Testing a multi-group model of culturally competent behaviors among underrepresented nurse practitioners

Translation, Adaptation, and Validation of the Cultural Competence Assessment in Portuguese Nurses

Background and Purpose: Previous research shows significant benefits resulting from improving culturally competent nursing care. Thus, the purpose of this study was to translate, adapt, and validate the Cultural Competence Assessment (CCA) in a sample of Portuguese nurses. Methods: A psychometric study of the CCA, after translation into European Portuguese, was performed with a snowball sample of 284 nurses. Participants were asked to fill in a sociodemographic questionnaire and the CCA. Results: The four-factor model of the CCA (Portuguese version) exhibited satisfactory indices of fitness without item nine. Cronbach's alpha was 0.85. Correlations between subscales and the total score scale were strong and statistically significant. Conclusions: These data add to the cultural competence knowledge of nurses to promote better practices and culturally competent care.

Psychometric Evaluation of Turkish Version of the Cultural Competence Assessment Tool: CCA-EUnurse Project

It is important to understand nurses' cultural competency all across the world, as globalization and international migration are increasing day by day. The evaluation of the cultural competence of nurses is necessary to provide better quality and adequate health services to individuals, and to improve patient satisfaction and health outcomes. The aim of this study is to evaluate the validity and reliability of the Turkish version of the "Cultural Competence Assessment Tool". The methodological study was performed to assess instrument adaptation and validity and reliability testing. This study was conducted in a university hospital in western region of Turkey. The study sample consisted of 410 nurses who worked in this hospital. Validity was tested using content validity index, Kendall's W test and exploratory and confirmatory factor analyses. Reliability was tested using item-total and interitem correlations, Cronbach's α coefficient of reliability and test-retest analysis. The results of this research demonstrated that the Cultural Competence Assessment Tool showed a good construct validity, internal reliability and test-retest reliability. Confirmatory factor analysis indicated that a construct with four factors showed an acceptable model fit. In conclusion, this study concluded that the Turkish version of the Cultural Competence Assessment Tool is a valid and reliable measurement tool.

Unlocking the benefits of diversity among healthcare workforces: a holistic view

PURPOSE

The increasing diversity among workforces - as well as the increasing diversity among patient populations served - offers a variety of opportunities and potential pitfalls for healthcare organizations and leaders. To unravel this complexity, the authors aim to holistically understand how to maximize provider and patient experiences regardless of (1) the degree to which diversity is present or lacking, and (2) the type(s) of diversity under consideration.

DESIGN/METHODOLOGY/APPROACH

This conceptual paper develops a framework that combines three organizational behavior theories - emotional labor theory, similarity-attraction theory and climate theory - with evidence from the broader healthcare literature.

FINDINGS

Authentic interactions yield positive outcomes for providers (i.e. improved job attitudes and work-related well-being) and patients (i.e. patient satisfaction) and acts as a mediator between demographic diversity and positive outcomes. Demographic similarity facilitates authentic interactions, whereas demographic diversity creates an initial barrier to engaging authentically with others. However, the presence of a positive diversity climate eliminates this barrier.

ORIGINALITY/VALUE

The authors offer a conceptual model to unlock positive outcomes - including reduced absenteeism, better morale and improved patient satisfaction - regardless of the level and types of diversity present within the workforce. In addition to deriving an agenda for future research, the authors offer practical applications regarding how diversity can be more effectively managed and promoted within healthcare organizations.

The effect of ethnocentrism and moral sensitivity on intercultural sensitivity in nursing students, descriptive cross-sectional research study

BACKGROUND

Factors affecting intercultural sensitivity and care are becoming an increasingly important issue due to ethnic diversity. Nurses play a crucial role in care and therefore should keep up with this trend and improve their intercultural sensitivity.

OBJECTIVE AND DESIGN

This descriptive cross-sectional study investigated the effects of ethnocentrism and moral sensitivity on intercultural sensitivity in nursing students.

METHODS AND PARTICIPANTS

Data were collected using a demographic characteristics questionnaire and the Intercultural Sensitivity Scale, Generalized Ethnocentrism Scale, and Moral Sensitivity Scale. The sample consisted of 1343 nursing students. The Pearson correlation coefficient was used to determine correlations between scale scores. Multiple linear regression was used to determine the effects of ethnocentrism, moral sensitivity, and demographic characteristics on intercultural sensitivity.

RESULTS

Intercultural sensitivity was found to be negatively correlated with ethnocentrism and positively correlated with moral sensitivity. Ethnocentrism predicted intercultural sensitivity more than moral sensitivity. Ethnocentrism and moral sensitivity explained 16.8% of the total variance of intercultural sensitivity. However, ethnocentrism affected intercultural sensitivity more than moral sensitivity did (beta = -0.406).

CONCLUSION

Nursing education should adopt strategies to reduce ethnocentrism by helping students develop cultural competence and intercultural sensitivity. Such education can equip nurses to provide higher quality care to patients of different cultural backgrounds.

A comparison of provider perspectives on cultural competency training: A mixed methods study

BACKGROUND

We aimed to identify differences in training among colorectal cancer physicians and advanced practice providers with high and low cultural competency METHODS: Using explanatory sequential mixed methods, we surveyed providers and dichotomized into high and low cultural competency (CC) groups, conducted qualitative interviews, and analyzed verbatim transcripts using deductive and inductive codes to compared findings across groups using a joint display.

RESULTS

Fifty-four of 92 providers (59%) responded; 10 respondents from each group (20/36 invited) completed semi-structured interviews about previous CC trainings. Low CC providers' training included explanations of cultural differences that, in practice, improved awareness and utilization of communication tools, but they also desired decision-making tools and cultural exposure. High CC providers' training included action-oriented toolkits. In practice, they admitted failures, improved communication, and attributed patient behaviors to external factors. High CC providers desired performance evaluations.

CONCLUSIONS

Behaviorally-oriented CC training offered a robust foundation for culturally competent care.

Supportive Clinical Practice Environments Associated With Patient-Centered Care

A lack of organizational supports in clinical settings may prevent nurse practitioners from providing patient centered care. Using a cross sectional survey design, data were collected from NPs in 1,571 practices across four states to investigate clinical practice environments and the extent to which they are associated with NP integration of patient preferences. Three-quarters of NPs reported frequent integration of patient preferences into clinical care. Overall, 371 practices (23.6%) were classified as good practice environments; the remaining 76.3% were mixed or poor environments. NPs in good environments were significantly more likely to integrate patient preferences (O.R. = 2.3, p <.001).

Immigrant nurses' perceptions on cultural differences-based job concerns: A phenomenological study in Shanghai China

AIMS AND OBJECTIVES

To explore the experiences of immigrant nurses working in Shanghai, China.

BACKGROUND

With the development of China, population growth has been accelerating. Simultaneously, the number of immigrant nurses in Shanghai has been increasing dramatically. Meanwhile, their turnover rate is abnormally high, primarily because of job concerns stemming from cultural differences. An understanding of immigrant nurses' job concerns caused by cultural differences can be used to help them to work more efficiently and cohesively. We aimed to investigate immigrant nurses' lived experiences regarding job concerns caused by cultural differences in Shanghai, China.

METHODS

This is a phenomenological study. In-depth semi-structured interviews were conducted with fifteen immigrant nurses from January-July 2016. Data were collected using audio-taped face-to-face interviews; the narratives were then transcribed verbatim and analysed thematically.

RESULTS

The following three major themes emerged from the data: "communication difficulties," "work adjustment difficulties" and "life adjustment difficulties." The eight sub-themes within these were as follows: (i) language barrier, (ii) inability to integrate oneself with the local culture, (iii) feelings of unfairness, (iv) difficulty asking for leave, (v) feeling stressed, (vi) not being acclimatised, (vii) feeling helpless and (viii) feeling guilt at being unable to take care of their family.

CONCLUSION

It is important to implement appropriate training programmes on language and cultural adaptation for immigrant nurses. To enhance integrate immigrant nurses into Shanghai's society, more support needs to be provided.

RELEVANCE TO CLINICAL PRACTICE

Administrators in hospitals should pay attention to immigrant nurses' job concerns that are caused by cultural differences and provide timely and effective assistance.

Evaluation of the psychometric properties of the Korean version of the Cultural Competence Assessment

AIM

The 25 item Cultural Competence Assessment assesses the cultural competence of multiple types of healthcare providers. This study aimed to examine the validity and reliability of the Korean version of the questionnaire (KCCA) and to determine the need for changes to improve its validity and reliability.

METHODS

Data from 161 hospital nurses were used for the item analysis and to assess the reliability and construct validity of the KCCA before and after the deletion of nine items.

RESULTS

The KCCA did not demonstrate acceptable construct validity and subscale internal reliability. Nine items with high interitem correlations, high modification indices, and relatively lower factor loadings were deleted. The 16 item Modified KCCA showed improved construct validity, convergent and discriminant validity, and reliability.

CONCLUSION

While further psychometric evaluation of the Modified KCCA should be undertaken with larger samples and diverse professionals, the study's data provide evidence that the Modified KCCA might be a more suitable measure for use among Korean healthcare providers.

Cultural competence course for nursing students in Taiwan: A longitudinal study

BACKGROUND

Culturally competent care is an essential ability for nursing students. However, little is known about the effects of educational intervention on attitudes or behavior changes with regard to cultural competence in Taiwan.

PURPOSE

This study evaluates the effects of a cultural competence course for nursing students.

METHODS

Using a longitudinal study design, 105 participants were assigned to an experiment group (51 participants) and control group (54 participants) based on the school they attended. Students in the experiment group received a two-credit course on cultural competence care. Using the Cultural Competence Assessment Instrument-Chinese Version (CCA-CV), data were collected between 2012 and 2013 at three points in time: before and after the course and again 6 to 8 months after the two groups (experiment and control) had completed the clinical practicum.

RESULTS

The results of a generalized estimating equation (GEE) analysis indicate that the cultural competence of all participants had improved at the posttest assessment, with the experiment group showing a significantly better improvement over the control group. However, the overall effectiveness of the training diminished with time. This study supports that taking a cultural competence course effectively enhances the cultural competence of nursing students for a limited period of time immediately following the course.

CONCLUSIONS AND APPLICATIONS

These results support that the benefits of incorporating a cultural competence course in clinical practice should be considered in the future. Furthermore, healthcare institutions should be encouraged to provide greater support and consideration to cultural competence issues in the nursing workplace in order to reinforce and extend the benefits of cultural competence courses provided at nursing schools.

Mutations that hamper dimerization of foot-and-mouth disease virus 3A protein are detrimental for infectivity

Foot-and-mouth disease virus (FMDV) nonstructural protein 3A plays important roles in virus replication, virulence, and host range. In other picornaviruses, homodimerization of 3A has been shown to be relevant for its biological activity. In this work, FMDV 3A homodimerization was evidenced by an in situ protein fluorescent ligation assay. A molecular model of the FMDV 3A protein, derived from the nuclear magnetic resonance (NMR) structure of the poliovirus 3A protein, predicted a hydrophobic interface spanning residues 25 to 44 as the main determinant for 3A dimerization. Replacements L38E and L41E, involving charge acquisition at residues predicted to contribute to the hydrophobic interface, reduced the dimerization signal in the protein ligation assay and prevented the detection of dimer/multimer species in both transiently expressed 3A proteins and in synthetic peptides reproducing the N terminus of 3A. These replacements also led to production of infective viruses that replaced the acidic residues introduced (E) by nonpolar amino acids, indicating that preservation of the hydrophobic interface is essential for virus replication. Replacements that favored (Q44R) or impaired (Q44D) the polar interactions predicted between residues Q44 and D32 did not abolish dimer formation of transiently expressed 3A, indicating that these interactions are not critical for 3A dimerization. Nevertheless, while Q44R led to recovery of viruses that maintained the mutation, Q44D resulted in selection of infective viruses with substitution D44E with acidic charge but with structural features similar to those of the parental virus, suggesting that Q44 is involved in functions other than 3A dimerization.