-assessment requires students to explore their own cultural background, family origin, and the perceived advantages and disadvantages belonging to their own racial/ethnic group. As part of the self-assessment, students explore their biases and prejudices about their own group and those in other groups. Students are also asked to reflect on the cultural norms specific to end-of-life care in their own culture. This self-assessment is not a graded assignment to honor the privacy of the student. Discussions The module contains a discussion post assignment that requires students to share a clinical experience in which they perceive communication with a patient or caregiver from a different culture positive. They are also required to share an experience where the student perceived that communication was negatively impacted due to cultural barriers. As part of the discussion assignment, students read and respond to peer posts. Students are encouraged to provide suggestions to fellow students on ways to turn perceived negative communication experiences to positive experiences in the future. This allows them to learn from peers about other cultures that they may not have encountered in their practice. Scholarly Paper For the scholarly writing assignment, students are asked to identify a culture, other than their own, and research the culture's practices related specifically to death and dying. This research serves as the basis for the paper. Using writing is an effective way of teaching cultural competence (Slade, Thomas-Conner, & Tsao, 2008). The development of writing skills is an integral part of the nursing curriculum, and faculty should explore and evaluate ways to educate and empower students to use writing assignments to improve their understanding of important topics, such as culturally competent care (Troxler, Vann, & Oermann, 2011).Nursing students, especially those who are already licensed, identify a difference between academic writing style and the type of writing used in nursing practice. For RN-to-BSN students, this evidence is important, and the assignment helps them develop a deeper understanding of the cultural variations in end-of-life care and in death and dying. This writing assignment is more effective than a simple reading assignment focused on transcultural issues. Writing requires the students to synthesize information, which causes them to critically think at a higher level (Troxler et al., 2011).The assignment encourages students to choose a cultural group that they routinely care for in their clinical practice.Students are required to research cultural beliefs and practices related to terminal illness, dying, and death. The paper guidelines require students to compare and contrast these practices with their own culture. They must also address how the knowledge gained will impact future nursing practice. Written Reflection The final assignment in the module utilizes the teaching strategy of reflection.Using the discussion tool in the online course, students are asked to reflect on what they have learned in the cultural competence module and how the new knowledge will impact their clinical
M.H. Cheshire, H.P. Strickland / Teaching and Learning in Nursing 13 (2018) 153–155
practice. Reflection on how to ensure a good death for patients and their families based on the patients' cultural beliefs and practices. In addition to their own reflection, students are responsible for reading and responding to other students posts. This strategy allows the students' knowledge to extend beyond the specific culture they researched. This provides a broader view of multiple cultural beliefs and practices, which may influence the care they provide in the future. Evaluation of Strategies The cultural content for this course has evolved over several semesters. Student feedback is encouraging and indicates that the assignments have effectively expanded the students' knowledge and understanding of various cultures. One student explained: “I have been a nurse for years, and never realized the care I was providing my Hispanic patients, when they were dying, was not culturally sensitive.” Two other student comments indicate that the module had a positive impact based on their reflection assignment feedback: “Culturally sensitive care can make all the difference in a good death for my patients and their families,” and “This writing assignment has transformed my understanding of the Asian culture and increased my confidence when caring for this patient population during end of life care.” Quantitative student feedback from standardized program surveys indicates that student learning outcomes are achieved by completion of these cultural competency assignments. Approximately 85% (n = 96) of students reported that these assignments enhanced their ability to meet the cultural competency course objectives. Conclusion Cultural competence continues to be an essential nursing concept given the increased multicultural patient population. In today's society, all nurse educators realize the importance of teaching cultural competence. Nurse educators in distance programs are faced with unique challenges and must implement innovative teaching strategies that intentionally address cultural care.RN-to-BSN faculty have the opportunity to build on students' previous nursing practice and target more specific issues, such as end-of-life care. The strategies
155
discussed in this article can enable students to develop their cultural competencies.Continued development of cultural competencies when providing end-of-life care is an ongoing process for all nurses and requires lifelong learning.
References Alpers, L. M., & Hanssen, I. (2014). Caring for ethnic minority patients: A mixed method study of nurses' self-assessment of cultural competency. Nurse Education Today, 34(6), 999–1004. American Association of Colleges of Nursing (2008). The essentials of baccalaureate education for professional nursing practice. D.C.: Washington. Arbour, M., Kasper, R., & Teall, A. (2015). Strategies to promote cultural competence in distance education. Journal of Transcultural Nursing, 26(4), 436–440. Denton, J. M., Esparza, S., Fike, D. S., Gonzalez, J., & Lundquist Denton, M. (2016). Improvements in cultural competence through classroom and local cross-cultural service-learning activities. Journal of Physical Therapy Education, 30(2), 6–13. Diaz, C., Clarke, P., & Gatua, M. (2015). Cultural competence in rural nursing education: Arewe there yet? Nursing Education Perspectives, 36(1), 22–26. https://doi.org/10. 5480/12-1066.1. Ghaddar, S., Ronnau, J., Saladin, S., & Martinez, G. (2013). Innovative approaches to promote a culturally competent, diverse health care workforce in an institution serving Hispanic students. Academic Medicine, 88(12), 1870–1876. Heitzler, E. T. (2017). Research: Cultural competence of obstetric and neonatal nurses. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46, 423–433. https://doi.org/ 10.1016/j.jogn.2016.11.015. Institute of Medicine (2010). The future of nursing: Leading change, advancing health. International Council of Nurses (2013). Framework of competencies for cultural and linguistic nursing practice. Geneva: International Council of Nurses. Loftin, C., Newman, S., Gilden, G., Bond, M., & Dumas, B. (2013). Moving toward greater diversity. Journal of Transcultural Nursing, 24(4), 387–396. https://doi.org/10. 1177/1043659613481677. Mareno, N., & Hart, P. L. (2014). Cultural competency among nurses with undergraduate and graduate degrees: Implications for nursing education. Nursing Education Perspectives, 35(2), 83–88. 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. Repo, H., Vahlberg, T., Salminen, L., Papadopoulos, I., & Leino-Kilpi, H. (2017). The cultural competence of graduating nursing students. Journal of Transcultural Nursing, 28(1), 98–107. https://doi.org/10.1177/1043659616632046. Riley, D., Smyer, T., & York, N. (2012). Cultural competence of practicing nurses entering an RN-BSN program. Nursing Education Perspectives, 33(6), 381–385. Slade, D., Thomas-Conner, I., & Tsao, T. (2008). When nursing meets English: Using a pathography to develop nursing students culturally competent selves. Nursing Education Perspectives, 29(3), 151–155. Troxler, H., Vann, J., & Oermann, M. (2011). How baccalaureate nursing programs teach writing. Nursing Forum, 46(4), 280–288.