Journal of Nursing Education

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Major Articles 

Development of a Multidisciplinary Course in Cultural Competence for Nursing and Human Service Professions

Cora C. Munoz, PhD, RN; Cheryl Conrad DoBroka, PhD; Saleem Mohammad, PhD

Abstract

A multidisciplinary teaching model was used to develop a pilot course for students in the human service professions of nursing, education, and social work to gain additional knowledge and skills in providing diverse clients with culturally appropriate services during field and clinical experiences. This article focuses on the process of developing a multidisciplinary course in cultural competence that is consistent with a university mission to prepare students for leadership and service in an increasingly diverse society. Using the theoretical framework of Campinha-Bacote’s process of cultural competence and the six developmental stages of intercultural competence in Bennett’s developmental model of intercultural sensitivity, the course content covered the five components of cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desire. Students’ written reflections indicated growth in acquisition of cultural knowledge, skills, and desire. Faculty collaboration across disciplines included the benefits of an enriched knowledge base and shared scholarship.

Abstract

A multidisciplinary teaching model was used to develop a pilot course for students in the human service professions of nursing, education, and social work to gain additional knowledge and skills in providing diverse clients with culturally appropriate services during field and clinical experiences. This article focuses on the process of developing a multidisciplinary course in cultural competence that is consistent with a university mission to prepare students for leadership and service in an increasingly diverse society. Using the theoretical framework of Campinha-Bacote’s process of cultural competence and the six developmental stages of intercultural competence in Bennett’s developmental model of intercultural sensitivity, the course content covered the five components of cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desire. Students’ written reflections indicated growth in acquisition of cultural knowledge, skills, and desire. Faculty collaboration across disciplines included the benefits of an enriched knowledge base and shared scholarship.

Dr. Munoz is Professor, College of Natural Sciences, Nursing and Health, Dr. DoBroka is Associate Professor of Education, and Dr. Mohammad is Professor of Social Work, Capital University, Columbus, Ohio.

This study was supported in part by internal grant funding from Capital University, Columbus, Ohio.

Address correspondence to Cora C. Munoz, PhD, RN, Professor, College of Natural Sciences, Nursing and Health, Capital University, 1 College and Main St., Columbus, OH 43209; e-mail: cmunoz@capital.edu.

Received: May 28, 2008
Accepted: November 24, 2008
Posted Online: September 08, 2009

The shifting demographics and increased diversity in the communities of the United States, highlighted by the most recent census in 2000, challenge health, social, and educational service providers to become more knowledgeable about and responsive to the diverse needs of their clients. Differences in perceptions of health, values, and practices, as well as diverse belief systems and worldviews, are realities that providers in service professions face when planning care and addressing their clients’ physical, social, and educational needs. Lack of in-depth knowledge about these differences, as well as an accompanying lack of sensitivity in addressing what is known, has been associated with health, social service, and educational disparities.

Compelling evidence exists that minorities in this country experience a higher incidence of disability, disease, and death compared with the mainstream population (Agency for Healthcare Research and Quality, 2005; Betancourt, Green, & Carrillo, 2002; Flaskerud, 2002; Smedley, Stith, & Nelson, 2003). The Institute of Medicine report entitled “Unequal Treatment: Confronting the Racial & Ethnic Disparities in Health Care” (Smedley et al., 2003) has identified various factors that lead to health disparities, including socioeconomic status, cultural and linguistic factors, and lack of culturally competent health care. There is growing interest in examining the role of discrimination, oppression, and racism (both perceived and experienced) in the health status of minority populations (Hausmann, Jeong, Bost, & Ibrahim, 2008; LaVeist, Rolley, & Diala, 2003; Shavers & Shavers, 2006; Williams, Nabors, & Jackson, 2003). Equally compelling evidence exists that individuals of particular racial, ethnic, and socioeconomic backgrounds often experience disparities in education and social services. In public schools, minority students have higher dropout rates, experience reduced access to adequately funded and equipped schools, face lower academic expectations, and are disproportionately placed in classes for lower ability learners (Kozol, 1991; Nieto, 2002; Noguera, 2003). Social workers and mental health professionals are often the last resort of minority clients who seek help because of suspicion or resistance due to concerns for confidentiality, historical discrimination, or institutionalized racism. The rates of social service use for personal and mental health concerns among minorities are comparatively low due to past negative experiences with cultural inappropriateness, unpleasant experiences with service providers, language barriers, or limited financial resources (Attneave, 1982; Lum, 2005; Topper, 1992).

Overall, it is crucial that human service professionals develop a level of awareness, knowledge, and skill to effectively serve diverse populations. Research across disciplines that prepare human service professionals emphasizes that there is a relationship between those professionals’ levels of cultural competence and their ability to provide culturally responsive services (Campinha-Bacote, 2003; Gay, 2000; Lum, 2005; National Association of Social Workers, 2001). Although the term cultural competence has been defined in the professional literature in various ways, for the purposes of this discussion, it is defined as a developmental and dynamic process that involves integrating knowledge with awareness of diverse human experiences to increase the quality of cultural engagement among those preparing for leadership and service in a diverse society.

The 2003 Institute of Medicine report identified the cultural competence of those who provide health care services as a vital component in eliminating health disparities (Smedley et al., 2003). In their 2008 document on cultural competency in baccalaureate nursing education, the American Association of Colleges of Nursing provided a framework that develops competencies essential for nursing students to provide culturally competent care. Particulars of alignment with the social work profession’s established standards for cultural competence among practitioners (National Association of Social Workers National Committee on Racial and Ethnic Diversity), as well as teacher education’s alignment with the National Council for the Accreditation of Teacher Education’s diversity standards in professional school curricula, are left up to local decisions at each institution of higher learning. It is still the case that incorporating course work in cultural competence in a systematic, strategic manner continues to be a challenge in many academic programs that train human service professionals (Chapman, Bates, O’Neil, Chan, & Donini-Lenhoff, 2008; Murrell, 2008).

Literature Review

The concept of training nursing professionals in cultural competence appears to be the most widely accepted among the human service professions. The concept of transcultural nursing stated by Leininger and McFarland (2002) focuses on the study and analysis of different cultures and subcultures and examines them regarding their patterns of behavior, values, and beliefs about health and patterns of illness. The goal of transcultural nursing is to prepare nurses to be culturally sensitive and knowledgeable about these culturally defined patterns to be able to provide culturally competent care to all clients and their families. One of the basic concepts of transcultural nursing is transcultural communication, which addresses a nurse’s need to understand how illness and disease are defined by people from diverse cultural backgrounds, so that nursing interventions may be culturally sensitive and linguistically appropriate (Leininger & McFarland, 2002; Munoz & Luckmann, 2005).

Campinha-Bacote (2003) stated that because developing cultural competence among health care professionals is an ongoing process, every professional needs to continuously learn about various cultures and various ways to provide services that are respectful and acknowledge clients’ cultural backgrounds. Betancourt et al. (2002) recommended that training for cultural competence be required in and integrated into the professional development of health care providers at all levels, given that the recipients of health care services will become increasingly culturally and linguistically diverse. A recent document from the Health Resources and Services Administration (2007), entitled Transforming the Face of Health Professions Through Cultural & Linguistic Competence Education, provides guidance for incorporating cultural competence in curriculum for preparing health professionals. Sullivan (2004) also identified a need to have more minorities in the helping professions. Lewy (2005) encouraged the establishment of an interdisciplinary curriculum in cultural competence.

Recognizing that cultural competence is vital for current educators, Manning and Baruth (2004) charged teacher education programs to unilaterally commit to training culturally competent professionals. A professional educator’s ability to connect with the culture of each student is a key in addressing disparities, as is the wider school community’s ability to create a school culture that has high efficacy, in terms of high academic expectations and purposeful connections to real-world expectations for an educated citizenry (Gay, 2000). Culturally responsive teaching, according to Gay (2000), requires knowledge about the cultural values, learning styles, and achievements of different ethnic groups; skills to translate that knowledge about diversity into classroom practices; and the determination to establish high academic expectations for children who are currently underachieving in schools. Teachers develop these in-depth levels of knowledge, dispositions, and skills as purposeful instruction in cultural competence strategically coupled with hands-on experience with diverse populations in the schools.

The social work profession also promotes the advancement of culturally competent practice methods that meet the needs of multiracial and multiethnic clients who have experienced racism, discrimination, and marginalization because of their cultural and ethnic heritage (Lum, 2005). In establishing guidelines related to developing cultural competence in social work practice, Sue (2006) called for culturally competent social workers to acknowledge and question their own worldviews as they work to overcome personal biases, stereotypes, and assumptions about other cultural groups. Social work literature also suggests the importance of developing intervention models that are culturally competent (Harper & Lantz, 1996; Lum, 2005). Establishing culturally sensitive relationships is also critical to establishing meaningful connections between social work practitioners and their clients from differing socioeconomic, racial, cultural, and ethnic backgrounds. Social service delivery barriers in properly assessing and successfully treating minority clients can be addressed by increasing providers’ cultural awareness, general knowledge of cultural history, accurate information about clients’ values and cultural heritage, and skill development (Attneave, 1982; Topper, 1992).

Rationale for Teaching Cultural Competence in the Human Service Professions

The three disciplines of nursing, education, and social work share several similarities regarding professional practice. The various health, social, and educational needs of diverse client populations are greatly influenced by their cultural values and practices. These influences greatly affect clients’ ability to access health, educational, and social services, as well as how they accept professional interventions and treatment approaches. Human service professionals are expected to be culturally competent, as mandated by professional organizations and standards of practice (American Nurses Association; National Council for the Accreditation of Teacher Education; National Association of Social Workers). This multidisciplinary course in cultural competence was conceived to enhance and improve professional care provider and educator knowledge, skills, and appropriate dispositions in serving diverse populations. As discussed previously, a lack in these areas may contribute to a continuation of disparities in health, education, and social services.

The School of Nursing and the Education and Social Work departments in this private midwestern university have identified the importance of consolidating resources to better prepare nurses, teachers, social workers, and others in human service professions to become culturally competent. A project funded by an internal university grant provided the necessary resources to move beyond discussing the need toward designing a plan for developing a multidisciplinary pilot course in cultural competence to address the need. Each respective discipline represented had previously woven cultural competence into its program and course offerings on many levels; however, there was not yet a mechanism in place that encouraged individual students to formally and systematically assess their own cultural competence as they progressed through their professional programs. The pilot project provided the necessary structure and faculty expertise for each respective academic discipline (and our university) to begin to do so. In addition, the cultural competence course opened dialogue for developing a university learning goal in inter-cultural competence for all students at our university.

Conception of a Multidisciplinary Course

Working for social justice is firmly embedded in the university’s mission and the curriculum of both general education and human service professions. A focus on developing students as servant-leaders who are independent, critical thinkers is foundational to the Lutheran identity of the university and has led to the establishment of a university-wide cultural diversity initiative. A goal of university-level instruction in cultural competence is to encourage learners in professional programs to develop an informed compassion for those who act, speak, think, and perceive the world differently. The shared understanding of values, goals, and diversity shape the vision of a multicultural community and learning environment of this university. Consistent with this mission and accompanying goals, the authors designed a multidisciplinary pilot course on cultural competence to provide opportunities for students to incorporate cultural concepts and principles into their field and clinical experiences in nursing, education, and social work.

In preparation for teaching this pilot course on cultural competence, the authors received funded training through the Intercultural Communication Institute in Portland, Oregon. The education faculty member became certified as a trainer through an intensive 3-day qualifying seminar to administer and interpret the Intercultural Development Inventory (IDI), the statistically reliable, valid assessment of intercultural sensitivity that was used as a diagnostic measure during the opening session of the pilot course (Hammer & Bennett, 2002). The nursing and social work faculty members gained additional expertise in fostering intercultural communication and developing intercultural sensitivity through attending a week-long interactive summer training institute. The latter two faculty members already had considerable expertise, as voices from nonwestern cultures who had taught cross-cultural courses and published in their respective fields of nursing and social work. Establishing a significant level of faculty expertise in cultural competence was foundational to this pilot venture; combining this expertise across disciplines created a well-qualified, highly engaged multidisciplinary team that carried credibility with colleagues, students, and members of the community.

As prerequisites to the pilot course, the authors built on the foundational knowledge that all undergraduate students at this private midwestern university receive through taking two general education core courses, Cultural Pluralism and Global Awareness, which provide a comprehensive introduction to racial, ethnic, class, gender, geographic, and cultural differences and conflicts among people in the United States and in countries abroad. Students’ backgrounds with an additional cultural competence course requirement for nursing majors, Transcultural Nursing, and for social work majors, Diversity Among People in the USA, added to the richness of the knowledge and experiences that majors brought together in a common course. It was the desire of the authors to build on this common foundation of learning and to develop within our students increased awareness, knowledge, and skill regarding the various multicultural components necessary in establishing the kinds of interpersonal relationships needed to work with diverse populations.

Theoretical Framework

Process of Cultural Competence in the Delivery of Health Care Services

The theoretical framework used in the development of the course was based on Campinha-Bacote’s five components of the process of cultural competence in the delivery of health care services model for delivering health care services (2003) (Figure), which are:

  • Cultural awareness.
  • Cultural knowledge.
  • Cultural skill.
  • Cultural encounters.
  • Cultural desire.

Campinha-Bacote’s Process of Cultural Competence in the Delivery of Health Care Services. © 1998, J. Campinha-Bacote. Reprinted with Permission from Transcultural C.A.R.E. Associates.

Figure. Campinha-Bacote’s Process of Cultural Competence in the Delivery of Health Care Services. © 1998, J. Campinha-Bacote. Reprinted with Permission from Transcultural C.A.R.E. Associates.

The first component, cultural awareness, is the deliberate cognitive process in which students appreciate and are sensitive to the cultural values of each client or service recipient. This awareness also includes an awareness of one’s own cultural beliefs, values, and practices. The second component, cultural knowledge, consists of the sound educational foundation that students establish as they gather cultural information in a formal or informal manner. This knowledge may include worldviews, values, and beliefs of different cultures, as well as perceptions about health and illness. Worldview is one’s individual perception of the world, which is greatly influenced by one’s cultural background and life experiences. Cultural knowledge also includes an understanding of the biological variations that are found in individuals with different cultural backgrounds. The third component, cultural skill, is the ability to collect relevant cultural data through an interview process to obtain pertinent history and cultural context. Various culturological assessment tools have been developed to gather data about ethnic and cultural values and beliefs of service recipients. Communication styles and meanings become very important in gathering cultural data in the assessment process. The fourth component, cultural encounters, is the process in which the student seeks opportunities to engage in cross-cultural interactions directly or indirectly. A direct cultural encounter is when the student gives direct care to an individual from a different cultural background, using cultural knowledge and implementing cultural skill in the care provided. An indirect encounter is when the student obtains cultural information based on the experiences of another student in a direct encounter. The fifth component, cultural desire, is the commitment and motivation of human service professionals to provide culturally competent care. Inherent in cultural desire is the acceptance and appreciation of differences that lead students to be caring toward all recipients of their care, taking into consideration cultural values, beliefs, and practices.

Developmental Model of Intercultural Sensitivity

Theory and practice were further connected in the course using the six developmental stages of intercultural competence outlined in Bennett’s (1993) developmental model of intercultural sensitivity (DMIS). The six stages of Bennett’s (1993) DMIS originate with the denial of difference stage and progress through defense against difference, minimization of difference, acceptance of difference, adaptation to difference, and integration of difference stages. The first stage of the DMIS, denial of difference, highlights an absence of contact with and awareness of other cultures. Students in the denial stage have been largely isolated from cultural differences, and they respond to any perceived difference with benign stereotyping or superficial declarations of tolerance for everyone. In the second stage, defense against difference, students respond to their emerging awareness of cultural differences by negatively evaluating another culture and elevating the superiority of their own. As students are able to minimize difference in the third stage, minimization of difference, they are able to move beyond a primary focus on differences to instead focus on similarities and commonalities of human experience across cultures. In the fourth stage, acceptance of difference, students are able to recognize, appreciate, and respect cross-cultural differences in attitudes, behaviors, and values, to the extent that they want to learn more about them. As students are able to adapt to difference in the fifth stage, adaptation to difference, they demonstrate skill in engaging individuals from other cultures in communication and other meaningful interactions across cultural boundaries. In the sixth stage, integration of difference, students have successfully integrated another culture’s frame of reference and have become bicultural. The first three stages of Bennett’s model are defined as ethnocentric—students focus basically on the self and the frame of reference is mostly one’s own personal culture; the second three stages are defined as ethnorelative—students demonstrate an accelerated desire to learn more about others and to meaningfully interact with them in culturally appropriate ways.

Development of Multidisciplinary Course in Cultural Competence

A multidisciplinary course in cultural competence was designed as a 7-week, early evening pilot seminar that met for 2 hours per week. This format provided opportunities for students in the human service professions to gain additional intercultural knowledge and skills for providing culturally appropriate services to diverse clients during their field and clinical experiences in a normal work day; then, in the evening, the class became a forum for discussion, reflection, and further learning. A small self-selected sample of junior and senior students were enrolled in both the fall and spring semesters of this pilot. Course topics, assignments, and discussion built on students’ prior knowledge concerning racial and ethnic disparities in health, education, and social services that are embedded in society—prior knowledge that was part of the 6 semester hours of university core coursework mentioned previously.

It has been established how the course was conceived within the theoretical framework of Campinha-Bacote’s process of cultural competence and organized according to its five components. These five components (cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire) provided the structure for the content covered in the 7 weeks of instruction. Three main course objectives guided students to define cultural competence and identify its scope in the academic disciplines of nursing, education, and social work; give critical thought to the role of culture in professional practice; and apply the six stages of Bennett’s DMIS in considering the worldview, structure, and lived experience of diverse populations. Students became familiar with various definitions and models of cultural competence in human service professions and explored these models through assigned readings and written response papers, role-playing, interacting with guest speakers, and reflecting through class discussion (Table). Course components were assembled and arranged in a sequence that supported and extended students’ reflection on and growth from field and clinical experiences.

Cultural Competence Pilot Course Content, Linked to Campinha-Bacote’s (2003) Five Components of the Process of Cultural Competence

Table: Cultural Competence Pilot Course Content, Linked to Campinha-Bacote’s (2003) Five Components of the Process of Cultural Competence

During week 2, the 60-item IDI (Hammer & Bennett, 2002) was administered to gather composite baseline data of students’ intercultural sensitivity on a 6-point measured scale of ethnocentrism to ethnorelativism. This quantitative instrument, which is based on the six developmental stages outlined in Bennett’s DMIS (1993), is described by its originators as “a statistically reliable, cross-culturally valid measure of an individual’s or group’s capability to exercise intercultural competence” (Summer Institute for Intercultural Communication, 2006, p. 10). Our training in administering the IDI taught us that one semester (40 hours) of instruction is generally needed to advance a student’s development one standard deviation along this instrument’s 6-point continuum from ethnocentrism to ethnorelativism; therefore, we determined that the IDI was not an appropriate instrument to use to demonstrate short term, pretest, and posttest gains in our particular course (Hammer & Bennett, 2002). However, we determined that the IDI would be useful in providing a single snapshot of students’ collective, developing intercultural sensitivity at this point in their university program, at which they had completed 6 semester hours of core course-work in cultural pluralism and global awareness. As such, an IDI group profile with statistics indicated that our students had worked through the continuum from the ethnocentric stages of denial, defense, and minimization and were moving into the ethnorelative stages of acceptance and adaptation.

This composite information about students’ developmental level of intercultural sensitivity provided the professors with key information that informed the content of lectures, class discussions and reflections, and planned learning opportunities for the remainder of the course.

Beginning in week 3, students examined how the theory associated with cultural competence that was presented in faculty lectures, in assigned readings, and by guest speakers could inform and enhance their practice in their field and clinical settings. Professional articles and books from the disciplines of nursing, education, and social work were on closed reserve in the campus library; these resources were required reading for each of the five reflection papers. Guests from several distinct cultural communities were invited to the campus as part of a speaker series; students had opportunities to ask questions during the interactive presentations, as well as engage these speakers in more in-depth conversation afterward. As students identified and discussed critical incidents in their field and clinical placements each week, they were guided by professors, peers, and guest speakers from the community to assess and add to their awareness, knowledge, skills, encounters, and desire relative to dealing with diverse cultures. They were also guided to question and critique what they heard, read, and experienced.

Course Evaluation

The developmentally sequenced, experiential learning opportunities in our 7-week course heightened our students’ awareness of other cultures, challenged stereotypes and attitudes, broadened their cross-cultural knowledge and perspectives, and stimulated critical thinking. Class discussion of critical incidents that had occurred during each week’s field and clinical experiences served as informal assessment of students’ developing cultural competence. Reflective interactions with peers in class, as well as written reflections that incorporated professional literature, added to students’ cultural awareness and knowledge. Qualitative indications of growth in cultural competence were gathered by means of students’ reflection papers and course evaluations, in which they were given an opportunity to document learnings that corresponded to our three course objectives.

Reflection Papers

Students completed five weekly reflection paper assignments that focused on intercultural experiences they gained during field and clinical placements. These written assignments gave students an opportunity to link theory with practice as they reflected on each week’s cultural encounters and referenced current professional publications in their analysis. Two selections from reflection papers, included below, describe how students were able to integrate their learnings from class into their respective fields of practice as they applied Bennett’s (1993) DMIS and reflected on Campinha-Bacote’s (2003) five components of the process of cultural competence.

Bennett’s denial of difference stage of development was demonstrated in a critical incident shared by an education student who was assigned to an inner city elementary school with a substantial Asian population. In leading a class discussion about the practice of changing one’s name to an American name, our student proceeded with the assumption that this was a common, well-accepted practice as students assimilated to American culture. However, when she asked the children in her class why they changed their names, she received answers that opened her eyes to other viewpoints she had not considered. Children told her “they changed my name because it was hard to pronounce.” One child became defensive and tearful as she recalled how she was forced to change her name. Our student reflected that she had never realized the depth of cultural identity that was associated with one’s birth name and native language. She confessed that both she and her mentor teacher were surprised at the depth of emotion displayed by the children when they were asked to share information about the meaning of their names, incorporating images and expressions from their own languages. In reflecting on Campinha-Bacote’s (2003) theoretical framework, this cultural encounter with Asian children increased our education student’s awareness of Asian culture, as well as her desire to know more about it.

Bennett’s (1993) acceptance of difference stage of development was demonstrated by a nursing student who made a home health care visit, with her preceptor, to a woman from Rwanda and her newborn infant. On the trip to the client’s home, the preceptor handed our student an Internet printout of Rwandan culture, which explained cultural characteristics like communication styles and time-space orientation. The preceptor explained, “I like to look up information about a new culture before I make a visit.” Our student was impressed with the way her preceptor actively modeled respect for cross-cultural differences through her willingness to look up and share information. In her written reflection, our nursing student established a connection between her decision to add that kind of cultural information in expanding the knowledge base for her own professional practice and Campinha-Bacote’s (2003) components of cultural awareness, cultural knowledge, and cultural desire.

Narrative Course Evaluations

Selected student comments from a three-question narrative course evaluation are presented below, along with composite summaries, to highlight significant instances of student growth and development as culturally competent professionals as related to our three course objectives.

In response to the first question, “In what ways during your fieldwork or clinical experiences did you apply conceptual models of cultural competence that were discussed in this course?”, students demonstrated an understanding of the scope of Campinha-Bacote’s (2003) five components of the process of cultural competence. Students uniformly expressed an increase in cultural awareness and knowledge, in areas ranging from differences in language, race, and ethnicity, to differences in religion, sex, customs, or beliefs. Several students gave examples of an enhanced ability to effectively interact with diverse populations in teaching, social service, or health care settings. One nursing student shared that she had developed a desire to choose patients with different backgrounds than her own so that she would have an opportunity to learn from their differences and offer them the best care she could. An education student summed up the value of her multi-disciplinary learning as follows:

I think now I see cultural competence in a different light. I know different models and strategies to use while I am teaching. I have made connections between nursing and education so I have two views I can refer to.

In response to the second question, “In what ways do you think the cultural concepts you have learned in this course may apply to your career as a human service professional?”, students from all three disciplines—nursing, education, and social work—expressed they felt more prepared to address the wide range of cultural differences they will encounter in their professions. Several nursing students noted an increase in comfort level and confidence in asking questions of a sensitive nature to individuals from different cultures. These same students also noted an increased sensitivity to culture-based needs and preferences in health care settings that individual clients from diverse cultures may have. One education student who worked with deaf students in an inner city setting learned of culturally based differences in values and basic needs as she compared her own culture with the cultures of her students. A social work student detailed her increased awareness of linguistic and social differences in her interactions with autistic children from Arab backgrounds. One nursing student summed up the value of the course as she admitted:

I’m not as culturally competent as I assumed I was. No one is culturally proficient in relation to all cultures. It takes effort.… You have to want to learn.

In response to the third question, “What did you learn about cultural competence from this course?”, students’ answers demonstrated that they had learned to recognize and critically assess their own growth along Bennett’s (1993) DMIS. In reflecting on Bennett’s stages of development, an education student who was placed in an inner city school setting shared that:

I could see myself moving through the DMIS model in my field experience. It was helpful to learn that what I was going through was normal, and that my denial of difference and my embracing of my own culture as superior was a…reaction to a situation where I initially experienced culture shock.

Students recognized and accepted responsibility for personal tendencies to stereotype and judge others without knowing them, and they documented concerted efforts to look for commonalities across perceived differences. Several students reported increased awareness and knowledge to apply to future cross-cultural encounters, as well as increased ability to identify barriers to communication across cultures. One nursing student astutely concluded that becoming culturally competent “is a dynamic process that takes continual practice” over time.

Discussion

The idea of a stand-alone, multidisciplinary course focusing on cultural competence has not yet been widely embraced as a necessary component of professional curricula. Support from university administration is critical to the viability of this kind of course in the following three areas: determining faculty workload and applying team teaching formulas; allocating budgetary support for travel and additional training for human service faculty who demonstrate an interest in intercultural issues; and funding to bring diverse community speakers to campus. Gathering widespread support from among a university’s faculty as a whole, regarding additions to or changes in the curriculum, is also essential. A long-range goal of adopting a course similar to this one necessitates support from colleagues who perform academic advising duties.

Courses in cultural competence must be carefully piloted and well marketed, with the focus and rationale for the course carefully explained, to generate and sustain student interest. Because this course was an elective for students in professional programs who already had full schedules with their clinical placements, recruiting students was a challenge. To accommodate their schedules, the course was offered once per week for 3 hours in an evening slot. Finding guest speakers from diverse communities who would come for a small honorarium was also challenging, yet not impossible. The greatest challenge with guest speakers was in limiting a panel of people who had important stories to tell within the confines of a single evening class session. There were often more student questions than time to dialogue on critical issues they raised concerning racism, equal access, class distinctions, social justice, and homophobia, among other topics. After participating in these sessions, students were challenged to reflect on what they heard and apply it to their next clinical session. In recognizing the various logistical challenges, faculty and students were flexible in accepting time limitations and adapting as needed to meet the goals of the course.

Conclusion

What has been built with these interdisciplinary efforts is a beginning. As our students prepare to function as professionals in the human service professions, it is imperative that they be provided with regular opportunities in their professional curricula to increase personal awareness, gain knowledge of intercultural differences, practice intercultural skills, and develop the overall ability to provide culturally competent services. The kind of multidisciplinary approach to teaching and learning outlined in this article has been shown to be a benefit to a small sample of students. Faculty benefited as well, with positive outcomes that included the following: participation in a rewarding, learner-centered teaching collaboration with colleagues who shared common goals in achieving the university’s mission to prepare students to function in a diverse society; opportunities for contributions to the university’s diversity initiative in promoting the generation and adoption of an additional university learning goal “to create inter-cultural competence and the ability to work with diverse groups”; and research opportunities that resulted in national and international conference presentations, as well as in publications. Overall, the authors believe the positive outcomes of professional collaboration across human service disciplines will be far reaching, as it brings together colleagues with similar goals, enriches the knowledge base of our disciplines, and enhances our ability to raise up the kind of culturally competent professionals who are vital in serving future diverse generations in the United States.

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Cultural Competence Pilot Course Content, Linked to Campinha-Bacote’s (2003) Five Components of the Process of Cultural Competence

Course ContentCultural awarenessCultural KnowledgeCultural SkillCultural EncountersCultural Desire
Week 1Overview of theories and models of cultural competencyInitial self-assessment of interactions with persons from different culturesStandards for professional practice across disciplines
Week 2Intercultural Development InventoryIntroduction to reflection paper assignments and professional materials on reserveStudent reflection on specific skill application from field and clinical placementsRole playing activities in intercultural communicationStudent sharing of and reflection on intercultural experiences from field and clinical placements
Week 3Reflection paper #1Guest speaker: “Eliminating health disparities”Student skill reflection (ongoing)Guest speaker: “Eliminating health disparities”Student sharing (ongoing)
Week 4Reflection paper #2Guest speaker: “Cultural competency in education”Student skill reflection (ongoing)Guest speaker: “Cultural competency in education”Student sharing (ongoing)
Week 5Reflection paper #3Intercultural panel of speakers (Somalian, Laotian, Vietnamese, Gay/Lesbian)Student skill reflection (ongoing)Intercultural panel of speakers (Somalian, Laotian, Vietnamese, Gay/Lesbian)Student sharing (ongoing)
Week 6Reflection paper #4Intercultural panel of speakers (African American, Appalachian, Hispanic)Student skill reflection (ongoing)Intercultural panel of speakers (African American, Appalachian, Hispanic)Student sharing (ongoing)
Week 7Reflection paper #5Review of theories and models of cultural competencyStudent skill reflection (final evaluation)Final self-assessment of interactions with persons from different culturesStudent sharing (final reflections)
Authors

Dr. Munoz is Professor, College of Natural Sciences, Nursing and Health, Dr. DoBroka is Associate Professor of Education, and Dr. Mohammad is Professor of Social Work, Capital University, Columbus, Ohio.

This study was supported in part by internal grant funding from Capital University, Columbus, Ohio.

Address correspondence to Cora C. Munoz, PhD, RN, Professor, College of Natural Sciences, Nursing and Health, Capital University, 1 College and Main St., Columbus, OH 43209; e-mail: .cmunoz@capital.edu

10.3928/01484834-20090610-03

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