1 Intercultural sensitivity of students from departments of nursing and healthcare administration Abstract Since globalization requires people from diverse cultural backgrounds to communicate effectively, being a global citizen has become our educational goal. Researchers argue that intercultural sensitivity is crucial in enabling people to live and work with others from different cultural backgrounds. Intercultural sensitivity is defined as sensitivity to the importance of cultural differences and to the points of view of people in other cultures (Bhawuk & Brislin, 1992, p.414). A person with higher intercultural sensitivity will become a more confident global citizen as his understanding of cultural difference becomes more sophisticated. The nurses and health care providers are especially argued to increase their intercultural sensitivity in order to provide their clients from culturally diverse backgrounds with mental support and respect (Rosenbaum, 1991). In this study, the intercultural sensitivity of students from a private college of technology in the east of Taiwan was investigated, using the Intercultural Sensitivity Scale developed by G. M. Chen and Starosta. Based on a survey of 85 participants from the nursing department and the department of Healthcare Administration, this study focused on five dimensions of the intercultural sensitivity and the participants demographic factors affecting their performances on intercultural sensitivity. A significant difference was found on the dimension Respect for cultural differences between students of the two departments. Results showed that the decision of studying abroad and the experiences of living abroad could effectively predict the participants intercultural sensitivity through Stepwise multiple regression. The results of these multiple regressions also provide a detailed account about how intercultural sensitivity affects a person s intercultural communication performance. Key words: Intercultural sensitivity, Intercultural Sensitivity Scale, non-english major
2 Introduction Since globalization requires people from diverse cultural backgrounds to think about how they can communicate effectively, becoming a global citizen has become an important educational goal. Landis and Bhagat (1996) argue that intercultural sensitivity is crucial to enabling people to live and work with others from different cultural backgrounds. With higher intercultural sensitivity, a person will become more confident as a global citizen as his understanding of cultural difference becomes more sophisticated. Bhawuk & Brislin (1992) define Intercultural sensitivity as sensitivity to the importance of cultural differences and to the points of view of people in other cultures (p.414). Some people might not agree that intercultural sensitivity is necessary in their daily lives. However, nurses and health care providers who would frequently meet people from diverse cultures in their workplaces are strongly suggested to work towards higher intercultural sensitivity. Rosenbaum (1991) suggests that pre-service nurses and health care providers need to increase their self-awareness and their level of intercultural sensitivity towards their patients in the culturally diverse hospitals of the future. Leininger (1996) also mentions that cultures will influence the patients self-belief, so the health care providers should provide them with individual mental support and physical care according to their diverse cultures. In this study, the researcher attempts to understand the intercultural sensitivity of students from a private college of technology in the east of Taiwan, using the Intercultural Sensitivity Scale developed by G. M. Chen and Starosta. Based on a survey of 85 participants from the nursing department and the department of Healthcare Administration, this study focuses on five dimensions of the intercultural sensitivity and the participants demographic factors affecting their performances on intercultural sensitivity. The results of this survey would be important references for the teachers in the nursing department and the department of healthcare administration when designing a culture training course for their pre-service nurses.
3 Literature Review Intercultural sensitivity Over the decades, many studies have focused on Intercultural communication competence. Relevant studies indicated intercultural communication competence was defined generally as the knowledge, motivation, and skills for effective communication (Spitzberg, 1989; Wiseman, 2001). Thus, intercultural communication competence was confused, overlapped, and at least used indiscriminatingly with intercultural awareness, intercultural adroitness, and intercultural sensitivity (Peng, 2006, p.39). For example, Bhawk and Brislin (1992) state, To be effective in other cultures, people must be interested in other cultures, be sensitive enough to notice cultural differences and also be willing to modify their behavior as an indication of respect for people of other cultures. A reasonable term that summarizes these qualities of people is intercultural sensitivity. (p.416) The above statement implies that Bhawk and Brislin viewed intercultural sensitivity as a developmental process. Bennett (1993) supported and elaborated on this concept and suggested that intercultural sensitivity is composed of six developmental stages: denial, defense, minimizing, acceptance, adaptation and integration of cultural difference. Hammer, Bennett, & Wiseman (2003) state one s potential competence in intercultural relations increases as one s experience of cultural difference becomes more complex and sophisticated. To be more specific, Bennett (1984) described intercultural sensitivity as people s ability to transform them affectively, cognitively and behaviorally from denial stage to integration stage in the developmental process of intercultural communication. In other words, intercultural sensitive people can reach the level of dual identity and enjoy cultural differences by gradually solving the problems of denying cultural differences and attempting to defend their own world views, and going on to develop the empathic ability to accept and adapt cultural differences.
4 Chen and Starosta (1996) claim intercultural communication competence is constructed by three concepts intercultural awareness (cognitive aspect), intercultural sensitivity (affective aspect), and intercultural adroitness (the behavioral aspect). They argue that the three are closely related but separate concepts. The affective aspect of intercultural communication competence is represented by the concept of intercultural sensitivity. That is, intercultural sensitivity refers to the subjects active desire to motivate themselves to understand, appreciate, and accept differences among cultures (Chen & Starosta, 1998, p.231). Measuring Intercultural sensitivity There are two effective instruments for measuring intercultural sensitivity one is IDI and the other is the Intercultural Sensitivity Scale (ISS). These two important assessment instruments are described as follows: Developed by Hammer & Bennett (1998), the Intercultural Development Inventory (IDI) - a self-assessment tool is widely used internationally. For example, it could be used with pre-service teachers to assess the effectiveness of course content and methodology (Van Hook, 2000). The IDI, an empirical measure of intercultural sensitivity containing six stages, is usually applied to measure the six orientations toward intercultural sensitivity outlined in Bennett s (1986, 1993) developmental model. The six stages are presented in a linear continuum and might infer that the development of intercultural sensitivity follows a continuous line of progress. In addition, the IDI may be used as a pre-test and post-test tool for assessing the effectiveness of a new curriculum. Scores on the IDI would reflect the stage at which a student has issues to resolve before progressing to the next stage. A 24-item version of Intercultural sensitivity scale (ISS) formulated by Chen & Starosta (2000) includes five dimensions (a) interaction engagement, (b) interaction confidence, (c) respect for cultural differences, (d) interaction enjoyment, and (e) interaction attentiveness. Items 2, 4,
5 7, 9, 23, 25, 28, 30 and 22 should be reverse-coded before summing the 24 items. Scale examples of each dimension are as follows: Interaction engagement: I enjoy acting with people from different cultures. Respect for cultural differences: I think people from different cultures are narrow-minded. Interaction confidence: I am pretty sure of myself in interacting with people from different cultures. Interaction enjoyment: I often get discouraged when I am with people from different cultures. Interaction attentiveness: I am very observant when interacting with people from different cultures. Since ISS is also broadly used in different cultural settings (Fritz, Molfgang, and Chen, 2001), it is translated into many language versions. The Chinese version ISS scale translated by Peng (2006) who used it to measure the responses of 382 Chinese subjects in a survey. The reliability analysis showed an overall Cronbach alpha of.799 on all 24 measures. Factors affecting intercultural sensitivity Staffon (2003) conducted an exploratory study to measure the level of intercultural sensitivity of 336 high school students attending an international school. Results showed the length of time that a student had attended an international school was found to have a statistically significant relationship with the students level of Intercultural Sensitivity. Peng s (2006) study found that English proficiency affects intercultural sensitivity in certain ways. In addition, intercultural experience had significant effects on the dimensionality of intercultural sensitivity (Peng, Rangsipaht, and Thaipakdee, 2005). The experience of studying abroad significantly improved the level of intercultural sensitivity (Anderson, Lauton, Rexeisen, and Hubbard, 2006). Moreover, a preparation program or curriculum can help students progress in their intercultural sensitivity (VanHook, 2004). Kelly (1963) even argues that a person can witness an event, such as participating in an overseas study program,
6 without ever experiencing the culture to enhance his intercultural sensitivity. In summary, factors such as language proficiency (foreign or English language), experiences of interacting with foreign cultures, and culture education affect a high level of intercultural sensitivity. Based on the above statement, both the IDI and ISS are valid, culture-free and effective instruments to assess people s intercultural sensitivity and situate people s status on the stages of acculturation. However, users are required to take training workshops before using the IDI whereas ISS is easier to retrieve, by using the internet. Therefore, the researcher used ISS as the instrument in this study. Method The intercultural sensitivity of 85 non-english major students from a private college of technology in the east of Taiwan was investigated, using the Intercultural Sensitivity Scale (Cronbach s α = 0.88) developed by G. M. Chen and Starosta (2000). Based on a survey of 85 participants from the nursing department and the department of Healthcare Administration, this study focused on five dimensions of the intercultural sensitivity and the participants demographic factors affecting their performance on intercultural sensitivity. Demographic variables such as English proficiency, experiences of study abroad, etc were added in front of the ISS in order to find out the differences between groups and the possible factors affecting students intercultural sensitivity. A five-point Likert scale was used to respond to each item: 5 = strongly agree, 4 = agree, 3 = uncertain, 2 = disagree, and I = strongly disagree. Participants completed the 24-item version of ISS at the end of the semester. Higher scores of this measure are suggestive of being more interculturally sensitive. Data collected were computed by SPSS/PC 12.0 for Windows. Results and discussion In this study, the Cronbach alpha reliability coefficient of this scale was From the
7 five dimensions of intercultural sensitivity, the participants had the highest score for (2) Respect for the cultural differences (3.88) and had the lowest score (3) Interaction confidence (2.76). Descriptive statistics showed there were 41 students from nursing department and 44 students from department of healthcare administration, there were only 4 students living abroad, and 45 out of 85 students had taken English proficiency tests. Table 1 summarizes the mean scores for each dimension of this scale. From Table 1, the second dimension Respect for cultural differences has the highest mean score 3.88 whereas Interaction Confidence has the lowest score The total mean score on the ISS scale is Table 1 Mean scores on each dimension of ISS scale Dimensions Minimum Maximum Mean S.D. Intercultural Engagement Respect for cultural differences Interaction Confidence Interaction Enjoyment items Interaction Attentiveness Total From the result of the t-test on future plans for studying abroad, there is a significant difference between the four factors of intercultural sensitivity among the 28 students who are planning to study abroad and those who are not planning to, except respect on cultural differences. That is, the students who are planning to study abroad hold higher intercultural sensitivity than those who are not. It is probably because those students preparing for study abroad are more willing to accept foreign cultures. Between students of the nursing department and the healthcare administration, a significant difference was found on Respect for cultural differences. As shown in Table 3, students from the nursing department had higher score than students from the department of healthcare administration on only one factor- Respect for cultural differences of ISS scale.
8 Table 2. Results of t-test on the students plan of study abroad Dimensions t Sig. (2-tailed) Intercultural Engagement *** Respect for cultural differences Interaction Confidence *** Interaction Enjoyment items * Interaction Attentiveness *** Total *** *p <.05, **p<.01, ***p<.001 Table 3. Results of t-test on the students of different majors Dimensions t Sig. (2-tailed) Intercultural Engagement Respect for cultural differences * Interaction Confidence Interaction Enjoyment items Interaction Attentiveness Total *p <.05, **p<.01, ***p<.001 There was a significant differences between students who have a foreign relative and those who do not (t= 2.889, p=.005). Students who have a foreign relative had higher scores on Interaction confidence (t= 3.524, p=.001) and Interaction Enjoyment (t=2.621, p=.01) than those who had not. Table 4. Results of t-test on if or not the students have foreign relatives Dimensions t Sig. (2-tailed) Intercultural Engagement Respect for cultural differences Interaction Confidence ** Interaction Enjoyment * Interaction Attentiveness Total ** *p <.05, **p<.01, ***p<.001
9 There were 45 students in this study who had taken English proficiency tests before, whereas 40 students had not. Results of the t-test showed that there were no significant differences between these students. That is, the experiences of taking English proficiency tests did not influence students intercultural sensitivity. Results generated by stepwise multiple regression indicated planning to study abroad and experiences of living abroad could effectively predict the participants intercultural sensitivity. The results found in this study were similar to previous studies reviewed. Students who are planning to study abroad tend to have a higher level of foreign language learning motivation and are more willing to accept foreign cultures. Therefore, they are more sensitive to culturally diverse people or situations. The multiple correlation coefficient is.485, and the stepwise regression revealed quite a good fit (R Square =.235) which meant 23.5% of the criterion variable s variation is accounted for by the predictors (see Table 5). Table 6 showed the p-value <.001 and the linear relationship between these variables is statistically significant ( F(2, 82) = , p<.001). As shown in Table 7, planning to study abroad and experiences of living abroad contribute to this multivariate model. That is, the multiple regression results showed there is a significant negative relationship between planning to study abroad and the sum of ISS; there is a significant negative relationship between experiences of living abroad and the sum of ISS. The multiple regression equation is: Sum of intercultural sensitivity scale = planning to study abroad *(-7.18) + experiences of living abroad * (-11.05) Table 5 Model Summary Model R R Square Adjusted R Square Std. Error of the Estimate Predictors: (Constant), Study Abroad, Live Abroad
10 Table 6 ANOVA Model Sum of Squares df Mean Square F Sig. Regression *** Residual Total Predictors: (Constant), Study Abroad, Live Abroad Dependent Variable: Sum of intercultural sensitivity scale Model Table 7 Coefficients Unstandardized Standardized Coefficients Coefficients t Sig. B Std. Error Beta (Constant) Study Abroad *** Live Abroad * Dependent Variable: Sum Interaction engagement Respect for cultural differences Interaction confidence Interaction Enjoyment Interaction Attentiveness Table 8 Regression model and Beta Interaction Respect for Interaction Interaction Interaction engagement cultural confidence Enjoyment Attentiveness differences *.376*** ** ***.221* ***.485***.502*** R R Adjusted R F *** 9.698*** *** 6.098*** *** N=85
11 The results generated by multiple regressions (Table 8) showed different weightings for the five dimensions of ISS among the 85 participants. Contributions to interaction engagement from the other four dimensions of ISS showed Interaction Enjoyment (.221*) and Interaction attentiveness (.457***) contributed significantly to the level of interaction engagement. Results from regression of Respect for cultural differences on other dimensions showed only one significant contributors Interaction attentiveness (.485***). Interaction confidence was affected by interaction attentiveness (.502***). Interaction Engagement (.344*) had affect on their level of Interaction enjoyment. Interaction attentiveness was affected by Interaction engagement (.376***), Respect for cultural differences (.291**), and interaction confidence (.316***). The results of these multiple regressions provide a detailed account about how intercultural sensitivity affects the intercultural communication performance. Peng (2006, p.42) claims, Engagement in intercultural communication is only the first step of the entire communication process. The effects of the dimensional factors to interaction engagement reveal that respect for cultural differences, interaction confidence, and interaction attentiveness fundamentally affect their interaction engagement when communicating with people from other cultures. During the process, people should show their respect by accepting cultural differences and being attentive to the messages. The participants interaction attentiveness is connected with their interaction engagement, respect for cultural differences, and interaction confidence. That is, the more they are engaged in, the more they respect for cultural differences, and the more confident they are, and then the more attentive they will be. Students majoring in nursing and healthcare administration are usually expected to be competent in an intercultural communication setting because their future career is to serve people all over the world.
12 Conclusion and recommendations In conclusion, the 85 participants from nursing department and the department of healthcare administration were investigated to see their current performance on intercultural sensitivity. 1. From results of t-tests, there is a significant difference on the four factors of intercultural sensitivity between 28 students who are planning to study abroad and those who are not planning to except respect on cultural differences. 2. The significant difference between the students of different majors was on Respect for cultural differences. Students of nursing department had higher score than students from department of healthcare administration on only one factor- Respect for cultural differences of ISS scale. 3. Students who had foreign relatives had higher scores on interaction confidence (t= 3.524, p=.001) and Interaction Enjoyment (t=2.621, p=.01) than those who had not. 4. The experiences of taking English proficiency tests did not have the impact on the students intercultural sensitivity. 5. Results of stepwise multiple regression indicated planning to study abroad and experiences of living abroad could effectively predict the participants intercultural sensitivity. 6. Results generated by multiple regressions showed different weightings of the five dimensions of ISS among the 85 participants and provided a detailed account about how intercultural sensitivity significantly affects the intercultural communication performance. The teachers teaching in the nursing department and the department of healthcare administration are strongly recommended to design a course for enhancing students intercultural sensitivity in order to prepare them for their clients with diverse cultural backgrounds. The school administrators are recommended to provide students with opportunities to study abroad, for example, short-term study abroad or exchange student
13 program, according to the result of this study. Furthermore, another empirical study using ISS could be conducted in more nursing schools in Taiwan in order to find out if further factors affect intercultural sensitivity. For more detailed information, qualitative data from oral interviews or observations are needed in the future studies.
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