title: Developing graduate student competency in providing culturally sensitive end of life care in critical care environments - a pilot study of a teaching innovation.
abstract: BACKGROUND
  Australia's immigration policy has generated a rich diverse cultural community of staff and patients in critical care environments. Many different cultural perspectives inform individual actions in the context of critical care, including the highly sensitive area of end of life care, with nurses feeling poorly prepared to provide culturally sensitive end of life care.
  
  
  OBJECTIVE
  This article describes and evaluates the effectiveness of an educational innovation designed to develop graduate-level critical care nurses' capacity for effective interpersonal communication, as members of a multi-disciplinary team in providing culturally sensitive end-of-life care.
  
  
  METHODS
  A mixed method pilot study was conducted using a curriculum innovation intervention informed by The Excellence in Cultural Experiential Learning and Leadership Program (EXCELL),(1) which is a higher education intervention which was applied to develop the nurses' intercultural communication skills. 12 graduate nursing students studying critical care nursing participated in the study. 42% (n=5) of the participants were from an international background. Information about students' cultural learning was recorded before and after the intervention, using a cultural learning development scale. Student discussions of end of life care were recorded at Week 2 and 14 of the curriculum. The quantitative data was analysed using descriptive statistical analysis and qualitative data was thematically analysed.
  
  
  RESULTS
  Students demonstrated an increase in cultural learning in a range of areas in the pre-post surveys including understandings of cultural diversity, interpersonal skills, cross cultural interactions and participating in multicultural groups. Thematic analysis of the end of life discussions revealed an increase in the levels of nurse confidence in approaching end of life care in critical care environments.
  
  
  CONCLUSIONS
  The EXCELL program provides an effective and supportive educational framework to increase graduate nurses' cultural learning development and competence to manage culturally complex clinical issues such as end of life care, and is recommended as a framework for health care students to learn the skills required to provide culturally competent care in a range of culturally complex health care settings.
authors.affiliation: Faculty of Health, University of Canberra, Australia. Electronic address: holly.northam@canberra.edu.au.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Northam
authors.affiliation: Faculty of Health, University of Canberra, Australia.
authors.forename: Gylo
authors.initials: G
authors.lastname: Hercelinskyj
authors.affiliation: Griffith Health Institute, Griffith University & Gold Coast Hospital and Health Service, Australia.
authors.forename: Laurie
authors.initials: L
authors.lastname: Grealish
authors.affiliation: Faculty of Health, University of Canberra, Australia.
authors.forename: Anita S
authors.initials: AS
authors.lastname: Mak
mesh_terms: D000328:Adult; D001315:Australia; D003142:Communication; D064648:Critical Care Nursing / Q000193:education*; D054521:Cultural Competency; D003479:Curriculum; D004511:Education, Nursing, Graduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D013727:Terminal Care
keywords: Communication; Critical care; Cultural competency; Education; End-of-life; Multi-disciplinary; Multicultural; Pilot study