Measures of cultural competence in nurses: an integrative review

Examining the pedagogical practices that support cultural proficiency development in graduate health science students

BACKGROUND

Health disparities are often a function of systemic discrimination and healthcare providers' biases. In recognition of this, health science programs have begun to offer training to foster cultural proficiency (CP) in future professionals. However, there is not yet consensus about the best ways to integrate CP into didactic and clinical education, and little is known about the role of clinical rotations in fostering CP.

METHODS

Here, a mixed-methods approach was used to survey students (n = 131) from a private all-graduate level osteopathic health sciences university to gain insight into the training approaches students encountered related to CP and how these may vary as a function of academic progression. The research survey included instruments designed to quantify students' implicit associations, beliefs, and experiences related to the CP training they encountered through the use of validated instruments, including Implicit Association Tests and the Ethnocultural Empathy Inventory, and custom-designed questions.

RESULTS

The data revealed that most students (73%) had received CP training during graduate school which primarily occurred via discussions, lectures, and readings; however, the duration and students' perception of the training varied substantially (e.g., training range = 1-100 hours). In addition, while students largely indicated that they valued CP and sought to provide empathetic care to their patients, they also expressed personal understandings of CP that often fell short of advocacy and addressing personal and societal biases. The results further suggested that clinical rotations may help students attenuate implicit biases but did not appear to be synergistic with pre-clinical courses in fostering other CP knowledge, skills, and attitudes.

CONCLUSIONS

These findings highlight the need to utilize evidence-based pedagogical practices to design intentional, integrated, and holistic CP training throughout health science programs that employ an intersectional lens and empowers learners to serve as advocates for their patients and address systemic challenges.

Development and Psychometric Evaluation of the Clinical Nursing Cultural Competence Scale

Background and Purpose: Cultural competence in clinical nurses can lead to comprehensive care for patients from different cultures. Currently, an appropriate instrument to assess cultural competence in clinical nurses is limited. This study aimed to design and determine the psychometric properties of the clinical nursing cultural competence scale (CNCCS). Methods: This methodological study was conducted in 2018-2019 in two phases. In the first phase, a literature review and semistructured interviews with 18 clinical nurses from Isfahan and Ahvaz were conducted, and the results were used for item generation. In the second phase, the face, content, construct validity, and reliability of the questionnaire were assessed. For construct validity assessment through exploratory factor analysis (EFA), 200 clinical nurses were purposefully recruited to fill out CNCCS. Results: In the first phase, 140 items were produced. In the second phase, the item number was reduced to 40 after the face and content validity assessment. In EFA for construct validity assessment, 13 more items were deleted, and the remaining 27 items were loaded on six factors. The Cronbach's alpha and the test-retest intraclass correlation coefficient were CNCCS 0.86 and 0.93, respectively. Conclusions: The CNCCS had acceptable psychometric characteristics in Iranian nurses and can be used for assessing cultural competence among clinical nurses. The use of this scale can help nursing policymakers and managers develop their understanding of nursing cultural competence and develop strategies for its improvement.

Nursing Students' Self-Efficacy in Immigrant Health

BACKGROUND

The United States has the largest, most diverse immigrant population. Nurses will care for immigrant clients in all areas of nursing practice.

PURPOSE

The purpose of this study was to determine nursing students' self-efficacy in working with immigrant clients following a service-learning experience.

METHODS

A pre-/posttest descriptive study was used to measure students' self-efficacy in cultural aspects of screening, providing health education, and assisting with health care access prior to and after a voluntary service-learning experience at a resettlement agency.

RESULTS

Statistical significance was found in overall scale score and in all 19 individual items except 2 related to working with (P = .21) and communicating with (P = .49) the health care team. Overall, pretest and posttest results revealed that students' self-efficacy working with immigrant clients was improved.

CONCLUSION

Collaborating with an immigrant resettlement program to provide a structured immigrant health learning experience for prelicensure nursing students can improve self-efficacy in working with immigrant clients.

Identifikacija merskih instrumentov za merjenje kulturnih kompetenc pri medicinskih sestrah in študentih zdravstvene nege

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.

Investigation of the Cultural Competence Levels of Diabetes Nurses

Objective: It is important for nurses to have cultural competence in order to keep up with the cultural diversity brought by globalization. In this study, we aim to examine the cultural competence levels of diabetes nurses in diabetes education and care in accordance with the cultural characteristics of individuals with diabetes. Methods: This study was conducted in a cross-sectional descriptive type with 183 diabetes nurses between September 15 and December 15, 2020 in Turkey. The data were collected using the Introductory Information Form and the Nurse Cultural Competence Scale. Results: We determine that almost all of the diabetes nurses had cultural competence above the average. We find that having a postgraduate degree from diabetes nurses, receiving cultural education before, and having a diabetes nurse experience of 6 years or more affected the cultural competence levels (p

Cultural Competence of Turkish Nurses and Nursing Students: An Integrative Literature Review

INTRODUCTION

Turkish population is characterized by its great cultural diversity, thus, Turkish nurses and nursing students often interact with patients of different cultural backgrounds from theirs. Cultural competence is needed to provide qualified contemporary nursing care. This study aimed to explore the literature on the cultural competence of Turkish nurses and nursing students.

METHODOLOGY

The Whittemore and Knafl review methodology was used to extract, summarize, and synthesize data of 15 primary research articles published between January 2011 and January 2021. The search was done in the Turkish Academic Network and Information Center-ULAKBIM (PubMed, TRDizin, DergiPark).

RESULTS

Three themes were identified: cultural competence, cultural-related problems, and importance of training on transcultural nursing.

DISCUSSION

Appropriate educational courses on transcultural nursing should be implemented in Turkish nursing schools as well as in continuing education programs for Turkish nurses.

Cultural Competence and Cultural Intelligence of Healthcare Professionals Providing Emergency Medical Services

Background: There are more and more foreigners in Poland who become clients of the Polish healthcare system. They use, among others, emergency medical services provided by healthcare professionals: doctors, nurses, and paramedics. Skillful care for culturally different patients requires cultural competencies and cultural intelligence to ensure good quality of care and cultural safety. The study aimed to measure and assess the cultural competencies and cultural intelligence of medical professionals working in hospital emergency departments (HEDs) and hospital emergency rooms (HERs) in Małopolska, a region in southern Poland. Methods: The following questionnaires were used in the study: the Cross-Cultural Competence Inventory (CCCI), the Cultural Intelligence Scale (CQS), and Questionnaire on Attitudes Towards Culturally Divergent People. In total, 709 medical professionals participated in the study, including 363 nurses, 223 paramedics, and 123 doctors. Results: Cultural intelligence—the overall score and the scores on the metacognitive, cognitive, motivational, and behavioral subscales were significantly higher among HED and HER doctors. Cultural competencies—the overall score and the score on the cultural adaptation subscale were also significantly higher among HED and HER doctors. The CCCI and CQS scores were influenced by selected variables: taking care of and close interactions with representatives of other cultural circles; staying outside Poland for more than a month. Doctors were the group of medical professionals that were most tolerant and most positive towards people from other cultures. Conclusions: The research results confirm the positive impact of contact of medical professionals with people from other cultures on their cultural competencies and cultural intelligence. They indicate the need for training in acquiring cultural competencies and developing cultural intelligence, especially among nurses. They demonstrate the need to raise awareness among HED and HER medical professionals about issues in intercultural care and to increase diversity efforts, especially among nurses.

Midwives' experiences of cultural competency training and providing perinatal care for migrant women a mixed methods study: Operational Refugee and Migrant Maternal Approach (ORAMMA) project

BACKGROUND

The number of international migrants continues to increase worldwide. Depending on their country of origin and migration experience, migrants may be at greater risk of maternal and neonatal morbidity and mortality. Having compassionate and culturally competent healthcare providers is essential to optimise perinatal care. The "Operational Refugee and Migrant Maternal Approach" (ORAMMA) project developed cultural competence training for health professionals to aid with providing perinatal care for migrant women. This presents an evaluation of ORAMMA training and explores midwives' experiences of the training and providing care within the ORAMMA project.

METHODS

Cultural competence was assessed before and after midwives (n = 35) received ORAMMA compassionate and culturally sensitive maternity care training in three different European countries. Semi-structured interviews (n = 12) explored midwives' experiences of the training and of caring for migrant women within the ORAMMA project.

RESULTS

A significant improvement of the median score pre to post-test was observed for midwives' knowledge (17 to 20, p < 0.001), skills (5 to 6, p = 0.002) and self-perceived cultural competence (27 to 29, p = 0.010). Exploration of midwives' experiences of the training revealed themes of "appropriate and applicable", "made a difference" and "training gaps" and data from ORAMMA project experiences identified three further themes; "supportive care", "working alongside peer supporters" and "challenges faced".

CONCLUSIONS

The training improved midwives' knowledge and self-perceived cultural competence in three European countries with differing contexts and workforce provision. A positive experience of ORAMMA care model was expressed by midwives, however clearer expectations of peer supporters' roles and more time within appointments to assess the psychosocial needs of migrant women were desired. Future large-scale research is required to assess the long-term impact of the ORAMMA model and training on practice and clinical perinatal outcomes.

Evaluating the Effectiveness of Cultural Education Training: Cultural Competence and Cultural Intelligence Development among Nursing Students

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.

Psychometric Properties of Nurse Cultural Competence Scale among Filipino Nurses

Purpose: Assessment of the cultural competence of nurses is becoming an important parameter in assessing the provision of quality care to patients especially in multicultural populations such as the Philippines. The study was conducted to assess the construct validity and internal consistency reliability of the Nurse Cultural Competence Scale (NCCS) among Filipino nurses. Methods: A methodological study was utilized and a convenience sample of 124 Filipino nurses were included in the study. An exploratory factor analysis was used to assess the construct validity of the instrument while internal consistency reliability was determined using Cronbach’s α coefficient and item-total correlations. Results: The 20-item NCCS was loaded on one dimension with factor loadings ranging from 0.72 to 0.95, explaining 79.19% of the total variance. Cronbach’s α was 0.986 which demonstrated high reliability and item-total correlations were between 0.811 and 0.929. Conclusion: The NCCS is a reliable and valid instrument for the measurement of cultural competencies among Filipino nurses. Keywords: Cultural competence, Filipino nurses, Reliability, Validity

Psychometric properties of a modified cultural awareness scale for use in higher education within the health and social care fields

BACKGROUND

Cultural awareness and cultural competence have become important skills in higher education as populations continue to grow in diversity around the world. However, currently, there are few instruments designed to assess student awareness of the aspects of culture, and the existing instruments need further development and testing for use with different target populations. Therefore, the aim of this study was to test the psychometric properties of a modified version of the Cultural Awareness Scale (CAS) for use in higher education within the health and social care fields.

METHODS

A modified version of the CAS was developed, which was tested psychometrically using cross-sectional data. In total, 191 undergraduate students from different health and social care undergraduate programs in Sweden and Hong Kong responded to a call to test the modified instrument.

RESULTS

The results showed that the modified CAS is a four-factor measure of cultural awareness and possesses satisfactory internal consistency. Results also support the use of the modified CAS as a generic tool to measure cultural awareness among students in higher education within the health and social care fields.

CONCLUSION

The modified CAS showed satisfactory psychometric properties and can be recommended as a generic tool to measure cultural awareness among students in higher education within the health and social care fields. However, further psychometric testing on the effectiveness of the modified CAS as a tool to evaluate the efficacy of cultural awareness interventions is required.

Psychometric properties of instruments used to measure the cultural competence of nurses: A systematic review

BACKGROUND

Cultural competence is a key component of culturally congruent nursing care. In order to reduce healthcare inequalities and to identify potentials for improvement in nursing practice, researchers need to be able to assess cultural competence properly. Although many instruments for the assessment of cultural competence have been developed, their measurement properties have not yet been reviewed systematically. Such an overview of existing instruments, however, would allow researchers to identify the most valid and reliable instrument for nursing practice.

OBJECTIVE

The purpose of conducting this review is to identify and critically appraise the psychometric properties of instruments used to measure the cultural competence of nurses.

METHODS

A systematic literature search was performed in November 2019 in the following electronic databases: Cumulative Index of Nursing and Allied Health Literature, Embase, PsycINFO and PubMed. Studies that were conducted to assess any measurement property of instruments used to measure the cultural competence of nurses were included. Two reviewers independently screened the articles and assessed the risk of bias using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. The quality of included instruments was assessed on the basis of the updated criteria for good measurement properties, and the quality of the summarised results was graded based on the principles of Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

In total, 44 studies describing 21 instruments were included in this study. We found that most instruments were tested for at least some forms of validity, but seldom for reliability. The quality of the psychometric properties was evaluated using the criteria for good measurement properties for the following: content validity, structural validity, internal consistency, reliability, measurement error and construct validity. No studies were found in which cross-cultural validity, criterion validity, or the responsiveness of the included instruments were evaluated. The Transcultural Self-Efficacy Tool, the Cultural Competence Assessment, and the Cultural Competence Health Practitioner Assessment showed sufficient levels of quality for psychometric properties and can be recommended for the assessment of cultural competence in nurses.

CONCLUSION

Given the broad availability of self-administered instruments to assess cultural competence, the development of new instrument is not recommended. A particular need was identified to conduct further psychometric evaluation studies on existing instruments and to adapt them accordingly, and especially on less frequently evaluated properties, such as reliability, measurement error and responsiveness.

Self-Reported Cultural Competence of Nurses Providing Nursing Care in Slovakia

PURPOSE

The goals of this study were to determine and evaluate the perception of cultural competence of nurses in the Slovak healthcare system, identify factors that influence their perception, and ascertain opportunities to improve nurses' cultural competence.

DESIGN

Cross-sectional nonexperimental study.

METHODS

Nurses from Slovakia were surveyed in this cross-sectional study using the standardized Cultural Competency Assessment (CCA) questionnaire. Statistical analysis was conducted using SPSS version 22 (IBM Corp., Armonk, NY, USA).

RESULTS

In total, 267 nurses responded. Only 28% perceived themselves as very culturally competent to care for people from other cultures. Over 68% received no diversity training. Age (p < .011) and prior diversity training (p < .006) were significantly associated with culturally competent behavior (CCB). A significant relationship (r = 0.17; p < .015) was also confirmed between the self-reported CCA and CCB.

CONCLUSIONS

Culturally competent care is a professional imperative. The ability to deliver high-quality, culturally congruent care may be enhanced by cultural diversity education and training. Further research is needed to identify other influences on cultural competency and the impact on patient care and outcomes.

CLINICAL RELEVANCE

There is a need for nurses to enhance their knowledge and skills related to cultural competency, awareness, sensitivity, and behaviors. Education and training contribute to nurses' ability to provide high-quality, culturally competent nursing care to patients from different cultures, and may possibly contribute to decreased health disparities.

California State University (CSU) System nursing faculty: Are you culturally competent to teach in a multicultural state?

BACKGROUND

The predicted changes in demographics are forcing health care professionals to recognize they must become not only more culturally sensitive, but also culturally competent.

PURPOSE

The purpose of this descriptive, correlational study was to describe the level of cultural competence of faculty teaching BSN pre-licensure programs, and faculty personal (age, gender, race/ethnicity, ability to speak another language) and professional characteristics (years in nursing education, highest degree earned, certification, continuing education in cultural competency, and nursing specialty areas) predictive of cultural competency, and the relationship between cultural competency and transcultural teaching behaviors.

METHOD

Campinha-Bacote's (1999) model of cultural competence theoretical framework guided the study. The Cultural Diversity Questionnaire for Nurse Educator-Revised Scale measured a sample of 152 (n = 152) faculty cultural competence and transcultural teaching behaviors.

RESULTS

CSU System faculty were moderately culturally competent. The overall regression model with faculty personal predictors were statistically significant F(4, 145) = 2.98, p = .02, and variables accounted for 7.6% of the variance in cultural competency (R² = 0.076). The overall regression model with faculty professional predictors were statistically significant F(9, 139) = 3.62, p < .001, and variables accounted for 19% of the variance in cultural competency (R² = 0.190). Major findings revealed four aspects of cultural competence predictive of transcultural teaching behaviors. The overall regression model was statistically significant F(5, 146) = 182.71, p < .001, and variables accounted for 86.2% of the variance in transcultural teaching behaviors (R² = 0.862).

CONCLUSION

The personal characteristic ability to speak another language was predictive of cultural competence. Professional characteristics nursing specialty area of mental health, and continuing education in cultural competency were predictive of cultural competence. The four aspects of cultural competence awareness, knowledge, skills, desire are predictive of transcultural teaching behaviors.

Cultural competence of nurses in Pudong New Area, Shanghai: a mixed-method study

Objective

Cultural competence has gradually attracted attention from many countries, including China. This study was undertaken to determine the cultural competence of registered nurses in Shanghai, China, and to identify the cultural competence among registered nurses in Pudong New Area, Shanghai.

Methods

Qualitative interviews were conducted in combination with a quantitative survey. Fifteen clinical nurses were interviewed, and 1088 clinical nurses were recruited for the survey with cultural competence scale for registered nurses, based on the results of the qualitative and quantitative studies.

Results

The overall level of cultural competence among registered nurses in Shanghai's Pudong New Area was moderate. Among the seven dimensions, cultural encounter had the highest score, followed by cultural practice, cultural awareness, cultural desire, cultural skill, cultural experience, and cultural knowledge. Age, level of hospital care, mastery of secondary level, and studying overseas were the influencing factors.

Conclusions

Hospitals and universities should be aware of the importance of studying cultural competence. Cultural competence-related courses should be increased, and various forms of training should be undertaken to enhance the interest of nurses.

Development of an instrument to measure the cultural competence of health care workers

OBJECTIVE

To validate an instrument measuring the cultural competence in health care workers from Chile.

METHODS

Using Sue & Sue’s theoretical model of cultural competence, we designed a scale, which was assessed by health care workers and experts. Subsequently, the scale was applied to a sample of 483 different health care workers, during 2018 in Santiago de Chile. The analysis included: exploratory and confirmatory factor analysis, estimation of reliability, and analysis of measurement bias. Finally, the level of cultural competence was calculated for every professional who participated in this study.

RESULTS

The final scale include 14 items that are grouped into three dimensions concordant with the theoretical model: sensitivity to own prejudices, cultural knowledge, and skills to work in culturally diverse environments. This scale showed good fit in factor models, adequate reliability and lack of evidence of measurement bias. Regarding the performance of health care workers, sensitivity showed a lower level compared with the other dimensions evaluated.

CONCLUSION

The scale for measuring the level of cultural competence in health care workers (EMCC-14) is a reliable instrument, with initial support for its validity, which can be used in the Chilean context. Additionally, the results of this study could guide some possible interventions in the health sector to strengthen the level of cultural competence.

Nurses’ Barriers to Care of Ethnic Minorities: A Qualitative Systematic Review

Several studies have reported nurses’ challenges when caring for ethnic minority patients from diverse cultures and who have language differences. This qualitative systematic review aims to identify and describe barriers to nursing practices and to understand the common perceptions that nurses in Western countries have when providing culturally competent care to ethnic minority patients. In this review, eight qualitative, peer-reviewed studies published from 2010 to 2018 are synthesized to identify barriers to nurses’ practice with ethnic minority patients. Qualitative systematic review protocols with thematic synthesis as a methodology were employed, and five common themes were identified: communication issues; unclear, missing, or culturally inappropriate care information and resources; insufficient cultural training and education; challenging therapeutic relationships with patients; and concern about quality of care. These results suggest that future studies should explore the cost-effectiveness of cultural competency training.

Design and psychometrics cultural competence questionnaire for health promotion of Iranian nurses

INTRODUCTION

As an important factor in the quality of nursing care, cultural competence of nurses should be assessed to improve the quality of care provided. Nursing care is sensitive to culture; therefore, it is necessary to design a tool for evaluation of cultural competence. In this regard, the present study intended to develop a cultural competence questionnaire for Iranian nurses.

MATERIALS AND METHODS

In this methodological study, 350 nurses working in all educational hospitals affiliated to Tabriz University of Medical Sciences were selected through convenience sampling. Questions related to cultural care were selected by experts of this field, and a questionnaire was designed and its validity and reliability were examined.

RESULTS

A 20-item questionnaire was developed which assessed the three areas of learning and education, awareness and knowledge, and skills. Cronbach's alpha of the whole questionnaire was 0.912, and its validity based on the Kaiser-Mayer-Olkin Index was 0.891.

CONCLUSION

This study provides proper evidence regarding the strength of factor structure and the reliability of the developed questionnaire; therefore, it can be considered as a scientific tool for research, educational, and practical purposes in Iranian nurses.

One Year On: Cultural Competence of Australian Nursing Students Following International Service-Learning

BACKGROUND

The effective delivery of health care to the growing multicultural population within Australia is a challenge for the nursing profession. A breakdown in cross-cultural communication and understanding, which stems from the tendency of nurses to project their own culturally specific values and behaviors onto patients and colleagues from other countries, can contribute significantly to non-compliance in migrant populations and conflict in collegial relationships.

METHOD

The Inventory for Assessing the Process of Cultural Competence-Revised was administered to Australian undergraduate nursing students immediately before, immediately after, and 12 months after returning from international clinical placement. Data were analyzed using descriptive and inferential functions of SPSS.

RESULTS

Overall cultural competence increased immediately following the placement and was sustained over time. However, there were significant differences among the five constructs measured.

CONCLUSION

International clinical placements enhance cultural competence but targeted activities need to be undertaken pre-placement to develop specific aspects, in particular cultural desire. [J Nurs Educ. 2019;58(1):17-26.].

Testing the psychometric properties of the Finnish version of the cross-cultural competence instrument of healthcare professionals (CCCHP)

Background

To test the validity of the Finnish version of the Bernhard et al.’s Cross-Cultural Competence instrument of Healthcare Professionals (CCCHP).

Methods

The study sample comprised registered nurses (N = 810) from the Finnish “Competent workforce for the future” -project (COPE). Exploratory factor analyses and structural equation modelling were applied to test structural validity of the CCCHP. Internal consistency of the sub-scales was evaluated using the Cronbach’s alphas. Criterion validity was explored in terms of received education for multicultural work, perceived difficulty of patients, and job satisfaction variables.

Results

The revised version of the instrument including four (motivation/curiosity, attitudes, skills and emotions/empathy) of the five original dimensions provided satisfactory psychometric properties (internal consistency, a good model fit of the data). Of the four remaining competence sub-scales, motivation/curiosity, attitudes and emotions/empathy were associated with the amount of received education for multicultural work, and all with perceived difficulty of patients, and all but attitudes with job satisfaction.

Conclusion

This revised Finnish version of the CCCHP provides a useful tool for studies focusing on the healthcare personnel’s cross-cultural competence in delivering effective and culturally sensitive healthcare services for patients from different cultures.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4105-2) contains supplementary material, which is available to authorized users.

Diversity Awareness and Documentation Practices Among Oncology Advanced Practice Providers

Advanced practice providers (APPs) care for widely diverse populations. The Institute of Medicine (IOM) states that bias, prejudice, and stereotyping by a health-care provider may contribute to disparities, which are associated with worse outcomes. The IOM called for efforts to increase awareness among health-care providers. The objective of this study is to assess the cultural self-awareness of oncology APPs who practice in a community-based outpatient cancer center and investigate the extent to which APPs include cultural care into patient assessments and document this data. Oncology APPs completed a questionnaire evaluating cultural self-awareness. A prospective, quality improvement chart review was performed to analyze the extent to which cultural themes were addressed during oncology clinic visits. A list of cultural keywords was used as a guide. About 10% of the 2015 cancer population at the institution was examined, which included a stratified sample of the top six disease groups. Responses were analyzed. All APPs demonstrated average or above-average cultural awareness. Documentation of cultural assessment was low. Of the 28 cultural keyword items, an average of 4.88 items were addressed during each visit. Multiple cultural items, including literacy, language, insurance status, and belief about the disease were addressed less than 5% of the time.

The Cross-Cultural Competence Inventory: Validity and psychometric properties of the Polish adaptation

BACKGROUND

Due to changes in Polish society resulting from a significant inflow of immigrants to Poland, the need to develop the cultural competences of various professional groups who have contact with immigrants in their work has increased. These groups should include healthcare professionals, especially because of the significant increase in the number of culturally diverse patients. Therefore, medical education in Poland has had to rapidly adapt to this novel situation. For instance, the teaching process should be now more focused on the development and evaluation of the cultural competences of prospective health care workers. However, there is still a lack of standardized, valid and reliable instruments to assess cross-cultural competences among healthcare professionals. The purpose of the present paper was to describe, for the first time, the translation, adaptation, and psychometric evaluation of the Polish version of the Cross-Cultural Competence Inventory.

METHODS

Across two studies, we examined psychometric properties of the Cross-Cultural Competence Inventory (CCCI) such as reliability (i.e. internal consistency, test-retest reliability, factor structure) and validity (i.e. theoretical, criteria, convergent). In the first study, 408 participants (75% were healthcare professionals) completed the Polish version of the CCCI and the Positive/Negative Attitude Towards Culturally Divergent People Questionnaire. In the second study, 317 participants (97% were healthcare professionals) completed the CCCI twice, with an interval of at least 22 days. In addition, across two study sessions, participants completed questionnaires constructed to measure (a) cultural intelligence, (b) need for cognitive closure, (c) emphatic sensitiveness, (d) emotional intelligence, (e) self-esteem, (f) social desirability, and (g) personality. Finally, to additionally examine the theoretical validity, 36 professional cross-cultural competence trainers completed the CCCI during a one-session study.

RESULTS

Our findings confirm the reliability and validity of the CCCI. More precisely, in study 1 we proved the theoretical validity and reliability (i.e. internal consistency) of the CCCI. While the assumed structure did not fit the data well, all items were significantly related to the general factor, thus providing strong support for the usage of the total score of the CCCI. In study 2, we additionally estimated the test-retest reliability and theoretical, criterion and convergent validity. Across two studies we were able to successfully confirm these psychometric properties. The reliability was satisfactory and ranged from .83 to .86. We also observed a high and significant positive correlation between CCCI and the Cultural Intelligence Scale, which measures a concept similar to the one measured by CCCI. In addition, a significant relationship between intercultural competences (CCCI) and other variables such as personality, empathic sensitivity, emotional intelligence, self-esteem (positive correlations) and the need for cognitive closure (mainly negative correlation) were demonstrated.

CONCLUSIONS

The obtained results support the usage of the CCCI questionnaire in scientific research, such as, for example, among healthcare professionals (nurses, doctors) and students of medical fields (nursing, medicine).

Competencia cultural de enfermeras en salud pública con población indígena

Objetivo: identificar elementos de competencia cultural (CC) en las enfermeras en salud pública (ESP) cuando cuidan a población indígena emberá-chamí.Metodología: etnografía interpretativa con observación participante y entrevistas en profundidad a diez colaboradores.Análisis de datos basado en la propuesta de Leininger con apoyo de los programas ATLAS.ti y Excel.Resultados: el patrón cultural permite identificar la capacidad de las esp para analizar su propia cultura, conocer, comprender e interactuar con la cultura del indígena y mediar a través de comunicación caracterizada por empatía, adaptación del lenguaje verbal y no verbal que evidencian respeto por la singularidad indígena, en un contexto de armonía con laspolíticas institucionales basadas en la cultura indígena.Conclusión: la CC de esp es un proceso amplio, tanto de ESP con la comunidad como de la articulación con políticasinstitucionales para atender la cosmovisión indígena.

Effect of the Diverse Standardized Patient Simulation (DSPS) Cultural Competence Education Strategy on Nursing Students’ Transcultural Self-Efficacy Perceptions

Introduction: Standardized patient simulation can be an effective strategy to foster cultural competence education. Methodology: Guided by the Cultural Competence and Confidence Model, this grant-funded, longitudinal, one-group, pretest and posttest study used the Transcultural Self-Efficacy Tool (TSET) to examine the effect of the Diverse Standardized Patient Simulation (DSPS) cultural competence education strategy on students’ ( n = 53) transcultural self-efficacy. Developed by following recommended guidelines and standards, the DSPS had content validity review. It aimed to improve students’ knowledge, skills, and attitudes with regard to providing culturally competent nursing care. The statistical methods included t-tests, McNemar’s test, correlation analyses, and Mann–Whitney U-test. Results: The DSPS influenced statistically significant changes (increase) in students’ transcultural self-efficacy perceptions ( p < .05). All students regardless of background benefited from formalized cultural competence education. Discussion: Evidence-based strategies such as the DSPS can offer a valuable guide for educators to foster cultural competence education.

Exploratory Factor Analysis of the Caffrey Cultural Competency in Health Care Scale

Background and Purpose:

The purpose of this study was to psychometrically analyze the Caffrey Cultural Competence in Healthcare Scale (CCCHS), a scale that measures self-assessed cultural competency of nursing students participating in international immersion experiences during their nursing curriculum.

Methods:

A sample of 105 health professions students completed the CCCHS. Inter-item correlations, exploratory factor analysis (EFA), and Cronbach’s α were used to examine validity and reliability. Results: Results indicated that items were positively related. A 1-factor model of the CCCHS was found in which all items loaded onto a single factor at ≥ .30, except two items dealing with national policy, which may not be a component of cultural competence.

Conclusion:

The CCCHS was internally consistent (α = .93) and is a valid and reliable scale consisting of a unidimensional factor.

An Enhanced Cultural Competence Curriculum and Changes in Transcultural Self-Efficacy in Doctor of Nursing Practice Students

Purpose: The Doctor of Nursing Practice (DNP) degree is the most advanced clinical leadership role in nursing. Curricula prepare these students to design, implement, evaluate, and continuously improve high-quality culturally specific health care delivery and outcomes. Design: Guided by the cultural competence and confidence model, the Transcultural Self-Efficacy Tool was used to assess the impact of an enhanced cultural competence curriculum on transcultural self-efficacy perceptions of DNP students ( n = 54). Method: The study used a pre–post paired t test, nonexperimental design. Findings: A significant gain from pre- to postmeasure in students’ overall transcultural self-efficacy was demonstrated. Discussion: Changes in DNP students’ transcultural self-efficacy were identified after completing an enhanced cultural competence curriculum. Conclusions: Transcultural self-efficacy may be influenced by formal education and learning experiences of DNP students. Implication for Practice: Educational outcomes research can demonstrate the impact of a DNP programs curriculum on meeting national and professional goals for culturally competent nursing practice.

Nurse Competence Scale: a systematic and psychometric review

AIM

The aim of this study was to report a systematic and psychometric review.

BACKGROUND

The Nurse Competence Scale is currently the most widely used generic instrument to measure Registered Nurses' competence in different phases of their careers. Based on a decade of research, this review provides a summary of the existing evidence.

DESIGN

A systematic literature review of research evidence and psychometric properties.

DATA SOURCES

Nine databases from 2004 - October 2015.

REVIEW METHODS

We retrieved scientific publications in English and Finnish. Two researchers performed data selection and appraised the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist.

RESULTS

A total of 30 studies reported in 43 publications were included. These consisted of over 11,000 competence assessments. Twenty studies were from Europe and 10 from outside Europe. In addition to experienced nurses, the Nurse Competence Scale has been used for the competence assessment of newly graduated nurses and nursing students, mainly in hospital settings. Length of work experience, age, higher education, permanent employment and participation in educational programmes correlated positively with competence. Variables including empowerment, commitment, practice environment, quality of care and critical thinking were also associated with higher competence. The Nurse Competence Scale has demonstrated good content validity and appropriate internal consistency.

CONCLUSION

The value of Nurse Competence Scale has been confirmed in determining relationships between background variables and competence. The instrument has been widely used with experienced and newly graduated nurses and their managers. Cross-cultural validation must be continued using rigorous methods.

Predictors of cultural competence among nursing students in the Philippines: A cross-sectional study

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.

Validity and Reliability of the Turkish Version of the Nurse Cultural Competence Scale

Purpose: 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. Design: 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. Results: 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. Conclusions: Psychometric properties of the NCCS-T were highly reliable and valid. Implications for Practice: The scale can be used in the cross-cultural studies to compare nurses’ cultural competency.

Culture and Cultural Competence in Nursing Education and Practice: The State of the Art

PROBLEM

The concept of cultural competency has developed a substantial presence in nursing education and practice since first attracting widespread attention in the 1990s. While several theories and corresponding measures of cultural competency have been advanced and tried, much work remains, as many nursing professionals continue to call for greater evidence-based research and attention to patient perspectives and outcomes.

METHODS

Using a method provided by Hawker et al. to appraise articles, this paper compares nine recent (2008-2013) studies (including two composite studies) related to cultural competency, undergraduate curricula, and teaching strategies in nursing to assess the state of the art in this important area of care.

FINDINGS

The studies applied phenomenological, study abroad, online, and service learning strategies, four of which relied on some version of Campinha-Bacote's IAPCC© model. These studies reported a general improvement in competency among students, though generally only to a level of cultural awareness, and admitted being constrained by several common limitations.

CONCLUSION

Improved results and more realistic expectations in this area may require a closer understanding of the nature of the "culture" that underlies cultural competence. Harkess Kaddoura.

Cultural competence in mental health nursing: validity and internal consistency of the Portuguese version of the multicultural mental health awareness scale-MMHAS

BACKGROUND

Cultural competence is an essential component in rendering effective and culturally responsive services to culturally and ethnically diverse clients. Still, great difficulty exists in assessing the cultural competence of mental health nurses. There are no Portuguese validated measurement instruments to assess cultural competence in mental health nurses. This paper reports a study testing the reliability and validity of the Portuguese version of the Multicultural Mental Health Awareness Scale-MMHAS in a sample of Portuguese nurses.

METHODS

Following a standard forward/backward translation into Portuguese, the adapted version of MMHAS, along with a sociodemographic questionnaire, were applied to a sample of 306 Portuguese nurses (299 males, 77 females; ages 21-68 years, M = 35.43, SD = 9.85 years). A psychometric research design was used with content and construct validity and reliability. Reliability was assessed using internal consistency and item-total correlations. Construct validity was determined using factor analysis.

RESULTS

The factor analysis confirmed that the Portuguese version of MMHAS has a three-factor structure of multicultural competencies (Awareness, Knowledge, and Skills) explaining 59.51% of the total variance. Strong content validity and reliability correlations were demonstrated. The Portuguese version of MMHAS has a strong internal consistency, with a Cronbach's alpha of 0.958 for the total scale.

CONCLUSIONS

The results supported the construct validity and reliability of the Portuguese version of MMHAS, proving that is a reliable and valid measure of multicultural counselling competencies in mental health nursing. The MMHAS Portuguese version can be used to evaluate the effectiveness of multicultural competency training programs in Portuguese-speaking mental health nurses. The scale can also be a useful in future studies of multicultural competencies in Portuguese-speaking nurses.

Competence of nurses in the intensive cardiac care unit

INTRODUCTION

Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses' competences. This study aimed to explain nurses' competence in the ICCU.

METHODS

This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012-2013. Interviews were recorded, transcribed verbatim, and analyzed by using the content-analysis method.

RESULTS

The main categories were "clinical competence," comprising subcategories of 'routine care,' 'emergency care,' 'care according to patients' needs,' 'care of non-coronary patients', as well as "professional competence," comprising 'personal development,' 'teamwork,' 'professional ethics,' and 'efficacy of nursing education.'

CONCLUSION

The finding of this study revealed dimensions of nursing competence in ICCU. Benefiting from competence leads to improved quality of patient care and satisfaction of patients and nurses and helps elevate nursing profession, improve nursing education, and clinical nursing.

School Nurse Cultural Competence Needs Assessment: Results and Response

NASN conducted a needs assessment to learn about the cultural competence skills needed by school nurses. The purpose of this article is to describe the results of the needs assessment and describe actions taken to address cultural competency needs for the U.S. school nurse workforce.