The paradigm shift.

This article examines current trends in nursing education and proposes undergraduate curriculum changes that are needed to meet the needs and goals of the Institute of Medicine Report: The Future of Nursing, Leading Change, Advancing Health, and The Patient Protection and Affordable Care Act. Curricular changes were developed and implemented during the development of the Affordable Care Act, the Future of Nursing Initiative report, and the Carnegie Report on Undergraduate Nursing Education. The changes will continue to evolve dynamically and are presented here for consideration.

Lesbian, gay, bisexual, transgendered, or intersexed content for nursing curricula.

There has been limited identification of core lesbian, gay, bisexual, transgendered, or intersexed (LGBTI) experience concepts that should be included in the nursing curricula. This article addresses the gap in the literature. To move nursing toward the goals of health equity and cultural humility in practice, education, and research, nursing curricula must integrate core LGBTI concepts, experiences, and needs related to health and illness. This article reviews LGBTI health care literature to address the attitudes, knowledge, and skills needed to address curricular gaps and provide content suggestions for inclusion in nursing curricula. Also considered is the need to expand nursing students' definition of diversity before discussing the interplay between nurses' attitudes and culturally competent care provided to persons who are LGBTI. Knowledge needed includes a life span perspective that addresses developmental needs and their impact on health concerns throughout the life course; health promotion and disease prevention with an articulation of unique health issues for this population; mental health concerns; specific health needs of transgender and intersex individuals; barriers to health care; interventions and resources including Internet sites; and legal and policy issues. Particular assessment and communication skills for LGBTI patients are identified. Finally, there is a discussion of didactic, simulation, and clinical strategies for incorporating this content into nursing curricula at the undergraduate and graduate levels.

Cultural competency of graduating BSN nursing students.

Providing culturally appropriate care is an essential nursing competency for new graduates. Multiple curricular approaches are being used to achieve this end. When measured by Campinha-Bacote's Inventory for Assessing the Process of Cultural Competency Among Healthcare Professionals-R, graduating students (n = 515) from six different BSN programs scored, on average, in the culturally aware range. These results suggest that no one curricular approach is proving to be more effective than another in achieving essential cultural competency.

Cultural competence in the undergraduate nursing curriculum.

More demands are being put on nursing faculty to incorporate content related to cultural competence in the undergraduate curriculum. Adding more content into an already full curriculum and becoming proficient at teaching cultural competence throughout the curriculum are challenging to nursing faculty. In addition, identifying personal bias to ensure that students are prepared to deliver culturally sensitive care requires a certain amount of self-awareness of personal prejudice. The purpose of this article is to present the implementation of the newly developed Blueprint for Integration of Cultural Competence in the Curriculum (BICCC) into an undergraduate nursing curriculum as a framework for teaching cultural competence in an undergraduate nursing curriculum. This will include defining culture and cultural competence as they relate to teaching, presenting educational standards of cultural competence in accrediting agencies, presenting level objectives for learning cultural competent information, describing a curriculum incorporating cultural competence in an undergraduate nursing program, and providing examples of implementation of cultural competence teaching strategies for nursing faculty.

Cultural competence in the master's curriculum--a course exemplar.

This article focuses on the teaching-learning strategies for integration of cultural competence in the first clinical core course in Primary Care of the Middle Aged and Older Adult, a required course for graduate students enrolled in the Adult Health Nurse Practitioner Program, Gerontology Nurse Practitioner Program, and the Family Health Nurse Practitioner Program at the University of Pennsylvania School of Nursing. Multiple teaching-learning strategies for the first clinical course consisted of preliminary online self-assessment, clinical case scenarios, critique of multicultural clinical vignettes, and cultural assessment of the clinical agency. In the outcomes of these teaching-learning strategies, it was shown, through the use of reflective diaries of nurse practitioner students and course evaluations, that the multiple strategic approaches were effective for cultural competence integration within each of the nurse practitioner programs.

Student perceptions of cultural competence content in the curriculum.

The 31-item Blueprint for Integration of Cultural Competence in the Curriculum (BICCC) was used as an organizing framework and an evaluative tool to survey student perceptions of inclusion of cultural-specific content in undergraduate and graduate courses. Quantitative and qualitative data were used to complete this survey, which provided definitive information about the strengths and deficiencies of the curriculum initiative. Findings show that faculty made considerable progress with the curriculum integrative efforts. With responses of sometimes to quite often on the BICCC survey, 90% of the master's, 87% of senior, and 25% of first-semester freshmen participants reported a sufficient level of teaching in response to the survey items on aspects of culture and health. For all cohorts, the survey showed that content related to critique of health disparities research and theoretical formulation about culture, health, and nursing were not sufficiently addressed. Open-ended comments showed that freshmen reported a solid foundation of culturally related courses in arts and humanities courses; seniors disclosed a high level of knowledge about aspects of culture competence; and master's participants had high levels of self-awareness about values, cultural beliefs, and challenges of cross-cultural communication. The BICCC provided substantial information for faculty to address areas of omission, deficiency, and redundancy in the cultural competence education.

Factors associated with distress in urban residential fire survivors.

PURPOSE: To identify factors associated with recovery in a sample of urban residential fire survivors. DESIGN AND METHODS: 440 survivors, of residential fires were interviewed at approximately 3, 6, and 13 months after the fire to measure psychological distress. A set of factors was identified that correlated with survivors' ability to recover from the fire event. Potential predictors of increased distress were identified. Hypotheses were that participants who were lower in socioeconomic status, who were minority members, who had less social support, who engaged in attributional thinking, and had greater concurrent life stresses would have greater psychological distress in response to a residential fire and would be less able to recover from the fire event. FINDINGS: Distress after fire was high at 3 months and decreased for the majority of participants, although one-third of survivors had higher distress at 13 months than at 3 months. Loss of control and attributional variables had the strongest influence on psychological distress over time. CONCLUSIONS: The findings are consistent with stress-response tendencies expected after a stressful event. A set of predictor variables was identified to help clinicians target survivors at high risk for psychological distress after a residential fire.