Evaluating Cultural Competency Concepts Using Program Theory-Driven Evaluation Framework.

Nursing programs rely on accreditation to show quality and excellence in nursing education. Accrediting bodies in higher education evaluate nursing programs and their ability to meet their educational objectives. Seen as "peer review" by governing organizations established to ensure sound nursing educational programs, an extensive self-evaluation process is conducted to show accreditors how program objectives are being met (Billings & Halstead, 2012). The Accreditation Commission for Education in Nursing (ACEN; formerly the National League for Nursing Accrediting Commission) modified accreditation standards for associate degree programs by adopting standards for cultural competency that are similar to those for baccalaureate degree programs (ACEN, 2013; Commission on Collegiate Nursing Education, 2009).Because schools of nursing cannot afford the risk of not meeting accreditation standards, research has shown that the use of a systematic evaluation for nursing programs can be beneficial (Billings & Halstead, 2012; Calvillo et al., 2009). Cited in the literature as effective for program analysis is the technique associated with program theory-driven evaluation science (Billings & Halstead, 2012; Chen, 2006; Donaldson, 2007). A review of the literature indicated the need for further research on cultural competency education and a systematic evaluation of cultural competency in different levels of nursing education; however, no studies were found using this evaluative process. Thus, the purpose of this research was to use program theory-driven evaluation science to determine if program outcomes of an AD program aligned with the American Association of Colleges of Nursing's (2008) definition of cultural competence.Although considered a neutral science, program theory-driven evaluation allows the researcher to develop evaluation questions without the constraints of a specific scientific design. It blends both the social and scientific principles to yield pertinent data valued by program stakeholders (Donaldson, 2007). Two research questions were developed: 1) Is there congruence between program theory implementation and outcomes for development of cultural competency in an AD nursing program? 2) Is there alignment of accreditation standards and program components in meeting cultural competency standards? Specifically, is there congruence between program standards and program outcomes, between program outcomes and curriculum, and between curriculum and implementation?BACKGROUNDConceptual FrameworkProgram theory-driven evaluation is a conceptual framework developed to review program construction that determines what ought to be (normative theory) and what is actually (causative theory) in an effort to determine program effectiveness. It reviews why a program is supposed to work based on an evaluation of how IT was implemented (Chen, 2006). This type of evaluation combines both the practical and scientific aspects of research to formulate evaluation questions that look at the ability of inputs to yield anticipated outcomes. It is useful in assisting stakeholders to identify program weaknesses or assist in program modifications (Chen, 1990; Donaldson, 2007). The relevance of this research is timely, in light of the changes to accreditation for AD programs.The Associate Degree ProgramAD programs were developed as a solution to the nursing shortage experienced post-World War II. Although these programs are recognized by some as "stepping stones" to nursing practice, AD nurses comprise the majority of the current workforce. The AD program typically offers lower costs, flexibility, a condensed curriculum, and appeals to the adult learner who must juggle multiple priorities (Andrist, Nicholas, W Maneval & Teeter, 2010). It is unknown whether graduates are meeting professional nursing practice goals, which include the capability of the nurse to provide culturally competent nursing care to a diverse patient population (Institute of Medicine, 2010). …