For most of the past century, grade school students in the United States have been taught that their country is a “melting pot” of cultures. They are taught that new immigrants bring with them their culture and blend it with American culture (Bisin & Verdier, 2000). This however is not the case. America, rather, is like a salad bowl of cultures. The vegetables in a salad co-exist in the same bowl while still retaining their identity as a tomato or a carrot. This is apparent to any observer walking in the China Towns, “Little Italys,” and other immigrant communities throughout the U.S.
This diversity is reflected in the health care system. Between 1999-2008 long term care facilities in the U.S. have witnessed a 55% and 54% increase in Hispanic and Asian residents while at the same time seeing a 10% reduction in white residents (Feng, Fennell, Tyler, Clark, &
Mor, 2011). Diversity is also rising in other areas of healthcare as because ethnically different people are at a greater risk for disease and major health problems and therefore are more likely to make use of the health care system (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003).
This increasing diversity in the healthcare system is pushing the need for more culturally competent healthcare workers (Institute of Medicine, 2002). Culturally competent healthcare workers are better able to treat patients because they can more efficient communicate with a patient to prevent misdiagnosis and explain treatment and recover procedures. This is because a culturally competent person can establish stronger trust and report with a culturally different person. A culturally competent person is aware of their own and others’ cultural values, is knowledgeable about other cultures, and is able to use their awareness and knowledge to skillfully cultivate cross-cultural relationships (Smith, 1998). Culturally competent care is not just providing to patients a culturally knowledgeable medical staff but providing a staff that can sensitively and effectively interact with patients with respect to patients’ beliefs and traditions (Huff & Kline, 1999).
Nurses are the backbone of any hospital, clinic, and nursing home. Their daily interactions with patients are often the only contacts between a patient and a health care system.
Many health care organizations such as the Pew Health Professions Commission (1995) and the
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American Association of Colleges of Nursing (1998) have publicly stated the need for cultural education in health care providers. Indeed, it is hard to sell the idea that nurses can improve their care giving by considering non-medical issues: “The toughest change in nursing will be with nurses who have become so medicalized and focused on diseases, symptoms, and treatment modes that they will neglect to consider the client’s culture” (Leininger, 1995, p. 687).
Background of the Study
Researchers investigating intercultural competencies (ICC) in nurse practitioner students found that students planning to work in rural areas after graduation had a higher score in cultural competency behavior scores (Benkert, Tanner, Guthrie, Oakley, &Pohl, 2005). Other predictors supported by the same researchers were a nurse’s level of comfort with diversity and the weight that nurse gave to cultural knowledge (Benkert et al., 2005). The study showed there was in fact a link between a student’s ICC level and their intended area to work. However, it did not investigate if there was a correlation between the students and whether they hailed from a rural or urban background. Furthermore the study only looked at predictors of culturally competent behavior which falls under the ICC subset of intercultural adroitness and not intercultural insensitivity. Another study looking at intercultural sensitivity levels in middle school students however did find a correlation between a student’s community setting and their level of intercultural communication sensitivity (Pederson, 1997). The students from a suburban area had higher scores than their urban or rural counterparts (Pederson, 1997). This study will not only verify the validity of using a nursing student’s planned area of study as a predictor of ICS but also investigate the links between a community setting and their level of intercultural sensitivity.
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Problem Statement
Increasing globalization and the formation of immigrant pockets in the general population is driving a growing need for culturally competent health care workers in the United States. Administrators of nursing education institutions need more information regarding their enrollees’ learning abilities so they can appropriately tailor intercultural curriculum.
There is little research looking into the factors that predict intercultural sensitivity in nursing students. There is little existing research concerning healthcare students and intercultural sensitivity. Nursing school administrators need more reliable predictors that can be drawn from simple demographic and background data for determining enrollees’ cultural competency learning capabilities.
Rationale for the Study
Many researchers have shown that there is a strong connection between a person’s intercultural competence and their job performance while working in multicultural work environments (Mol, Born, Willemsen, & Molen, 2005; Tucker, Bonial, & Lahti, 2004). Nurses are also subject to this connection. Culturally competent nurses provide better care to culturally different patients. Intercultural competency is a process divided into three subsets: awareness, sensitivity, and adroitness. Intercultural Sensitivity (ICS) facilitates the transition between awareness and adroitness (Chen, 1997). ICS is the rope bridge that carries a person from ethnocentrism over to ethnorelativism. The higher the level of one’s ICS, the more quickly they will transition from ethnocentric to enthorelative states of mind (Chen, 1997). By measuring the level of an individual’s sensitivity, intercultural trainers can better adjust their techniques to match their student’s needs. Therefore by investigating predictors of intercultural sensitivity, the transitory subset of ICC linking intercultural awareness and adroitness, healthcare institutions and educations centers can better tune their recruitment efforts and in-house training programs to raise the level of care and performance of their nursing staff.
Furthermore, nursing schools like most educational institutions, work on limited budgets and so must make the best use of their resources. Administrators responsible for planning and
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allocating resources for various curriculums need accurate indicators regarding the cost and effectiveness of particular teaching methods and how those methods match up with their students’
needs. There are many methods for teaching intercultural competency, including classroom lectures, literature review, scenario training, and immersion (Crandall, George, Marion, & Davis 2003; Halloran, 2009; Lasch, Wilkes, Lee, &Blanchard, 2000; Lipson & Desantis, 2007; Mazor, Hampers, Chande, & Krug, 2002). These strategies vary in effectiveness and expense with immersion notably being the most effective and most expensive strategy for teaching cultural competency. The effectiveness of these training strategies is also greatly affected by the level of intercultural sensitivity of the participants. Understanding the intercultural communication sensitivity (ICS) predictors of their students will allow nursing programs to tailor their cultural learning curriculum to meet their pedagogical needs in accordance with their fiscal abilities.
Purpose of the Study
This study tested for links between the background of nursing students, and the level of their intercultural sensitivity along the Gulf Coast. The study collected demographic data and administered a self-assessment tool to measure ICS levels.
Research Questions
This study intended to answer the following questions:
1. Does a nursing student’s background setting, in terms of coming from a rural area versus an urban area, have an effect on their intercultural sensitivity?
2. How much of a nursing student’s prior exposure to cultural experiences affects their intercultural sensitivity?
3. Is there a significant difference in ICS between male and female subjects?
4. Does a nursing student’s intended work setting, in terms of working in a rural area versus an urban area, have an effect on their intercultural sensitivity?
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Contribution of the Study
This study adds to the body of knowledge that nursing schools use to design their curriculum with regards to the origins of their students. This study also contributed new knowledge to current research by focusing on links between intercultural sensitivity predictors in nursing students and their demographic and background information. The study also sought to develop and validate new scales in this area of research. In accordance with this author’s information, there are no such studies examining this area of research.
Definition of Terms
Culture –the learned and shared point of view of a particular people group’s concerns about life that ranks important ideas, shapes attitudes concerning certain matters, and dictates behavior (Beamer &Varner, 2003).
Intercultural Competency (ICC) – a combination of knowledge, awareness, sensitivity, attitudes, and skills which empower an individual to have effective interaction with culturally different persons while maintaining acknowledgement and respect for the clients’ culture and traditions (Onyoni & Ives, 2007).
Intercultural Sensitivity (ICS) – the affective subset of ICC; ICS represents the active internal process of an individual accepting and appreciating cultural differences and their motivation to better understand those differences (Chen &Starosta, 1998).
Competency – a set of personal characteristics and knowledge which have a significant effect on an individual’s behavior and effectiveness in a given situation.
Contact Theory – an idea that suggests that the more interaction an individual experiences with an alien group, then the more comfortable, confident, and competent that individual will be during future experiences with alien groups.
Intended Work Setting – the community setting in terms of rural or urban where a nursing student wishes to work after graduation and establishment as a professional nurse.
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Community Setting – the setting, in terms of rural or urban, where from a respondent hails.
Prior Exposure – the degree to which a respondent has encountered or has had experiences with other cultures.
Rural Area – any area outside of an urban area (US Census Bureau, 2012).
Urban or Suburban Area – city or area consisting of between 2,500 residents and 50,000 (US Census Bureau, 2012).
Metropolis or Large City – city or area consisting of an urbanized core of at least 50,000 residents and is surrounded by urban clusters and urbanized areas (US Census Bureau, 2012).
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