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When assessing the fragility that characterizes the health of an immigrant person, a culturally competent transformation of the nurse–patient teaching-learning process is necessary. Therefore, it is considered essential to incorporate cultural competence and intercultural communication in higher nursing education.
To determine the content and knowledge of cultural competence and intercultural communication offered in higher education in nursing courses.
The Campinha-Bacote model of cultural competence was used as the primary reference.
A scoping review was conducted about studies published in the period 2003 and 2020. The research was conducted between May and October 2020. More than a hundred documents (books, chapters, articles, conference proceedings) have been consulted.
Undergraduate nursing courses and postgraduate education move toward promoting cultural competence and sensitivity through teaching strategies.
Teaching projects that combine multiple competencies are more effective, including teacher training. A predominant element is a need for continuous and transversal projects. University nursing education must adapt culturally competent curricula.
Keywords: nurses, education, cultural competence, cultural sensitivity, healthThe incorporation into the European Higher Education Area (EHEA; Somoza et al., 2011), has meant changes of great importance in university teaching (Sánchez-Ojeda et al., 2018). This fact has led to significant legislative, professional, and social changes. Therefore, introducing a series of transformations at a structural and operational level has been promoted, directly impacting the skills and professional profiles of university education. This change process has given an increase to a teaching paradigm in which the student becomes the center of the entire educational process: this has led to a redefinition of both roles of teachers and students (Backes et al., 2011).
It is known that first-level nursing higher education is oriented to professional activities, so they need to work a lot on the students’ training (Backes et al., 2011; Gómez Cantarino et al., 2015). Successful completion of these undergraduate courses will give access to a Bachelor’s or Postgraduate degree, which appears in the Registry of Universities, Centers, and Titles (RUCT). Instead, second-level education (e.g., Master’s) is oriented to acquiring advanced training, as specialized or multidisciplinary topics. It also promotes initiation into research tasks (Gómez Cantarino et al., 2015).
University training in nursing follows a human, scientific, and teamwork perspective. They train students (in degree or Master’s) to identify, act, and evaluate the health needs of a target population. It also affects the health promotion and education for individuals, family, and community, considering their cultural environment (Backes et al., 2011; García et al., 2011). In this sense, Meleis (2010), a nurse theorist, indicates that nursing is considered a human and holistic science, with an orientation to care practice at any time and place, which begins with acquiring skills within the classroom (Cantarino et al., 2015). Considering the requested skills, fundamental for care at any place, and for any target population, the care is considered culturally competent when congruent to the people’s values and symbols influenced by the culture (Leininger, 1994).
The concept of cultural competence has its origin in the theories of intercultural nursing, specifically within the Leininger model, in the 1970s (Leininger, 1994; Leininger and McFarland, 2006). This model considers the analysis of the different cultures concerning: nursing, care practices, values and beliefs, concepts of health and disease. Its outcome guarantees effective and meaningful nursing care, in line with the cultural values and context (Ibidem).
It was only in the mid-1990s that this concept became more important. Even the American Academy of Nursing defined cultural competence, indicating that it includes a complete integration of knowledge, attitudes, and skills, facilitating intercultural communication and interactions between people (Leininger and McFarland, 2006). For this reason, United States began to incorporate cultural competence into nursing studies in the 1980s, specifically in San Francisco. In 1982, California introduced specific graduate studies in nursing (masters) to educate students on cultural competence. The literature suggests it is necessary to plan the students’ training to recognize their attitudes, enabling them to instill positivity in their relationship with patients in hospital and community care (González, 2008; Gómez Cantarino et al., 2015).
The term, cultural competence, also began to be more considered in the scientific community, thanks to the emergence of new theories, which are following described. For example, Purnell (with Tilki and Taylor) presents a model of cultural competencies and listening skills useful for health care professionals. It starts from the consciousness of the professional, and it considers four phases in mutual interaction: self-awareness, cultural identity, Attachment to inheritance and family assets, ethnocentrism (Purnell and Fenkl, 2019). Spector’s health traditions model is based on recognizing specific behaviors strongly related to the culture of origin. It analyzes how people manage their health concerning these. Giger and Davidhizar’s (2002) model of cross-cultural nursing describe six cultural phenomenal which need to be known by the health professionals in order to guarantee effective care: the communication barriers/problems; space/setting; the social organization of the context; the dedicated time; the environment control; the biological modification (structure of the body) (Karaburak et al., 2014). Last is the Campinha-Bacote cultural competence model, which interprets cultural competence as a dynamic process, and it requests health care providers to consider this competence a priority. The main assumptions are: (1) cultural competence is a process; (2) it consists of five main elements: cultural awareness, cultural knowledge, cultural skills, cultural encounter, and cultural desire; (3) within the groups there is more variation than across them; (4) health care providers’ cultural competence is strongly related to services providing culturally responsive care for ethnically diverse people (Campinha-Bacote, 2008, 2007, 2002).
In 2019, which corresponds to 3.5% of the world’s population, 272 million migrants traveled worldwide. The vast majority of these people arrive in a new country with precarious health, generally due to the conditions in which they made the trip (Guild et al., 2020). Indeed, the living conditions in the new country and the stress of acculturation can cause a rapid deterioration of the health capital; good health has been verified in most of the migrant population, based on a selection of people from the country of origin who are young and in good health (Tizzi et al., 2018). It is even found that the differences observed in the health problems of migrants, compared to the local population, are constitutional, cultural, or endemic in the countries of origin (for example, cervical cancer, female genital mutilation, tuberculosis). In addition, mental health problems are observed, often associated with migration routes coupled with living conditions in the host country (Sánchez-Ojeda et al., 2018; Tizzi et al., 2018).
It is important to note that the literature indicates an improvement of cultural competence in the higher nursing education educational offer. However, some common problems still arise in the teaching plans and training: (1) the lack of consensus on what should be taught; (2) the related timing; (3) the lack of standard references; (4) a limited and inconsistent formal evaluation of educational interventions (Spector, 2018). It is a shared opinion that university nursing courses (Undergraduate/Postgraduate) need to educate and prepare future professionals, providing them skills to face challenges and complexity generated by cultural diversity; ability to understand that care includes tolerance, respect, and critical self-reflection; ability to understand that values (related to culture but not only) are strongly involved in the therapeutic relationship.
Therefore, nursing courses are called to adopt curricula that support cultural competence to make future nurses able to promote social justice in care contexts. This concern is framed in what today is clearly defined as a standard of socio-political knowledge in nursing (Munn et al., 2018).
The objective of this scoping review is to analyze how undergraduate nursing programs and postgraduate education are promoting cultural competence and sensitivity in the learning programs.
A scoping review has been processed to analyze if and how nursing courses’ curricula promote cultural competence and sensitivity. A vision of the focus of the documents is even acquired, which allows researchers an evaluation, synthesis, and criticism of the evidence inherent to the objective of the study (Siles González, 2005; Peters et al., 2015). As the primary conceptual model, we use the Process of Cultural Competence in the Delivery of Healthcare Services Model (PCCSS), proposed by Campinha-Bacote (2008, 2007, 2002). It is the most promising model to guide research since it can respond comprehensively and globally in all dimensions to the proposed objective. It is also the reference point for the analysis carried out with the designed strategy.
Through this model, culture provides the individual with a set of beliefs and values that define feelings of belonging and continuity. It also facilitates social integration and communication between members of a group (Campinha-Bacote, 2007). As previously mentioned, the PCCSS methodology is based on interpreting cultural competence as a continuous process. Students and health professionals strive to achieve skills with the different cultural groups of clients to serve (individual, family, community). Thus, cultural competence based on this model results from the integration of five concepts (1) Cultural awareness, which includes the exploration of one’s own cultural and professional background. In addition to the prejudices and stereotypes that are held toward people of different cultures. Therefore, it reviews cultural awareness and sensitivity through training (2) Cultural knowledge, where beliefs and values about health are integrated. To develop cultural competence within higher education studies in nursing (3) Cultural skills include identifying needs for care and adaptation to the context. Closely related to the development of didactic strategies in nursing university studies, (4) Cultural encounter promotes the need to involve the student and the health professional in inter-cultural immersions to prevent stereotypes. Use information and communication methodologies (5) Cultural desire, based on respecting differences and reinforcing similarities. It implies the will to learn on the part of the student–teacher (Campinha-Bacote, 2003) ( Figure 1 ).