Student Nurses' Experience of Interaction with Culturally Diverse Psychiatric Patients

"Mental health core providers should not only be happy uiith knowing about man's disease, but should rather also endeavour to knoui about man himself." abstract A study of Baccalaureate nursing stu­ dents was conducted to explore and describe undergraduate nursing stu ­ dents' experience of interaction with cul­ tu ra lly d ive rse p s y c h ia tric patients. Thirty-seven nursing students partici­ pated in this research project. Sixteen of the students came from a predominantly black university and the other twenty-one students came from a p redom i­ nantly white university. Both universities are situated in the same city and allo­ cate their nursing students to the same psychiatric hospital for practical experi­ ence. The student nurses reported having ex­ perienced both positive and negative as­ pects of interacting with culturally diverse psychiatric patients. Positive aspects in­ cluded inter alia, optimism, racial unity, equality of facilities, enrichm ent and challenge, whereas negative experience included inter alia, discrimination, supe­ riority complex, cultural ignorance, inef­ fectiveness of patient care, hostility and general unhappiness. The undergradu­ ate program should therefore begin to include cultural content in the curricu­ lum so as to enable future nurse practi­ tioners to utilize a culture-sensitive ap­ proach in rendering care to their patients. opsomming ' n S tu d y van B a cca la u re a te verpleegkundige studente was uitgevoer om voorgraadse studente se ervaring van interaksie m et kultureel diverse p s ig ia trie s e p a s ië n te te verken en verduidelik. Sew e en d e rtig v e rp le e g k u n d ig e stu de nte het deelgeneem in hierdie n a v o rs in g s p ro je k. S estien van die s tu d e n te w as a fk o m s tig van ' n oorheersende swart universiteit en die a n d e r een en tw in tig s tu d e n te was a fk o m s tig van ' n o o rh e e rs e n d e w it u n ive rsite it. A lbei u n ive rsite ite is in dieselfde stad gesitueer en stuur hulle verpleegkundige studente na dieselfde p s ig ia trie s e h o s p ita a l v ir p …

"Mental health core providers should not only be happy uiith knowing about man's disease, but should rather also endeavour to knoui about man himself."

Research Article abstract
A study of Baccalaureate nursing stu dents was conducted to explore and describe undergraduate nursing stu dents' experience of interaction with cul tu ra lly d ive rse p s y c h ia tric patients.Thirty-seven nursing students partici pated in this research project.Sixteen of the students came from a predominantly black university and the other twentyone students came from a p redom i nantly white university.Both universities are situated in the same city and allo cate their nursing students to the same psychiatric hospital for practical experi ence.
The student nurses reported having ex perienced both positive and negative as pects of interacting with culturally diverse psychiatric patients.Positive aspects in cluded inter alia, optimism, racial unity, equality of facilities, enrichm ent and challenge, whereas negative experience included inter alia, discrimination, supe riority complex, cultural ignorance, inef fectiveness of patient care, hostility and general unhappiness.The undergradu ate program should therefore begin to include cultural content in the curricu lum so as to enable future nurse practi tioners to utilize a culture-sensitive ap proach in rendering care to their patients.

introduction
Given the enormous social and political changes presently occurring in South Africa, it becomes imperative for mental health care providers and indeed all other health care providers for that mat ter, to begin to learn about and under stand every patient placed in their care wholly, in the real sense of the word, in order to give appropriate and effective care to the patient.Mental health care providers should not only be happy with kn o w in g a b o u t m a n 's d ise ase , but should rather also endeavour to know about man himself.
M ental health care is costly, by any standards.No longer can South Africa afford to waste millions of Rands annu ally through lack of cultural sensitivity by mental health care providers, resulting in misdiagnoses, often with tragic and dangerous consequences (Tshotsho, 1992:46-47).
In South Africa, the challenge to psychi atric nurses and student nurses today lies in interacting with psychiatric pa tients from different cultures in a mean ingful way.To do this, a therapeutic re lationship between psychiatric patient and nurse needs to be established and nurtured.The therapeutic relationship is the cornerstone of psychiatric nursing.It implies the establishment of a warm, trusting relationship between the psychi atric nurse and patient for the purpose of helping the patient (Beck, Rawlins and Williams, 1988:92-94).Certain ingredients such as trust, empa thy, genuineness, concern and caring, respect, tolerance and acceptance, hon esty, commitment to the relationship and dependability are required to maintain such a relationship (Okun, 1987:22).T hese in g re d ie n ts are not u su a lly present at the beginning of a relation ship but develop over time as people get to know one another.All health care services are challenged to move from a unicultural approach to a multicultural one in helping people.Individuals and groups representing dif ferent cultural lifeways are no longer just satisfied with minimal caring; they are expecting sensitive service that includes an understanding of their cultural values.One of the most urgent and significant challenges for health professionals dur ing the next decade, therefor is to sys tematically and critically study trans-cultural health illness patterns of caring and curing w ithin the concom itant health care systems of different cultures in the world (Leininger, 1981:365-371).In view of this, nurses (nursing students included) should therefore recognise that cultural value differences exist and that misunderstandings are more likely to occur when communication does not conform to expectations about how peo ple should think or act.Nurses and pa tients from different socio -e co no m ic groups may also have different values (Beck, Rawlins and Williams, 1988:93).The nurse's awareness of the values of patients from different classes and cul tures may help prevent misunderstand ings that ultimately impede the therapeu tic relationship -a crucial element for accurate diagnosis, treatment and reha bilitation.The purpose of this study was to explore and describe student nurses, experience of interaction with culturally diverse psy chiatric patients in answer to the re search question: how do student nurses experience interaction with culturally di verse patients?

theoretical framework
Nursing for the Whole Person Theory (NWPT) was the point of departure for this study.This theory reflects the focus on the whole person -body, mind and spirit, as well as the parameters of nurs ing se rvice and beliefs abo ut man, health, illness and nursing (Oral Roberts University, Anna Vaughn School of Nurs ing, 1990: 136-142; Rand Afrikaans Uni versity, Department of Nursing, 1992: 5-7)

research design
An exploratory and descriptive qualita tive study which is contextual in nature, w as fo llo w e d (M o uton & M arais, 1991:43-45)

research method
A phenomenological method of datagathering using naive sketches was used (G io rg i, 1985:10-19).Naive sketches provide the respondents the opportunity to write their personal sto ries of their lived experience.Before the data gathering will be described reliabil ity and validity measures adhered to and sampling will be described.After that data gathering, data analysis and a lit erature control will be discussed.

reliability and validity
Reliability and validity measures as de ve lo p e d by W oods and C atan zaro (1988:135-138) were adhered to.

■ reliability
Control measures applied to counteract the threat to the reliability of the study included:

researcher's status or position as a threat to reliability
Control m easures A clear explanation of my role as a re searcher, as a student in Psychiatric Nursing at the Rand Afrikaans University was given to the student nurses.A fu ture explanation that the research study serves a part of the requirements for the acquisition of Masters' Degree in Psychi atric Nursing was also provided.

choice of participants as threat to reliability:
C ontrol m easures A description of the characteristics of the student nurses and the decision making process involved in the choice of student nurses was provided, to ensure that the student nurses who participated in this study complied with the set criteria.

social situational conditions as threat to reliability
C ontrol m easures Field notes were written during and di-26 Curationis June 2000 rectly after the completion of the naive sketches, so that all relevant information could be recorded within context.This included outlining of the context (social, physical and psychological) within which the data was gathered.

the method of research as threat to reliability
C ontrol M easures i) The strategies that are used to gather data were accurately and thoroughly noted, analyzed and reported on.
ii) The researcher made use of an inde pendent coder who is a Masters pre pared advanced practitioner in psychi atric nursing to identify relationships, central themes and categories after hav ing pro vid e d her w ith a p ro to co l as guideline.
iii) The findings and results of the study were compared with similar existing re search (or published studies), to ensure the reliability of the study as well as to establish commonalties and uniqueness of the c u rre n t s tu d y (W oods and Catanzaro,1988:136-138).

■ validity
Control measures applied to counteract the threat to the validity of the study in cluded:

observer effect as threat to validity
C ontrol measures i) Changes in the researcher -student nurse relationship that are recurrent, pro gressive and cyclical were identified.ii) Maturation was distinguished from ef fects of naive sketches by use of con stant comparative analysis and discrep ant case analysis.iii) Dependent corroboration from stu dent nurses, discrepant -case analyses and observation.iv) Substantive and theoretical coding likely to elicit contrived responses.v) Comparison of data to theories and analytical models derived from literature.vi) Presentation of data in relation to the researcher's position and relationship, i.e. as a researcher and a psychiatric nurse e d u c a to r c o n c e rn e d w ith the population's mental health.vii) Constant comparative analyses and validity checks with student nurses.viii) Follow -up interview s were co n ducted with three student nurses to as certain if the obtained results reflected their lived experience.

selection and regression as threat to validity:
C ontrol m easures i) Those s tu d e n t nurses w ho m eet purposive sam pling criteria were re cruited (Woods & Catanzaro 1988:136-138), by m aking use of the stu de nt nurses' lecturers as mediators.ii) Commonly assumed meanings were questioned and discrepant-case analy sis was utilized.iii) C on sisten t fo llo w -u p to stu de nt nurses in the form of information about the ongoing study to maintain their in volvement and interest was provided; a summary of the research results was made available to student nurses who requested it.

sampling
A p u rp o sive co nve n ie n ce sa m p lin g method was carried out (Burns & Grove, 1987:218).The sample consisted of stu dent nurses from two universities situ ated in the same city, one a predom i nantly black university (university A) and the other a predominantly white univer sity (university B).Students from both universities do their practice training at the same psychiatric hospital.The criteria for selection into the sample included the following: • must be in the process of studying for a B.Cur degree, for which psychiatric nursing is an integral component of the curriculum.
• must have worked in an integrated psychiatric hospital for a minimum of four weeks during their practical period.
• m ust give researcher a written in formed consent.

data gathering
A pilot study was done with three stu dent nurses to identify any possible po tential problems.Subsequently all the participants wrote naive sketches in the same venue for each participating uni versity.The researcher requested the participants to write down their experi ence of interacting with diverse cultural psychiatric patients whilst they were car ing for them during their practical period at the integrated psychiatric hospital.The researcher made sure the two ven ues were com fortable, well ventilated and free from noise.She stayed with the students in the venues respectively while the naive sketches were being written, so as to write her own field notes.Fol low-up interviews were done with three student nurses to ascertain if the results obtained by the researcher were indeed what the student nurses described.
Ethical aspects related to the research were observed, including the protection of anonymity and informed consent.No mental discomfort was experienced by the student nurses following the comple tion of the naive sketches as well as the follow-up interviews.Thus, no referral to support systems was made by the re searcher.

data analysis
Data analysis of the naive sketches was done using the com bine m ethods of data analysis by Giorgi (1985:20-30, in Ornery 1983:53-56 and Kerlinger 1986: ).The steps that were followed in the data analysis by the researcher and in dependent coder were: • reading through the naive sketch look ing at the participants experience; • underlining words and themes; • classifying words and themes into major categories; • clustering word and themes into sub categories.
An independent coder, who via a psy chiatric nurse specialist was used as a reliability measure in identifying and cat egorizing central themes.A Protocol was provided to the inde pendent coder to serve as guidelines for analyzing the data, separately from the researcher.Subsequently, the two met for a consensus on the categories, sub categories and their relationships.The categories were then prioritized based on the number of student nurses who had e xp e rie n c e d s im ila r a spe cts (Zwane, 1993:26-28).

literature control
Similar studies regarding cultural diver sity were investigated and com pared with results of this study.Common and unique aspects from the study were es tablished, respectively.

research results
Sixteen students from university A and twenty one students from university B participated in this research (Zwane, 1993:29-61) Examples of statements cited are quoted verbatim from naive sketches in order to highlight and en hance the quality of the described ex perience.The research results are re flected as patterns of interaction be tween students' internal and external environment (Nursing for the Whole Per son Theory, Rand Afrikaans University Department of Nursing 1992 : 5-7).

positive experiences by student nurses:
Student nurses had positive experiences in interacting with culturally diverse pa tients.This was made possible by their experience that the facilities for all pa tients were equal which led to their ex perience of optimism.The racial unity and co-operativeness of patients were 27 Curationis June 2000 also experienced positively.It was ex perienced as a challenge and enrich ment to be able to interact with cultur ally diverse patients.Each of these cat egories will now be discussed.

Cquolity of facilities:
Student nurses of university A experi enced the equality of facilities for all pa tients positively.The follow ing state ments written by students highlight this: " It is good for the under-privileged to now enjoy all the benefits that other groups did enjoy long before integration; and this is one of the pleasant things we can talk about'.
" Most of the black patients could not play volleyball at first, but were taught by their fellow white colleagues to play it w ell" .
Optimism related to the exposure to cul turally diverse individuals.An experience of optimism is evident amongst student nurse of both universities as seen in the following quotations: " Regardless of all the problems, I actu ally found it a challenge (especially for the new South Africa) to work with peo ple of diverse cultural backgrounds ...." " It is interesting to work with patients of diverse cultural backgrounds because I tend to learn different things and prac tices from the patients, and the white pa tients are also interesting..."

racial unity and co operativeness :
Student nurses from university A experi enced that integrating psychiatric pa tients of diverse cultural backgrounds also forged harmony between the differ ent racial groups, as seen in the follow ing statements extracted from their na ive sketches: " I re a lly e n jo y e d th e w ay m o rn in g prayers were handled; we used to alter nate days for Afrikaans, English and Ver nacular."" ... and this promotes the love and un derstanding between black patients and their white counterparts.NB.This will not only promote love between psychi atric patients alone, but also between family members of the tw o" .
The student nurses from university A found most black psychiatric patients to be co-operative whilst their white coun terparts are nagging and demanding.The follow ing statements confirm this aspect: " Most black patients were co-operative; they respect the nurses and do as they are told most of the time" .
" Blacks in hospital X behave, as they know and understand that they are not in their own homes but in an institutions to be treated.So, most of them do not have a problem in dem anding many things.They accepts and appreciate what is given to them " ." I found white patients nagging, they al ways come to you to ask for something, e.g. to phone home, to find out if any one has phoned them, headache tab lets ...."

Challenge and enrichment:
Student nurses from both university A and University B regard their experience of working psychiatric patients from di verse culture as a challenge and enrich ing.
" It is interesting, challenging and a posi tive dem and on one's general know l edge and psychiatric knowledge"."To work with different culture groups is a challenge" .
" During the group activities, both groups of patients told each other their experi ences and therefore were learning from each other's mistakes.We were all very pleased to learn how other races view things" .
Huttlinger (1989:27) agrees that working with people from various cultural back grounds can be rewarding and challeng ing.Hegyvary (1992:261) also observed that faculty and students who experience cross-cultural practice gain perspectives that are otherwise out of reach.

negotive experiences by student nurses :
The central story line in student nurses' negative experience of interacting with culturally diverse patients is based on their experience of ethno centrism re lated to superiority complex; discrimina tion, cultural ignorance and hostility.This led to their experience of unhappiness as well as barriers in communication re lated to mistrust, rejection, misbehaviour, exploitation and politicization.Student nurses also experienced that patients received ineffective patient care.Each of these categories w ill now be d is cussed.

experience of ethnocentrism related te superiority complex; discrimination, cultural ignorance and hostility:
Ethnocentrism is a concept that refers to one cultural group experiencing them selves as s u p e rio r to other cu ltural groups and also demonstrating this in their verbal and non-verbal behaviour.The student nurses from university A experienced an overwhelming superior ity complex displayed by white patients, "When watching television,the white pa tients decided which channel should be watched because they regarded them selves as superior to the black patients" .
"White patients see themselves as dif ferent from black patients, they claim that they are not mad but suffering from men tal d is tu rb a n c e s , e.g.d e p re s s io n , whereas black patients are mad" .
Another student nurse also uirote: " .... but with white patients, most of them did not accept me as a person who is there to help, some even thought that they could hire me to go and work in their homes as a maid" .
The student nurses from university A expressed dissatisfaction about the dis crimination being practiced amongst the different cultural groups at the institution in question, as evidenced by the follow ing quotations: "There are still some white nurses who cannot tolerate black nurses, let alone black patients" .
White sisters used to listen to white pa tients' problems and try to solve them but with black patients, they would just listen and ignore" ." .... it did not matter whether we were nurses and there to help him, to him we were still Kaffirs" .
In line with these findings Capers (in Wilson & Kneisl, 1992: ) points out that although they move in and out of white society, blacks are generally socialised am ong blacks and suffer from racial p re ju d ice and d iscrim in atio n.Doku (1990:69-70) notes that black and other ethnic people who settled in the United Kingdom initially seemed to display cer tain types of mental illness in the form of physical symptoms.When no physical cause was found, they were labelled as malingerers.Consequently their depres sion is under treated.This implies they have to be more ill than others to be re ferred to specialists.Ethnocentrism can also be linked to cultural ignorance of other cultural groups.
Both universities' student nurses seem to be ignorant of each other's culture as seen in the following expression by stu dent nurses from university A: " Black patients have their own cultural practices like "go phasa badim o" (ap peasing the ancestors), which is miscon strued to be psychiopathology by the white personnel" "W hite p a tie n ts w ere n auseated by watching black patients using their bare hands to eat their meals" .
Student nurses from university B echoed the same sentiments.
"Since we do not know each other's cul tural backgrounds, we cannot really un derstand each other's way of thinking and doing" .
"Even some of the black staff members do not understand the white patients, especially Afrikaners, then they accuse them false" .
Linked to these findings are the conclu sions of Herbst (1990:22) that there is a lack of knowledge concerning trans-cultural nursing issues that causes many problems in South Africa.Cooper (in Wright & Giddey, 1993:91) also state that the lack of adequate cultural knowledge within nursing regarding ethnic groups prevents p ro p e r in te ra c tio n s ta king place in any meaningful way.
Experiencing ethnocentrism also results in individuals experiencing hostility.Stu dent nurses from university A experi enced a hostile attitude.The following were some of the expressions extracted from their naive sketches: " .... and when the sister tried to explain everything to her, she (the patient) actu ally went mad, breaking glasses and throwing everything on the floor..." " .... and others want to always control the TV thinking that it is their right, and at times results in physical fights, espe cially among male patients.Wilson & Kniesl (1992:914) found that in patient staff in one study perceived blacks as more violent than whites, al "To uiork with different culture groups is o challenge".
th o u g h o b je c tiv e fin d in g s revealed blacks to be less violent.This is in line with the student nurses of university A experience that the white patients are more hostile than black patients.

Unhappiness related to ethnocentrism:
Unhappiness related to ethnocentrism stood out as a prominent feeling experi enced by student nurses from both uni versities.The following statements by them highlights this: " One day a black patient was told he is a (vark) pig, by a fellow white patient and this did not make me happy at all" " S o m etim es the n on -w h ite p atie nts would speak in their own language, look at you and laugh.This made me feel rather uncomfortable" .

Communication barrier related to mistrust, rejection, misbehaviour, exploitation and politicization:
From the student nurses sketches it seems as if their experience of ethnocen trism caused a comm unication barrier because of their lack of knowledge about other culture groups.Because of their lack of this knowledge it makes them mistrustful and let them experience re jection from an individual from another cultural group.One group also per ceives the other group as misbehaving, exploiting others and politicizing.Each of these aspects will now be discussed.All the student nurses (both university A and university B) expressed discontent as far as comm unication between the different cultural groups is concerned as evidenced by the following extracts from their naive sketches: "Communication is a problem between patients of different cultural groups.It is more serious between white nurses and black patients" ." I have experienced not being able to talk or assess patients because I could n ot c o m m u n ic a te in th e ir own la n guage" .Dawes (1986:148) states that health workers have often identified communi cation barriers as their biggest problem.Language alone did not create a com m unication barrier but also m istrust.Student nurses from both universities expressed this in the following manner: "They would rather verbalize their prob lems clearly to the white health provided and be very cooperative with them.To me, this shows a sense of hatred, mis trust and unacceptance" .
"White patients had a tendency of ask ing use to leave the doctor's consulting rooms or refused to talk in our pres ence" .
Because of the mistrust the white pa tients demonstrated, the student nurses from university A also experienced rejec tion.
"White patients usually gave problems to black nurses of cours e.g.nurse X was interviewing patient A and the patient told nurse X to keep a big distance from her because she was not sure whether nurse X has TB or not" ."There was a white patient in my ward who wanted to be transferred to another ward because she felt another patient from different culture was evil and was going to kill her because she was a child of the devel" .Wright & Giddey (1993:192) states that p e o p le fro m m in o rity e th n ic b a c k grounds tend to find health agencies dif ficult to approach and trust.
Related to the experience of mistrust and rejection was the students' perception of m isbehaviour of patients.Student nurses of university A perceived misbe haviour by the patients of another cul ture as seen in the following extracts: "Afrikaans speaking patients have a ten dency of forming sub-groups within the ward; these sub-groups were actually very difficult to manage such that they would go to the tuck shop at any time they feel like, regardless of whether it is medication time or group therapy time" ." During prayer meetings, most people involved are blacks, whites will tell you that they will pray for themselves" .
The student nurses from university A also experienced that members of one cul ture took advantage of members of an other, less privileged culture.This is ex plicit in the follow ing quotations from their naive sketches: " .... for example, a black psychiatric pa tient making the bed for a white fellow patient and being paid with a cigarette" ." I remember one morning when I found one black (mrs A) patient bathing Mrs B (a white female patient).When I tried to intervene, Mrs B was so cross, claiming the Mrs A is her servant, after all" .
All these experiences the student nurses blame on the politics of South Africa, for example: "Because there is an inferiority complex in black patients, I feel they must be nursed alone first and will combine only when apartheid is over" .
" Because these people are all mentally ill, why does Government have to force fully integrate them -is it because the Government takes advantage of them because they depend on the Govern ment for everything ....?" The experienced communication barri ers let student nurses experience that ineffective patient care is provided.A student nurse expresses this as follows: "There is always someone needed to translate whatever you are saying to the patient and vice versa, resulting in loss of valuable time and a confidential rela tionship cannot really be established with the patient" .
In line w ith this Anderson (1990:36) points out that health professionals are often unaware of the com plex factors that influence clients' responses to pro fessional care; the cultural meaning that shape p a tie n ts ' experiences are not taken into account by practitioners in the planning of care.Consequently, patients may not com ply with prescribed treat ment regimes or may modify treatments so as not to conflict with their system of priorities.A real danger of course, is that, under these circumstances, the patient may be seen as difficult, unmotivated or labelled.Andrews (1992:7) also found that there are little understanding for di verse cultures by health professionals that may lead to misdiagnosis and treat ment that is not appropriate.

conclusion
Student nurses in both universities had both positive and negative experiences with interacting with culturally diverse "I hove experienced not being oble to tolk or ossess patients because I could not communicate in their ouin language".psychiatric patients.The challenge, en ric h m e n t, ra cia l u n ity and c o operativeness the student nurses expe rienced could contribute to constructive interaction between student nurses and patients.On the other hand the student nurses' experience of ethnocentrism and their related experience of unhappiness, communication barriers and ineffective patient care could lead to destructive in teraction and conflict between the stu dent nurses and culturally diverse psy chiatric patients.This in turn could be detrimental for the mental health of all the role players involved.

limitations of the study
Data was gathered from the university A group of students three months follow ing their experience of interacting with culturally diverse psychiatric patients, whereas the university B group of stu dents were still in the process of inter acting with the said psychiatric patients though they had already completed a minimum of four weeks.This implies that a time lag existed between their experi ence and that could have influenced the results of this study.(Zwane, 1993) recommendations Recommendations made in this study are three-pronged, i.e. for psychiatric nursing education, psychiatric nursing practice, as well as psychiatric research.

psychiatric nursing education
cross-cultural nursing is fast becoming a recognised, legitimate and growing area of stu dy in basic nursing p ro grammes the world over, the implications of this for south africans is that curricula for basic nurse training program m es should be designed in such a manner that cultural content is built in so as to enable the psychiatric nurse practitioner to render a more holistic and effective service to culturally diverse communities.
maintain a sense of discovery about their n ursing pra ctice that seem s greater knowledge and commitment to the het erogeneous community they serve and the communities around them.

psychiatric nursing research
research to determine the South African patient's understanding of mental illness in its correct cultural perspective is cru cial, with a view to ultimately co-operate with alternative practitioners in the treat m ent o f the c o m m u n ity 's m ental illhealth, since therapies by alternative practitioners frequently include common sense rationales for their efficacy that im press patients.In addition, they are usu ally based in the community and may have social relationships with the patient, the patient's family, friends and neigh bours.This often contrasts with the lower level of integration that biomedical prac titioners have with the patient comm u nity.

acknowledgement
This article is based on research con ducted as a requirement for a disserta tion for the M.Cur (Psychiatric Nursing) degree, Rand Afrikaans University,South Africa.

psychiatric nursing practice
a culture sensitive approach offers the nurse an opportunity to meet the goal of holistic as well as personalized care for all, irrespective of who they are or where they come from, not only does it help the nurse achieve these goals, but it also promotes a sense of success and self esteem fo r the nurse, a cco rd in g to Chrisman (in Patrick, Wood & Craven, 1991:46), people who have used culturesensitive care in practice report they la u re a te verpleegkundige studente was uitgevoer om voorgraadse studente se ervaring van interaksie m et kultureel diverse p s ig ia trie s e p a s ië n te te verken en verduidelik.Sew e en d e rtig v e rp le e g k u n d ig e stu de nte het deelgeneem in hierdie n a v o rs in g s p ro je k .S estien van die s tu d e n te w as a fk o m s tig van ' n oorheersende swart universiteit en die a n d e r een en tw in tig s tu d e n te was a fk o m s tig van ' n o o rh e e rs e n d e w it u n ive rsite it.A lbei u n ive rsite ite is in dieselfde stad gesitueer en stuur hulle verpleegkundige studente na dieselfde p s ig ia trie s e h o s p ita a l v ir p ra k tie s e ervaring.Die v e rp le e g k u n d ig e stu d e n te het gerapporteer dat hulle positiewe sowel as negatiewe aspekte ervaar het tydens in te ra k s ie m et k u ltu re e l d ive rse psigiatriese pasiënte.Positiewe aspekte s lu it in o p tim is m e , rasse -e e n h e id , gelykheid van fasiliteite, verryking en u itd a g in g ; w aar negatiew e ervaring d is k rim in a s ie , s u p e rite its k o m p le k s , kulturele ignorering, oneffektiwiteit van p a s ië n te s o rg , o n g e s k ik th e id en algem ene ongelukkigheid insluit.Die voorgraadse program moet dus begin om kulturele inhoud by die kurrikulum in te sluit om sodoende toekom stige verpleegkundige praktisyne in staat te stel om 'n kultuur-sensitiewe benadering aan te neem in die versorging van hul pasiënte.