Teaching Innovation and Cultural Diversity: A Pilot Project on Intercultural Sensitivity for Nursing Students Volume 59- Issue 1

Raquel Caballero de la Calle*

• Doctor in Health Sciences, Associate Professor at the University of Castilla-La Mancha, Spain

Received: October 02, 2024; Published: October 10,2024

*Corresponding author: Raquel Caballero de la Calle, Doctor in Health Sciences, Associate Professor at the University of Castilla-La Mancha, Spain

DOI: 10.26717/BJSTR.2024.59.009240

Abstract PDF

Objective: To descriptively and inferentially analyze intercultural sensitivity in first-year Nursing students at the Faculty of Ciudad Real UCLM.

Methodology: A non-experimental, cross-sectional, quantitative and retrospective study was developed in which the Intercultural Sensitivity Scale adapted and validated by Ruiz Bernardo [1] was applied to a sample of 115 first-year Nursing students from the Faculty of Ciudad Real UCLM. The analysis procedure suggested by the author was implemented. Correlational and variance analyzes were performed to investigate the effects of sociodemographic and general factors. The SPSS v24.0 program for Windows was used, and a significance level of p < 0.05.

Results: The results of the study indicated favorable attitudes towards intercultural sensitivity of the study participants, regardless of the sociodemographic and general factors evaluated. For its part, interrelationships were found between the dimensions that justified such favorable attitudes.

Conclusion: Although favorable attitudes towards intercultural sensitivity were found, it is necessary to carry out educational intervention programs to strengthen them, with emphasis on considering that the sample elements were first-year Nursing students.

Keywords: Intercultural Sensitivity; Students; Nursing

Intercultural sensitivity is defined as the desire towards the motivation of individuals regarding interaction (i.e., knowledge, understanding, appreciation, and acceptance) with different cultures (Chen, et al. [2]). Considering the phenomenon and process of globalization, the construct of intercultural sensitivity gains special importance, as it relates to the cultural competence required in constant interpersonal relationships (Pérez Islas [3]). The study aimed to descriptively and inferentially analyze intercultural sensitivity in first-year Nursing students at the Faculty of Ciudad Real UCLM.

A non-experimental, cross-sectional, quantitative, descriptive, correlational, and retrospective study was conducted. A non-probabilistic, intentional, and incidental sample of 115 first-year Nursing students from the Faculty of Ciudad Real UCLM was selected. This included students of any age, gender, simultaneous study and work, marital status, health-related work, whether they have children, preferred living location, and acceptance of a person of another race into their home. Cases that did not provide verbal informed consent were excluded. Sample elements were incorporated into the study through direct contact with them, considering that the author of the study is a professor of one of their subjects. The Intercultural Sensitivity Scale, validated and adapted by Ruiz Bernardo [1], was used. It consists of 24 items distributed across six subscales or dimensions: Feelings of frustration in relations with people from other cultures, ethnocentric attitude; Positive feelings towards interaction with people from other cultures; Guidelines for adult and respectful interaction; Perceptions and behaviors that manifest positive and negative intercultural sensitivity; Self-confidence; Attention during interaction. Each item is rated on a five-point Likert scale (1: Completely disagree, 2: Disagree, 3: Not sure, 4: Agree, 5: Completely agree). The instrument's form is presented in Appendix Table 1. Regarding the analysis of the ISS, the data were analyzed according to the strategy proposed by Ruiz Bernardo [1]. The discrimination of items by dimension, as presented in Appendix Table 2, was considered.

Appendix Table 1: Form of the ISS used in the study (Ruiz Bernardo, [1]).

Note: Then read each of the sentences that appear and according to your first impression, mark with an X the degree of agreement or disagreement with each of the sentences. I remind you that there are no good or bad answers. 1. Strongly Disagree 2. Disagree 3. I’m not sure 4. Okay 5. Totally agree

Appendix Table 2: Item Distribution According to ISS Scales/Dimensions (Ruiz Bernardo, [1])

Algebraic sums of the items in each dimension were performed, first after reversing the scores of the inversely formulated items (2, 4, 8, 10, 13, 15, 18, 20, and 22). Considering the possible and resulting minimums and maximums of the study, as well as the 25th, 50th, and 75th percentiles of each dimension (and the total scale), tendencies were categorized as low, medium-low, medium-high, and high attitude towards intercultural sensitivity. From a general analytical perspective, both descriptive and inferential strategies were implemented. Among the descriptive, counts and associated percentages were reported for nominal quantitative variables, while descriptive statistics (mean, 95% confidence interval -CI95%-, standard deviation -SD-, median, minimum, and maximum) were used for continuous quantitative variables. Among the inferential analyses, the chi-square test was implemented to investigate the existence of statistically significant differences between response option counts. Additionally, Pearson and Spearman correlation coefficients (for continuous or ordinal data, respectively) were calculated to explore relationships between different constructs, as well as univariate ANOVAs to discriminate the results, both total and dimensional, of the ISS. Parametric analyses were justified based on the Central Limit Theorem (Guisande González et al. [4]). Data were analyzed using SPSS v24.0 for Windows, using a significance level of p < 0.05.

Sociodemographic and General Data

Regarding the sociodemographic and general characteristics of the sample elements, they were characterized by the following statistically significant general aspects (p < 0.05): Nursing students aged 18-25, predominantly women, mainly just students, working without a relation to health, single or in a relationship, without children, with a preference for living in the city, and with a predisposition (yes) or uncertainty (maybe) to admit a person of another race into their usual residence (Table 1). From the correlational analysis between the aforementioned sociodemographic and general aspects (Spearman's Rho), the statistically significant correlations (p < 0.05) indicated in Table 2 were found. This table outlines the key correlations found between different sociodemographic variables, providing insights into the relationships explored in the study. These data provided an interpretative context characteristic of an idiosyncrasy that could be seen as expected for the students representing the sample elements. This context will later allow for future interpretations concerning the results of the ISS. It is worth noting that no statistically significant associations (p > 0.05) were found with the items "Preferred place to live" and "Admission of a person of another race into one's home," indicating that these are independent of the remaining sociodemographic and general factors. Table 3 presents the results of the total ISS scale, as well as the different subscales or dimensions, according to the validation by Ruiz Bernardo [1].

Table 1: Counts, percentages, and chi-square tests for the sociodemographic and general factors of the sample elements (n=115).

Note: Source: Own elaboration. *p < 0.05; § Data series with a count of < 5 cases are not included to avoid statistical biases inherent to the chi-square test (Guisande González et al. [4]).

Table 2: Statistically significant correlations between sociodemographic and general factors, and their interpretation.

Note: Source: Own elaboration. *p < 0.05. This table outlines the key correlations found between different sociodemographic variables, providing insights into the relationships explored in the study.

Table 3: Descriptive Results of the ISS and Its Dimensions (n=115).

Note: Source: Own elaboration. Dimension 1: Feelings of frustration in relationships with people from other cultures, ethnocentric stance; Dimension 2: Positive feelings toward relationships and interaction with people from other cultures; Dimension 3: Guidelines for adult and respectful interaction; Dimension 4: Perceptions and behaviors manifesting positive and negative intercultural sensitivity; Dimension 5: Self-confidence; Dimension 6: Attention during interaction.

Here is the text translated into English: In this regard, relatively favorable results were found towards intercultural sensitivity, considering the interpretations for the total sample. Table 4 presents the statistically significant correlations (p < 0.05) found between the different dimensions of the ISS (Pearson correlation coefficients). In this regard, the relatively favorable results towards intercultural sensitivity found in the description of the total sample were reflected in significant relationships between all the dimensions of the ISS, indicating appropriate trends of the sample elements concerning the evaluated construct. Finally, Table 5 presents the results of the univariate ANOVAs for the ISS and its dimensions, categorized according to sociodemographic and general factors. In this sense, the relatively favorable attitudes towards intercultural sensitivity of the study participants were presented, almost entirely, independently of the sociodemographic and general factors evaluated.

Table 4: Presents the statistically significant correlations (p < 0.05) found between the different dimensions of the ISS (Pearson correlation coefficients).

Note: *p < 0.05; Source: Own elaboration. Dimension 1: Feelings of frustration in relationships with people from other cultures, ethnocentric stance; Dimension 2: Positive feelings towards relationships and interaction with people from other cultures; Dimension 3: Guidelines for adult and respectful interaction; Dimension 4: Perceptions and behaviors manifesting positive and negative intercultural sensitivity; Dimension 5: Self-confidence; Dimension 6: Attention during interaction.

Table 5:

Note: Source: Authors. *p < 0.05; **Relatively favorable parameters of the dimensions and the total scale towards intercultural sensitivity are recalled; Dimension 1: Feelings of frustration in relationships with people from other cultures, ethnocentric stance; Dimension 2: Positive feelings towards the relationship and interaction with people from other cultures; Dimension 3: Guidelines for adult and respectful interaction; Dimension 4: Perceptions and behaviors that manifest positive and negative intercultural sensitivity; Dimension 5: Self-confidence; Dimension 6: Attention during interaction.

The results of the study indicated favorable attitudes towards the intercultural sensitivity of the study participants, regardless of the sociodemographic and general factors evaluated. These results coincide with those of Pérez Islas [3], who conducted a similar evaluation in nursing students. Furthermore, it is highlighted that, consequently to the relational cluster found for the intercultural sensitivity of the study participants, first-year nursing students (the sample elements of this study) possess competencies that require reinforcement, especially considering they are just beginning their careers. This is emphasized by Hua, et al. [5], who indicated in their study that data from a total of 104 students were analyzed. The mean intercultural sensitivity of the students significantly improved from 79.88 ± 8.47 (pre) to 83.04 ± 8.63 (post). Participants in the elective course (n=7) showed significantly higher levels of intercultural sensitivity than non-participants. The self-assessed English proficiency of second- and third-year students who took English courses improved significantly after the courses. Themes extracted by participants in the elective course revealed students' perceptions of learning about diverse cultures, resilience, and intercultural communication skills, which can be utilized in future nursing practice. It was concluded that undertaking international nursing courses can increase the intercultural sensitivity of nursing students.

Universities are encouraged to offer international nursing courses to help enhance their cultural sensitivity and competence for their future nursing careers. Similarly, the descriptive and correlational findings of the present study agreed with those of Ayaz-Alkaya, et al. [6], as multiple linear regression revealed that the country where nursing students were studying and the fact of speaking a second language were significant predictors of intercultural sensitivity in the present study. The findings of the two-way ANOVA indicated that the interaction effect between nursing students from two schools and sociodemographic variables was not statistically significant (p > 0.05). Nursing students from both universities presented a moderate level of intercultural sensitivity. This level is low compared to previous results reported in the literature. The findings of the study can help faculty administrators to make new arrangements in the nursing curriculum and contribute to providing equitable and non-discriminatory health services to individuals. Intercultural education programs within the curriculum should be offered as standalone courses and/or integrated into courses to develop culturally competent knowledge, awareness, and skills throughout undergraduate nursing education.

Favorable attitudes towards intercultural sensitivity were found, a construct that was manifested as a cluster or relational conglomerate regarding all its dimensions. Furthermore, these favorable attitudes appeared independently of the sociodemographic and general factors evaluated for the study participants. Although favorable attitudes towards intercultural sensitivity were found, it is necessary to carry out educational intervention programs to strengthen them, with an emphasis on considering that the sample elements were first-year nursing students. It is suggested to conduct experimental or quasi-experimental studies with a control group in which an intercultural sensitivity educational program is designed and implemented.

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