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A Multicountry Perspective on Cultural Competence Among Baccalaureate Nursing Students
Abstract
Purpose:
To assess cultural competence among nursing students from nine countries to provide an international perspective on cultural competence.
Design:
A descriptive, cross-sectional design.
Methods:
A convenience sample of 2,163 nursing students from nine countries was surveyed using the Cultural Capacity Scale from April to November 2016.
Results:
The study found a moderate range of cultural competence among the students. The ability to teach and guide other nursing colleagues to display culturally appropriate behavior received the highest competence rating, while the ability to discuss differences between the client's health beliefs or behaviors and nursing knowledge with each client received the lowest competence rating. Differences in cultural competence were observed between students from different countries. Country of residence, gender, age, year of study, attendance at cultural-related training, the experience of taking care of patients from culturally diverse backgrounds and patients belonging to special population groups, and living in a multicultural environment were identified as factors affecting cultural competence.
Conclusions:
The international perspective of cultural competence among nursing students provided by this study serves as a vital preview of where nursing education currently stands in terms of providing the necessary preparatory competence in the cultural aspect of care. The variation of cultural competence among nursing students from different nations should serve as a cue for designing a focused yet multimodal nursing education program in guiding them to be culturally sensitive, culturally adaptive, and culturally motivated.
Clinical relevance:
The training of nursing students in providing competent culturally appropriate care should be ensured considering that adequate preparation of nursing students guarantees future competent nursing practice, which can positively impact the nursing profession in any part of the globe.
... Because a high cultural competence can increase the quality of the interaction developed between patients and nurses and increase the provision of safe, equal, and appropriate health services [6], nurses' cultural competence should be developed through training continually, starting in undergraduate school [7]. Furthermore, as future professional nurses, nursing students also need high cultural competence to provide tailored nursing care that considers patients' cultural characteristics in hospitals, schools, and communities, through specialized education and practice [8][9][10][11][12]. However, in the Republic of Korea, 21.9-28.7% of nursing students had foreign friends, 11.6-36.4% had previously stayed in foreign countries for more than a month, and 4.6-33.5% had experience of international health care [4,9,13]. ...
... This difference can be seen as the fact that direct multicultural contact opportunities have decreased under the prolonged COVID-19, but the extra time and place created by online classes and clinical practice have increased students' chances to contact an online media content such as film, drama, information, news through YouTube, SNS; Twitter, Instagram, Facebook et al. As such, it seems that nursing students, who are digital generation, maintained and promoted CC through rapid acquisition and sharing of domestic and foreign news and information [8,11,19]. Additionally, furthermore, nursing students tend to increase CC as the grade increases [8,11,19], so it can affect the CC levels in this study which has a higher proportion of junior and senior students than previous studies (45.0~67.2%) [8,10,19]. ...
... As such, it seems that nursing students, who are digital generation, maintained and promoted CC through rapid acquisition and sharing of domestic and foreign news and information [8,11,19]. Additionally, furthermore, nursing students tend to increase CC as the grade increases [8,11,19], so it can affect the CC levels in this study which has a higher proportion of junior and senior students than previous studies (45.0~67.2%) [8,10,19]. ...
Globally, foreign citizens, particularly ethnic and racial minorities, experienced discrimination and received imbalanced medical services and insufficient economic resources during the COVID-19 pandemic. This study aimed to examine the factors that affect the cultural competence of nursing students. This is descriptive cross-sectional study adheres to Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. A convenience sample of 235 nursing students from two nursing colleges in D city completed an online Google Forms questionnaire from 9 August to 12 August 2022. The self-report questionnaire included a sociodemographic data form, a cultural intelligence scale, an ethnocentrism scale, a global competence scale, and a cultural competence scale. The mean score of cultural competence was 95.39 ± 15.64 (out of 135 points); cultural competence was significantly positively correlated with cultural intelligence and global competence (p < 0.001), and significantly negatively correlated with ethnocentrism (p < 0.001). The factors that significantly affected cultural competence were cultural intelligence (β = 0.31, p < 0.001) and global competence (β = 0.37, p < 0.001). The explanatory power of these effects was 47.3%. To improve the cultural competence of nursing students, it is necessary to develop, apply, and evaluate the results of curriculum and programs that can enhance the cultural intelligence and global competence of nursing students.
... Articles which met the purpose and aim of our study were critically assessed using the Critical Appraisal Skills Programme (CASP) with the CASP checklist for systematic literature review (CASP, 2014). According to the results of this appraisal, more than half of the included studies were rated as good (Halter et al., 2015;Kouta et al., 2016;Cai et al., 2017;Safipour et al., 2017;Herrero-Hahn et al., 2019;Park et al., 2019) and some studies as excellent (Delgado et al., 2013;Noji et al., 2017;Cruz, Aguinaldo et al., 2017;Baghadi & Ismaile, 2018). The studies included in the analysis involved a total of 11,937 participants, of whom 8,493 were registered nurses, 2,983 were nursing students, and 461 were nursing teachers and mentors. ...
... Using a comprehensive analysis of the psychometric characteristics of questionnaires, such as validity and reliability, we identified the following questionnaires as the most suitable for measuring cultural competence in nurses: IPACC-R (Delgado et al., 2013), CCATool (Kouta et al., 2016, NCCS , and CCS (Cruz, Aguinaldo et al., 2017). According to our findings, the following questionnaires are suitable for measuring cultural competence in nursing students: TSET (Halter et al., 2015), CCCHS (Noj et al., 2017), CAS (Safipour et al., 2017); and CDQNE (Baghadi & Ismaile, 2018) for measuring cultural competence in nurse educators. ...
... For CSES (Herreo-Hahn et al., 2019), the variance explained by factor analysis varied widely: from 33% for nurse educators (Kardong-Edgren & Campinha-Bacote, 2008) to 90% for community nurses (Bernal & Forman, 1993). The explained variance of the model was 20% only for the CCS questionnaire (Cruz, Aguinaldo et al., 2017), while for six questionnaires -TSET (Halter et al., 2015), CAS (Safipour et al., 2017), CCATool (Kouta et al., 2016, J-CCSN (Noj et al., 2017), NCCS , CCIN (Cai et al., 2017) -the explained variance of the model was more than 50%. ...
Uvod: Merjenje kulturnih kompetenc je temeljni korak pri oceni strategij učenja kulturnih kompetenc ter doseganju kulturne kompetentnosti med medicinskimi sestrami in študenti zdravstvene nege. Namen sistematičnega regleda literature je bil proučiti vsebino in lastnosti vprašalnikov ter izbrati najprimernejše vprašalnike za ocenjevanje kulturnih kompetenc pri medicinskih sestrah in študentih zdravstvene nege.
Metode: Izveden je bil sistematični pregled literature v podatkovnih bazah CINAHL, ERIC, EBSCO in ScienceDirect. Uporabljeni so bili angleški izrazi: transcultural nursing, cultural competent care, cultural competency, education nursing, questionaire. V pregled so bili vključeni izvirni znanstveni članki z ustrezno preiskovano tematiko, dostopni v celotnem besedilu ter objavljeni po letu 2010. 2010.
Rezultati: Izmed 247 člankov je bilo v končno analizo vključenih 11 člankov. Med analiziranimi vprašalniki smo na podlagi vsebine ter psihometričnih lastnosti, kot sta zanesljivost in konstrukcijska veljavnost, ugotovili, da so štirje vprašalniki najbolj primerni za merjenje kulturnih kompetenc pri medicinskih sestrah, trije vprašalniki za merjenje kulturnih kompetenc pri študentih zdravstvene nege in en vprašalnik pri medicinskih sestrah v izobraževanju.
Diskusija in zaključek: Določeni vprašalniki, ki smo jih vključili v naš pregled, so na podlagi analize kakovosti merilnih lastnosti vprašalnikov primernejši za merjenje kulturnih kompetenc pri medicinskih sestrah, ostali vprašalniki pa za merjenje kulturnih kompetenc pri študentih zdravstvene nege. Sistematični pregled literature predstavlja dobro izhodišče za druge raziskovalce s področja merjenja kulturnih kompetenc pri izboru ustreznih vprašalnikov za nadaljnje raziskave.
... Healthcare professionals should be competent to care for patients, families and groups from different cultural backgrounds [7]. According to Shepherd [8], "when nurses provide culturally sensitive care, clients are more likely to report greater satisfaction with care". ...
... Cultural competence is an essential component of nursing care. In this context, culturally competent nursing care integrates specific knowledge, skills and attitudes that guarantee appropriate and equitable care for all, including diverse patient populations [7,16]. ...
... However, preparing nurses to provide safe and culturally competent nursing care requires significant education and training [26,27]. Thus, the means of providing safe and culturally competent quality care should be central components of nursing education [7,28]. Yet, previous studies have suggested that student nurses often lack the confidence to provide culturally competent care [29,30]. ...
Introduction
European societies are rapidly becoming multicultural. Cultural diversity presents new challenges and opportunities to communities that receive immigrants and migrants, and highlights the need for culturally safe healthcare. Universities share a responsibility to build a fair and equitable society by integrating cultural content in the nursing curricula. This paper aims to analyze European student nurses´ experience of learning cultural competence and of working with patients from diverse cultural backgrounds.
Materials and methods
A phenomenological approach was selected through a qualitative research method. 7 semi-structured focus groups with 5–7 students took place at the participants’ respective universities in Spain, Belgium, Turkey and Portugal.
Results
5 themes and 16 subthemes emerged from thematic analysis. Theme 1, concept of culture/cultural diversity, describes the participants’ concept of culture; ethnocentricity emerged as a frequent element in the students’ discourse. Theme 2, personal awareness, integrates the students’ self-perception of cultural competence and their learning needs. Theme 3, impact of culture, delves on the participants’ perceived impact of cultural on both nursing care and patient outcomes. Theme 4, learning cultural competence, integrates the participants’ learning experiences as part of their nursing curricula, as part of other academic learning opportunities and as part of extra-academic activities. Theme 5, learning cultural competence during practice placements, addresses some important issues including witnessing unequal care, racism, prejudice and conflict, communication and language barriers, tools and resources and positive attitudes and behaviors witnesses or displayed during clinical practice.
Conclusion
The participants’ perceived level of cultural competence was variable. All the participants agreed that transcultural nursing content should be integrated in the nursing curricula, and suggested different strategies to improve their knowledge, skills and attitudes. It is important to listen to the students and take their opinion into account when designing cultural teaching and learning activities.
... She foresaw the current migratory movements and the need for nursing staff to provide culturally appropriate care to patients in the future (Gunn, 2019). Cultural diversity training, focused on providing care to patients from different backgrounds, has become increasingly prominent over the years (Preposi Cruz et al., 2017). Research shows that students exhibit prejudiced attitudes toward migrants (Grueso & Arroyo, 2016;Plaza del Pino, 2017;Sánchez-Ojeda, 2016), demonstrating the need for cultural diversity training. ...
... Similar results were obtained by Mei-Hsiang and Hsiu-Chin (2020) in a study on an educational intervention on cultural training, which, with a duration of 3 hours per week over the course of 4 weeks, improved cultural competence in nurses. These results coincided with those obtained by Preposi Cruz et al. (2017), which suggested that university students who had received cultural training over the past 12 months showed greater cultural competence with patients of various ethnicities. Results from other similar studies also indicate that positive changes in the attitudes of nursing students and nursing professionals occur (Chang et al., 2019;Nielsen et al., 2019). ...
... This was not the case with the students whose attitudes were positive from the beginning of the course. This must be taken into account, as it emphasizes the importance of training in university students (Cerezo et al., 2014, Preposi Cruz et al., 2017, especially those with cultural backgrounds where prejudices toward and stereotypes of migrants are more commonplace. ...
Introduction
Increased migration may lead to an increase in prejudiced attitudes in the host population, which may affect the nursing care provided to this group.
Objectives
To identify the attitudes of nursing students toward Moroccan patients and to analyze whether changes in attitude toward this population have taken place after completing a course on cross-culturalism.
Method
A quasi-experimental design with a single group and pretest/posttest measurements. The sample consisted of 116 nursing students.
Results
There were significant differences after receiving the course on cross-culturalism, with a more positive influence on students who exhibited the most negative attitudes in the pretest phase.
Discussion
Nursing students have negative attitudes toward the Moroccan population as do the rest of the host population, but these attitudes improve after their training in the course on cross-culturalism.
... To date, no literature has examined factors associated with cultural responsiveness in physiotherapy students. In other healthcare disciplines, students who are female, with greater empathy, self-efficacy and who have a lived experience with CALD communities (including speaking multiple languages), and prior training in cultural responsiveness, have been reported more likely to score higher on self-reported cultural responsiveness measures [22][23][24][25][26][27]. However, many of these factors have also been reported to not be significant predictors of students' cultural responsiveness in other studies [28][29][30]. ...
... Content validity for this section of the questionnaire was ensured by including questions and answer options based on published work in cultural responsiveness or based on the census data collection in Australia and Aotearoa New Zealand [9,23,35,36]. For example, questions related to demographic variables such as age, gender, level of study, self-identified ethnoculture, type of program or previous cultural training were either adapted from published studies assessing selfperceived cultural responsiveness or constructed based on the literature defining important factors associated with cultural responsiveness. ...
... Ten independent variables were entered in each model: age, gender, number of weeks of clinical placement attended, prior education related to culture or cultural responsiveness, speaks another language other than English, self-identified ethnoculture, religious affiliation, lives in culturally diverse area, dogmatism score, and social desirability score. These predictors were chosen based on the cultural responsiveness literature, and prior research in other health disciplines [18,23,34,54]. ...
Background
Ensuring physiotherapy students are well prepared to work safely and effectively in culturally diverse societies upon graduation is vital. Therefore, determining whether physiotherapy programs are effectively developing the cultural responsiveness of students is essential. This study aimed to evaluate the level of self-perceived cultural responsiveness of entry level physiotherapy students during their training, and explore the factors that might be associated with these levels.
Methods
A cross sectional study of physiotherapy students from nine universities across Australia and Aotearoa New Zealand was conducted using an online self-administered questionnaire containing three parts: The Cultural Competence Assessment tool, Altemeyer’s Dogmatism scale, and the Marlowe-Crowne social desirability scale- short form. Demographic data relating to university, program, and level of study were also collected. Data was analysed using one-way ANOVA, t-tests and multiple regression analysis.
Results
A total of 817 (19% response rate) students participated in this study. Overall, students had a moderate level of self-perceived cultural responsiveness (Mean (SD) = 5.15 (0.67)). Fewer number of weeks of clinical placement attended, lower levels of dogmatism, and greater social desirability were related to greater self-perceived cultural responsiveness. Additionally, fourth year undergraduate students perceived themselves to be less culturally responsive than first and second year students (p < 0.05).
Conclusions
These results provide educators with knowledge about the level of self-perceived cultural responsiveness in physiotherapy students, and the factors that may need to be assessed and addressed to support the development of culturally responsive practice.
... The tool aims to capture the perception of nurses towards their own cultural competence. The self-administered questionnaire includes 38 items, grouped as follows: the first section (items 1-10) collects socio-demographic information about age, sex, workplace, education, work experience and attendance to cultural competence courses; the second section (items [11][12][13][14][15][16][17][18][19][20][21] represents the cultural awareness and sensitivity sub-scale (CAS), which evaluates cultural awareness and sensitivity using a 7-point Likert scale, from strongly in agreement (1) to strongly disagree (7); the third section (items [22][23][24][25][26][27][28][29][30][31][32][33][34][35] represents the culturally competent behavior sub-scale (CCB), which evaluates culturally competent behavior using a 7-point Likert scale, from always (1) to never (7); the fourth section consists of two questions, which concern the nurses' interactions with ethnic groups (item 36) and other social groups (item 37) during the previous 12 months; the last question (item 38) is a self-assessment of the nurses' cultural competence using a 5-point Likert scale, from very competent (1) to very incompetent (5). ...
... For the benefit of nursing students and students of other health sciences, universities need to include multicultural training in undergraduate and postgraduate curricula (24). At the same time, internships must consider cultural realities; therefore, academic and clinical training (25) should be followed by field training in various territorial communities. ...
Background:
Cultural competence is a valuable and intangible heritage of knowledge, relationships and identity. Cultural competence is fundamental in nursing: sharing the objectives of all patients - not only foreigners - promotes patient's participation in healthcare and supports nurses' professional development, enhancing the intellectual capital that guides quality care. The aim of this study is to evaluate nurses' selfperceived cultural competence.
Study design:
This is a cross-sectional study.
Methods:
A self-administered cultural-competence questionnaire was used. Nurses working in hospitals and territorial healthcare settings in Rome, Italy, were involved in this study, from March 2017 to February 2018.
Results:
This study involved 192 nurses. The mean age was 46.2 ± 7.9. Most of the nurses (77.6%) were women. The nurses' mean work experience was 21.4 ± 8.8 years; 65.1% of them had never attended any type of course concerning multiculturalism. The mean score of the nurses' cultural competence was 4.19 ± 0.57 (range = 2.75-5.71). In all, 41.7% of the nurses did not consider themselves neither competent nor incompetent.
Conclusion:
The results show that nurses have an acceptable level of cultural competence, slightly higher in the territorial context.
... In 2011 there were over 34 million Christians in Poland, forming 88.8% of the population [6], although the religiosity of young adult Poles is on the decline [7]. This situation leads to the necessity of having, and therefore of forming, cultural competencies of healthcare workers [8] such as those in other countries [9,10]. Poland ratified the UNESCO Convention on the Protection and Promotion of the Diversity of Cultural Expressions in 2007, which makes possible an intensification of efforts to develop cultural competencies [11]. ...
... Our own research showed a high level of tolerance of the beliefs or behavior of various cultural groups in relation to health/illness and the ability to meet the needs of patients from different cultures by implementing nursing activities, increasing, as other authors indicate, the ability to act beyond cultural barriers [42,68], which include country of residence, gender, age, year of studies, participation in cultural training, experience in caring for patients from other cultures or from special population environments, and living in a multicultural environment [10]. ...
IntroductionMeasuring nurses' cultural competence is an important aspect in monitoring the acceptable quality in multicultural populations, and is a means for efficient modification of the educational process of nurses based on this assessment.PurposeThe goal of this article is to offer a preliminary assessment of the cultural competence of nurses based on a Polish-language and -culture version of the Nurse Cultural Competence Scale (NCCS).Research methodAn adaptive and diagnostic cross-disciplinary concept was used in the research. Two hundred thirty-eight professionally active nurses in the southeast region of Poland took part in this study. The NCCS-Polish version (NCCS-P) questionnaire was used after linguistic adaptation and analysis of psychometric properties.ResultsModerate levels of competence in the Cultural Knowledge Subscale (M = 3.42) were found in the group of nurses studied. The results indicate lowest competency levels in the Cultural Skill Subscale (M = 3.14). The highest values were obtained for the Cultural Awareness Subscale (M = 3.98) and the Cultural Sensitivity Subscale (M = 3.72). The Cronbach's alpha reliability coefficient for the NCCS-P scale was 0.94, with the subscale values ranging from 0.72 to 0.95. Factor validity analysis of the Polish adaptation of the NCCS-P scale pointed to its four-factor structure. The Kaiser-Mayer-Olkin sampling adequacy test was 0.905, and the Bartlett test of sphericity result was χ2 = 5755.107; df = 820; p
... Escuelas de Enfermería internacionales han reportado múltiples iniciativas para abordar la formación intercultural en el pregrado [23][24][25][26] . Las estrategias utilizadas incluyen, por ejemplo, la inclusión de contenido acerca de diversidad cultural, experiencias de inmersión cultural locales e internacionales, y evaluación continua del desarrollo de competencias. ...
In a health context marked by increasing health inequalities, population ageing, pandemics and migration, the development of competencies for the intercultural encounter between healthcare workers and patients is essential. Tertiary education institutions have a social responsibility to address this issue. Health Science programs are challenged to provide culturally sensitive care to diverse populations. Therefore, it is necessary to reflect upon the models that will guide this process, and to assess undergraduate curricula to determine their appropriateness to address this challenge. This article describes a methodology for assessing the undergraduate curriculum for the development of intercultural competence and presents a strategy for promoting its sustainable development across the curriculum.
... Escuelas de Enfermería internacionales han reportado múltiples iniciativas para abordar la formación intercultural en el pregrado [23][24][25][26] . Las estrategias utilizadas incluyen, por ejemplo, la inclusión de contenido acerca de diversidad cultural, experiencias de inmersión cultural locales e internacionales, y evaluación continua del desarrollo de competencias. ...
Developing a strategy to strengthen the intercultural competency in the undergraduate nursing curriculum In a health context marked by increasing health inequalities, population ageing, pandemics and migration, the development of competencies for the intercultural encounter between healthcare workers and patients is essential. Tertiary education institutions have a social responsibility to address this issue. Health Science programs are challenged to provide culturally sensitive care to diverse populations. Therefore, it is necessary to reflect upon the models that will guide this process, and to assess undergraduate curricula to determine their appropriateness to address this challenge. This article describes a methodology for assessing the undergraduate curriculum for the development of intercultural competence and presents a strategy for promoting its sustainable development across the curriculum. (Rev Med Chile 2021; 149: 1495-1501)
... Given that these countries are from similar economic zones and share the same collective culture, the differences across these countries might not be related to inequality in economic development and culture but other contextual factors (Cruz et al., 2017;Xiao et al., 2013). (Cruz et al., 2018;Sharma, 2013), the desire of many older persons to live independently (Enßle & Helbrecht, 2020), the responsibility of children to their elder family members, and available healthcare providers who are willing to work with the aging population (Roberto & Blieszner, 2015) may have contributed to the preferences of student nurses to work with older persons. Explicitly, further information on these notions is needed to understand how these factors affect student nurses' inclination to care for older J o u r n a l P r e -p r o o f persons. ...
Background: Addressing nursing students' lack of interest in providing care for the aged population is a global challenge for nursing educators. Despite global interest in student nurses' readiness for older people care, almost all the literature has been identified from single countries, predominantly with high income per capita. At present, no study has been conducted to provide evidence-based data related to this topic from a multi-country perspective.
Objective: The study's purpose was to examine the willingness to work with older persons and associated factors among student nurses from nine countries (or regions).
Design: This study utilized correlational and cross-sectional designs.
Settings: This was a multi-country survey study conducted in China, Chile, Egypt, Hong Kong, India, Greece, the State of Palestine (henceforth Palestine), the Philippines, and Saudi Arabia.
Participants: 2250 baccalaureate nursing students were recruited from nine universities in this study.
Methods: The survey that was used to collect data comprised four parts: socio-demographic data, attitude toward aging, older persons care perception, and willingness to work with such group.
Results: Respondents in five regions (including Mainland China, Greece, Hong Kong, Palestine, and Saudi Arabia) stated that older persons were the least favored group for future career choices. In comparison with mainland China, respondents in Chile, India, and the Philippines were significantly more likely to be willing to care for older patients, but those in Egypt and Greece indicated a lower tendency to choose this option. Favorable attitudes toward aging and older person care perception were significantly associated with having the willingness to provide care to gerontologic patients in the future.
Conclusions: Although attitudes toward aging and older person care perceptions have long been confirmed as important factors that are linked with willingness in caring for older people, this study adds that location is a more influential factor. Additional research in other countries is needed to advance the knowledge in this important area.
... In the presented studies, the mean result of the cultural intelligence of Polish nursing students after participating in the workshops, as measured by CQS, was 85.75 in study 1 and 86.02 in study 2. This was similar to the results obtained with the same CQS but carried out among Iranian nurses, i.e., 88.2 [12]. As many authors point out, a high level of cultural intelligence increases the ability to act beyond cultural barriers [35,36] and reduces stress among nurses [37]. Keyvanara et al. [10] draw attention to the need to develop cultural intelligence and effective methods of teaching CQ among students in Iran. ...
Background:
Since 2012, education standards in medical faculties in Poland have allowed medical universities to introduce content related to multiculturalism. On the one hand, this creates a necessity to introduce new strategies, forms, and techniques of education aimed at the development of knowledge, skills, and attitudes in terms of multiculturalism. On the other hand, there is a need to evaluate their effects. The main goal of this study was to evaluate the cultural competence and cultural intelligence of master's degree nursing students before the commencement of and two months after cultural education training in the form of the intercultural communication workshops included in the study program.
Methods:
The following questionnaires were used in the study: the Cross-Cultural Competence Inventory (CCCI) and the Cultural Intelligence Scale (CQS). Two consecutive classes (2019 and 2020) of master's nursing students were tested twice (pre-test, post-test). The study was conducted at a leading medical university that educates nurses at a master's level in Poland. In total, 130 master's nursing students took part in this evaluative study: 64 individuals in 2019 (study 1) and 66 individuals in 2020 (study 2).
Results:
In comparison to the pre-test, the post-test showed that the surveyed students in both study 1 and study 2 obtained significantly higher overall results in terms of cultural intelligence (p = 0.001; p = 0.004, respectively) as well as in the behavioral (p = 0.001; p = 0.002) and cognitive (p = 0.001; p = 0.008, respectively) subscales. The cultural competence results were also higher overall, but the difference was insignificant.
Conclusions:
The study shows the efficiency of training/workshops in the development of culturally specific knowledge and cultural intervention skills. At the same time, it postulates the need to plan and organize cultural education programs in a form that aims to improve the development of culturally sensitive attitudes.
... This issue should be studied as different cultures live in Melilla, with one of the most numerous being Moroccans, whose traditions and culture are quite rooted in the city. So, the fact that students from that city have developed a negative attitude against that culture highlights the importance of intercultural training at the university in order to reduce those prejudices, as numerous studies have shown that training in transculturality decreases negative attitudes among students and helps to build positive attitudes towards diversity [14,[51][52][53][54]. ...
Increased migration has led to increased prejudice towards immigrant populations. This study aims to analyse attitudes towards immigration among student nurses in three universities, two in Spain and one in Portugal. Methodology: A descriptive, transversal, prospective study was carried out among student nurses (n = 624), using the Attitude towards Immigration in Nursing scale. Results: Nursing students showed some positive attitudes towards immigration, such as that immigrants should have the right to maintain their customs or that immigrants should have free access to healthcare and education, in contrast to some negative attitudes, such as that crime rates have increased due to immigration or that immigrants receive more social welfare assistance than natives. Significant differences in attitudes were revealed between students from the three universities. Discussion: Training in transcultural nursing is necessary for all nursing students in order to reduce negative attitudes towards the immigrant population and increase the awareness and sensitivity of future healthcare staff in caring for patients of all backgrounds.
... The globalization of pharmacy education can be expected to provide not only broader knowledge, skills, and attitudes but also job opportunities for future graduates [6]. There are other reports suggesting that respect for patients and other healthcare professionals with various backgrounds and cultures is essential to improve competent nursing practice [7] and patient-centered pharmaceutical care [8] in the future. ...
The purpose of this research is to establish a model for assessing interest in international understanding among nursing and pharmacy students in Japan. The study design was a cross-sectional survey of nursing and pharmacy students in their first to fourth years at Josai International University. The International Understanding Scale (IUS2000), consisting of four domains (respect for human rights, understanding international culture, awareness of world solidarity, and understanding foreign languages) with 27 items, was used. A path analysis and confirmatory factor analysis were used to model international understanding. The model of international understanding of nursing and pharmacy students was established as the second-order four-factor mode. The international understanding of nursing and pharmacy students was mainly composed of respect for human rights and awareness of world solidarity and was less affected by understanding foreign languages. Nursing students in our study had a higher international understanding than pharmacy students. International understanding was considered relevant to students' learning about the importance of interprofessional collaboration as well as their interests in global learning environments for healthcare professionals. The relationship between international understanding and future progress in healthcare performance needs to be studied to show the importance of international understanding education.
... Factors such as gender, age, country of origin, the experience of caring for culturally diverse patients, and being a first-generation immigrant year of study can all impact on student's cultural competence. [28][29][30] Several educational interventions have been deployed ranging from lecturers, workshops, discussion groups, clinical experience, mentorship and consultation, freestanding courses, cultural immersion programs, and simulation. [31,32] Some of the educational interventions target the totality of the concept whilst others address a dimension of it such as cultural awareness. ...
The EU have set standards in relation to cultural competence, and findings from previously funded EU commission projects have illuminated an extensively developed body of knowledge in this area in relation to healthcare. Evidence from contemporary literature shows that education interventions have a positive impact on the cultural competence of health care professionals. Nonetheless, short accessible resources that can be used flexibly to support teaching and learning around cultural competence are not available across many European countries. The aim of the TransCoCon (2017-2020) project has been to develop innovative accessible multi-media learning resources to enable undergraduate nursing students and registered nurses in five countries to develop their cultural self-efficacy and cultural competence for nursing. The purpose of this paper is to describe and discuss this European ERASMUS + funded strategic partnership project (TransCoCon 2017-2020) and the creation of its underpinning theoretical and organising framework. The rationale for this guiding framework will be discussed within the context of supporting literature.
... Cultural competence education must be adaptive to the distinct sets of cultures within a country in order for students to capture appropriate cultural context (Cruz et al., 2018). Education alone is most likely insufficient to improve cultural competence, there is a need for organisational or systemic approaches to improvement of cultural competence in which the cost-effectiveness and aspects related to individual and organisational contexts are considered (Truong et al., 2014). ...
Background:
The assessment of nursing students' nursing competence is a matter of concern worldwide and the complexity of assessing students' clinical competence has challenged educators for decades. It has been recognized that there is inconsistency among assessment methods and tools between countries and institutions.
Objective:
To identify the current best evidence on the assessment of nursing students' competence in clinical practice.
Design:
Systematic review of reviews.
Data sources:
The electronic databases CINAHL, PubMed, Eric, Medic and the JBI Database of Systematic Reviews and Implementation Reports were searched in autumn 2018.
Review methods:
Two researchers independently assessed the eligibility of the studies by title, abstract and full-text, and then assessed the methodological quality of the included studies. Analysis of study findings was conducted using the thematic synthesis approach.
Results:
Six reviews were included following critical appraisal. Assessment tools used to assess students' nursing competence commonly focus on the domains of professional attributes, ethical practices, communication and interpersonal relationships, nursing processes, critical thinking and reason. Clinical learning environments and mentoring provide important support structures and guide the learning of students. The availability of assessment tools and criteria along with providing individualized feedback and time for reflection strengthen the objectivity and reliability of assessment.
Conclusions:
There continues to be a need to develop consistent and systematic approaches in assessment, and to use reliable and valid instruments in assessment. Mentors find assessment of students' competence to be particularly challenging and emphasize the importance of clear assessment criteria, support from nurse educators and further education on assessment. Further development in feedback practices and providing students with opportunities for reflection are important in supporting the continuous learning process of students.
... Cultural competence education must be adaptive to the distinct sets of cultures within a country in order for students to capture appropriate cultural context (Cruz et al., 2018). Education alone is most likely insufficient to improve cultural competence, there is a need for organisational or systemic approaches to improvement of cultural competence in which the cost-effectiveness and aspects related to individual and organisational contexts are considered (Truong et al., 2014). ...
Background:
Due to a steady rise in cultural and linguistic diversity in healthcare settings and evident challenges associated with this diversity, there is an urgent need to address cultural competency of nurses. Ongoing, continuing professional development is needed to ensure nurses can provide culturally congruent nursing care.
Objectives:
The aim of this systematic review was to identify current best evidence on the types of educational interventions that have been developed to improve nurses' self-assessed cultural competence and on the effectiveness of these interventions.
Design:
A systematic literature review.
Data sources:
Four electronic databases (PubMed, CINAHL, Medic, Eric) were searched for studies using a quasi-experimental design or randomised controlled trial published between January 2000 and June 2018.
Review methods:
Guidelines from the Centre for Review and Dissemination and the Joanna Briggs Institute guided the review. Two researchers independently assessed the eligibility of the studies by title, abstract and full-text and the methodological quality of the studies. Data tabulation and narrative analysis of study findings was performed.
Results:
Six studies met criteria for inclusion in the review. Studies used a quasi-experimental study design (n = 5) and a randomised controlled trial (n = 1). The participants (n = 334) were mainly nurses and interventions were conducted in various healthcare settings. Cultural competence education was offered through traditional contact teaching (n = 5) or web-based modules (n = 1) and ranged from one to 17 hours in length. Learning was enhanced through lectures, group discussions, case studies, reflective exercises and simulations. In two studies, following cultural competence interventions, participants in the intervention group had statistically significantly increased levels of competence in culture-related outcomes when compared to the control group. The four remaining studies did not include control group comparisons. Effect sizes (Cohen's d) of the studies varied from small (d = 0.22) to very large (d = 1.47).
Conclusions:
There continues to be a need for high quality studies investigating educational interventions to develop nurses' cultural competence. Further research should focus on reporting specific components of interventions that result in an increase in cultural competence.
... Cultural competence is an essential component of quality midwifery care that comprises knowledge, skills, and values that promote the ability of midwives to care for women from diverse cultural backgrounds safely. It enhances care which is respectful and individualised to the female population regardless of their cultural background (Cruz et al 2018). Not only does it enable midwives to communicate effectively with clients of different cultures, understanding their values, beliefs and health functions, it assists them in recognising their clients' needs, establishing appropriate relationships with them and providing individualised care (Bastami et al 2016). ...
... Existing studies suggest that culturally sensitive education removes differences in terms of healthcare services delivered to patients (Brach & Fraserirector, 2000) and improve healthcare quality so that it should be integrated to nursing curriculum (Waite & Calamaro, 2010;Cruz et al., 2018). However, evaluation of the impact of education on cultural sensitivity is as important as intercultural nursing education itself (Chen & Starosta, 2000). ...
The aim of the study evaluates cultural sensitivity in healthcare services among senior nursing students to patients with different cultural backgrounds. The study had a one-group pre-posttest model descriptive study design. Thirty-four nursing students taking the courses Emergency Care and Diabetes were included into the study. Standardized patients were used as a simulation technique. The difference between intercultural sensitivity scores before the simulation and those after the simulation was not statistically significant (p>0.05). Even though there were no differences between intercultural sensitivity scores before the simulation and the scores after the simulation, simulation based education is an effective teaching method in enhancement of cultural sensitivity. © 2018 Eurasian Society of Educational Research. All Rights Reserved.
... Cultural competence is an essential component of quality midwifery care that comprises knowledge, skills, and values that promote the ability of midwives to care for women from diverse cultural backgrounds safely. It enhances care which is respectful and individualised to the female population regardless of their cultural background (Cruz et al 2018). Not only does it enable midwives to communicate effectively with clients of different cultures, understanding their values, beliefs and health functions, it assists them in recognising their clients' needs, establishing appropriate relationships with them and providing individualised care (Bastami et al 2016). ...
Childbirth holds short and long-term physical and psychological effects for women. Yet, numerous investigations into childbirth have overlooked the delicate interrelated psychological and emotional interplay that women experience, in favour of the physical, such as the outcomes of birth, maternal mortality, and the physical skills of healthcare providers. Although quantitative measures derived from these are important to establish and evaluate maternal health, they are not adequate to explain the complexity of the human experience of childbirth. Without this understanding there is inadequate guidance about how to proceed to achieve the Sustainable Development Goals targeting maternal health. The aim of this study was to explore childbirth experiences of women giving birth in Zambia, in order to better understand how they experience and give meaning to the phenomenon. The study was guided by an interpretive phenomenology approach. This type of phenomenology was found to be appropriate because the study sought to understand childbirth within the context of everyday lives of women birthing in Zambia. Purposive sampling was utilised to recruit 50 women aged between 16 and 38 years. The women had birthing experiences that occurred between 2005 and 2011. The birthing experiences were from all the ten provinces of Zambia. Data were collected through in-depth unstructured interviews, which were tape recorded. Data analysis was guided by van Manen’s six steps of analysis. Seven themes namely: 1) Conforming to societal norms, 2) Clash between traditional and contemporary childbirth practices, 3) Being in a dilemma, 4) Loss of dignity, 5) Feeling insecure, 6) Inadequate service provision, and 7) Being there for the woman, emerged from the analysis. Each theme had several sub-themes that provided a clearer picture of how participants experienced the phenomenon. The embodied experiences of participants illuminated the complex context of childbirth, whereby, the phenomenon was experienced in private, behind the closed door of secrecy that encompassed difficulties and issues such as, lack of choice, sub-standard care, discrimination, fear and conflicting information. The findings revealed that there was a need for an attitudinal change in maternity care professionals towards a more caring approach, as well as a parallel need to build agency and autonomy in women. For women, the change needs to be addressed at an individual and societal level, beginning with simple things, such as assertiveness training through to educational opportunities, so that they develop economic independence. Macro-reforms (top-down change) need to be combined with micro-reforms (bottom-up change) to challenge existing discriminatory, oppressive and patriarchal attitudes and practices that impact on women’s birth experiences. Women’s voices need to be heard. Understanding maternal outcomes at a micro level can help inform decisions and influence policy at the larger macro levels of institutions and government. Overlooking this intrinsic level represented an important barrier to utilisation of skilled birth care and constituted a common cause of suffering and human rights violations for birthing women. The key implications for practice pointed to a need for all maternity care stakeholders in Zambia to have an understanding of how women birthing in Zambia experience and give meaning to the childbirth phenomenon. This could start by re-examining current approaches to improving reproductive health, and addressing the contextual factors and community based issues that have been brought to light in this study. In the absence of such an understanding it is difficult to map out interventions that do not infringe on women’s beliefs and practices.
Aim
Training for the development of cultural competence is often not part of the professional training of nurses within the European Economic Area. Demographic changes in society and the cultural diversity of patients require nurses and other medical staff to provide the highest quality healthcare to patients from different cultural backgrounds. Therefore, nurses must acquire the necessary cultural knowledge, skills, and attitudes as part of their training and professional development to provide culturally competent care to achieve this objective.
Objective
This review aims to summarize existing methods of developing cultural competence in nurses working in clinical practice.
Design
A scoping review of the literature.
Method
The following databases were used: PubMed, ScienceDirect, ERIH Plus, and Web of Science using keywords; study dates were from 2011 to 2021.
Results
The analysis included six studies that met the selection criteria. The studies were categorized as face-to-face, simulations, and online education learning methods.
Conclusion
Educational training for cultural competence is necessary for today’s nursing. The training content should include real examples from practice, additional time for self-study using modules, and an assessment of personal attitudes toward cultural differences.
Aims:
To determine the quality of decision-making and cultural competence in terms of cultural competence behavior and cultural awareness and sensitivity of nurse leaders. Furthermore, this study explores the relationships between selected demographic profiles, cultural awareness and sensitivity, cultural competence behavior, and quality of decision-making.
Background:
Diversity contributes to varying beliefs and practices in the workplace. Leaders with cultural competence, awareness, and sensitivity can evaluate alternatives for the decision-making process and develop effective strategies to implement decisions.
Methods:
A descriptive correlational design was utilized. The respondents (n=122) completed the Cultural Competence Assessment instrument and Decision Making Quality Scale questionnaire.
Results:
Cultural awareness and sensitivity are significantly related to the Middle Eastern race. Furthermore, cultural competence behavior is significantly related to years of experience in Saudi Arabia and leadership positions. Quality of decision-making is significantly related to years of experience in Saudi Arabia. Cultural awareness, sensitivity, and cultural competence behavior are significantly related to the quality of decision-making.
Conclusions:
Culturally aware, sensitive, and competent nurse leaders are more likely to adhere to the quality decision-making criteria.
Implications for nursing management:
Promoting training and continuing education for nurse leaders are crucial to ensure they possess the right cultural knowledge and skills.
Aim
This study explored the relationship between self-efficacy, professional identity and competence among nursing students and analyzed the mediating role of self-efficacy in the relationship between professional identity and competence. Background: Increasing attention has been paid to the cultivation of competence among nursing students; however, few studies to date have analyzed its related factors and examined their relationship.
Design
A quantitative study with a descriptive design was performed in this study, adopting an online survey with convenience and snowball sampling. A cross-sectional sample of 887 nursing students in the internship period of their education program in mainland China was recruited from November to December 2020.
Methods
The Nursing Students Competence Instrument, Professional Identity Questionnaire for Nurse Students and General Self-efficacy Scale were distributed online. Descriptive statistics, Pearson’s correlation, structural equation modeling (SEM) and the bootstrap method were employed in data analysis.
Results
Competence was significantly and positively correlated with professional identity (r = 0.598; P < 0.01) and self-efficacy (r = 0.692; P < 0.01). SEM analysis revealed that professional identity (β = 0.31; P < 0.01) or self-efficacy (β = 0.31; P < 0.01) could have a positive impact on competence. Meanwhile, self-efficacy played a mediating role in the relationship between professional identity and competence, with an indirect effect of professional identity creation through self-efficacy accounting for 52% of the total effect.
Conclusions
Self-efficacy mediates the relationship between professional identity and competence to some extent. School educators and clinical tutors should pay greater attention to students’ professional identity and self-efficacy to improve students’ competence.
Background
Achieving and improving cultural competence in nursing is an ongoing process, beginning in the student period and continuing through the professional career.
Objectives
The present study aims to compare pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors in Taiwan in terms of their respective levels of cultural competence, and to determine associated influencing factors.
Design
A comparative cross-sectional study.
Settings
Three universities and three hospitals (one regional hospital and two teaching hospitals) in Taiwan.
Participants
A total of 756 nurses/students (103 pre-graduate nurses, 321 newly graduated nurses, 101 registered nurses, and 231 nurse mentors).
Methods
The Cultural Competence Scale for Pre-Graduated Students to Licensed Professionals was used to measure the cultural competence level. One-way analysis of variance and hierarchical regression analysis were used for statistical analysis.
Results
For overall cultural competence and the subscales of knowledge, awareness, and skills, the pre-graduate students scored lower than the other three groups. Experience of caring for patients from diverse cultures and countries significantly influenced the cultural competence of all four groups. Ability to speak fluent English and receiving cultural competence education during nursing education only significantly influenced the cultural competence of the pre-graduate and new graduate nurses. Current job position and primary practice setting significantly influenced the cultural competence of the registered nurses and nurse mentors.
Conclusion
Pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors have differing levels of cultural competence and differing influencing factors. Cultural competence education that accords with the influencing factors for each nursing position would continuously cultivate nursing staff's cultural competence.
The migrant population has increased in recent years and, as a result, so has cultural diversity. Universities are incorporating specific modules addressing cultural diversity. However, the native population has negative attitudes towards immigrants, as they believe that immigrants receive more social benefits and abuse healthcare services. Nurses may have these attitudes too, which may affect the way they treat patients. The objective of this study was to determine nursing students' attitudes towards the rights of the migrant population. This is a descriptive ex post facto study using a cross-sectional design, with 821 nursing students in Melilla, Ceuta, and Almeria, Spain. An anonymous questionnaire was used for data collection. Students recognize the same rights for both the immigrant and native populations. More than 80% of the sample upholds the right of undocumented immigrants and their families to access publicly funded healthcare. Attitudes were more positive among students with a Berber background and first-year students. Students approved of the right of immigrants and their families to healthcare and education. The students' negative attitudes towards the social rights of immigrants need to be addressed with intercultural training to reduce their prejudices as future professionals in a multicultural society.
Background
The cultural competence education programme for health professionals aimed to ensure that all people receive effective health care, particularly those from culturally diverse backgrounds.
Objectives
The purpose of this study was to investigate the effect of a cultural competence educational course on nurses' self-assessment of their cultural competence.
Design
A single-blind, randomised control trial design was employed.
Participants and settings
Eligible nurses were recruited from a northern Taiwan medical centre with 2089 beds.
Methods
A permuted block of four was used to randomly assign participants to the experimental (n = 47) and control groups (n = 50). The educational course comprised four units and was conducted once weekly for four weeks, with each session lasting 3 h.
Results
A significant group-time interaction was identified regarding self-learning cultural ability, verifying the education intervention's effect on self-learning cultural ability after a two-month intervention. In addition, a significant main effect over time was discovered for total cultural competence; there was no significant interaction effect.
Conclusions
The study provided evidence that an educational programme effectively improved cultural competence in clinical nurses. The results provide a reference for health care providers to design in-service cultural competence education for improving quality of care.
Background: With the rising influx of migrants into Saudi Arabia, it becomes necessary to develop a valid and reliable tool that can accurately measure the cultural competence of the Saudi nursing students.
Aim: This study evaluated the psychometric properties of the Cultural Capacity Scale Arabic version (CCS-A) for nursing students.
Methods: A descriptive, cross-sectional study was conducted among 200 nursing students in Saudi Arabia. The scale reliability was assessed by internal consistency and stability reliability. Scale validity was established by content validity and construct validity. Exploratory factor analysis (EFA) was performed to extract the factors of the CCS-A.
Results: The computed Cronbach’s alpha coefficient was 0.96 and the ICC was 0.88. The CCS-A exhibited excellent content validity and good construct validity. The EFA revealed a single factor with a cumulative contribution rate of 57.4%.
Conclusion: The CCS-A exhibited acceptable reliability and validity, thus supporting its sound psychometric properties.
The ethnic proportions of the population in the United States are rapidly changing, with the nation's minority population at approximately 101 million. This is also true for the West Texas region, where locally in a city with 183,000 residents, 43 different languages are spoken suggesting that cultural education needs to be included in nursing program curricula. Therefore, a study was conducted during a period of curriculum revision to determine if the current nursing curriculum at a public university offers enough education and experience for graduating nurses to care for such a diverse population by comparing their perceptions of cultural competence with beginning sophomore nursing students' perceptions. Participants were asked to complete the Cultural Competence Assessment (CCA) tool in order to evaluate perceptions of cultural competence. Upon analysis of the data, perceptions of cultural competence among graduating nursing students were significantly higher (P = .002) than the perceptions of cultural competence among beginning nursing students. These results support that nursing students perceive that they have become culturally competent during their nursing education, leading to implications of the need for continued education relating to this concept, beginning with the first course and continuing throughout the nursing curriculum.
OBJECTIVES: Several published theoretical frameworks of cultural competence have been developed in North America, Europe and Oceania. The extent to which these frameworks share common characteristics is unknown. This study analyses the core components found in the descriptions of the most frequently cited theoretical frameworks of cultural competence. METHODS: Nine theoretical frameworks from three continents were identified and a documentary analysis was undertaken. RESULTS: Four main themes were identified, namely: an awareness of diversity among human beings, an ability to care for individuals, non-judgmental openness for all individuals, and enhancing cultural competence as a long term continuous
process. CONCLUSIONS: The components of each theme are presented and their similarities and
differences are considered. The findings can provide a useful framework for nurse educators, researchers and practitioners, when applying the concept of cultural competence to their practice.
Aim:
To assess the psychometric properties of the Cultural Capacity Scale Spanish version in Chilean nursing students.
Background:
The increased diversity in healthcare facilities and the current shortage of local nursing workforce in Chile present a significant challenge to the nursing education to train future competent local nurses. To facilitate cultural competence development among Chilean nursing students, it is necessary to regularly assess their cultural competence, which necessitates a culturally adapted valid and reliable tool.
Methods:
A convenience sample of 502 Chilean nursing students was surveyed in this cross-sectional study using the culturally adapted scale. Reliability of the instrument was established by internal consistency and stability reliability, while validity was established by content and construct.
Results:
The Cronbach's α value of the entire scale was 0.95, and the test-retest reliability was 0.85. The Corrected Item-Total Correlations ranged from 0.45 to 0.78. The tool manifested an excellent content and construct validity. The exploratory factor analysis confirmed a single factor of the scale.
Discussion:
The tool demonstrated evidence of internal consistency, stability reliability, content validity and construct validity. The study provided cross-cultural evidence for the potential application of this scale in Chile and other Spanish-speaking countries.
Conclusion:
The Cultural Capacity Scale Spanish version demonstrated sound psychometric properties for assessing the cultural competence of Chilean nursing students.
Limitations:
The sample was restricted to one university, and the tool was only used in Chilean nursing students.
Implications for nursing policy:
The establishment of the Spanish version of the tool will facilitate accurate and timely monitoring of the cultural competence among Chilean nursing students and other Spanish-speaking nursing students and nurses, which can inform the creation of nursing policies aimed at ensuring cultural competence development.
Aim: This study assessed the cultural competence of nursing students in a Saudi University.
Background: With the current situation of immigration in Saudi Arabia, the cultural diversity in healthcare
facilities is anticipated to grow. This presents a great challenge to the members of the healthcare team.
Methods: A cross-sectional study was conducted among 272 nursing students in a Saudi university using a
self-administered questionnaire consisting of two parts, namely the respondents’ demographics and cultural
background information sheet and the Cultural Capacity Scale Arabic version.
Results: The respondents showed the highest competence in their ability to demonstrate communication
skills with culturally diverse patients and lowest in the familiarity with health- or illness-related cultural
knowledge or theory. Gender, academic level, clinical exposure, prior diversity training, the experience of
taking care of culturally diverse patients and patients belonging to special population groups were
significant factors that could likely to influence cultural competence.
Discussion: The findings suggest that the Saudi nursing students possess the ability to provide culturally
appropriate nursing care to patients with a diverse cultural background.
Conclusions: Despite the good cultural competence reflected in this study, some aspects in ensuring a
culturally competent care rendered by Saudi nursing students need to be improved.
Implications for nursing & health policy: With the country’s Saudization policy in health care (replacing
foreign nurses with Saudi nurses), the findings can be used in designing training and interventions to meet the needs of Saudi nursing students regarding cultural competence development, which is integral in their
preparation to assume their future roles as nurses. Policy guidelines, such as including cultural competency
training and foreign languages training as mandatory continuing education for nurses, as well as integrating
cultural competency and foreign languages in the prelicensure curriculum, should be developed and
implemented in Saudi Arabia and other countries.
Healthcare providers (HCPs) seeking professional and personal development via an international placement may be enticed to choose the Middle East. With a unique setting and lifestyle rich in culture, tradition, history and religion, the Middle East also offers financial benefits that are more difficult to achieve in one’s own country of origin. Making a successful transition to another culture requires time and preparation to mitigate culture shock. The authors highlight some key recommendations to aid healthcare providers in transitioning to work in the Middle East. These recommendations are based on Campinha-Bacote’s (2002) cultural competence model, with the core tenets of cultural awareness, cultural knowledge, cultural skill, cultural encounter and cultural desire. Guidelines for transitioning to work in the Middle East are applicable to all healthcare providers and to other settings.
Background: With the continued emigration of Filipino nurses and increasing globalization, there is a need for globally competent nurses. Thus, the development of cultural competence among nursing students is critical in their preparation to assume their future responsibilities in the profession.
Objectives: This study investigated the predictors of cultural competence among nursing students in the Philippines.
Design: This is a descriptive, cross-section study.
Participants and Setting: This study included 332 Bachelor of Science in nursing students in three nursing schools situated in the northern Philippines.
Methods: The Cultural Capacity Scale was used to gather data from the respondents. The demographic characteristics and cultural background of the students were entered in a regression analysis to predict their cultural competence.
Findings: The respondents manifested appreciably good cultural competence with a mean score of 68.98±11.73. The ability to understand the beliefs of various cultural groups received the highest mean of 3.65±0.86, while the ability to identify the care needs of patients with diverse cultural backgrounds received the lowest (mean, 3.31±0.74). Living in an environment with culturally diverse people, prior diversity training, being in the latter years of the nursing program, and with experience of caring for patients from diverse cultures and special population groups, were identified as predictors, accounting for 68.1% of the variance of cultural competence.
Conclusions: Nursing education should devise strategies to ensure future culturally competent Filipino nurses. Considering the fact that most of the Filipino nurses will potentially work overseas, they should be well prepared to provide competent care that is culturally sensitive.
The purpose of this pilot project was to enhance faculty cultural competency in mentoring diverse students. The project was based upon Dr. Campinha-Bacote's Process of Cultural Competence in the Delivery of Healthcare Services model. A pretest–posttest design measured educator cultural competency in mentoring using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals for Mentoring (IAPCC-M). Fisher's analysis revealed a statistically significant increase in educator cultural competency with a two-tailed P value of 0.0011.
“This is a significant book… for a multitude of audiences, including scholars, practitioners, students, expatriates, travelers, and those who are simply interested in culture… This book is also an ideal reference tool, since the metaphors are easy to remember yet rich in contextual value and are presented in a logical structure for quick consultation. Overall, this book is enormously appealing, genuinely useful, and a worthy addition to any collection.” —Thunderbird International Business Review (2002) In Understanding Global Cultures, Fourth Edition, authors Martin J. Gannon and Rajnandini Pillai present the cultural metaphor as a method for understanding the cultural mindsets of individual nations, clusters of nations, and even continents. The fully updated Fourth Edition continues to emphasize that metaphors are guidelines to help outsiders quickly understand what members of a culture consider important. This new edition includes a new part structure, three completely new chapters, and major revisions to chapters on American football, Russian ballet, and the Israeli kibbutz. New and Continuing Features: Emphasizes clusters of national cultures and variations within each cluster, as well as both topic-oriented (authority-ranking cultures, market-pricing cultures, etc.) and cluster-focused descriptions Includes three new parts: India, Shiva, and Diversity; Scandinavian Egalitarian Cultures (Sweden, Denmark, and Finland); and Other Egalitarian Cultures (including Canada and Germany) Provides three completely new chapters: Finnish Sauna, Kaleidoscopic India and Diversity, and a final integrative summary chapter Integrates chapters through the frameworks of the GLOBE study, the Hofstede study, Hall, and Kluckholn and Strodbeck Highlights religious and ethnic diversity throughout AncillariesInstructor Resources are available on a password-protected website at www.sagepub.com/gannon4instr. These include applications, discussion questions, model examinations,100 exercises, and suggested syllabi. Qualified instructors may contact Customer Care to receive access to the site.Understanding Global Cultures: Metaphorical Journeys Through 29 Nations, Clusters of Nations, Continents, and Diversity is appropriate for courses in International Business and Management, Strategic Management and Planning, and Cultural Studies.
Measuring the cultural competence of nurses is becoming an increasingly important aspect to assess the quality care for individuals in multicultural populations such as Turkey. The purpose is to adapt the Nurse Cultural Competence Scale (NCCS) into the Turkish language and to determine its validity and reliability.
A total of 235 nurses were included in the methodological study in Antalya, Turkey. The NCCS-Turkish (NCCS-T) form was used after linguistics and psychometric measurements.
Cronbach's α value was .96, which demonstrated high reliability, and item-total correlations were between .66 and .81.Test-retest reliability correlation was .90. The content validity index was .98, and the 20 items of the NCCS-T loading on one factor varied between .70 and .83, explaining 59.02% of the variance.
Psychometric properties of the NCCS-T were highly reliable and valid.
The scale can be used in the cross-cultural studies to compare nurses' cultural competency.
© The Author(s) 2015.
This review reports on the current nursing literature as it relates to the progress the nursing community has made in the field of transcultural nursing. This review also reports on the current status of the nursing professions' initiative to integrate multi-cultural, diversity training into its educational programs and on the degree to which nurses' report on their preparedness to provide exemplary, culturally competent care following their educational training. The literature reveals we are still only beginning to understand how nursing's educators and employers can provide critical learning environments and workplaces for students, faculty and practitioners to grasp the concepts of transcultural nursing and to evaluate the effectiveness of our actions following training. This status report provides the nursing profession with opportunities to be creative in designing cultural immersion experiences, faculty workshops, educational programs, certification programs, and qualitative and quantitative evaluation tools to measure the effectiveness of our cultural competence programs and experiences. Further opportunities include the dissemination of important concepts and findings through research, conferences, scholarly journals, nursing publications, staff development programs, and continuing education programs.
This study evaluated the cultural competence and cultural confidence (self-efficacy) levels of baccalaureate nursing students in 3 types of programs: those with integrated cultural content, those with a required nonnursing culture course, and those with a culture course in nursing. A sample of 759 students participated. Only the students in the nursing culture course program reached a level of cultural competence. Cultural competence and confidence increased significantly from freshman to junior year in all 3 programs.
The author reviewed cultural competence models and cultural competence assessment instruments developed and published by nurse researchers since 1982. Both models and instruments were examined in terms of their components, theoretical backgrounds, empirical validation, and psychometric evaluation. Most models were not empirically tested; only a few models developed model-based instruments. About half of the instruments were tested with varying levels of psychometric properties. Other related issues were discussed, including the definition of cultural competence and its significance in model and instrument development, limitations of existing models and instruments, impact of cultural competence on health disparities, and further work in cultural competence research and practice.
The aim of this study was to describe the development of a Nurse Cultural Competence Scale using Mokken scaling.
The psychometrics of the present cultural competence assessment tools has been questioned. The levels of competence measured by existing tools are not capable of indicating individual differences.
This study employed a cross-sectional design. A convenience sample of 172 on-the-job nursing students in a college of technology in Taiwan was recruited.
Based on previous literature, the Nurse Cultural Competence Scale comprising 41 items was developed to measure the concept of cultural awareness, cultural knowledge, cultural sensitivity and cultural skill. Mokken scaling analysis was conducted to investigate the unidimensionality and hierarchical nature of the scale.
From the 41 items entered into the Mokken scaling procedure, 20 form a strong Mokken scale. The 20 items form a reliable and statistically significant scale which is negatively skewed. The ordering of the items from lowest to highest difficulty shows a hierarchy.
Nursing managers and educators may use this scale to assess the levels of cultural competence of their members or students and then provide the education according to individual needs.
At the core of both patient centeredness and cultural competence is the importance of seeing the patient as a unique person. For the purpose of this article, cultural competence is viewed as an expansion of patient-centered care. More specifically, cultural competence can be seen as a necessary set of skills for nurses to attain in order to render effective patient-centered care. However, a vexing question remains, "How does the nurse deliver patient-centered care when the patient's health beliefs, practices, and values are in direct conflict with medical and nursing guidelines?" The purpose of this article is to provide nurses with a set of culturally competent skills that will enhance the delivery of patient-centered care in the midst of a cultural conflict. I will begin by offering a conceptual framework for cultural competence and a description of the cultural skill needed to formulate a mutually acceptable and culturally relevant treatment plan for each patient. Next I will describe effective approaches for cultural encounters. Finally I will present a vignette that illustrates how the nurse can deliver patient-centered care when the patient's health beliefs, practices, and values are in direct conflict with medical and nursing guidelines.
In this article, lessons learned from the Chronic Care Model are discussed by addressing provider factors that may affect the delivery of care and patient adherence. Specifically, issues related to the provision of culturally competent and sensitive care are discussed in terms of race-concordant and discordant patient-provider relationships. Strategies for beginning and continuing the process of becoming culturally competent are presented, such as the ASKED framework for determining one's level of cultural competency and the LEARN framework for enhancing the patient-provider relationships. Lastly, tips are presented to assist providers in knowing their patients better which will ultimately enhance cultural competency and patient adherence to treatment regimes.
The need to address cultural and ethnic diversity issues in medical education as a means to improve the quality of care for all has been widely emphasised. Cultural competence has been suggested as an instrument with which to deal with diversity issues. However, the implementation of culturally competent curricula appears to be difficult. We believe the development of curricula would profit from a framework that provides a practical translation of abstract educational objectives and that is related to competencies underlying the medical curriculum in general. This paper proposes such a framework.
The framework illustrates the following cultural competencies: knowledge of epidemiology and the differential effects of treatment in various ethnic groups; awareness of how culture shapes individual behaviour and thinking; awareness of the social context in which specific ethnic groups live; awareness of one's own prejudices and tendency to stereotype; ability to transfer information in a way the patient can understand and to use external help (e.g. interpreters) when needed, and ability to adapt to new situations flexibly and creatively.
The framework indicates important aspects in taking care of an ethnically diverse patient population. It shows that there are more dimensions to delivering high-quality care than merely the cultural. Most cultural competencies emphasise a specific aspect of a generic competency that is of extra importance when dealing with patients from different ethnic groups. We hope our framework contributes to the further development of cultural competency in medical curricula.
This article presents the work of the American Association of Colleges of Nursing Advisory Committee in developing an integrated curriculum for cultural competence in baccalaureate nursing education. Five competencies for Cultural Competency in Baccalaureate Nursing Education were developed with supporting rationale. Suggestions for developing and implementing curricula for cultural competency, teaching content, specific integrative learning strategies, methods for evaluating nursing students' cultural competence and recommendations for effective implementation of the integrated curriculum are presented.
'Values are principles and standards that have meaning and worth to an individual, family, group, or community' (Purnell & Paulanka 1998: p.3). Values are central to the care provided by nurses. The provision of nursing care within the context of value clarification, has been explored from various perspectives, however, as values vary within cultures, there is a limited range of studies reflecting on Saudi Arabian nurses' perspectives of nursing care. Through a Heideggerian phenomenological research design, six nurses were enrolled through purposive sampling. Semi-structured, in-depth interviews, which were audio tape-recorded, were chosen as the methods of data collection. A seven stage framework approach was applied to analyse and organise the research findings in three conceptual themes: values in context of Islam, the nurse-patient relationship, and identity's influence on being in the world of nursing. The findings of the research indicate that values in nursing and the perception of care are closely linked to the Islamic values of the informants. However, one of the most challenging aspects emerging from this study is related to these nurses' experiences related to the public's negative perception of nursing as a profession for Saudi Arabian women.
Nursing's attention to cultural diversity has been influenced by the changing demographic composition of the U.S. population. Nursing must continue to increase awareness and promote attitudinal and behavioral changes that will result in the delivery of culturally appropriate nursing care. The nursing literature includes several models of cultural development to assist nurses and other health care professionals in conducting a cultural assessment and incorporating cultural data into nursing care plans. This article presents a synthesis model of cultural development that illustrates that cultural awareness, cultural sensitivity, and cultural competence do not achieve the level of cultural development necessary to meet the health care needs of a diverse population. Cultural proficiency is a concept that extends cultural competence into nursing practice, administration, education, and research. It is a philosophical and behavioral approach to cultural diversity that guides and prescribes individual and institutional behavior toward "cultural others."
Several models of service care delivery have emerged to meet the challenges of providing health care to our growing multi-ethnic world. This article will present Campinha-Bacote's model of cultural competence in health care delivery: The Process of Cultural Competence in the Delivery of Healthcare Services. This model views cultural competence as the ongoing process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community). This ongoing process involves the integration of cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.
This article describes a qualitative study that explored the perceptions of graduating students from a northeast baccalaureate nursing program regarding their life experiences with cultural diversity. Thirteen students were interviewed using an interview guide, and interviews were recorded on audiotape. Information obtained included participants' cultural heritage, life experiences before entering a nursing program, educational and clinical experiences in the nursing program, knowledge about cultural competence, and the students' reflections on their ability to provide culturally competent care. Primarily qualitative methods were used to gather and analyze data. This article focuses on one of the major themes that emerged: defining life experiences related to cultural diversity. Data were reanalyzed focusing on this theme, and three life patterns emerged: positive, neutral, and conflicted. These patterns affected the students' interest and desire to provide culturally competent care. Implications for further research and nursing education are discussed.
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Cultural competence assessment of baccalaureate nursing students: An integrative review of the literature
- Carey
Carey, R. E. (2011). Cultural competence assessment of
baccalaureate nursing students: An integrative review of
the literature. International Journal of Humanities and Social
Science, 1(9), 258-266.