Discussion of ResearchPeer Reviewed Articles

The Profile of an Intercultural Competence Educator for Healthcare and Other Professions

by Susan Schärli-Lim et al.

Introduction 

Once upon a time, an international student started a 3-day work shadowing in a community setting. At the end of the first day, the community supervisor refused to work with the student stating that the student was uninterested, because she didn´t ask any questions! The student was shocked and said that she was really interested. She thought it was impolite to ask the expert any questions. Once they were guided to reflect on their different expectations, they both agreed to continue and learned a lot. 

This situation reflects the need for trainers and students to be interculturally competent. The development of this competence is a complex process, and requires nurse educators to be interculturally competent themselves, and to be pedagogically prepared to facilitate intercultural learning and growth. In fact, the educator needs to be ethnorelative, and one stage ahead of the developmental aim of the educators and students. However, Baghdadi and Ismaile (2018) indicate that nurse educators have moderate levels of intercultural competence. Long (2012) criticized the lack of training of faculties, as only one out of 94 nursing faculties held a certificate in intercultural nursing. Kardong-Edgren et al., (2005) also reported that half of the lecturers teaching intercultural competence do not have any memorable academic preparation in this field. Therefore, it is important to develop programs for nurse educators. This need to train nurse educators led to the development of the TraINErS project (Training Intercultural Nursing Educators and Students) – an EU and Movetia funded project. In order to develop those programs it is important to have a clear definition of the competencies needed by those educators, so this project started with the identification of a profile of an intercultural competent nurse educator. Although this profile has been specifically created for nurses, many of the elements may be transferable to other professions. 

Goals

The first aim of the TraINErS project consists in the development of a profile of an intercultural competent nurse educator. The profile presented in this article will be validated in a second step of the project.

Apart from this, TraINErS will develop a blended training program, based on the profile, to train educators involved in the development of nursing students’ intercultural competence. The program will also create an assessment tool and evaluate the effectiveness of the blended learning program in intercultural competence. 

Methodology 

The development of this profile was based on the findings of an exhaustive literature review, a field study and discussions between expert intercultural educators. The literature search was conducted in the following databases: MEDLINE, PsycINFO, CINAHL, Cochrane, Proquest Central and Eric. Inclusion criteria consisted of publications in books, theoretical papers, research articles and grey literature published from 1985 to date. Literature was searched in the languages of the countries engaged in the project (Danish, Dutch, English, German, Spanish, Italian, Macedonian and Serbian). Out of the 391 pieces of bibliography found, 49 were selected. This profile will be validated in the future through a Delphi study.

Results: The proposed profile

The profile of the intercultural competence educator classifies 127 competences in four dimensions (Personal, Professional, Pedagogical – Intercultural competent educator, Pedagogical – Educator that trains intercultural competence). In addition, the competences have been categorized into knowledge, attitudes and values, and skills. A summary of the profile is presented in this article, the complete and unabridged version can be found in the resources menu of the World Council on Intercultural and Global Competence web page (https://iccglobal.org/resources/).

The Personal Intercultural Competence Dimension 

This dimension presents the intercultural competence aspect that forms the basis for a professional intercultural competent nurse and a nurse educator teaching intercultural competence. Personal intercultural competence is the process in which the person becomes increasingly sensitive to cultural differences (Bennett, 2013). In the setting of an intercultural nurse educator, it is a prerequisite that the individual is ethnorelative, this allows the person to predict the effectiveness and appropriateness of intercultural interactions. The individual is able to experience one’s own and other cultures as “relative to context.” They should be able to 1) recognize the prevailing cultural context in which they are operating; 2) shift their experience into an alternative worldview sufficiently to generate appropriate behavior; and 3) maintain a climate of respect for cultural difference while making ethical decisions. Table 1 presents the summary of the competences of the Personal Intercultural Dimension. 

Table 1. Personal Intercultural Competence Dimension

Personal Intercultural Competence
An ethnorelative individual is able to
Knowledge– Identify culture and cultural features which affect intercultural interaction
– Explain the influence perception plays on the attribution of meaning
– Identify sociolinguistic constituents specifically intercultural communication styles
– Describe deep cultural knowledge of oneself and cultural others
– Recite cultural frameworks for exploring cultural value differences
– Identify models to develop intercultural competence
Attitudes/Value– Be open and respect the cultural other 
– Value human dignity and diversity 
– Be interested and  seek intercultural interactions 
– Be empathic and humble 
– Tolerate ambiguity 
– Show patience and flexibility 
Skills  – Challenge own cultural assumptions, seek other perspectives and shift perspectives
– Communicate appropriately and effectively with cultural others
– Differentiate and use stereotypes/generalisations as hypothesis
– Behave appropriately to cultural context and the desired outcome
– Seek engagement and cooperation with cultural other

The Professional Intercultural Competence Dimension 

Professional intercultural competence is the application of personal intercultural competence to a professional context, such as nursing. A nurse educator who trains intercultural competence requires the ability to provide care adapted to the cultural background of the patient, groups and communities.  This includes the ability to work in multicultural teams. Ethnorelativity is a prerequisite for professional intercultural competence. Table 2 illustrates the additional attributes of an intercultural competent nurse. 

Table 2. Professional Intercultural Competence Dimension

Professional Intercultural Competence  
The intercultural competent nurse is able to
Knowledge– Know different health belief models
–  Explain the diversity of health beliefs, of patients, family and nurse roles and their mutual expectations
–  Understand culture shock, migratory and acculturation processes and their diverse impact on humans
–  Describe ethical dilemmas about cultural diversity and the determinants in health inequalities
–  Describe models of (inter)cultural competence in nursing
Attitudes/Value – Accept and respect the role of diverse cultures in care, especially of health- and healing beliefs
–  Show interest in the diverse life-worlds of the patients
–  Be aware of stereotypes, prejudices and cultural biases
–  Demonstrate motivation to increase cultural competence
–  Demonstrate cultural empathy
–  Demonstrate commitment to provide culture-sensitive care 
Skills  – Provide culturally congruent and sensitive care based on individual, family, community needs
–  Communicate in an interculturally competent manner according to diverse values and individual, family, community expectations
–  Manage ethical dilemmas and conflicts with appropriate strategies that satisfy all people involved
–  Apply social equity in the care
–  Work inclusively in a multidisciplinary and multicultural team 

The Pedagogical Dimension: Intercultural Competent Educator

This pedagogical dimension focuses on the nurse educator’s ability to teach students in an intercultural competent way (Table 3). The intercultural competent nurse educator should demonstrate 1) awareness of their own cultural approach and biases; 2) awareness of the diversity of the students; 3) adaptation of the teaching and learning process to the diversity of the students.

Table 3. Pedagogical Dimension: Intercultural Competent Educator

Pedagogical: Intercultural Competent Educator 
The nurse educator is able to
Knowledge – Identify the cultural diverse factors that condition learning
–  Formulate the impact of their own culture and the culture of the learning material on the subject taught
–  Identify risk factors, challenges and barriers that learners might surface during teaching and learning activities
–  Describe educational strategies to lead a culturally diverse group 
Attitudes/Value – Acknowledge, accept and integrate cultural differences among students or teachers and various ways of learning 
– Feel cultural empathy for students’ need of safety and trust 
– Display honesty and fairness in all monitoring activities 
Skills– Provide educational interventions adapted to cultural diversity 
– Model and encourage perspective shifting / multiperspectives in the teaching and learning process 
– Use intercultural communication skills in the teaching and learning process 

The Pedagogical Dimension: Educator that trains Intercultural Competence 

This dimension focuses on the competence to teach and foster the development of intercultural competence of nursing students (Table 4). The educator that trains intercultural competence should demonstrate the ability to: 1) design, implement, and manage intercultural competence educational programs in nursing; 2) conduct effective teaching and guiding according to the individual intercultural developmental process of the students; 3) manage a variety of methods, especially experiential, to promote intercultural competence.

Table 4. Pedagogical Dimension: Educator that trains intercultural competence

Pedagogical: Educator that trains intercultural competence 
The nurse educator that trains intercultural competence is able to…
Knowledge– Identify effective goals, objectives, and content of the educational program for the development of cultural competence in nursing
–  Explain the purpose, advantage and disadvantages of the different training strategies according to the students’ stage of intercultural sensitivity
–  Describe the principles of coaching for students in cultural immersions 
Attitudes/Value – Show commitment towards continuous adaptation of the training strategies to individualise the learning process to develop intercultural competence
– Show a positive attitude to apply active, effective methods aimed at reflective and critical thinking 
– Demonstrate commitment towards the ethics of culture teaching, learning and the ethics of culture contact 
Skills– Design integrated training programs with the appropriate mix of experiential and didactic methods, culture-specific and culture-general content, cognitive-affective-behavioural learning activities
–  Utilize specific strategies for each developmental stage to enhance intercultural development
–  Foster reflection on differences and commonalities and analysis to under-stand the impact of culture, and the dangers of ethnocentrism in nursing
–  Employ counselling strategies that help students to deal with cultural challenges 

Future perspectives

This article presents a profile of an intercultural competence educator that emerged out of the extensive literature review and a discussion of intercultural competence experts. This profile clearly indicates that an educator that teaches intercultural competence requires a multifaceted mix of personal, professional and pedagogical competencies. 

The profile identification was the first step of the TraINErS project. Next steps include validation of the profile by intercultural experts using the Delphi method and the creation of a blended learning program based on the output of the profile. To ensure that the profile comes to life, it will be tested by intercultural educators being trained and using the blended learning program. The results of the project process will be evaluated by the end of May 2022. At that moment, the blended learning program will be available for free on the project website. Additionally, the results of the TraINErS project will be disseminated in international and national events to inform and involve universities, healthcare services, and patient organisations.

We expect the TraINErS project will contribute to the effectiveness of teaching intercultural competence to current and future healthcare professionals, as well as maximizing the experiences and cost-effectiveness of cultural immersions. In healthcare, the improvement of the intercultural competence of professionals can contribute to overcome health disparities such as language barriers, cultural beliefs and practices, unconscious and conscious bias, variations in care access and quality. The intercultural competence of professionals will also facilitate international and intercultural teamwork, preventing culture shock and helping them to adapt to new work environments, a very important aspect that has become visible in the current COVID-19 pandemic.


Literature

Bennett, M. J. (2013). Basic concepts of intercultural communication: paradigms, principles & practice: selected readings. Boston: Intercultural Press.

Baghdadi, N. A., & Ismaile, S. (2018). Cultural competency of nursing faculty teaching in baccalaureate nursing programs in the United States. Australasian Medical Journal, 11(2), 126–134. https://doi.org/10.21767/AMJ.2018.3335

Kardong-Edgren, S., Bond, M. Lou, Schlosser, S., Cason, C., Jones, M. E., Warr, R., & Strunk, P. (2005). Cultural attitudes, knowledge, and skills of nursing faculty toward patients from four diverse cultures. Journal of Professional Nursing, 21(3), 175–182. https://doi.org/10.1016/j.profnurs.2005.04.001

Long, T. B. (2012). Overview of teaching strategies for cultural competence in nursing students. Journal of Cultural Diversity, 19(3), 102-108. 


Authors Trainers Project group (https://www.ap.be/en/research/trainers):

Elena de Lorenzo, Servicio Vasco de Salud Osakidetza, Spain elena_delorenzo@ehu.eus

Mette Bønløkke, VIA University College, Denmark  mebo@via.dk

Petra Bourkia, Berner Bildungszentrum Pflege, Switzerland petra.bourkia@bzpflege.ch

Izabela Filov, University St Kliment Ohridski, North Macedonia belafilov@gmail.com

Cinzia Gradellin,i Università Degli Studi di Modena e Reggio Emilia, Italy Cinzia.Gradellini@ausl.re.it

Daniela Händler-Schuster, Zurich University of Applied Sciences, Switzerland haed@zhaw.ch

Daniela Mecugni, Università Degli Studi di Modena e Reggio Emilia, Italy

Milton Bennet, Intercultural Development Research Institute, Italy milton.bennett@idrinstitute.org

Marija Mijatovic, Udruzenje Centar Djordje Vajfert, Serbia marijamijatovic.jagodina@gmail.com

Marilize Pretorius, InterCulturate, Belgium contact@interculturate.org

Susan Schärli-Lim, Zurich University of Applied Sciences, Switzerland scaa@zhaw.ch

Valérie Vanceulebroeck, AP University of Applied Sciences and Arts Antwerp, Belgium valerie.vanceulebroeck@ap.be 

Sofie Vermeiren, AP University of Applied Sciences and Arts Antwerp, Belgium sofie.vermeiren@ap.be

Uwe Weber, Berner Bildungszentrum Pflege, Switzerland uwe.weber@bzpflege.ch

Jagoba Zarandona, Servicio Vasco de Salud Osakidetza, Spain jagoba_zarandona@ehu.eus


Special acknowledgement to the European Nursing Module Network (ENM). The ENM Network is a consortium of 36 Higher Education Nursing Institutions from 16 European countries with a focus on developing intercultural competence of nursing students, offering the opportunity for a short-term module in another European country. This TraINErs project emerged from the ENM Network (https://www.enm-network.com/).

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