Teaching cultural competence using an exemplar from literary journalism.

Fadiman's work of literary journalism, The Spirit Catches You and You Fall Down, was used as a case study to teach transcultural and other nursing concepts to undergraduate nursing students. Campinha-Bacote's model of cultural competence was used to organize transcultural nursing concepts in the course. Before and after the course, students completed assessments consisting of two cultural attitude questionnaires and a paper describing a personal experience with adherence and failure to adhere by a Mexican American client. After reading Fadiman's book and completing several short writing assignments examining key course concepts, student scores on the questionnaires were mostly unchanged. However, students demonstrated growth in cultural awareness and skill in their "after" papers. Results suggest that valid, reliable tools are needed to detect changes in cultural competence. Qualitative data suggest that students can begin the process of becoming culturally competent through the creative use of literature in nursing education.