Proposition théorique constructiviste du développement de la compétence culturelle infirmière

In a context of globalization, political and geographical barriers are more diffuse and involve a blend of cultures both locally and internationally. This cultural pluralism, also observed in health care settings, creates issues and challenges for nursing practice and education. The development of cultural competence among health care professionals is considered an essential condition to promote quality and equity in health care. In nursing science, cultural competence is generally treated from an essentialist perspective. To our knowledge, there have been no published studies to date of the processes involved in the development of cultural competence among nurses and students nurses that are embedded in a constructivist approach. The purpose of this study is to develop a constructivist theoretical proposition pertaining to the development of cultural competence in nursing from a constructivist perspective. A grounded theory design (Corbin & Strauss 2008) was implemented to study the developmental process of cultural competence among nurses and student nurses in a health care and social service center situated in a culturally diverse setting. A purposive sampling strategy allowed to recruit nurses recognized by their peers as having a high level of proficiency in cultural competence, as well as nurses that were preoccupied by culturally competent practice and senior undergraduate level students. A total of 24 study participants includes 13 nurses and 11 students. Data collection proceeded via a sociodemographic questionnaire, participant observation and semi-structured interviews. The central category dlearning to combine different realities to provide effective care in a context of cultural diversitye was constructed using an inductive qualitative data analysis process. This central category is divided in three subcategories : dbuilding the relation with the othere, dgoing beyond the usual course of practicee and dreinventing its practice through actione. The resulting theoretical proposition describes the concomitant evolution of these three categories into three developmental levels of cultural competence: "opening to different realities of practice in the context of cultural diversity", "challenging one's practice" and "bringing together different realities of practice in the context of cultural diversity in an integrated mannere. The resulting theoretical proposition reflects a constructivist perspective, is grounded in empirical data, delineates inter-related developmental stages of cultural competence, from initiation to expertise, and situates learning in context. These contextual elements suggest the addition of social and political dimensions to the conceptual definition of cultural competence. The main theoretical contributions of this study are two fold. First, the interaction between nurses and their environment and, second, clinical experience, both contribute significantly to the development of cultural competence. The outcomes of this study are relevant not only for nursing education but also for nursing practice, management, and research.

Keyphrases: Analyse qualitative, Cultural competence, Competence development model, Nursing education, Constructivism, Grounded theory, Qualitative data analysis