Influence of Culture in Nursing Curriculum | Research

Influence of Culture in Nursing Curriculum | Research Amber Hussain Abstract: The aim of this study is to identify the influence of culture in nursing curriculum. 30 nursing instructors participated in the study. A questionnaire was distributed, which included five thematic categories. Findings revealed that teachers view definition of culture differently and they are aware of its importance in nursing in order to provide cultural sensitive patient care, but they view student diversity as challenging in classroom setting. Introduction: Development of curriculum plays a vital role in creating educational change. In order to improve classroom practices and students learning, large-scale curriculum reforms are instigated but these often fall short. There can be variety of reasons for these shortfalls, among which cultural influence is one. To develop and implement a high quality curriculum, a culture-sensitive approach to curriculum development is necessary (Nijhuis, Pieters Voogt, 2013). This approach have equal or even more importance in the field of nursing, as nurses are the one who are confronted with patients who belong to different cultural backgrounds. According to Spritzer et al. (1996), in order to improve nurse’s cross-cultural awareness, major efforts have been made to develop culturally sensitive theoretical knowledge. To develop this awareness, teacher has to play a major role as; teachers’ multicultural competency is becoming an increasingly vital element in educational curriculum (Malta, 2012). Therefore, a teacher’s role is to be aware of their own culture, student’s culture and make students sensitive to cultural diverse patient care, which can be implemented by using varied teaching strategies in classroom setting. According to Maltby (2008), there are a variety of teaching techniques that can be used to engage students in the process of becoming culturally competent such as role plays, using exemplars and web-based interactions. Methodology Using convenience sampling, 30 nursing instructors of more than 1 year experience, participated in study. The participants teach at different teaching institutions of nursing i.e. Ziauddin college of Nursing, Baqai College of Nursing and Aga Khan University School of Nursing. A survey questionnaire was given to rate responses according to five broad aspects: definition of culture, cultural content, students’ diversity, teachers own cultural values and classroom pedagogies on 3 point likert scale (refer Appendix A). Results The study found that the definition of culture is perceived differently by different teachers. 83% view it as lifestyle of people, 33% believe that it is transformed from one generation to another and 37% perceive it as identity of people. 77% teachers disagree that cultural diverse patient care is incorporated in nursing curriculum taught in Pakistan and almost the same percentile (80%) of teachers agreed with the consensus that the curriculum is adapting from west and it diverts students from own culture. 73% stated that diversity among students creates conflict and it arise difficulty in students learning.100% teachers perceive that they are aware of their own culture, 93% knew that it is their responsibility to know about student’s culture and therefore 83% believe that it is important to train teachers regarding cultural diversity. 80% believe that they also face challenge to teach multicultural class. Majority of teachers use different teaching pedagogies like ice breake r (90%), case studies (77%), internet/videos (70%), reflections (67%) and group work (86%), still there are few who are not using these pedagogies. Discussion To investigate what teachers think about the role of culture in teaching and learning in nursing curriculum, questions were asked from them. Results are presented in appendix B and C. The results suggest that teachers in nursing schools perceive the understanding of culture differently. Majority view it as life style of people and few perceive it as identity of people and few believe that it is transformed from one generation to another .There are various understandings regarding culture. According to Stephens (2007, as cited in Nijhuisetal., 2013), culture gives meaning to beliefs and actions of individual and societies. It is an ideational tool which can be used to describe and evaluate that action. Nijhuis, Pieters and Pieters (2013) view culture as static or fixed phenomena. For nursing content part, results show that 77% of the teachers disagree with the opinion that the curriculum present in local context provides enough cultural information. These finding indicated that the kind of information available on the textbooks is not sufficient to teach the culture, which indentifies a gap in the curriculum content that expose students to foreign culture. Maltby (2008) also questioned the depth of cultural content taught in nursing curriculum. Moreover 80% agree that, nursing curriculum is adapted from western culture and it diverts students from their local culture. The idea emphases that, as most of the textbooks of nursing are adapted from foreign culture, they may cause learners to lose their own cultural identity. According to Thomas (1997) Poor contextual curriculum leads to cultural mismatches on the level of local context. In relation to the cultural diversity in students, majority of instructors reported that their classroom students are culturally diverse, and they believe that this creates challenge for both students and teachers, for example for teachers it would be difficult to respect and inculcate each individual student’s cultural needs and use teaching strategies accordingly, whereas, for students, diversity creates difficulty in reaching to a consensus. According to Phuntsog (2001) diversity in student directs teachers to provide equal opportunities to all students irrespective of their culture, caste and learning style. On the other hand, according to Marshall (1995) many institutions value cultural diversity but find it as challenging in a group work because there is a probability of developing a false consensus, as one think differently than other. Moreover, Majority of teachers have reported that they are familiar with their own cultural values and responsible towards knowing student cultural values. This brings forward the idea of culturally responsive teachers who takes the cultural identities of the students in the classroom into account. This would help teachers to teach in a way that recognizes that each learner is an individual, with a particular cultural inheritance, who may rely on a different ways of knowing. According to Malta (2012) by recognizing student diversity it would be possible for teachers to become aware of cultural barriers and learn to teach from a culturally sensitive perspective. Apart from this, majority of teachers had consensus on importance of receiving cultural training, since course trainings would help them to handle cultural themes and topics in more ease due to gaining proficiency in the subject area. Lastly, the study shed light on what kind of activities teachers practice in their Classrooms. Majority of teachers agree that they use different teaching methodologies i.e. icebreakers, case studies, videos, internets, reflection writing and group work, in order make students understand their own culture, be socially comfortable and understand aspects of foreign culture. These findings are parallel to that of Gonen and Saglam (2012) whereby teachers use different channels of information which expose students to foreign culture. Therefore, teachers develop a critical view towards foreign culture and these various sources of information a use to foster understanding of diverse culture. Conclusion In conclusion, culture has an influence in nursing curriculum in the area of content, teaching and learning. In the field of nursing, there is a lack of in depth content regarding culturally diverse patient care and that limited knowledge is mainly adapted from foreign culture due to which we tend to neglect the aspect of native culture. Moreover, students and teachers’ diverse cultural background and values are also affecting the learning outcome in classroom setting. Therefore, it is important for teachers to incorporate those teaching pedagogies which foster the concept of cultural sensitive patient care and respect among each other. References Davidhizar, R., Giger, J.N. (2002). Teaching culture within nursing curriculum using the GigerDavidhizar model of transcultural nursing assessment. Journal of Nursing Education, 40 (6), 282-284. Flintoff, V.J., Rivers, S. (2012). A reshaping of counseling curriculum: responding to the changingcultural context. British Journal of Guidance and Counseling, 40 (3), 235-246. Malta, B.V. (2012). Am I culturally competent? A study on multicultural teaching competencies among school teachers in Malta. The Journal of Multiculturalism in Education, 8 (1), 1-43. Maltby, H.J. (2008). A reflection on culture over time by baccularte nursing students.Contemporary Nurse, 28 (1), 111-118. Marshall, S.P. (2006).Cultural competence in nursing curricula: How are we doing 20years later? Guest Editorial, 45(7), 243-244. Nijhuis, C.G., Pieters, J.M., Voogt, J.M. (2013). Influence of culture on curriculum development in Ghana: an undervalued factor? Curriculum Studies, 45(2), 225-250. Phuntsog, N. (2001). Culturally responsive teaching: what do selected United States elementary School teachers think? Intercultural Education, 12, 51-64. Ruth, L.A. (2003). A critical way of knowing in a multi cultural nursing curriculum. Intuition a Way of Knowing, 24 (3), 129-134. Sairanen, R., Richardson, E., Kelly, L., Bergknut, E., Koskinen, L., Lundberg, P., Muir, N., Olt, H., Vlieger, L. (2013). Putting culture in the curriculum: A European project. Nurse Education in Practice.13, 118-124. Simunovi, V.J., Hren, D., Ivanis, A., Dorup, J., Krivokuca, Z., Ristic, S., verhaaren, H., Sonntag, H., Ribaric, S., Tomic, S., Vojnikovic, B., Selescovic, H., Dahl, M., Marusic, A., Marisic, M. (2007). Survey of attitudes towards curriculum reforms among medical teachers in different socio-economic and cultural environments. Curriculum Reforms among Medical Teachers, 29, 833-835. Spitzer, A., Kesselring, A., Ravid, C., Tamir, B., Granot, M., Noam, R. (1996). Learning about another culture: project and curricular reflections. Journal of Nursing Education, 35 (7), 322-328. Thomas, E. (1997). Developing a culture-sensitive pedagogy: tackling a problem of melding ‘global culture’ within existing cultural contexts. International Journal of Educational Development, 17(1), 13–26. Vikers, D. (2010). Social justice: A concept for undergraduate nursing curricula. Southern Online Journalof Nursing Research, 8(1). Appendix A: Questionnaire used for data collection along with consent form: Purpose: The purpose of this project study is to identify the influence of culture on nursing curriculum. In this study, culture refers to values, beliefs, language and customs of a particular people that impact the area of nursing education and practice. The project basically analyze the presence of cultural content in nursing curriculum and its significance, effects of students diverse cultural characteristic in classroom learning and teachers competency in relation to culture. Consent: This is a project being conducted by Amber Hussain MSCN student in a course of Curriculum, Teaching and Learning at IED (institute of Educational Development). You are invited to participate in this project because you are associated with teaching in nursing profession. Your participation in this study is voluntary. The procedure involves filling a questionnaire. Your responses will be kept confidential and the results of this study will be used for research purpose. Participant Signature: ______________________ Appendix B: Compilation of the responses received by respondents on a 3 point likert scale: Appendix C: Graphical representation of the responses based on 5 broad categories: Graph 1: The above graph depicts that 83% of the teacher’s view culture as a lifestyle of people and about one third of the respondents view it as people identity and a permanent phenomena which is transformed from one generation to another. Graph 2: The above graph shows that 77% of the teachers believe that nursing curriculum taught in Pakistan does not provide opportunities for culturally diverse patient care but 77% of the respondents agreed that the nursing curriculum reflect patient’s values and beliefs. Around 80% of the respondent’s view that nursing curriculum is adopted from western culture and it alienates students from native culture. Graph 3: The above graph depicts that more than 77% of the teacher’s agreed that the student body in classroom is culturally diverse. Around 70% of the respondents also agreed that the language barriers create difficulty in learning and diversity creates conflicts in classroom. Graph 3: Graph 5: The above graph depicts that more than 70% of the teacher’s use the above teaching methodologies frequently in order to achieve different learning objectives.