The purposes of this study were to evaluate the effect of integrating cultural content (ICC) in an undergraduate nursing curriculum on students' self-perceived cultural competence, and to determine whether a 5-week clinical immersion in international nursing (ICC Plus) had any additional effect on students' self-perceived cultural competence. Cultural competence was measured using a 28-item scale regarding students' self-perceived knowledge, self-awareness, and comfort with skills of cultural competence. Pretest scores from admission into the program were matched with posttest scores obtained just prior to graduation for 32 students, 7 of whom also participated in a 5-week immersion experience in Guatemala. Results, expressed in effect sizes, showed small to moderate gains for the 25 students in the ICC group, and very large gains for the 7 students in the ICC Plus group, related to perceived cultural competence. These results are consistent with the two-phase (cognitive and affective) development of cultural competence proposed by Wells.

Caregiving has been extensively explored in developed countries, but less so in developing regions. In Thailand, a rapidly expanding elderly population and a declining birthrate have important implications for future care of the elderly. This report is based on further exploration of data obtained from a larger study in rural Northeast Thailand of 89 households with elderly age 65 and over. Four levels of caregiving and methods for caregiver selection were identified from this data. In addition, a subgroup of 39 caregivers were interviewed for their perspectives on the activities of caregiving, the impact of caregiving on caregivers' lives, support of kin and the meaning of caregiving to the involved caregivers. Poverty was the most common problem identified by these caregivers, but caring for men and difficulty in pleasing the elders were seen as contributing to the non-enjoyment of caregiving. Affective rewards and a strong norm of filial obligation may be the motivating forces for children to continue to care for parents in the context of cultural change.

Can nurses practice caring within a healthcare system that promotes codependency? Caring promotes mutual empowerment of all participants while codependent caring disempowers. Nurses are expected to practice caring with clients, The authors contend, however, that nursing, as historically and currently practiced within bureaucratic/patriarchal organizations, is founded on a value system that fosters codependency. Until nursing is practiced within the context of caring organizations and a caring healthcare system, nurses will continue to be powerless to shape their own practice as carers and burnout will continue to be a problem.