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Teaching and Learning Forum 2004 [ Proceedings Contents ]
The Cummins Model: Helping foreign nursing students cope in a Baccalaureate course

Janet Williams
Auckland University of Technology

There has been an increasing number of foreign born nursing students in New Zealand, and it is important to research ways to help these students cope with the expectations of this training program. The aim of the present study is to explore the ways foreign students adapt culturally to the expectations within the baccalaureate nursing program, and to identify the students' perception of their cultural identity, cultural difficulties and any effects such difficulties have caused. The purpose is to assist students to gain control over their learning and increase their ability to cope with their clinical assessments. The study was based on Cummins (2000) 'interactive/experiential' model, using collaborative critical inquiry, which helped the students to relate the content to their individual and collective experience and to identify individual difficulties, in small co-operative teams. The Cummins model was tested for its usefulness in helping foreign nursing students cope in the nursing course. The model successfully enabled the students to cope better with their clinical nursing experience by facilitating the identification of individual challenges, the planning and actioning of suitable strategies.

The study also assessed the students' perceived competence in speaking English, their cultural identity and psychological adjustment and found the model did not affect these factors. The implications for nursing educators is that foreign nursing students could be assisted by Cummins Program to achieve their assessments within the clinical setting, by helping them understand what is expected within this new and different culture. The participants were 21 foreign student nurses, who were divided into two separate groups. One group, of 8 students, underwent an adaptation of the Cummins program, in weekly tutorials, over four weeks, in place of clinical tutorials. A comparison group of 13 students had the usual clinical tutorials. Members of both groups completed a questionnaire, on 3 separate occasions. Interviews were conducted with the 6 lecturers involved with the students who took part in the Cummins Program.


Introduction

New Zealand's population has become much more culturally diversified as a result of a change in the immigration policy to a criteria based on personal merits, skills and qualification in 1986 (Ho, 1995). The 2001 census found almost 20% of New Zealand residents were born overseas, with one quarter coming here from Oceania, and one eighth emigrating from Asia. This represents an increase of 15.5% between the 1996 and 2001 censuses (Statistics New Zealand, 2002). As the cultural diversity in New Zealand has changed, so has the cultural diversity of students within nursing courses. There are also rising numbers of culturally diverse patients and many authors cite the need for an appropriately diverse nursing workforce, to help with the delivery of culturally competent care for these patients (see Abriam-Yago, Yoder, & Kataoka-Yahiro, 1999; Campinha-Bacote, 1998; Dickerson & Neary, 1999).

The aims of the study were to explore the ways foreign students adapt culturally and for these students to gain a better understanding of the expectations of the nursing course, control their learning, and find solutions to their difficulties, particularly in the clinical setting. The present study was designed to assist both nurse educators and foreign nursing students by identifying the problems foreign nursing students in the study have experienced, and the effects of these problems. Secondly, the study sets out to evaluate effectiveness of the Cummins Program in helping student nurses cope within the nursing course.

There is almost no research into the difficulties foreign nursing students experience in the clinical area, however theories of the affects of immigration and research involving the challenges faced by foreign university students, have provided relevant information on some the issues. For example, theorists suggest that migrating from ones' native culture into a strange, new, and radically different culture, to live, work and/or study, can cause feelings of helplessness, discomfort and disorientation, as the "outsider" tries to comprehend and adapt to the new culture (Berry, Kim, Minde, & Mok, 1987). Asian students were found to have more difficulty with inter-personal relationships, dealing with people of different status and in establishing friendships than their Australian counterparts, in a large, quantitative study in an Australian university (Barker, Child, Gallois, Jones, & Callan, 1989). A lack of language proficiency has been identified by many authors (for reviews, see Abu-Saad & Kayser-Jones, 1982; Chalmers & Volet, 1997; Kennedy, 1995; Shakya & Horsfall, 2000) as a major factor in learning difficulties for foreign students. Many authors have emphasised that all immigrants experience a process of adaptation as they acculturated to the host environment (Taft, 1989; Asante & Gudykunst, 1989; Kim, 2001; Ward, Bochner & Furnham, 2001). The process has been found to be complex, enduring, and involves multiple factors that can be very stressful for the immigrants (Taft, 1987).

Foreign nursing students also have to deal with the complex and uncertain nature of the clinical setting and being observed closely by the clinical lecturer, which Wilson, (1994) found to be very stressful for the majority of nursing students, regardless of nationality, in a large American study. The specific criteria that the students must meet to pass their clinical experience, creates unique educational needs for the foreign students, as they must be able to demonstrate valuing, respect, advocacy skills, therapeutic touch, non-verbal skills, and communication skills with their patients. It has been suggested that these concepts are interpreted in vastly different ways within different cultures (Novinger, 2001). Examples of how each of the concepts may be viewed in culturally specific ways are well documented in the literature (Andrews & Boyle, 1999; Giger & Davidhizar, 1999; Luckmann, 1999; Nolan, 1999). Novinger (2001) explained that direct eye contact signifies honesty and attentiveness in European culture, and is what is expected within the course, but in some Polynesian and Asian cultures, direct eye contact shows disrespect and boldness, or even aggression. Even a smile, which western cultures would read as showing happiness, may be used by a Japanese person to cover unpleasantness or grief, which should not be inflicted on others. For example, a Japanese student nurse might smile "inappropriately" at a newly bereaved western family, which could be very upsetting for the family. The students are also expected to communicate warmth, closeness and availability or "immediacy behaviours". High-contact cultures, such as Western cultures, value such caring behaviours as being a very important part of nursing care. In low-contact cultures such behaviours may be viewed as being inappropriate, or even be seen as disrespectful or embarrassing for the person who is upset. In Japan, a nurse would leave a patient who was upset and crying, so the patient could compose themselves and not to embarrass them further; an action that would be negatively judged by both staff and patients in western cultures. This raises the question of how aware our foreign students are of their cultural interpretations of the concepts, in contrast to the expected interpretations of the nursing course and the impact of these cultural differences on their ability to acculturate into the course.

Cummins theory

Jim Cummins has been primarily known for his work in the bilingual education field (Abriam-Yago et al., 1999). The Cummins model of language acquisition has provided a framework for understanding second language issues, related to context and cognitive complexity and forms the basis of the present study. Cummins (1989) has suggested that it is crucial for educators to understand that, although a lack of English fluency may be a secondary contributor to lack of academic success, it is not necessarily the cause of failure. The "fundamental causal factors of both success and failure lies in what is communicated" to students during interactions with educators and how these interactions make the students feel (Cummins, 1989, p. 33). He explained that failure is frequently associated with the educators making the minority students feel alienated, that they do not belong, and undermining their confidence. Furthermore, it has been suggested that frequently the learning difficulties English for Second Language (ESL) students experienced are pedagogically induced and are more a "function of inadequacies in teaching" rather than inabilities on the part of the students (Martin & Ramsden, 1987, p. 165). Cummins suggested that the aim was to encourage students to become active generators of their own knowledge by using reciprocal interaction between teachers and students.

The approach recommended by Cummins (1989) to achieve this 'interactive/experiential' model was based on Freire's (1978) pedagogical approach, to achieve what he termed 'Critical Literacy'. It included five phases, that take the students through the Experiential phase (brainstorming what the student knows about the topic to be learnt); the Literal phase (questions such as where, when, how, did it happen, who did it, why?); Personal phase (relate questions to their own experiences and feelings); Critical phase (abstract process of critically analysing the issues or problems raised); Creative phase (translate the results of the previous phases into concrete action).

The Cummins Program was adapted to link to the clinical setting and was designed to "validate students' background experiences" by encouraging them to "express, share and amplify these experiences" (Cummins, 1989, p. 29). The central tenet of the model consisted of guidance and facilitation by the lecturer, genuine dialogue between student and lecturer, and encouragement of student-student talk in a collaborative learning context. This facilitated the use of meaningful language, with conscious integration of curricular (nursing/medical) language and focused on developing a higher level of cognitive skills, such critical analysis, and tasks that produce intrinsic motivation. As Freire (1978, p. 28) argued, "it is only through participation in an educational climate in which open dialogue is fostered that students can develop the skills for critical engagement with their world and a genuine sense of participation in a common life".

In summary, Cummins (2000) recommended having the students in small co-operative teams to engage in collaborative critical inquiry. The aim was to encourage students to relate the content to their individual and collective experience and to discuss ways in which they might take action to change their educational realities.

The following questions were investigated:

Method

Qualitative and quantitative methods were used in this study and for analysis/interpretation of the data. Initially a focus group laid the foundation for the study, which consisted of four newly New Zealand graduate foreign staff nurses, who took part in a once only guided discussion. The second part of the study involved a quasi-experimental design was used to test the usefulness of the Cummins program in helping foreign nursing students cope with the nursing degree program, assess their cultural identity, evaluate their English competency and psychological adjustment. The questionnaire is attached as Appendix I. The clinical lecturers of the foreign students taking part in the study were also interviewed.

Procedure

The goals of the study and the nature of the Cummins Program were explained to foreign nursing students from across the three years of the nursing course and volunteers were sort. The participants comprised of 21 nursing students, who were born outside New Zealand and rated themselves as foreigners to the New Zealand culture and volunteered to be part of the study. The eight students who took part in the Cummins program consisted of four first-year students in one group, and a second group of three second-year and one third-year student. The Comparison group comprised 13 students. The groupings were dictated by the geographic closeness of the clinical placements, willingness to attend four weekly sessions and perceived need. The clinical lecturers responsible for the clinical learning of the eight participants of the intervention, the Cummins Program, participated in face-to face interviews while the Program was running.

The same self-report questionnaire was used on three different occasions during this study. The six-page questionnaire consisted of 5-point Likert scales and some open-ended questions, which were selected and adapted from published research for this study. As the modifications to the questionnaire were very minor, the questionnaire was not trialed before use. All the students in the Program group completed the questionnaire three times (Time 1, before the program commenced, Time 2, when the program was completed four weeks later, and Time 3, two months after the completion of the program). Three students in the Comparison group did not complete the questionnaire at Time 2. All other students in the Comparison group completed the questionnaire on every occasion.

Table 1: Demographics of the participants


ProgramComparison
Range of ages17-50 years17-50 years
Length of residency2-14+ years2-13 years
Time in nursing course1-3 years1-2 years

Approval to undertake the study was granted by the University of Auckland Human Subjects Ethics Committee and Auckland University of Technology Ethics Committee.

Measures

Qualitative data - The focus group was asked three guided questions regarding the problems they had experienced during their clinical experience, how these problem made them feel, and if the problem had been resolved, and if so, how?

The clinical lecturers supervising the participants' were asked to report on observed changes in attitude or practice in their students twice over the period of the clinical experience.

Quantitative data - The questionnaire included sections for demographic information; Perceived competence in speaking English; Perceived cultural difference; Psychological adjustment; and Coping scale. Statistical analysis was carried out using SPSS 10.1 for Windows 98. Descriptive statistics, reliability analysis, and univariate analysis of variance were generated by SPSS.

Findings

Figure 1

Figure 1: Comparison of coping over time

Repeated measures multivariate analysis of variance was performed on the within groups levels of coping, which were statistically significant over time, Time 1, F(20) = 1.76, p <.05, Time 2, F(1,17)= .71, p <.05; and Time 3, F(1,20) = 1.02, p <.05.

There was a main effect for the effect for the differences in the program differences between the Cummins Program and the Comparison groups, F(1,16) = 5.79, p <.05.

Figure 2

Figure 2: Comparison of the perceived competency in speaking English over time

Repeated measures multivariate analysis of variance was performed using SPSS, to compare the mean scores on the perceived confidence in speaking English for all the students at Time 1, Time 2 and Time 3 but this was not statistically significant. Although all students gained in their perceived confidence to speak English over time, as seen in Figure 2, there were no statistically significant change between the group in the Cummins Program and the Comparison group over time with F = 0.27 at Time 1, F = 0.16 at Time 2, and F = 1.57 at Time 3, <.05. Within subjects tests also demonstrated that the students within each group did not change over time, F=.004, at p <.05.

Figure 3

Figure 3: Comparison of maladjustment overtime.

Although all students were low in maladjustment and decreased over time, it can be seen in Figure 3 that the Comparison group were less maladjusted at Time 1 and remained very stable. The Program group were slightly higher in maladjustment at Time 1 and Time 2, but were reducing by Time 3. Multivariate analysis of variance found that there was no difference between the group in the Cummins Program and the Comparison group over time; Time 1, F = .48, Time 2, F = 1.89, and Time 3, F = .82. Within subjects tests also demonstrated that the students within each group showed no statistical significant change over time, F = 2.02, p <.05.

Figure 4

Figure 4: Comparison of ethnic identity

Repeated measures multivariate analysis of variance was performed on the within group ethnic identity, which were not statistically significant over time, Time 1-F(1,20) = 0.004, p = .95; Time 2-F(1,17) = 0.005, p = .94; and Time 3-F(1,19) = 0.67, p = .80. There was not a main effect for the effect for the differences in the program differences between the Cummins Program and the Comparison groups, F(1,19) = 0.14, at p =.71.

Clinical lecturers' feedback

The clinical lecturers' comments varied according to the individual students taking part in the study. Several lecturers noted that the students in the Program they had in clinical were becoming more relaxed and confident when discussing their practice. They also observed that the students seem to be able to ask more questions and be able to participate a little in tutorials. The majority of the students were noted to be making steady progress but this was not seen as a "big leap forward". Whereas some clinical lecturers noted large changes, stating "I couldn't believe the changes in just one week. Both in attitude and in the confident way she spoke to me ". Another clinical lecturer involved with this student also commented an "unbelievable change in just one week", that just developed further over the coming months. At first, the clinical lecturer did not believe the change was related to the Program, until she noticed similar changes in another student taking part in the Program. They found that the students were much better organised and had clear goals and strategies to improve their learning, all written down and spoke with confidence of their belief that they could achieve these goals.

Student feedback

The students discovered that one of the most important blocks to being able to control their learning was a lack of cultural understanding of the expectations of the clinical lecturers and the nursing course. As one student commented, "...the lecturer asks me about my clinical practice and I don't really understand what she wants to know". During interviews with the clinical lecturers it was evident that assumptions were made about students' understanding of the clinical assessments, which complicated the situation further. The lecturers indicated that the information on clinical assessments was given in writing, for all of the students to read, therefore, they have the necessary information. The students almost universally thought that the clinical lecturer wanted to know about the "tasks" they had completed, such as doing dressings, giving injections, or washing people. Most of the students only realised that the lecturer also wanted them to give examples of how well they had used concepts such as advocacy, professionalism, autonomy, or respect, when they went through the clinical assessment criteria, during Phase 3 of the Program.

When they understood that they also needed to be able to give analysis of their strengths and weakness and to outline strategies for improvement, the students indicated this was not something that they had experienced in the education they had been through in their culture (Kennedy, 1995). As one student said, "In my culture we expect the teacher to evaluate us, it is not something we would do. And I would feel embarrassed to tell her about my weaknesses". It became apparent that the culturally specific definitions contained within the concepts, upon which the students are being assessed, needed to be deciphered with the students, in a safe, supportive and non-judgmental environment, as recommended by Darder, (1991). The students had always had the written assessment criteria, but they had not understood the implications of the requirements of the criteria, from the perspective of the nursing course.

The success of the Cummins Program was evident for one student, who announced after the final session, "This is the best thing I have ever done for myself. I was not sure that it would help me, before it began, I couldn't see how it could work, but now I can see how to control my learning; I feel I have the ability to work through it now. I feel great". This student demonstrated ownership of the changes she had made for herself and she indicated that she now feels she has the power and control over her learning and nursing future.

Discussion

A statistically significant increase in coping with the nursing degree was found for the foreign nursing students in the Program group. As shown in Figure 1, at Time 1, the Program group, with a mean score of 3.3, were not coping as well as the Comparison group, who had a mean score of 3.6. This may have been part of the motivation for the Program group to volunteer to be part of the program. An increase in coping is seen by the Program group by the time the program was completed (Time 2), to a mean score of 3.4. This had increased even further two months later, after the program was completed (Time 3) to a mean score of 3.8, by which time they were indicating higher levels of coping than the Comparison group, who changed very little over time, as seen in Figure 1. This may indicate that the strategies the students in the Program had developed, during the program, were continuing to be perceived by these students as being useful in helping them to cope with the expectation of the nursing course, two months after the Program was completed.

The findings are consistent with those in an American School of Nursing, which used a similar approach to help minority students identify their major stressors, plan coping strategies, take action, and reflect on which strategies were successful with their academic work (Kirkland, 1998). It also supported previous research findings with first year students across disciplines, that found that a contextually embedded approach, linked to the curriculum, which allowed for interaction between the students and the lecturers and facilitated explicit understanding of the teachers expectations, within a supportive, open and friendly atmosphere, helped new students per se cope with tertiary education (Martin & Ramsden, 1987).

Cummins pedagogical approach, implemented within the Program, was designed to encourage students to assume greater control over setting their own learning goals and collaborating actively with each other in achieving these goals (Cummins, 1989). This seemed to provide a basis for the students to move towards self-regulated learning (Winnie, 1997), an important feature of adult learning, (Brookfield, 1991) in a cycle, similar to Kolb's experiential learning, in that each step depends on completion of the previous step, starting with a concrete experience, reflection from differing perspectives, abstract conceptualisation and active experimentation (Papai, Bourbonnais, & Chevrier, 1999).

Competency in speaking English, Figure 2, was rated at a high level by both the Comparison group (at 3.7 out of a possible 5) and the Program group (at 3.9 from a possible 5) . Overall, 95% of the students rated their confidence greater than 3 (from the possible rating of 5) over the four months of testing. Several of the participants in the focus group, in the present study, indicated that they had difficulties being able to express themselves and feeling that this reflected on judgments of their intelligence, but did not feel that this was a measure of their English speaking ability. This reflected findings of a qualitative study with Hispanic nurses in America (Villarruel, Canales, & Torres, 2001).

The results indicated that both groups were very low in maladjustment (ie. high in adjustment), with mean scores of 2.05 (Time 1), 2.05 (Time 2) and 2.02 (Time 3). This indicates that the students became more adjusted by Time 3, as the score was lower (the lower the score, the higher the adjustment), as seen in Figure 3. The present study supported previous findings that low levels of maladjustment are related to many inter-related factors, such as support, acceptance, self-esteem, equal rights employment prospects, participation, language skills, education, wage employment and ownership (see Berry et al., 1987; Kim, 2001). The students in the Program indicated positive self-esteem, a sense of worthiness, and a feeling of equality and acceptance, which has been found to be consistent with low maladjustment (Wong & Wong, 1982). The majority of the students also reported high levels of support from their families in New Zealand, their ethnic communities, and their friends within the school. This reflected similar findings to a study with Pacific Island university students in New Zealand, where a significant association was found between social support and psychological well being for their participants and low levels of stress and anxiety (Tofi, Flett, & Timutimu-Thorpe, 1996).

The mean scores for the cultural identity questions, Figure 4, indicated that the students were well connected to their own cultural identity, with scores of 3.36 (Time 1), 3.30 (Time 2) and 3.46 (Time 3). The present study revealed that most of the students were well connected to both their own culture and European Kiwi culture. This meant that most of the students were, by Berry and Sam's (1997) definition, "Integrated" in their acculturation process. At the first questionnaire, 81% were Integrated, rising to 95% by the last questionnaire. The present study supported previous findings that English competency and European identity formation were positively correlated, reported in a large study with immigrants in Norway (Sam & Berry, 1995). Eyou (1997) suggested that English competency is vital for effective communications with European Kiwis and that is it associated with greater acceptance by the host community, and becoming integrated within the new culture.

In sum, the students in the Program verified the factors required for successful acculturation were in place for them. They indicated confidence with their English speaking, felt accepted within New Zealand culture and the nursing course, had good connections with and support from their own cultural group and were positive about the changes they had made and their future.

Limitation

Although this study found a statistically significant relationship between the Cummins Program and the ability to cope, there are some limitations of this study that require acknowledgment. Firstly, the sample was not large enough to explore subgroup differences. Secondly, the voluntary self-selection, rather than random assignment of the groups means that the extent to which the findings meaningful differences in baseline changes between groups is limited. Thirdly, the fact that the sample is drawn from only one School of Nursing means it may not be representative of all nursing degree courses. Despite these limitations, the present findings suggest that a Cummins Program was a useful tool in helping foreign students to understand the expectations of the School of Nursing. The Program may be useful for other parts of the nursing course, in helping them decipher academic demands. A larger study for first year foreign students is required to test the reliability of the findings.

In conclusion, the present study was successful in assisting these foreign nursing students cope with this nursing course using the adapted Cummins model. The students had felt that not understanding what was expected of them within the nursing course, did lead to a feeling of lack of power over their learning and not being able to control their assessment outcomes, which gave rise to a feeling that they were not be able to cope.

References

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Appendix I: Questionnaire

This questionnaire concerns how you feel about your "Ethnic group', which is the people from your country of origin and the 'European Kiwis', who are the Europeans born in New Zealand (ie. Pakehas).

Background information

Could you please answer the following questions? The information will not be used to identify you. I will use it to combine your answers with those of people who are similar.
  1. Are you Male [    ] or Female [    ]. Please tick.
  2. How old are you? ________Years.
  3. What was the last country you lived in before you migrated to New Zealand? ____________________
  4. How long have you lived in New Zealand? _________Years ________Months?
  5. How long have you been in the nursing course? _________________

A. Perceived competence in speaking English

Please circle the number that best describes your level of comfort when speaking to the following European Kiwis.
1 = Very Uncomfortable; 2 = Uncomfortable; 3 = Not very comfortable; 4 = Comfortable; 5 = Very comfortable

1.How comfortable do you feel when speaking English to a European Kiwi Lecturer? 12345
2.How comfortable do you feel when speaking English to the staff in the clinical setting? 12345
3.How comfortable do you feel when speaking English to a European Kiwi patient? 12345

B. Ethnic identity scale

Please indicate how much you personally agree or disagree with each statement. There are no right or wrong answers.
1 = Strongly disagree (SD); 2 = Disagree (D); 3 = Neither agree nor disagree (N); 4 = Agree (A); 5 = Strongly agree (SA).

1.It is important for me to have some friends from my ethnic group. 12345
2.I feel proud whenever people from my ethnic group achieve international success, (for example, in sports, film, or music). 12345
3.I do not like to mix with people from my ethnic group. 12345
4.The values of my ethnic group influence my views on life issues (such as family, education, or work). 12345

C. Please indicate how often each of the following statements is true for you.

Circle one of the numbers next to each statement.
1 = Never; 2 = Rarely; 3 = Sometimes ; 4 = Often; 5 = Always

1.I participate in the cultural practices of my ethnic group (such as food, celebrations or traditions). 12345
2.I'm involved in organisations or social groups that includes mainly people from my ethnic group. 12345
3.I mix with people from my ethnic group. 12345
4.I think about how European Kiwis are different from my ethnic group. 12345
5.I think about why some people from ethnic groups experience racial prejudice. 12345
6.I think about what European Kiwis should do to improve their relationship with my ethnic group. 12345

D. European Kiwi identity scale

Please indicate how much you personally agree or disagree with each statement. There are no right or wrong answers. Please circle the numbers next to each statement.
1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree 5 = Strongly agree.

1.It is important for me to have some European Kiwi friends. 12345
2.I do not need to know about the history of the European Kiwis. 12345
3.I feel proud whenever European Kiwis achieve international success (for example in sports, films, or music). 12345
4.I do not like to mix with European Kiwis. 12345
5.The values of European Kiwis influence my views on life issues (such as family, education, or work). 12345

Please indicate how often each of the following statements is true for you. Circle one of the numbers next to each statement.
1 = Never; 2 = Rarely; 3 = Sometimes; 4 = Often; 5 = Always

6.I participate in the cultural practices of European Kiwis (such as food, celebrations, or traditions). 12345
7.I'm involved in organisations or social groups that include mainly European Kiwi members. 12345
8.I mix with European Kiwis. 12345
9.I spend time learning the history of European Kiwis. 12345
10.I spend time learning about the traditions and customs of European Kiwis. 12345
11.I think about how my ethnic group is different from European Kiwis. 12345
12.I think about why some European Kiwis are prejudiced against people from my ethnic group. 12345
13.I think about what people from ethnic group should do to improve their relationship with European Kiwis. 12345

E. Perceived cultural difference

1.In your opinion, how different are European Kiwis from your ethnic group? They are different in: 1 = Every way; 2 = Most ways; 3 = Some ways; 4 = A few ways; 5 = No way. Please circle one number 12345
2.If you think that there are similarities between European Kiwis and your ethnic group, could you please explain how they are similar?



3.If you think that there are differences between European Kiwis and your ethnic group, could you please explain how they are different?



F. Cultural identity categories

Please look at the 4 categories below and answer the following questions:

A = people who identify with both their own ethnic culture and European Kiwi culture
B = people who identify with their own culture but have weak ties with European Kiwi culture
C = people who identify with European Kiwi culture but have weak ties with their ethnic culture
D = people who have weak ties with their own ethnic culture and European Kiwi culture

Which of the 4 types of people described above are you most similar to? _____
Which of those 4 types do you think is best? _____
Why?




G. Psychological adjustment

Please indicate how often you fell the way described in each of the following statements. These questions are about your own PERSONAL FEELINGS. There are no right or wrong answers.
Please circle one of the numbers next to each statement. 1 = Never; 2 = Rarely; 3 = Sometimes ; 4 = Often; 5 = Always

1.I feel that I am useful and needed. 12345
2.I think that I am no good. 12345
3.I feel that I do not have much to be proud of. 12345
4.I feel like a failure. 12345
5.I feel that I have some good qualities. 12345
6.I feel useless sometimes. 12345

H. The depressive tendencies scale

1.I am often sad without seeing any reason for it. 12345
2.Sometimes I think everything is so hopeless, that I don't feel like doing anything. 12345
3.My life is meaningful. 12345
4.Sometimes I think life is not worth living. 12345
5.I have a lot of things to look forward to in the future. 12345
6.I often feel depressed without really knowing why. 12345
7.Sometimes I am just that depressed that I feel like staying in bed for the whole day. 12345

I. The psychological and somatic symptoms scale

1.I get headaches. 12345
2.I get stomach aches. 12345
3.I get backaches. 12345
4.I feel low. 12345
5.I get irritable or bad tempered. 12345
6.I feel nervous. 12345
7.I have difficulties in getting to sleep. 12345
8.I feel dizzy. 12345

J. Coping scale (academic work and clinical work)

Please indicate how much you personally agree or disagree with each statement. There are no right or wrong answers.

1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree

1.I do not feel stressed by the university academic work I do. 12345
2.Most of the time I can handle the work load expected at me at university. 12345
3.I have much control over the academic work I do. 12345
4.I usually know what is expected of me when I do my academic work. 12345
5.I plan goals for my academic work. 12345
6.I usually achieve my learning goals. 12345
7.I look forward to the clinical work I do each day. 12345
8.I usually know what is expected of me when I do my clinical work. 12345
9.I do not feel stressed by the clinical work I do. 12345
10.I plan goals for my clinical learning. 12345
11.I usually achieve my goals in my clinical learning. 12345
12.I am a good problem solver in the clinical setting. 12345


Adapted from the Wellness Evaluation of Lifestyle Questionnaire - Copyright 1995, University of NC at Greensboro

Author: Janet Williams, Senior Lecturer
School of Nursing, Auckland University of Technology
Jackson Cresent, Martin's Bay, RD2, Warkworth, New Zealand
Tel: (09) 425 5969 Email: williamsconsult@big.pl.net

Please cite as:Williams, J. (2004). The Cummins Model: Helping foreign nursing students cope in a Baccalaureate course. In Seeking Educational Excellence. Proceedings of the 13th Annual Teaching Learning Forum, 9-10 February 2004. Perth: Murdoch University. http://lsn.curtin.edu.au/tlf/tlf2004/williams.html


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Created 21 June 2004. Last revision: 21 June 2004.