FACTOR EMOCIONAL

needs of increased number of minority ethnic groups are reflected in government policies, such as those for health (National Resource Centre for Ethnic Minority Health) and housing (Communities Scotland). The Strategy for Nursing and Midwifery in Scotland: Caring for Health (SEHD 2001) also recognised, implicitly rather than explicitly, the need for nursing and midwifery to embrace this changing population in its future actions. The new Capability Framework for Community Health Nursing (NES 2007c) indicates in Domain: Knowledge for Practice 2 that the community health nurse ‘is critically aware of all aspects of social, cultural and environmental diversity, and its impact on health, illness and disease’.

Given that, in relation to student nurses and midwives, the NMC standards for both nursing and midwifery education (NMC 2004a, 2004b) include proficiency in ‘providing care which demonstrates sensitivity to the diversity of patients and clients’ (nursing) and ‘practice in a way which respects, promotes and supports individual’s rights, interest, preferences, beliefs and cultures’ (midwifery), it was evident that students were given exposure to the issues rather than any competency development. Their actual practice experience of meeting people from different cultural backgrounds appeared to be influenced by where they were placed and this varied across the two professions. It also has to be noted that, although this had been one of the key questions to students regarding the kind of preparation they had regarding diverse and multicultural communities, the actual data, when fully analysed, were not as prominent as other data sets. There were, however, indicators that preparation for meeting the needs of diverse communities appears to be focused on very broad principles only and that it may well be integrated throughout curricula delivery, in situations such as PBL, rather than specific modular content as the following comments indicate:

In one class last year, communication, we learnt about, we were broken up into small groups, we had to do different religions, and do the presentation on those and we have had lectures telling us about transcultural things like that …. The translator services …. We had a health visitor who works with ethnic minorities – Bangladeshi …and she was saying, you know, from her point of view, she gives them some of her experience when she walks in the house and the man does all the speaking but she is talking abut this pregnant lady, you know does everything you say goes through the husband actually… (Student nurse Case study K)

They have a module on social and ethical implications of child bearing but in it’s widest context and the assessment for that requires them to go out and look at a specific area and look at statistics from that area and interpret it with relation to child bearing women, so, you know, they are going out and looking at age difference, cultural difference, religious difference and all those sorts of things and looking at services that are provided for them in areas and ask , as part of the assessment, well how does this impact on the provision of midwifery care and is there a way in which this could be enhanced. (Academic Case study D)

In clinical practice, students’ commented on the nature of the communities in which they were based or that information was available to them should they need it if caring for patients from different cultures:

Well up here I think it is different, because although there is a variety, it is not as varied as say the mainland… everybody knows everybody…. (when asked further if they had any training)…We’ve had lectures on it...when you’re on placement, like if there’s a patient, your mentor will explain to you , like washing and things like that, and different beliefs ….If you’re not open to things like that, then your shouldn’t be doing nursing, if you’re not non judgemental then you’re in the wrong job. (Student nurse Case study C)

Its theory based, very basic – they just kind of skim the surface. Also because of our location we don’t have a lot of ethnic minorities in our area so it is quite difficult even with the theory that you get. (Student nurse Case study F)

I’ve found in practice as well that its very much what’s the word...information is available on the ward about their like their eating habits or dying wishes. (Student nurse Case study F)

I didn’t realise until I went on community, there are so many different languages, we’ve got Polish, Albanian, Nigerian... (Student midwife Case study B)

It is interesting to note that a report, published in 2004 by the National Resource Centre for Ethnic Minority Health in Scotland (Pankaj 2004), examined the current status of cultural competency training in NHS Scotland. It indicated that the driving force for training had been the Race Equality Schemes and Fair for All (NHS Health Scotland 2006), which provide the legal and moral cases for training in the area of cultural competency. The recommendations from the report included ‘developing innovative ways to generate awareness of diversity through informal programmes could be used to create motivation, understanding of the need and importance of learning’. It may be that given the policy drivers and health needs of a changing population that further work is now needed to examine the impact on pre-registration education nursing and midwifery curricula in Scotland. This view that it is important to learn about culture, was also held by the authors of a paper that focused on the experience of a group of lecturers from Scotland in a European initiative (Wimpenny et al 2005). They concluded, from their shared experience with European teachers and students, that ‘learning about culture is central to the development of modern and relevant practice in a multicultural world’.