Lakhasly

The incorporation of the European Higher Education Area (EHEA) has significantly impacted university teaching, particularly in nursing, necessitating the evaluation of the effectiveness of related educational strategies. The study focuses on analyzing how undergraduate and postgraduate nursing programs promote cultural competence and sensitivity.

The main objective is to review how nursing curricula are incorporating cultural competence through various methods, including:

• Development of cultural competence modules: These modules are designed to equip future nurses with the knowledge and skills to address cultural diversity in patient care.
• Promoting cultural encounters: This involves providing students with opportunities to engage with individuals from diverse cultural backgrounds to foster understanding and sensitivity.
• Utilizing clinical cases and cultural immersion projects: These hands-on experiences enhance the practical application of cultural competence in real-world scenarios.
• Integrating cultural knowledge: The curriculum should incorporate the beliefs and values of different cultural groups, emphasizing social justice, cultural competence, and security.

The study uses the Campinha-Bacote model of cultural competence, which highlights five key elements: cultural awareness, cultural knowledge, cultural skills, cultural encounter, and cultural desire. It emphasizes the importance of respecting differences and reinforcing similarities, while recognizing the need for continuous improvement and development of cultural competence as a dynamic process.

The study concludes that there is a clear need for a shared national, European, and international curriculum in higher education focusing on cultural competence. This curriculum should address general, transversal, and specific competencies related to cultural sensitivity and diversity. University training in nursing should follow a human, scientific, and teamwork perspective, ensuring effective and meaningful care aligned with cultural values and contexts.

Introduction The incorporation into the European Higher Education Area (EHEA; Somoza et al., 2011), has meant changes of great importance in university teaching (Sanchez-Ojeda et al., 2018).The effectiveness evaluation of the related educational strategies is recommended.Abbreviations EHEA, European Higher Education Area; RUCT, Registry of Universities, Centers and Titles; PCCSS, Model of Cultural Competence in the Provision of Health Services Campinha-Bacote; NCP, Nursing Care Process; PBL, Problem-Based Learning; ICT, Information and Communication Technologies; ECTS, Credit Transfer System; WHO, World Health OrganizationThe resolution of cases in the classroom is also promoted, and even the confrontation with vulnerable populations (Caffrey et al., 2005; Kardong-Edgren et al., 2005; Sealey et al., 2006; Upvall and Bost, 2007; Callen and Lee, 2009; dit Dariel, 2009; Gradellini et al., 2012; Riner, 2013; Lin et al., 2015; Ahn, 2017).The main assumptions are: (1) cultural competence is a process; (2) it consists of five main elements: cultural awareness, cultural knowledge, cultural skills, cultural encounter, and cultural desire; (3) within the groups there is more variation than across them; (4) health care providers' cultural competence is strongly related to services providing culturally responsive care for ethnically diverse people (Campinha-Bacote, 2008, 2007, 2002).It is a shared opinion that university nursing courses (Undergraduate/Postgraduate) need to educate and prepare future professionals, providing them skills to face challenges and complexity generated by cultural diversity; ability to understand that care includes tolerance, respect, and critical self-reflection; ability to understand that values (related to culture but not only) are strongly involved in the therapeutic relationship.A phenomenological study of Caucasian undergraduate nursing sciences teachers, who work on cultural differences, highlighted the need to ensure continuity in specific learning topics and promote relational exchange (Beach et al., 2005; Amerson and Livingston, 2014).Even the American Academy of Nursing defined cultural competence, indicating that it includes a complete integration of knowledge, attitudes, and skills, facilitating intercultural communication and interactions between people (Leininger and McFarland, 2006).Some of these reforms are related to the development of cultural competence modules (Roberts et al., 2014; Everson et al., 2015; Gradellini and Mecugni, 2015); currently, specific postgraduate training in cultural diversity is being conducted promoted (Rozendo et al., 2017).Even in the development of clinical care, most patients continue to be cared for by health professionals and students in training, who emphasize biological or biopsychological aspects, making minimal effort to expand toward an integral dimension that considers cultural awareness counts (Renzaho et al., 2013; Hsieh et al., 2016).In them, work is being done to promote competence and cultural sensitivity through different teaching strategies (Bentley and Ellison, 2007; Jeffreys and Dogan, 2012; Bohman and Borglin, 2014; Flood and Commendador, 2016; Purnell and Fenkl, 2019).Precisely, it has been verified that the activities identified concerning the educational offer determine contributions aimed at reducing inequalities in health and strategies to sensitize vulnerable populations (Lane et al., 2017).Funding The ENDOCU Research Group, 2020-GRIN-29236/2021-GRIN-31242 (Nursing, Pain, and Care), co-financed with European Regional Development Funds (ERDF) in resolution of 19/02/2020 and 27/01/2021 DOCM of the University of Castilla-La Mancha, has subsidized this research.Giger and Davidhizar's (2002) model of cross-cultural nursing describe six cultural phenomenal which need to be known by the health professionals in order to guarantee effective care: the communication barriers/problems; space/setting; the social organization of the context; the dedicated time; the environment control; the biological modification (structure of the body) (Karaburak et al., 2014).It is even found that the differences observed in the health problems of migrants, compared to the local population, are constitutional, cultural, or endemic in the countries of origin (for example, cervical cancer, female genital mutilation, tuberculosis).A vision of the focus of the documents is even acquired, which allows researchers an evaluation, synthesis, and criticism of the evidence inherent to the objective of the study (Siles Gonzalez, 2005; Peters et al., 2015).It starts from the consciousness of the professional, and it considers four phases in mutual interaction: self-awareness, cultural identity, Attachment to inheritance and family assets, ethnocentrism (Purnell and Fenkl, 2019).Materials and Methods Study Design A scoping review has been processed to analyze if and how nursing courses' curricula promote cultural competence and sensitivity.To give an example, the two-week teaching modules (Culturally Competent Nursing Modules), proposed by the United States Office of Minority Health, have been used as a Joint Commission standard criteria for the accreditation of hospitals and primary care centers (Allen, 2010; Noble et al., 2014).National, European, and international interuniversity mobility have an excellent learning impact since it encourages fieldwork in cultural contexts different from those learned (Peek and Park, 2013; Bohman and Borglin, 2014; Carr and Knutson, 2015).The objective of this scoping review is to analyze how undergraduate nursing programs and postgraduate education are promoting cultural competence and sensitivity in the learning programs.Closely related to the development of didactic strategies in nursing university studies, (4) Cultural encounter promotes the need to involve the student and the health professional in inter-cultural immersions to prevent stereotypes.Even the acceptance and respect for cultural differences, the sensitivity to understand how these differences influence relationships with people, and the ability to offer strategies that improve cultural encounters, are essential requirements for cross-cultural care in nursing to be consolidated.In this sense, Meleis (2010), a nurse theorist, indicates that nursing is considered a human and holistic science, with an orientation to care practice at any time and place, which begins with acquiring skills within the classroom (Cantarino et al., 2015).Thus, a specific university training is achieved and even with a specialized vision where fundamental concepts such as culture, stereotype, prejudice, and determinants of health are worked on (Sanner et al., 2010; Clark et al., 2011).Regarding cultural knowledge, most articles present a limited number of educational activities that emphasize social justice, cultural competence, security, and cultural promotion (Renzaho et al., 2013).The UK General Medical Council has also included cultural competence as one of the primary skills students must develop throughout their medical training (Horvat et al., 2014; Cantarino et al., 2015).Successful completion of these undergraduate courses will give access to a Bachelor's or Postgraduate degree, which appears in the Registry of Universities, Centers, and Titles (RUCT).Considering the requested skills, fundamental for care at any place, and for any target population, the care is considered culturally competent when congruent to the people's values and symbols influenced by the culture (Leininger, 1994).The literature suggests it is necessary to plan the students' training to recognize their attitudes, enabling them to instill positivity in their relationship with patients in hospital and community care (Gonzalez, 2008; Gomez Cantarino et al., 2015).Indeed, the living conditions in the new country and the stress of acculturation can cause a rapid deterioration of the health capital; good health has been verified in most of the migrant population, based on a selection of people from the country of origin who are young and in good health (Tizzi et al., 2018).However, some common problems still arise in the teaching plans and training: (1) the lack of consensus on what should be taught; (2) the related timing; (3) the lack of standard references; (4) a limited and inconsistent formal evaluation of educational interventions (Spector, 2018).Search Strategy The scoping review process begins with an exploratory research question (Campinha-Bacote, 2003) to systematically synthesize existing knowledge (Colquhoun et al., 2014).As a clinical experience, the participation of students in cultural immersion projects, together with the use of clinical cases, is determined as a successful strategy in the acquisition of cultural competence (Sanner et al., 2010).Following this line, it would be very positive to incorporate cross-cultural thinking into the nursing training curriculum, which induces awareness of humans (Garneau, 2016; Repo et al., 2017).Conclusion From this scoping review, the importance of defining a shared national, European and international curriculum in higher education on specific topics related to general, transversal, and specific competencies emerged clearly.The concept of cultural competence has its origin in the theories of intercultural nursing, specifically within the Leininger model, in the 1970s (Leininger, 1994; Leininger and McFarland, 2006).This model considers the analysis of the different cultures concerning: nursing, care practices, values and beliefs, concepts of health and disease.Last is the Campinha-Bacote cultural competence model, which interprets cultural competence as a dynamic process, and it requests health care providers to consider this competence a priority.In addition, mental health problems are observed, often associated with migration routes coupled with living conditions in the host country (Sanchez-Ojeda et al., 2018; Tizzi et al., 2018).Therefore, nursing courses are called to adopt curricula that support cultural competence to make future nurses able to promote social justice in care contexts.As the primary conceptual model, we use the Process of Cultural Competence in the Delivery of Healthcare Services Model (PCCSS), proposed by Campinha-Bacote (2008, 2007, 2002).Thus, cultural competence based on this model results from the integration of five concepts (1) Cultural awareness, which includes the exploration of one's own cultural and professional background.To develop cultural competence within higher education studies in nursing (3) Cultural skills include identifying needs for care and adaptation to the context.It is crucial that health professionals know and respect these practices to guarantee a confluence of traditional and conventional treatments (Siles Gonzalez, 2005, 2004).Many published experiences confirm the need to improve the acquisition of cultural competence in nursing students as future promoters of the right to health.Publisher's Note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.Therefore, introducing a series of transformations at a structural and operational level has been promoted, directly impacting the skills and professional profiles of university education.Its outcome guarantees effective and meaningful nursing care, in line with the cultural values and context (Ibidem).It is important to note that the literature indicates an improvement of cultural competence in the higher nursing education educational offer.As previously mentioned, the PCCSS methodology is based on interpreting cultural competence as a continuous process.Use information and communication methodologies (5) Cultural desire, based on respecting differences and reinforcing similarities.However, it is true that graduate students, in general, show a higher disposition when it comes to acquiring knowledge about other cultures (Watts et al., 2008; Sanner et al., 2010; Gordon et al., 2016).Among these, the development of cultural competence stands out, and the need to define the actual effectiveness of educational strategies related to it.

Both the combination of different educational skills and the training of expert teachers should be considered critical points in the teaching of higher education in nursing.Therefore, it is unquestionable that the progress of this care and respect for the individual, family, and community is the first requirement to achieve culturally competent care, essential to guarantee the integrity of the person.This change process has given an increase to a teaching paradigm in which the student becomes the center of the entire educational process: this has led to a redefinition of both roles of teachers and students (Backes et al., 2011).It is known that first-level nursing higher education is oriented to professional activities, so they need to work a lot on the students' training (Backes et al., 2011; Gomez Cantarino et al., 2015).Instead, second-level education (e.g., Master's) is oriented to acquiring advanced training, as specialized or multidisciplinary topics.It also affects the health promotion and education for individuals, family, and community, considering their cultural environment (Backes et al., 2011; Garcia et al., 2011).In 1982, California introduced specific graduate studies in nursing (masters) to educate students on cultural competence.The term, cultural competence, also began to be more considered in the scientific community, thanks to the emergence of new theories, which are following described.The vast majority of these people arrive in a new country with precarious health, generally due to the conditions in which they made the trip (Guild et al., 2020).This concern is framed in what today is clearly defined as a standard of socio-political knowledge in nursing (Munn et al., 2018).Through this model, culture provides the individual with a set of beliefs and values that define feelings of belonging and continuity.Students and health professionals strive to achieve skills with the different cultural groups of clients to serve (individual, family, community).Therefore, it reviews cultural awareness and sensitivity through training (2) Cultural knowledge, where beliefs and values about health are integrated.In this sense, studies have been reviewed that focus teaching effort on increasing the understanding of students, future health professionals, toward the cultural framework of the patient.These required students and health professionals to know the perceptions and explanatory models of different cultures' people's health and disease, and how these could vary.It has been proven that in the cases that act as translators of the native language, they can communicate errors in the transcription of health information (Kalischuk, 2014).The described educational's proposals underline common hindering factors for its development.Author Contributions CG and SG-C contributed to conception and design of the study.PD-I, B-MG, DM, and MIU-G performed the collection, organization, and analysis of data.All authors contributed to manuscript revision, read, and approved the submitted version.Acknowledgments The WHO suggests that equal treatments, access to health care, and respect for all people are a prerequisite for culturally competent care.It also promotes initiation into research tasks (Gomez Cantarino et al., 2015).For this reason, United States began to incorporate cultural competence into nursing studies in the 1980s, specifically in San Francisco.For example, Purnell (with Tilki and Taylor) presents a model of cultural competencies and listening skills useful for health care professionals.Spector's health traditions model is based on recognizing specific behaviors strongly related to the culture of origin.In 2019, which corresponds to 3.5% of the world's population, 272 million migrants traveled worldwide.It is the most promising model to guide research since it can respond comprehensively and globally in all dimensions to the proposed objective.It also facilitates social integration and communication between members of a group (Campinha-Bacote, 2007).Although, indeed, the translation that this fact has in clinical practice is not specified (Hsieh et al., 2016).Health professionals reinforce the knowledge of the individual's health culture and the traditional practices used by their patients, which appear essential to know all health-related practices.It has also been evaluated if these practices are oriented to promoting health, preventing the disease, or the cure.Beliefs or practices held by a group cannot be generalized; within each group, there might be intra-group variation.The situation that leads to not reducing the human being to the lowest part of himself, on the contrary, the multiple aspects that each being brings in the person's condition will be discovered (Charles et al., 2014).CG and SG-C wrote the first draft of the manuscript and the sections of the manuscript.Conflict of Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.The acquisition of cultural competence in nursing students as future promoters of the right to health should be a must.There's a need to define a shared curriculum in higher education to teach cultural competence and sensitivity.University training in nursing follows a human, scientific, and teamwork perspective.Campinha-Bacote (2002) model of cultural competence.These changes in higher education have generated modifications in the curricular plans of the Degree in Nursing.On the other hand, the most practical activities within the undergraduate and postgraduate nursing degrees propose carrying out activities within the same setting where the care will be developed.Specific skills that could be recommended to enhance cultural competence have been proven.The response of patients to various symptoms or diseases (Sealey et al., 2006).Although this situation indeed generates exponential learning of the new culture in future professionals, one must be cautious in believing that this situation conditions the knowledge of an entire community.A point to consider is the personal attitude and sensitivity to specific issues of the target population of care due to personal experience (Guild et al., 2020).Therefore, equal treatment, access to health care, and respect for all people are a prerequisite for culturally competent care, where the person's integrity is guaranteed.In addition to the prejudices and stereotypes that are held toward people of different cultures.It implies the will to learn on the part of the student-teacher (Campinha-Bacote, 2003) (Figure 1).FIGURE 1 www.frontiersin.org Figure 1.Along these lines, the Liaison Committee on Medical Education (United States) established new accredited standards in 2000.However, it is necessary to know if patients want a particular person (partner, family, friend, or relative) to be present during the care processes within cultural skills.The lack of knowledge about minority groups by health personnel is striking.Nursing is a science that is based on care and respect for individual differences.This fact has led to significant legislative, professional, and social changes.They train students (in degree or Master's) to identify, act, and evaluate the health needs of a target population.It analyzes how people manage their health concerning these.It is also the reference point for the analysis carried out with the designed strategy.Source: Authors' own creation.At the international level, the World Health Organization (WHO) recommends, since 1946, the highest level of health standards as a fundamental right of every human being.Critical points, requesting a specific attention are the combination of different educational skills and the training of expert teachers.Although it is true that the role that said person plays must be known.It was only in the mid-1990s that this concept became more important.