“KNOWING IS NOT THE SAME AS PRACTISING”: A QUALITATIVE STUDY OF NURSING STUDENTS’ EXPERIENCES OF A TRANSCULTURAL TRAINING PROGRAMME IN KARACHI, PAKISTAN

Abstract

Education in cultural competence is a crucial aspect of nursing training, but studying cultural difference does not always lead to culturally competent clinical practice. This study aimed to find out the experience of Bachelor of Science in Nursing (BSN) students in a four-week Transcultural Training Programme (TTP) and to elicit the barriers to transferring the learning to clinical practice in the city of Karachi, Pakistan. A qualitative descriptive design with phenomenological approach was used in four nursing colleges. Students with the highest and lowest scores in cultural competence questionnaire after training were selected using purposive extreme case sampling. Ten in-depth interviews and one focus group discussion with five students were conducted. Semi-structured expert-reviewed and piloted guides were used, audio recordings of the sessions were made in Urdu or English, and then verbatim transcription was done. Thematic analysis was used in combination with framework analysis, with cultural knowledge, sensitivity and skill being deductive codes, and inductive codes formed from students' accounts. The analysis resulted in the following themes: increased cultural awareness, better communication, and difficulties in implementing training. The barriers reported were lack of exposure to cultural diversity, time pressure and weak institutional support. The results indicate that students might appreciate and experience benefits from trans-cultural structured learning, but that they also experience clinical realities that restrict opportunities for enactment. Therefore cultural competence education must be seen in the context of placement experiences, supervision, workload and institutional reinforcement. The findings do not give causal estimate of training effectiveness, and conclusions should be supported by direct quotations from the participants and a detailed description of the analytic process.