Effects of an educational intervention on mentors’ competence in mentoring culturally and linguistically diverse nursing students

Abstract The aim of this study was to develop an educational intervention and evaluate its effects on mentors’ competence in mentoring culturally and linguistically diverse nursing students during clinical placement. The Medical Research Council framework for complex interventions guided the developmental, piloting, evaluation and implementation phases of the study. First, a cross-sectional study was conducted to describe mentors’ (n=323) competence in mentoring diverse nursing students during clinical placement and identify factors that affect mentoring. A systematic review was conducted to identify evidence on educational interventions (n=6) designed to improve nurses’ self-assessed cultural competence and on the effectiveness of these interventions. The identified theory was used as a basis for the development of the educational intervention. Next, the intervention was pilot tested, delivered according to the published study protocol and evaluated for its effects on mentors’ competence in mentoring diverse nursing students during clinical placement. A nonrandomised, quasi-experimental design was used. Participants were mentors employed at two hospitals. The intervention group (n=49) completed newly developed blended learning mentoring education with a cultural competence component and the control group (n=62) online mentoring education without a cultural competence component. Data were collected from both groups at baseline, immediately after the education, and six-months follow-up using the Mentors’ Competence Instrument and Mentors’ Cultural Competence Instrument. Wilcoxon signed-rank test and Mann-Whitney U test were used to find differences before and after education. General mentoring competence areas improved statistically significantly in both groups following education. Competence in cultural interaction and safety and cultural skills improved statistically significantly in the intervention group. Differences between groups were statistically nonsignificant. Educational preparation of mentors in the mentoring of diverse nursing students has the potential to improve mentors’ competence. Education alone without continuous support may be insufficient to maintain mentors’ cultural competence in mentoring. Adequate time, support and resources must be allocated to maintain mentors’ competence and motivation towards the mentoring of diverse nursing students.Tiivistelmä Tarkoituksena oli kehittää koulutusinterventio ja arvioida sen vaikuttavuutta opiskelijaohjaajien osaamiseen ohjata kulttuurisesti ja kielellisesti monimuotoisia sairaanhoitajaopiskelijoita harjoittelun aikana. Tutkimuksen kehittämis-, pilotointi-, arviointi- ja implementointivaiheita ohjasi Medical Research Council:n laatima kehys monimuotoisille interventioille. Tutkimuksen ensimmäisessä vaiheessa toteutettiin poikkileikkaustutkimus, jossa kuvattiin ohjaajien (n=323) osaamista ohjata monimuotoisia sairaanhoitajaopiskelijoita harjoittelun aikana ja selvittää ohjaukseen vaikuttavia tekijöitä. Toteutettiin järjestelmällinen kirjallisuuskatsaus sairaanhoitajien kulttuurista osaamista edistävistä koulutusinterventioista (n=6) ja niiden vaikuttavuudesta. Katsauksessa tunnistettua teoriaa käytettiin intervention kehittämisen perustana. Tutkimuksen seuraavissa vaiheissa interventio pilotoitiin, se toteutettiin tutkimusprotokollan mukaisesti, ja sen vaikutus ohjaajien osaamiseen arvioitiin. Ei-satunnaistettua kvasikokeellista tutkimusasetelmaa käytettiin. Osallistujat koostuivat kahden sairaalan opiskelijaohjaajista. Koeryhmä (n=49) suoritti vasta kehitetyn sulautuvana opetuksena toteutetun opiskelijaohjauskoulutuksen, johon sisältyi kulttuuriseen osaamiseen liittyvä teema. Kontrolliryhmä (n=62) suoritti verkon kautta opiskelijaohjauskoulutuksen, johon ei sisältynyt kulttuuriseen osaamiseen liittyvää teemaa. Aineisto kerättiin molemmilta ryhmiltä lähtötilanteessa, välittömästi koulutuksen jälkeen ja kuuden kuukauden seurantajakson jälkeen käyttämällä Opiskelijaohjausosaamisen sekä Opiskelijaohjaajan kulttuurisen osaamisen kyselyä. Wilcoxon signed rank testiä ja Mann-Whitney U testiä käytettiin erojen löytämiseksi ennen ja jälkeen koulutusta. Yleiset opiskelijaohjausosaamisen alueet kehittyivät tilastollisesti merkitsevästi molemmissa ryhmissä koulutuksen jälkeen. Koeryhmässä osaaminen kulttuurisessa kohtaamisessa ja turvallisuudessa sekä kulttuuritaidoissa kehittyi tilastollisesti merkitsevästi. Ryhmien välillä ei ollut tilastollisesti merkitsevää eroa. Ohjaajien kouluttaminen monimuotoisten sairaanhoitajaopiskelijoiden ohjaukseen mahdollistaa ohjaajien osaamisen kehittymisen. Pelkkä koulutus ilman jatkuvaa tukea voi olla riittämätön ylläpitämään ohjaajien kulttuurista osaamista. Ohjaajien osaamisen ja motivaation ylläpitämiseksi tulee ohjaukselle varata riittävästi aikaa, tukea ja resursseja

Clinical mentors’ experiences of their intercultural communication competence in mentoring culturally and linguistically diverse nursing students:a qualitative study

Abstract Background: Intercultural communication has become increasingly important in nursing due to the cross-border mobility of patients, health professionals and students. Development of cultural competence continues to be a challenge, particularly among professionals such as educators or healthcare providers who work in professions requiring communication across cultural boundaries. Despite challenges in nursing education related to cultural diversity, competence in intercultural communication has been proven to empower students and to help them grow professionally. Objectives: The aim of this study was to describe clinical mentors’ experiences of their intercultural communication competence in mentoring culturally and linguistically diverse nursing students during completion of their clinical practice. Design: Qualitative study design. Participants: The participants were 12 nurses who had previously mentored at least two culturally and linguistically diverse nursing students. Methods: Data were collected during spring 2016 using semi-structured interviews of 12 mentors working in specialized nursing care at one hospital located in central Finland. Data were analyzed using deductive-inductive content analysis. The main concepts of the Integrated Model of Intercultural Communication Competence were used during the semi-structured theme interviews and during analysis. These concepts include empathy, motivation, global attitude, intercultural experience and interaction involvement. Results: Mentors stated that empathy motivates them in the development of intercultural communication. Mentors experienced a lack of resources and support from their superiors, which caused psychological and ethical strain and reduced mentors’ motivation. Mentors openly admitted that they had experienced fear towards unknown cultures, but that this fear was reduced through positive mentoring experiences and cultural encounters. Conclusions: Continuous education on intercultural communication competence could succeed to further develop clinical mentors’ mentoring expertise, which could have the potential to greatly benefit students, patients and staff. Such education could be designed, implemented and measured for its effect in collaboration between health care organizations and higher educational institutions

Mentors’ competence in mentoring culturally and linguistically diverse nursing students during clinical placement

Abstract Aims: To describe mentors’ competence in mentoring culturally and linguistically diverse nursing students during clinical placement and identify the factors that affect mentoring. Background: Healthcare education is confronted by several challenges in a time characterized by globalization and increasing international migration. Nursing students from diverse backgrounds continue to experience difficulties during clinical placement. Students can overcome these difficulties and assume responsibility for their learning when mentored by supportive and competent mentors. Design: A cross‐sectional, descriptive explorative study design was used. Methods: Data were collected during spring 2016 through a survey sent to mentors (n = 3,355) employed at five university hospitals in Finland. Mentors’ competence in mentoring culturally and linguistically diverse nursing students was measured with the self‐assessment Mentors’ Competence Instrument and the Cultural and Linguistic Diversity in Mentoring scale. The analysis included descriptive statistics, non‐parametric tests and binary logistic regression analysis. Results: Mentors with experience mentoring nursing students from diverse backgrounds rated their overall competence in mentoring as good. However, the results show continued challenges related to competence in linguistic diversity in mentoring. Seven factors that affect mentors’ competence in linguistic diversity were identified. Despite high evaluations by mentors of competence related to cultural diversity in mentoring, there are still opportunities for improvement in this area. Conclusion: Innovative and effective strategies are needed to develop mentors’ competence in mentoring culturally and linguistically diverse nursing students. Educational and healthcare organizations should strive to enhance collaboration and increase the competence of both mentors and nursing students to work in increasingly diverse healthcare environments

Culturally and linguistically diverse registered nurses’ experiences of integration into nursing workforce:a qualitative descriptive study

Abstract Background: The nursing shortage is a global and ongoing phenomenon that is expected to worsen. In many countries, imbalances in the nursing workforce will require international recruitment and plans to increase domestic and international nursing graduates. Nurses from culturally and linguistically diverse backgrounds have been reported to experience challenges while integrating into the workforce. Aim: To describe culturally and linguistically diverse registered nurses’ experiences of their integration into the Finnish nursing workforce. Methods: The study adopted a qualitative descriptive design. Data were collected during the spring of 2021 from 24 culturally and linguistically diverse registered nurses working in various healthcare settings in Finland. Data were analyzed using content analysis, which resulted in 596 open codes, 21 sub-categories, and 8 categories. Results: According to the performed analysis, culturally and linguistically diverse nurses in Finland face cultural, ethnic and linguistic challenges. Organizational acceptance and acknowledgement of culturally and linguistically diverse nurses’ competence can help decrease the practice of deskilling and the perception that foreign nurses have purely opportunistic goals. Cultural and language learning support, tailored orientation programs, and mentorship are the most common organizational strategies for supporting integration and competence development. The role of the nurse manager and organizational strategies were also identified as essential components of smooth integration, work wellbeing and retention. Conclusions: Finnish healthcare organizations need to implement strategies that support culturally and linguistically diverse nurses’ integration into the workforce. Nurse managers are important leaders that can foster culturally and linguistically diverse nurses’ competence development, ensure the efficient use of their specialized skills, promote work wellbeing, and improve nurse retention

Nurse educators’ views of integrating culturally and linguistically diverse future registered nurses into healthcare settings:a qualitative descriptive study

Abstract Aim: To describe nurse educators’ views of how culturally and linguistically diverse future registered nurses are integrated into healthcare settings. Design: A qualitative descriptive design was adopted. Participants: A total of 20 nurse educators were recruited from three higher education institutions in Finland. Methods: Participants were recruited in the spring of 2021 through snowball sampling. Individual semi-structured interviews were held and recorded. The collected data were analysed using inductive content analysis. Results: The performed content analysis identified a total of 534 meaning units from the data, which were categorized into 343 open codes and 29 sub-categories. Furthermore, nine categories were identified and categorized into three main categories. The first main category was pre-graduation and represented a time point during which educators experienced early integration, nurse educator support and cooperation with stakeholders. The second main category was integration strategies into healthcare settings, which included workplace strategies, language competence and individual competencies and attributes. The third main category was the post-graduation experience, during which educators reported organizational readiness, migration and efficacy of the integrational model. Conclusions: The results revealed a need for increased resources linked to how nurse educators support the integration of culturally and linguistically diverse future registered nurses. Moreover, a nurse educator’s presence during the last clinical placement, early transition and integration was found to exert a significant effect on the smooth integration of culturally and linguistically diverse future nurses. Impact: This study establishes the need to enhance stakeholder cooperation between universities and other organizations towards supporting the integration process. Maximizing nurse educators’ support during the final clinical practice, early transition and post-graduation allows for successful integration and intention to stay. Reporting Method: This study was reported according to the Standards for Reporting Qualitative Research (SRQR). Patient or Public Participation: Participating educators shared their experiences of culturally and linguistically diverse future nurses’ integration

Integration strategies and models to support transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments:an umbrella review

Abstract Aims: The aim of this umbrella review was to establish recent evidence on integration strategies and models to support transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments. Design: Umbrella review conducted according to Joanna Briggs institute guidelines. Data sources: Data were collected from CINAHL, PubMed, Medic, ProQuest and Scopus electronic databases in 2021. Review methods: Two researchers simultaneously screened studies’ eligibility by title, abstract and full text. Quality appraisal for the selected studies was assessed according to Joanna Briggs institute critical appraisal. Data were synthesized by conducting content analysis. Results: Twenty-seven reviews were included in the final synthesis. Strategies and models for supporting the transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments were structured as intra-organizational, sociocultural, and professional development. Intra-organizational strategies and models were unique to a particular organization and included policies and support, diversity, collegial and peer support, employee treatment and workplace environment. Sociocultural strategies and models addressed social, cultural and group dynamics using cultural training, learning and support, social support and friendships, language and communication, and personal skills development. Professional development enhanced nursing competence, ability to practice and workplace professional development. This was supported through licensure and orientation to work, career and competence development, and workplace mentorship and preceptorship. Conclusions: There is a need to understand culturally and linguistically diverse nurses’ needs and motivation to integrate, which is essential toward developing efficient integrational strategies and models. Strategies and models also need to support cultural and personal competence development of native nurses to aid efficient integration of culturally and linguistically diverse colleagues. Future studies can evaluate nursing workforce shortages and their implications on integration process

Educational interventions designed to develop nurses’ cultural competence:a systematic review

Abstract Background: Due to a steady rise in cultural and linguistic diversity in healthcare settings and evident challenges associated with this diversity, there is an urgent need to address cultural competency of nurses. Ongoing, continuing professional development is needed to ensure nurses can provide culturally congruent nursing care. Objectives: The aim of this systematic review was to identify current best evidence on the types of educational interventions that have been developed to improve nurses’ self-assessed cultural competence and on the effectiveness of these interventions. Design: A systematic literature review. Data sources: Four electronic databases (PubMed, CINAHL, Medic, Eric) were searched for studies using a quasi-experimental design or randomised controlled trial published between January 2000 and June 2018. Review methods: Guidelines from the Centre for Review and Dissemination and the Joanna Briggs Institute guided the review. Two researchers independently assessed the eligibility of the studies by title, abstract and full-text and the methodological quality of the studies. Data tabulation and narrative analysis of study findings was performed. Results: Six studies met criteria for inclusion in the review. Studies used a quasi-experimental study design (n = 5) and a randomised controlled trial (n = 1). The participants (n = 334) were mainly nurses and interventions were conducted in various healthcare settings. Cultural competence education was offered through traditional contact teaching (n = 5) or web-based modules (n = 1) and ranged from one to 17 hours in length. Learning was enhanced through lectures, group discussions, case studies, reflective exercises and simulations. In two studies, following cultural competence interventions, participants in the intervention group had statistically significantly increased levels of competence in culture-related outcomes when compared to the control group. The four remaining studies did not include control group comparisons. Effect sizes (Cohen’s d) of the studies varied from small (d = 0.22) to very large (d = 1.47). Conclusions: There continues to be a need for high quality studies investigating educational interventions to develop nurses’ cultural competence. Further research should focus on reporting specific components of interventions that result in an increase in cultural competence

Nurse leaders' experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings:an interview study

Abstract Aim: To describe nurse leaders' experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings. Design: A qualitative descriptive study design. Participants: A total of 13 nurse leaders were recruited from four primary and specialized healthcare organizations in Finland. Methods: Data were collected through individual semi-structured interviews and analyzed using inductive content analysis. Results: Nurse leaders' experiences were categorized into seven main categories as follows: leadership, which concerns a leader's roles, style, and experience; organizational strategy and culture, which includes structure, policies, and intra-organizational culture; support strategies, including workplace and outside-of-work integration strategies; relationships and interactions, which considers interpersonal relationships and interactions; nurse competence requirements and development, which concerns both organizational and ward level competence demands, and support for competence development; language competence, which concerns challenges relating to language proficiency and development of language competence; and cultural diversity, which considers the importance of competence development brought about through experiences of being in a multicultural workplace. Conclusions: Culturally and linguistically diverse nurses are important within healthcare systems. These nurses constitute additional human resources, bring diverse experiences and expertise, and add to organizational cultural capital. Nurse leaders require competencies that are suitable for leading a diverse workforce, utilizing its competencies, establishing staff members' needs, and ensuring their continuous development. Resourcing, planning, and structuring the integration process affects nurses' experiences of the organizational socialization process. Impact: The findings of our study can offer guidance to healthcare organizations with regard to structural integration strategies at an institutional level. Leadership and management educators can benefit from the findings towards developing a curriculum that supports leaders' diversity, equity and inclusion, knowledge management and formal leadership competencies. Finally, nurse leaders may benefit from this study through being more aware towards supporting a multicultural, cohesive, and competent workforce through strong social capital

Culturally and linguistically diverse healthcare students’ experiences of the clinical learning environment and mentoring:a qualitative study

Abstract Development of educators’ and students’ global competence in higher education is increasingly important due to internationalization. Internationalization significantly influences healthcare education through an increase in the mobility of students. When conducting clinical practice in healthcare education, culturally and linguistically diverse healthcare students face the challenges of having limited learning opportunities and social isolation. Further investigation is required of students’ experiences in this area while asking them to share their experiences. This study aimed to describe students’ experiences of clinical learning environment and mentoring. A qualitative research design was used during 2013–2016. Data were collected from 133 culturally and linguistically diverse healthcare students, including exchange students and students studying in English language-taught degree programmes at eight Universities of Applied Sciences in Finland. Data were analysed using inductive content analysis. Students’ experiences were related to their mentors’ competence in mentoring, culturally diverse pedagogical atmosphere, and aspects of diversity that influence clinical learning. Students reported that they had experienced social isolation, discrimination, bullying, sexual harassment and prejudice during their clinical placements. These issues related to mistreatment of students need to be addressed. Also, structured clinical environments should be developed in which competent mentors assist students in reaching their clinical placement goals

The influence of digital learning on health sciences students’ competence development:a qualitative study

Abstract Background: Health care experts need high levels of competence, yet there is little evidence on the influence of digital learning on health science students’ competence development. Objectives: This study aims to describe health sciences students’ experiences of the development of their competence and the influences of digital learning upon their competence. Design: A qualitative descriptive research. Participants: A total of 15 health sciences students were interviewed. Methods: The data was collected by using individual semi-structured interviews during the spring of 2021. The data was analyzed using content analysis. Results: The health sciences students felt that their expertise encompasses motivation for future career development, understanding the social and professional influences on their career development, versatile expertise in various aspects of health sciences, and developing competence in different learning environments. The students recognized that digital learning requires the active participation, digitalization is a part of a successful learning environment, and digital learning challenges social interactions. The students’ digital learning facilitated competence development, which broadened their understanding of skills relevant to health sciences; however, these benefits could only be obtained when including adequate support. Conclusions: The results hold social value for the development of health sciences education as policy-makers can use the presented information to develop high-quality, digital learning procedures