# Informing Culturally Safe Advance Care Planning: An Interpretive Descriptive Study of Internationally Educated Nurses in Ontario

## TL;DR

This study explores how internationally educated nurses in Ontario contribute to culturally safe advance care planning and highlights the need for better education and guidelines.

## Contribution

The study introduces new insights into how internationally educated nurses can lead culturally safe ACP discussions and identifies gaps in current nursing education and policy.

## Key findings

- Internationally educated nurses use cultural humility, cautious approaches, and client empowerment in culturally safe ACP.
- Establishing trust and addressing knowledge gaps are critical for culturally safe ACP conversations.
- Education and training in ACP and cultural humility should begin at the undergraduate level and be reinforced in practice.

## Abstract

Maintaining cultural safety during advance care planning (ACP) discussions is an essential component of holistic care provision. Most nurses feel unprepared to engage in ACP and the current literature offers limited recommendations on how nurses can lead culturally safe ACP discussions. Internationally educated nurses (IENs) have unique personal and professional experiences to address this gap.

The purpose of this study was to understand IENs’ contributions to culturally safe ACP and its implications to nursing practice and ACP policy.

An interpretive descriptive approach was undertaken. Ten IENs working in Ontario, Canada were individually interviewed using a semi-structured guide to understand their perspectives and experiences of engagement in culturally safe ACP practices.

IENs utilized various approaches that were reflected in three actions: practicing cultural humility, utilizing a cautious approach, and empowering clients and families. IENs engaged in intrapersonal and interpersonal cultural humility practices to recognize the unique influence of one's culture on the ACP process. Establishing trust in the nurse-client relationship and cautiously approaching ACP conversations was recognized as important in maintaining cultural safety. IENs also empowered clients by addressing knowledge deficits, misconceptions about ACP, and informing them of their decision-making rights.

Nurses require education and resources to carry out culturally safe ACP. Education should begin at the undergraduate level and include self-engagement in ACP and cultural humility training. Practicing nurses need ACP training and clear standards/guidelines. There is an opportunity for healthcare organizations and professional/governing nursing bodies to collaborate on developing culturally safe ACP guidelines.