Development and evaluation of a teaching and learning approach in cross-cultural care and antidiscrimination in university nursing students

Background:
Cross-cultural care and antidiscrimination are vital to ethical effective health systems. Nurses require quality educational preparation in cross-cultural care and antidiscrimination. Limited evidence-based research is available to guide teachers.

Objectives:
To develop, implement and evaluate an evidence-based teaching and learning approach in cross-cultural care and antidiscrimination for undergraduate nursing students.

Design:
A quantitative design using pre- and post-survey measures was used to evaluate the teaching and learning approach.

Settings:
The Bachelor of Nursing program in an Australian university.

Participants:
Academics and second year undergraduate nursing students.

Methods:
A literature review and consultation with academics informed the development of the teaching and learning approach. Thirty-three students completed a survey at pre-measures and following participation in the teaching and learning approach at post-measures about their confidence to practice cross-cultural nursing (Transcultural Self-efficacy Tool) and about their discriminatory attitudes (Quick Discrimination Index).

Results:
The literature review found that educational approaches that solely focus on culture might not be sufficient in addressing discrimination and racism. During consultation, academics emphasised the importance of situating cross-cultural nursing and antidiscrimination as social determinants of health. Therefore, cross-cultural nursing was contextualised within primary health care and emphasised care for culturally diverse communities. Survey findings supported the effectiveness of this strategy in promoting students' confidence regarding knowledge about cross-cultural nursing. There was no reported change in discriminatory attitudes. The teaching and learning approach was modified to include stronger experiential learning and role playing.

Conclusions:
Nursing education should emphasise cross-cultural nursing and antidiscrimination. The study describes an evaluated teaching and learning approach and demonstrates how evaluation research can be used to develop cross-cultural nursing education interventions.

A systematic scoping investigation of cross-cultural visual communication design

This research project provides a systematic and strcutured investigation into the issues associated with the emergent field of cross-cultural visual communication design. The results of the scoping research and the international cross-cultural design project offer clear guidance for designers through all stages of the communication process. 

Cross-cultural adaption of the Health Educaiton Impact Questionnaire: experimental study showed expert committee, not back-translation, added value

Objectives
To assess the contribution of back-translation and expert committee to the content and psychometric properties of a translated multidimensional questionnaire.

Study Design and Setting
Recommendations for questionnaire translation include back-translation and expert committee, but their contribution to measurement properties is unknown. Four English to French translations of the Health Education Impact Questionnaire were generated with and without committee or back-translation. Face validity, acceptability, and structural properties were compared after random assignment to people with rheumatoid arthritis (N = 1,168), chronic renal failure (N = 2,368), and diabetes (N = 538). For face validity, 15 bilingual people compared translations quality with the original. Psychometric properties were examined using confirmatory factor analysis (metric and scalar invariance) and item response theory.

Results
Qualitatively, there were five types of translation errors: style, intensity, frequency/time frame, breadth, and meaning. Bilingual assessors ranked best the translations with committee (P = 0.0026). All translations had good structural properties (root mean square error of approximation <0.05; comparative fit index [CFI], ≥0.899; and Tucker–Lewis index, ≥0.889). Full measurement invariance was observed between translations (ΔCFI ≤ 0.01) with metric invariance between translations and original (lowest ΔCFI = 0.022 between fully constrained models and models with free intercepts). Item characteristic curve analyses revealed no significant differences.

Conclusion
This is the first experimental evidence that back-translation has moderate impact, whereas expert committee helps to ensure accurate content.

Cross cultural exchange to support reasoning about socio-scientific sustainability issues

In this article, we describe a project on reasoning about socio-scientific issues (SSIs), involving French and Australian pre-service science teachers engaged in on-line discussion and development of a wiki. In the research, we developed frameworks for looking at the quality of reasoning about 'socially acute' sustainability questions. We found the level of reasoning was enhanced by the cross-cultural exchange, and identified the importance of context in framing reasoning quality. We argue that science teachers could effectively adapt this approach to develop students' scientific literacy and embed the 'science as a human endeavour' strand of the Australian Curriculum in their practice.

A cross-cultural study of somatic countertransference: a brief overview

Whilst countertransference is commonly experienced as feelings, thoughts, images, symbols and dreams endured by the therapist in relation to their client, somatic countertransference is positioned as embodied, physical manifestations in the therapist’s body. Common examples include headaches, nausea, aches, pains, sleepiness, sexual arousal, dizziness and trembling felt by the psychotherapist in session. Current interest in somatic countertransference spans the spectrum from the psychoanalytic, post-Jungian, dance movement and humanistic modalities to empirical studies originating from the trauma research field. Although the clinical literature emphasizes the therapeutic relevance and richness of somatic countertransference for understanding unconscious communications occurring in the session, trauma research advocates greater self-awareness and management of somatic countertransference to prevent therapist burnout. This article will outline the rationale and research process for proposing the first cross-cultural study of somatic countertransference. This study is suggested as a means to extend our understanding of, and ability to work with, somatic countertransference. Preliminary results from an initial study of Chinese psychotherapists will be discussed.

Place branding and cross-cultural visual communication : how do the theories and practices of place branding inform our understanding of cross-cultural visual communication design?

In a globalised environment, visual communication designers are now required to understand their audience’s needs, values and unique methods of communication, creating a new focus on the recipient. In a cross-cultural design context, the visual communication also needs to appeal to a broad range of stakeholders and multiple recipients who hold a strong emotional investment in the message being sent. Our understanding of the complexities of designing in this environment can be informed by recent developments in the research of place branding where the focus is on the increased possibility for failure, the strong potential for criticism and the issues associated with a broad range of stakeholders.

The outcomes of this connection are explored further in a case study involving eight countries as diverse as Australia, Brazil, Mexico, South Africa, Turkey, Qatar, United States of America and Zimbabwe. More than 140 student and lecturer participants reviewed a student driven cross-cultural visual communication project that produced over 560 designs. The increased potential for failure and strong, emotional criticism raised questions about the role of images and symbols in cross-cultural visual communication. The impact these have on the reception of the design, challenge our views on the use of stereotypical imagery. This paper will discuss the movement towards designing visual images that are generic and lacking in cultural representation presenting the view that stereotypical imagery is important to the recipient who relies on these cultural references to effectively read the message.