Internationally educated nurse potential contributions to culturally safe advance care planning (ACP) practices and policy in Ontario: An interpretive descriptive qualitative study
Bibliographic record
Abstract
ACP is recognized as a process that supports individuals in sharing their values, goals and preferences for future medical care. Engagement in ACP has been shown to be more influenced by culture than other factors. Uptake of ACP among ethnic minorities is low and failure to consider cultural preferences can cause moral harm for Canadian immigrants. Cultural safety aims to respect the values and beliefs embedded in one’s culture and allows individuals to experience a sense of security when making decisions. Existing literature on strategies to engage in culturally safe ACP is vague and poorly explored. Nurses play a key role in facilitating ACP discussions in their practice. In particular, internationally educated nurses (IENs) are uniquely positioned to share their home country and Canadian experiences and to speak about practices that can maintain cultural safety in the ACP process. An interpretive descriptive approach was applied to understand how IENs might contribute to facilitating culturally safe ACP and subsequently inform nursing practice and ACP policy. IENs reported that in their home countries, ACP was poorly carried out and not valued. In Ontario, IENs expressed that ACP was often focused on determining goals of care status. IENs recognized that ACP went beyond goals of care discussions as they sought to engage individuals and families in culturally safe ACP discussions. The analysis revealed that IENs engaged in various practices that were categorized under three key themes: cultural humility, a cautious open approach, and empowering clients. Participants described how culturally safe ACP practices could be supported in changes to nursing education, practice, and policy. Research, theory, and policy development are needed to advance the concept of culturally safe ACP. Best practices for culturally safe ACP and organizational supports are needed to assist nurses in delivering culturally safe ACP.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.016 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.019 | 0.013 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".