1. Developing, Implementing, and Evaluating Cultural Competency and Equality IN Nurse Training : What Are We Learning? Results From an Action Research Project to Mainstream Cultural Competencies and Equality Training in the Nurse Curriculum

2. Objectives   Background and purpose of the research.   Share findings and lessons learned.  Lecturers commitment to teaching cultural competencies and equality.  Lecturers self efficacy.  Curriculum management of teaching cultural competencies and equality.   Make recommendations for further inquiry.

3. Mainstreaming Cultural Competency and Equality Training Using Action Research Methodology As part of an action research project, the school of health made a commitment to promote cultural competence and equality training across all modules through a policy of mainstreaming. As part of an action research project, the school of health made a commitment to promote cultural competence and equality training across all modules through a policy of mainstreaming. The major aim of mainstreaming is to build capacity in curriculum provision, through planned curriculum development and embedding cultural competence and equality training to an agreed standard. The major aim of mainstreaming is to build capacity in curriculum provision, through planned curriculum development and embedding cultural competence and equality training to an agreed standard.

4. Our Vision “The ability to provide care to patients with diverse values, beliefs and behaviours including tailoring delivery of care to meet patients’ social, cultural, and linguistic needs. The ultimate goal is a health care system and workforce that can deliver the highest quality of care to every patient, regardless of race, ethnicity, cultural background, or English proficiency.” The commonwealth fund. New York, NY, 2002.

5. Rationale for Culturally Competent Health Care Responding to demographic changes Eliminating disparities in the health status of people of diverse racial, ethnic, & cultural backgrounds Improving the quality of services & outcomes Meeting legislative, regulatory, & accreditation mandates Gaining a competitive edge in the marketplace Decreasing the likelihood of liability/malpractice claims

6. The ASKED Framework A - awareness S - skill K - knowledge E - encounters D - desire Source: Campinha-Bacote J. Cultural competence in psychiatric nursing:

7. Study Design A case analysis of cultural competence and equality training. A case analysis of cultural competence and equality training. The evaluation adopted a pluralistic design that includes both quantitative and qualitative strategies and utilising participatory methods of data collection through an action research methodology. The evaluation adopted a pluralistic design that includes both quantitative and qualitative strategies and utilising participatory methods of data collection through an action research methodology.

8. Project included Questionnaire Survey Questionnaire Survey Curriculum mapping Curriculum mapping Self completion Audit Self completion Audit Focus Group Interviews Focus Group Interviews

9. FOCUS The views and perspectives of teaching staff, regarding the status of cultural and equality competence training in the School of Health

10. Instrument On-line questionnaire consisting of five sections and 26 items. On-line questionnaire consisting of five sections and 26 items.

11. Likert Scale On-line questionnaire consisting of five sections and 26 items. Relative importance within the curriculum, Feelings of self efficacy, Perceptions of behavior to support delivery, Perceived ability with subject management, Teaching opportunities.

12. Respondent Profile

17. Results

18. Sense of Self-Efficacy 1: inability to practise equal opportunities in employment. 2: challenge their personal and professional biases. 3: incorporating a clients cultural beliefs into practice and treatment. 4: capacity to empathize with their clients. 5: understand the biases in assessment tools and diagnostic criteria.

19. Self-reported: Promotional Behaviours 1: diffusion model 2: de-prioritisation of race equality 3: screen books, and other teaching resources for negative cultural, racial, age and gender- stereotypes. 4: finding news ways of teaching equality and cultural competency. 5: teaching effort.

20. Perceived Ability and Comfort With Teaching Skills 1 cultural beliefs, religious practices, disabilities and rights of my students. 2 culturally appropriate teaching techniques. 3 ability to teach students how to recognise oppression and discrimination and promote equality 4 inability to intervene when there is cultural insensitivity, gender bias or prejudice. 5 lack of training and confidence.

21. Teaching Opportunities 1: critically reflect upon their personal and professional cultural biases. 2: understand the barriers that prevent equality of access to health care.. 3: understand disease incidence and prevalence among ethnic groups.. 4: undertake a culturally based health needs assessment.. 5: directly engage in cross cultural interactions with clients from diverse cultural groups.. 6: work with interpreters.. 7: learn from others as cultural informants..

22. Headlines………….. There was a strong sense of public duty to promote equality and commitment to furnish nurses with the necessary competencies to meet the needs of a diverse society. There was a strong sense of public duty to promote equality and commitment to furnish nurses with the necessary competencies to meet the needs of a diverse society. An integrated approach to equality, and in particular, race equality was a priority, but less evidence of prioritising the subject above other course provision. An integrated approach to equality, and in particular, race equality was a priority, but less evidence of prioritising the subject above other course provision. Board self-assurance to manage cultural competence and equality training- responding well to the daily challenge of preparing nursing and midwifery students to care for multi-ethnic and multi-cultural populations. Board self-assurance to manage cultural competence and equality training- responding well to the daily challenge of preparing nursing and midwifery students to care for multi-ethnic and multi-cultural populations.

23. Barriers Lack of time in an already “packed curriculum” Lack of time in an already “packed curriculum” Difficult to allocate time to search out new and innovative ways to teach “such a sensitive subject” Difficult to allocate time to search out new and innovative ways to teach “such a sensitive subject” Lack of information and knowledge of some cultures and religions Lack of information and knowledge of some cultures and religions Lack of confidence Lack of confidence Large group for teaching Large group for teaching Staff attitudes “some staff think it is not important” Staff attitudes “some staff think it is not important”

24. Caveats…………….. The data suggests that prominence may be given to equality issues only in so far as these emanate from problem based and situated learning. The data suggests that prominence may be given to equality issues only in so far as these emanate from problem based and situated learning. Lecturers’ attributes critical to curriculum planning and innovation – commitment, ownership, reflection, action. Lecturers’ attributes critical to curriculum planning and innovation – commitment, ownership, reflection, action.

25. Sustained Inquiry: Key Questions

26. Continuity and Coherence The methods used to raise equality matters. The methods used to raise equality matters. Initiatives and techniques being used to raise student awareness of bias in assessment tools. Initiatives and techniques being used to raise student awareness of bias in assessment tools. Initiatives and techniques being used to promote cultural immersion and insight. Initiatives and techniques being used to promote cultural immersion and insight. The comparability of training opportunities. The comparability of training opportunities.

27. How Does High Self-efficacy Impact on Training? There is a need to establish: There is a need to establish: Levels of teacher self efficacy using reliable and valid measurement scales. Levels of teacher self efficacy using reliable and valid measurement scales. Factors contributing to variations in self- efficacy. Factors contributing to variations in self- efficacy. Correlate with audited behaviours and practices. Correlate with audited behaviours and practices.

28. The Positive Actions of Teachers Should Be Treated As a Resource, Audited and Models of Good Practice Established. The actions being taken by teachers : Address racial harassment within educational. Premises. Help students recognise oppression and. Discrimination. Understanding the cultural beliefs, religious. Practices, disabilities and rights of students.