Justification Respects Studentsã¢â‚¬â„¢ Cultural, Linguistic, and Family Background.

• Research article
• Open Access
• Published: 22 August 2019

Increasing cultural awareness: qualitative report of nurses' perceptions near cultural competence training

• Laura Hietapakka¹ &
• Tarja Heponiemi¹

BMC Nursing volume 18, Article number:38 (2019) Cite this article

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Abstract

Background

Present, healthcare professionals worldwide deliver treat increasing numbers of culturally and linguistically various patients. The importance of cultural competence is evident in terms of the quality of healthcare, and more knowledge is needed nigh different educational models and approaches that aim to increase cultural competence. This study examines the perceptions of nurses about the content and utility of cultural competence preparation that focuses on increasing awareness of one's ain cultural features.

Methods

The training was conducted at one primary care hospital in southern Finland. Participants were registered nurses (n = 14) and applied nurses (n = vi) from dissimilar hospital units. Four 4-h training sessions—including lectures, discussions and short spider web-based learning tasks—were arranged during a iv-calendar week catamenia. Semi-structured, small group interviews were conducted with ten participants to examine their perceptions about the content and utility of the grooming. Qualitative content analysis with a conventional arroyo was used to analyse the data.

Results

Perceptions about the training were divided into three master categories: full general utility of the training, personal utility of the preparation, and utility of the training for patients. Full general utility pertains to the general approach that the preparation provided on cross-cultural care, the possibility to initiate an open discussion, and the opportunity to improve current practices. Personal utility pertains to the opportunity to become aware of one's own cultural features, to change one's way of thinking, to obtain a new perspective on 1's own communication practices and to receive justification for carrying out particular workable practices. Utility for patients pertains to fostering better awareness and acknowledgement of patients' differing cultural features and an increased respect in healthcare commitment. Additionally, the quality of the training was highlighted, and suggestions for comeback were offered.

Conclusion

Grooming that increases healthcare professionals' awareness of their own cultural features was perceived as useful and idea-provoking. Increased sensation might facilitate the advice betwixt healthcare professionals and patients, which is a crucial component of quality healthcare. It seems that in the future, training opportunities that allow larger groups to participate are needed, regardless of the time and place, and utilising the potential of east-learning should exist considered.

Peer Review reports

Background

Healthcare professionals worldwide are required to deliver care for an increasing number of culturally and linguistically diverse patients. Problems related to language and cultural issues are recognised as a threat to patients' safety in hospitals [1] and the concept of cultural competence has gained attention equally a strategy to provide equal and quality healthcare services for culturally diverse patient groups [ii]. Cultural competence is known as a multi-dimensional construct, but it typically refers to a person's cultural sensitivity or attitudes, cultural awareness and cultural knowledge and skills [3,4,v]. In the healthcare setting, cultural competence is divers as an agreement of how social and cultural factors influence the health beliefs and behaviours of patients and how these factors are considered at different levels of a healthcare delivery system to assure quality healthcare [6].

Effective communication between healthcare providers and patients is known to be necessary for quality healthcare [7]. A large number of culturally diverse patients often nowadays communication challenges for healthcare delivery, especially if sociocultural differences are not completely accepted, appreciated, explored or understood [6]. A lack of cultural agreement increases negative attitudes towards cross-cultural care and besides affects healthcare professionals' perceived preparedness to take care of culturally diverse patients [eight]. Moreover, feet about interacting with people from different cultures has an influence on a person's level of engagement in intercultural advice [ix]. And when combined with dubiety, it further decreases effective communication and can lead to the increased use of stereotypes [x]. In dissimilarity, an increased awareness about the sociocultural components of disease as well as reflecting on a healthcare professional'due south own strengths and weaknesses when communicating with different populations are seen every bit key to overcoming different advice difficulties [xi].

During the past decade, the need to increase the cultural competence of healthcare staff has been clearly recognised. This can be seen in the number of educational interventions and training programs that accept been developed to improve the knowledge and skills essential to agreement and managing sociocultural issues in a healthcare setting [vi, 12]. To be able to ameliorate and sustain the cultural competency of healthcare professionals, preparation should exist offered throughout a professional's career [2, 12], tailored to take into account individual and organisational contexts [thirteen] and involving key stakeholders in the design, implementation and evaluation of the programs [xiv, 15]. Information technology is further recommended that both standard cultural competence training besides as more state of affairs-specific training should be provided [2].

Even though there is currently little evidence about the effectiveness of cultural competence training on patient-related outcomes [14, 16], there is clear evidence about the positive effects of these interventions on healthcare professionals' attitudes, noesis and behaviour with respect to cross-cultural care [5, 13]. Nevertheless, more knowledge is all the same needed to determine which educational models are about effective and feasible in what specific contexts and groups and how many resource (e.g. time) should be allotted for reaching the desired outcomes [13]. This qualitative study was conducted to examine the perceptions of nurses regarding the content, utility and implementation of cultural competence training that aimed to ease cross-cultural encounters by increasing awareness of ane'south own cultural features. The goal was to proceeds cognition that can be used in the development of national cultural competence preparation to healthcare professionals.

Methods

Setting and participants

The report was conducted in 1 big chief intendance hospital in southern Finland in autumn 2017. This infirmary was called considering it is located in an surface area that has a large number of immigrants (1/4 of all immigrants living in Finland). In 2017, 16% of the population in this surface area were foreign-language speakers (compared with 7% in the total population of Finland). The largest groups were Russian, Estonian and Arabic speakers [17]. An invitation to participate in the training was delivered to healthcare professionals in the hospital by the ward managers. Participants were expected to be physicians, registered nurses or licensed practical nurses with prior experience in taking care of culturally diverse patients. A group of 20 registered nurses (n = 14) and practical nurses (northward = half dozen) from vii dissimilar units were enrolled in the training. At the end of the grooming, an email was sent to all participants with an invitation to participate in minor group interviews. X (n = 10) participants responded and were willing to participate.

Cultural competence grooming

Cultural awareness was called as the primary construct for the training considering self-reflection on one's own culture can be seen as an important component of cultural competence, and agreement one's ain cultural features and values helps in understanding the behavior, values and behaviour of others [eighteen]. Cultural awareness is ane component of Campinha-Bacote's (2002) model of cultural competence in healthcare delivery, which explains cultural competence as a process that requires healthcare workers to appoint in an active and ongoing effort to achieve the ability to provide culturally responsive healthcare services [18]. Instead of providing culturally specific facts almost other cultures—which tin increment the use of stereotypes [5]—the preparation was designed to have a more general approach to cultures, with the main goal being to increase awareness of different cultures past scrutinizing i's own cultural features. In order to develop training that takes into account the context and interest of primal stakeholders, nosotros utilised a wide range of sources in the development. The content of the training was based on (a) the theoretical literature about the different cultural dimensions (e.g. differences in cultural values, such every bit individualism vs. collectivism, power distance or orientation in time) [19, xx]; (b) several research manufactures regarding cultural hurting, differences in personal space, and the importance of because the spiritual needs of foreign patients [21,22,23]; (c) knowledge obtained from different cultural experts such equally a priest and personnel from the Centre for Torture Survivors in Finland; and (d) knowledge obtained from our previous interview written report. Interviews with 25 Finnish healthcare professionals were conducted in gild to examine the chief challenges that such healthcare professionals (nurses, doctors and dentists) face when taking care of culturally diverse patients [24]. Additionally, these interviews assessed perceived educational needs. The interviews revealed that the challenges are mainly related to advice betwixt the patients and healthcare professionals, including language barriers, problems with visitors, gender issues and differences in pain interpretation. Perceived educational needs related to gaining an understanding of patients experiences with the Finnish healthcare organization, the demand to share experiences with colleagues about cross-cultural care, and learning some culture-specific facts or guidelines that could help in everyday nursing practice.

Constructivism learning theory was called as the pedagogical approach considering it highlights the activity and engagement of the learner in using one's ain prior experiences in constructing new cognition, developing an understanding, and making meanings [25]. The participants were encouraged to reflect almost their prior experiences and encounters with culturally various patients and talk over in groups in order to inspire further thinking. The training included xvi h of face-to-face instruction, which was divided into iv four-h sessions and arranged for 4 weeks. The sessions were arranged once a week to give participants an opportunity to ponder and assimilate the learned content in their daily work before the next session. Participants attended the sessions during their working hours, then afternoon times were chosen. It was believed that afternoon times would improve participants' opportunities to attend the sessions considering more than staff was present in the wards then.

The sessions were designed to move from the theoretical level to the practical level, and each session built upon the previous ane. The main teaching method was adapted from 'storytelling', wherein the educator—an experienced teacher from a multicultural centre—used existent-life examples, stories and pictures to demonstrate different cultural aspects. Storytelling was used because of its strength in promoting the adoption of multiple viewpoints and making sense of unknown theoretical situations, norms and values past using real-life experiences [26]. For example, the teacher described situations where differences in the way of communication (regardless of the language) accept created unexpected misunderstandings. Furthermore, the instructor showed pictures that demonstrated how differently people with different cultural backgrounds can perceive the aforementioned images. Each session as well included group discussions and learning tasks such as construing personal factors behind i's own cultural features in social club to get aware of the cultural variety and to empathize why civilization-specific 'facts' cannot be used in patient intendance. Web-based learning platforms such as Padlet (an on-line post-information technology board) were also utilised, equally they allowed the participants to share their thoughts anonymously with others. A description of the contents of the sessions is presented in Table i.

Table i Contents of the sessions

Total size table

Data drove

After the last preparation session, 3 semi-structured small group interviews (n = 4 + 2 + 3) and ane single interview (n = 1) were conducted in the hospital to explore the perceptions of the participants about training. Five (due north = 5) of the interviewees had attended all of the training sessions, 3 (n = three) had attended three sessions, and two (n = two) had attended 2 sessions.

Two researchers with a background in nursing and prior feel with interview studies conducted the interviews. The interviewers were familiar with the content of the training, as they had been present at each training session. The participants were asked questions such as how they perceived the content of the training, what they found useful or not useful in the training and why, whether something was missing from the training, and how they perceived the overall implementation of the training including the learning methods and the timing and length of the sessions. The interviews lasted 30–forty min and were audio-recorded and transcribed verbatim for the analysis. Field notes, such as demographics of the participants and the chief points from each interview, were also taken during the interviews and used afterwards in the cogitating discussion betwixt the two interviewers [27].

Data assay

Qualitative content assay with a conventional arroyo was used to analyse the data. The method is suitable for interview data collected from open-concluded questions, and it allows the researcher(due south) to explore personal perceptions without resorting to preconceived categories [28]. First, the interview transcripts were read through several times to obtain a moving picture of the data in its entirety. After familiarising ourselves with the data, the transcripts were read again to code all the expressions from the text that described participants' perceptions of the training. The length of the codes (the units of assay) varied between a few words and a few sentences. While coding, notes were also made about get-go thoughts and impressions. Next, codes with similar content were grouped every bit subcategories, which were given a descriptive name. Finally, subcategories that had the same perspective were then grouped into 5 chief categories (Table two). One researcher made the initial categorisation, which was then discussed and verified by another researcher (who was besides present during the data collection stage, had the field notes from interviews, and was familiar with the data).

Table two Categorisation of the perceptions of the training

Full size table

Results

The participants were registered nurses (north = 8) and licensed practical nurses (n = 2) from five different hospital wards. Most of the participants were female person (n = nine), 23 to 55 years erstwhile (boilerplate age of 37). Their work experience in the healthcare field varied betwixt ii and 33 years (average xiv years). None of the participants had previously attended a cultural competence training designed to address cantankerous-cultural care or multicultural problems. The participants reported whether they encounter patients from different cultural and linguistic backgrounds on a daily (due north = 3), weekly (north = 4) or monthly (northward = 3) footing.

We divided the participants' perceptions of the training into three main categories: full general utility, personal utility, and utility of the training for patients. The participants' perceptions of how the training had been implemented were divided into two categories: quality of the training and suggestions for comeback. Each main category had 2 to four subcategories (Table 2).

Full general utility

Participants expressed that they were pleased that the cultural competence training had provided them with a more full general, rather than entirely a healthcare-orientated, perspective on cultural issues. The fact that the educator in accuse was non a healthcare professional was seen as an reward because she was able to bring new ideas and viewpoints into the infirmary environment. Participants also stated that they were pleased that many of the real-life examples presented in the lectures were not from the healthcare environment but dealt with more than full general incidences from everyday life.

'Usually nosotros are educated by nurses or another healthcare professionals. They are and so shut to united states, and the hospital surround, that they tin can exist every bit bullheaded as we might be in these matters.' (i1, n4)

The participants saw the training equally an important opportunity to start a general and open give-and-take about cultural issues and, for example, about conviction, which workers typically avoid discussing and which is not part of the general piece of work culture. Having the possibility to share their thoughts with colleagues was highly appreciated, and the small group and engaging lecturing fashion of the educator seemed to facilitate participants' involvement in the discussions.

'The atmosphere was open and, considering we were a small grouping, it was piece of cake to interact. I realised that people rarely dare to speak up and hash out [things] as freely as we did. Usually people just sit down quietly in these grooming [situations].' (i2, n2)

Participants described the training as an opportunity to develop their current healthcare practices. In order to achieve whatever general improvements, they thought that the whole healthcare organisation should take the opportunity to nourish such trainings. Participants as well noted their own responsibility in making improvements, and they stated they were enthusiastic to share the learned cognition with their co-workers. Nonetheless, such sharing was noted to exist challenging because increasing cultural awareness was primarily seen as an individual process.

'It was difficult to tell others what was discussed in the lectures. The knowledge didn't just come from the sentences that we heard. It was also behind the sentences and cannot be explained with words. When I tried to describe these things to others, the message [got] inverse along the way.' (i1, n1)

Personal utility

The grooming was described as an important opportunity to become aware of ane's own cultural features. The participants realized the extent to which their own cultural 'cage' guided their behaviour, and how it also affects the way they interpret the behaviour of others. Subsequently, the participants noted changes in their way of thinking. They felt more open-minded; and they reported that after the training, they had started paying more attending to the way they acted when taking care of culturally various patients. Participants felt that the training provided them many new, even surprising, perspectives nigh their ain daily communication patterns. Realising the common features of their communication patterns, and how they might complicate their interactions with patients, allowed them to develop their communication skills.

'Grooming actually helped me to sympathise that that'southward exactly how we act, and maybe we should try to human action a bit differently … pay more attention to how we talk and interact with others.' (i2, n1)

'I really wasn't aware that nosotros often communicate with silence, [our] eyes, etc. … and how much we tend to communicate between the lines. These things had never crossed my listen because they're then automatic.' (i1, n2)

Despite the fact that several participants expressed a need to develop current practices and their ain fashion of acting, many participants also perceived the grooming as a justification for conveying out certain practices that they feel are important with respect to established community, regardless of the civilisation of the patient. The participants also reported that their courage to encounter culturally various patients increased as a consequence of the training.

'Sometimes I feel that female patients' husbands or relatives speak for the patients. I call back that every patient must have a right to speak upwards, and the training gave me courage to stick with this principle and say, "In hither, we would like to hear [from] the patient lone, therefore, could you please give us a infinitesimal … "' (i3, n1)

Utility of the training for patients

The participants reported that the training had utility value for the patients as a outcome of nurses having a better awareness of and power to acknowledge the differing cultural backgrounds of detail patients. For example, participants stated that they had started paying more than attention to supporting the communality of certain patient groups after the training.

'Many cultures are so much more communal than we are. People too want to have care of their relatives when they are in the infirmary, and I want to back up that. We should try to larn from that.' (i1, n4)

Additionally, participants reported that the training had increased the respect that culturally diverse patients receive when seeking healthcare. The participants emphasised the importance of providing equal treatment and being respectful and non-judgmental of others, especially when the customs of certain cultures differ from i's own ideology.

'Even if the patient and his or her relatives, family situations or way of living goes against my cultural behavior, information technology doesn't hateful that I have a right to discriminate against them. For case, in some cultures, girls get married young and men have ability in decision making. Despite (the fact that) that'south not happening in my life, in my land or in my culture, information technology doesn't get in wrong, and I have to respect that. The training gave me the tools to retrieve nearly these things.' (i3, n1)

Quality of the training

The participants felt that the preparation was of a high quality, and many stated that the grooming had exceeded their expectations. They also noted the importance of providing grooming that serves the needs of the learners and that it is highly important to consider the starting level of the learner when designing the training. Participants were mostly satisfied with the contents of the sessions, just many felt the discussion model in the confidence session was unnecessary or besides straightforward. Instead of using any pre-specified phrases, nurses felt that it is better to be sensitive to the situation and use their professional person skills every bit nurses when discovering patient's spiritual needs.

'I feel that equally a nurse, and after the nursing education [that] I have completed, I must exist able to discuss several things with patients, including [their] convictions. If yous can't do it, y'all're in the wrong place. The suggestions about how I can start a discussion with patients well-nigh [their] convictions didn't serve me in any way.' (i1, n1)

Participants stated that they greatly appreciated the expertise of the preparation provider and that the educator had done the proper background piece of work and knew what she was talking about. They likewise noted that excellent pedagogy skills and the educator's noesis of complex cultural issues were meaningful. The 'storytelling' blazon of lecturing, and the loftier number of real-life examples that were presented in the sessions, were perceived as inspiring among the participants.

'It was so immersive, lively and multidimensional. Even though information technology was lecturing, it was somehow creative.' (i3,n1)

Suggestions for training comeback

Participants brought up a few notable ideas that could make the training improve in the future. Some noted that hearing about the lived experiences of persons from dissimilar immigrant groups could exist added to the content. Some participants as well suggested that the training could be slightly condensed. They felt force per unit area to finish their work on time to go far to the sessions, and many felt that iv full afternoon sessions was likewise long to be outside the ward.

'It could have been a bit shorter, for instance by putting some material on the Web beforehand that could be used to orientate oneself and then having the face-to-face session where things would exist summarised and discussed.' (i2, n1)

Participants too shared their opinions about the ane-week pause afterwards each training session. Some participants felt that it allowed them to think about the contents of the sessions; merely others felt that information technology was difficult to remember what had been previously discussed, which complicated the presentation of the big picture. Many participants stated that a shorter time span would have helped them to think more conspicuously the content of a previous session and also helped them to assimilate the learned noesis. They suggested that a summary from each session could take been provided.

The participants by and large felt that afterward the training, they no longer needed to utilise checklists or guidelines about how to act with certain patient groups. However, they yet felt insecure about different religions and how the rules of unlike religions should be taken into account in their daily deportment.

'We discussed how we encounter individuals, only not well-nigh how we respect different religious customs. For example, sometimes a male person or female nurse is not allowed to aid the patient with bathing, etc., or there are certain customs when information technology comes to end-of-life intendance.' (i4, n1)

Discussion

In this study, we examined the healthcare professionals' perceptions of the content, utility and implementation of cultural competence training that focused on easing cross-cultural encounters past increasing nurses' awareness of their own culture and cultural biases. The prior expectations of participants regarding cultural competence preparation had to mainly do with acquiring sure 'quick-fix' solutions or guidelines on how to act with patients from different cultures. These thoughts matched with traditional cultural competence education, which focuses on providing knowledge almost common 'facts' or the generalised behaviours of certain cultural groups [29]. However, this approach could have increased the risk of stereotyping and ignoring nigh the individual differences that patients with similar cultural backgrounds may have [30]. In the end, participants said they were extremely satisfied with the grooming, which provided them with a totally unlike perspective on the subject field. Increasing awareness and gaining a better agreement of their ain (Finnish) cultural and communicational features seemed to aid them to recognise the common pitfalls of cantankerous-cultural communication, and thus allowed them to develop their communication skills. This finding is in line with previous evidence suggesting that the first step towards improving cantankerous-cultural communication is to enhance awareness of ane'southward ain exact and nonverbal communication styles [11]. It is essential to realise that communicational differences tin occur in how silences, pauses, center contact, and touching are used and interpreted, or in how articulate and straight messages are emphasised in unlike cultures (loftier- vs. low-context cultures) [31].

Interestingly, the participants in this study perceived it equally an advantage that the training was non provided by their own healthcare system or by a healthcare professional. They stated that it was useful to accept a unlike perspective on cultural issues, and they indicated that bringing new perspectives and ideas to the infirmary environment from exterior the healthcare field could facilitate the development of cross-cultural care. Standing education is commonly provided by the infirmary/organisation that employs healthcare professionals [32], and therefore utilising multiple perspectives by using professionals from different fields or organisations should be considered. Furthermore, the participants suggested that members of unlike immigrant groups could be invited to share their views in the training sessions. Participants believed they would thus achieve a amend agreement of different cultures and how these patients experience the Finnish healthcare services. This so-called 'educational partnership' method, whereby different indigenous community members share their lived experiences, has previously been shown to provide an efficient way to increase healthcare professionals' understanding of cultural differences and encourage further discussion [29]. Understanding the difficulties experienced past migrants could help professionals in increasing their cultural sensitivity and providing culturally competent care [33].

The importance of encouraging word near dissimilar cultural issues was highlighted in this written report, and the participants commonly expressed a willingness to share their experiences and learned knowledge with their co-workers. The claiming was on how to pass on the valuable lessons learned to others in the organisation in such a style that the messages lying 'behind the sentences' could also be understood. Passing on information tin be especially difficult in preparation settings that require one's own critical thinking and a certain level of self-awareness of the theme in question. Participants noted that in order to develop current practices regarding cantankerous-cultural care, the grooming should exist provided to all healthcare professionals working at different organisational levels. The findings of this study are similar to previous findings, which land that organisational-level cultural competency initiatives, strategies and commitments are needed to provide culturally competent healthcare [5, fourteen].

Providing cost-constructive training to a broader group of healthcare professionals would crave utilising different educational methods, such as e-learning and technology-enhanced learning [34]. Despite the fact that the participants expressed appreciation for the confront-to-face sessions with a storytelling-blazon of lecturing and discussions, they also had difficulties in detaching themselves from the busy wards and were stressed about being present and on time for all four training sessions. These difficulties, combined with irregular shift piece of work, led to a decreasing number of participants in the sessions (approximately 12/20 participants were nowadays per session). In addition, physicians were also invited to participate merely none attended. This indicates that information technology tin be difficult to arrange enough time in healthcare for this blazon of preparation and, therefore learning possibilities that are not bound to an exact time or identify demand to be further developed.

Limitations

Certain problems place limitations on the credibility and transferability of the results. A single organisation and a small sample size (consisting mainly of nurses working in somatic wards) restrict the generalisation of the results. It is possible that other healthcare professionals (such as physicians, physiotherapists and mental health specialists) can have different perspectives on cultural awareness. Perceptions about the training could too have differed or exist more multifaceted if all the nurses could have attended all four training sessions. Additionally, participants who enrolled in the preparation possibly were highly motivated to larn and had a more than positive attitude towards cantankerous-cultural care before attending the training, which might have affected their responses. Information technology must besides be considered that all the participants highlighted the education skills and feel of the educator; therefore their perceptions of the training could have been different if less competent educators would have been used. We did not ask for feedback from the participants nearly the data categorisation or interpretation of the results, which would have increased the trustworthiness of the results. However, two researchers were involved in the data collection and assay, and frequent discussions were held with the research grouping during unlike phases of the written report.

Conclusion

There is clearly an international demand to pay attention to the cultural competence of healthcare professionals. The results of this study indicate that increasing sensation of one's own cultural features can be useful for easing cross-cultural encounters in a healthcare setting and improving the cultural competence of nurses. Participants expressed that the training was useful on many different levels, and they saw the minor group size and inspiring lectures every bit important in facilitating word nigh cantankerous-cultural care. In the future, information technology will be essential to provide cultural competence preparation to professionals at different levels of the healthcare system to increment their awareness of cultural differences and how culturally various patients are treated. Educational methods that would allow large groups to participate without restrictions on time and place are besides needed. Future studies should compare traditional long-term grooming, such as the i used in the present study, to shorter training and Web-based learning platforms to find the most viable way to increment cultural awareness and improve the cultural competence of healthcare professionals.

Availability of data and materials

Not applicable.

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Acknowledgements

Nosotros would like to thank the healthcare professionals who participated in the training and interviews for their substantial contribution to this written report. Nosotros would also similar to give thanks the managers of the infirmary for their cooperation regarding the practical arrangements of the intervention.

Funding

This study was funded by the Strategic Inquiry Council (SRC) of the University of Finland (project 303607).

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Affiliations

1. National Plant of Health and Welfare, P.O. Box thirty, FI-00271, Helsinki, Finland

   Anu-Marja Kaihlanen, Laura Hietapakka & Tarja Heponiemi

Contributions

Substantial contribution to study conception and blueprint and drafting of the manuscript: A-Chiliad.Chiliad, 50. H, T.H. Data drove, data analysis and estimation of data: A-M.K, LH. All authors read and approved the final manuscript.

Respective author

Correspondence to Anu-Marja Kaihlanen.

Ethics declarations

Ethics approval and consent to participate

The ethics commission of the Finnish National Constitute for Health and Welfare provided the upstanding approval for this study. Permission for this report was also practical for and obtained from the participating hospital. Written informed consent to participate and permission for the sound recording of discussions were obtained from each participant prior to the interview.

Consent for publication

Not applicable.

Competing interests

The authors declare they have no competing interests.

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Kaihlanen, AM., Hietapakka, L. & Heponiemi, T. Increasing cultural awareness: qualitative study of nurses' perceptions about cultural competence training. BMC Nurs 18, 38 (2019). https://doi.org/10.1186/s12912-019-0363-ten

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• Received: 15 January 2018

• Accepted: 16 August 2019

• Published: 22 Baronial 2019

• DOI : https://doi.org/ten.1186/s12912-019-0363-x

Keywords

• Healthcare professionals
• Nurse
• Cultural awareness
• Cultural competence
• Grooming

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Source: https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-019-0363-x

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