Nursing education: Cultural transformation through guided critical reflection

Given the dynamic diversity within the world today, I began my study with a focus on exploring the phenomenon of cultural competence in practicing nurses; however as my research process developed, I discovered the importance of guided critical reflection toward nursing cultural transformative learning. Nursing has a strong directive for culturally competent care in professional nursing education and practice (AACN, 1998). My review of literature found that although nursing has made significant developments in the area of cultural competence, there are numerous critics who suggest culture in nursing education remains ethnocentric and lacking in a consistent outcome measurement. In my study, I used a purposive sample of eight practicing nurses who had participated in an undergraduate cultural immersion experience at a free standing birth center near the border of Mexico. I adapted Forneris and Peden-McAlpine's (2006) Contextual Learning Framework to use both quantitative and qualitative methods. The Transcultural Nursing Immersion Experience Questionnaire (Ryan & Twibell, 2002) was used to measure four dimensions relevant to the cultural immersion experience. My results revealed that nurse participants reported feeling immersed, experiencing communication barriers, getting new insight into caring for others of different cultures, changing their views of working with people different from the self, and changing their nursing practice. I interviewed each of the participants and tape-recorded their individual critical cultural incident (Brookfield, 1999) from practice followed by the guided narrative reflection process (GNRP). I used Pollio, Henley, & Thompson's (1997) phenomenological method of the hermeneutic circle to analyze the qualitative data. I discovered two main situations from the critical cultural incidents: Marginalization and Nursing Role Conflict. Each of the eight women in the critical incidents were described as different from the social norm or cast out from the societal center to the periphery based on their identity, associations, experiences and/or environments related to gender, race, culture or economic oppression. I found the participants' ideas of male dominance, powerlessness, and differences in knowledge and language confirmed the concept of marginalization. Nursing Role Conflict was the other major situation I confirmed in the critical incidents. This was intentional, as I asked the participants to confront ethnocentrism, which can exist in an interaction between persons or groups with differing cultural backgrounds or beliefs (Sutherland, 2002). Participants' ideas that I found confirming Nursing Role Conflict were Rules that Constrain Practice and Nurses in the Middle as Patient Advocate. The major insight I discovered during the GNRP was Transformation through Cultural Contextual Learning. This is where I was convinced that the essential component of critical reflection for significant learning or change was missing in culturally competent nursing care. I discovered participants made meaning with their transformation because of the guided critical reflection process. As we discussed the cultural conflict, the participants articulated their personal transformation (what they learned and how they changed) from the incident by critically examining their perspectives. I discovered that the GNRP stimulated some participants in their transformation process to find the cultural praxis (the action) that follows these new convictions the learners gained. Other participants freely shared their internalized transformation and the GNRP was a stimulus to freely urge them into describing how they performed cultural praxis as a patient advocate. Therefore, I named the phases of transformation demonstrated by these practicing nurses as: Expanded Transformation: Tense-New Cultural Perspective; Growing Transformation: Advocacy found in Cultural Praxis; and Self-Transformation: Advocacy Shared as Cultural Praxis. The results of this study have several implications for nursing education, practice, research and leadership. I have discussed the benefits and suggested recommendations for guided critical reflection strategies necessary for nursing cultural transformative education.