Swedish version of measuring cultural awareness in nursing students: validity and reliability test

Cross-Cultural Information for Japanese Nurses at an International Hospital: A Controlled Before-After Intervention Study

This study sought to evaluate the efficacy of providing health information through an ordinary travel guidebook combined with a short digital video compared with an ordinary travel guidebook alone by measuring the anxiety levels of Japanese nurses dealing with foreign patients. We conducted a controlled before-after intervention study in 2016 at a major international hospital in Japan. We created two interventions: (1) a brief piece of health information from a travel guidebook for Japan, (2) the same travel guidebook, and a four-minute digital video in English on health information in Japan, titled Mari Info Japan for nurses. After each intervention, we assessed the nurses' levels of anxiety about caring for foreign patients. We evaluated the results through statistical testing and the State-Trait Anxiety Inventory Form Y. Of 111 nurses, 83 (74.8%) completed both interventions and the questionnaires. The second intervention (the guidebook and video) proved more effective than the first (the guidebook) for reducing anxiety related to caring for foreign patients. Japanese nurses can lower their anxiety about dealing with foreign patients by learning about the content of various forms of health care information currently accessible to overseas visitors. Using both guidebooks and digital videos can help to reduce nurses' anxiety.

Understanding Motivation, Career Planning, and Socio-Cultural Adaptation Difficulties as Determinants of Higher Education Institution Choice Decision by International Students in the Post-pandemic Era

The world is facing an unprecedented health crisis with the spread of COVID-19 across different corners of the globe. This pandemic has raised more significant concerns about international students’ learning environment, personality development, and career planning, particularly in high-ranked institutes in China. Now the question concerning this dilemma is, would the COVID-19 pandemic negatively affect students’ education and the country culture where they are bound to seek information and the subject education? Therefore, this study examines the impact of innovative learning environment, career planning, and socio-cultural adaptation-related difficulties faced by international students as determinants of higher education institution choice decisions made by international students in the post-pandemic era. This quantitative study examined international students in high-ranked universities across China. The data from 260 students were collected through a structured questionnaire and analyzed using the AMOS technique. Moreover, it has been observed that the current global health crisis has intensified social inequalities across different international higher education systems. Countries fail to maintain the scale of the innovative international learning environment. The results further indicated that international students are more considerate of innovative learning environments, cultural adoption, career planning, and personality development, specifically after the outbreak of the COVID-19 pandemic, which has drastically affected the global higher education system. Unusually, more than half of the participants wanted to maintain the option of overall distance education after the pandemic. However, apart from this argument, it is appropriate to demand significant changes in post-pandemic education adapted to the post-digital era and to satisfy the concerns and expectations of the students.

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.

Clinical Relevance and Psychometric Properties of the Swedish Version of the Cultural Competence Assessment Instrument

Based on the increasing diversity of Swedish society, health professionals, like occupational therapists, find it challenging to provide culturally competent services to international clients. Consequently, cultural competence among professionals needs to be measured and improved using psychometrically tested instruments. This study examines the clinical relevance, construct validity, and reliability of the Swedish version of the Cultural Competence Assessment Instrument among Swedish occupational therapists. Material and Methods. A randomised sample of 312 Swedish occupational therapists answered a survey based on the Swedish version of the Cultural Competence Assessment Instrument with supplementary questions on the clinical relevance of the instrument. Descriptive statistics were used to examine the clinical relevance of the Swedish version of the Cultural Competence Assessment Instrument. Factor analyses, both exploratory and confirmatory, were run to examine the factor structure. Cronbach's alpha was performed to assess the internal consistency of the instrument. Results. The participants reported that the 24 items had high clinical relevance. The validation yielded a three-factor model: openness and awareness, workplace support, and interaction skills. All three of these factors showed high loadings. Conclusions. The study results indicated positive clinical relevance and psychometric properties for the Swedish version of the Cultural Competence Assessment Instrument and strong support to be utilised in Sweden. The implications of this study are important given the rapid growth in migration over the last few decades. A self-rating instrument measuring cultural competence could support occupational therapists' professional knowledge and development when they interact with international clients. As the tool was originally developed in English in the United States, the feedback from the Swedish version could potentially be useful for the instrument in modified form and for use by occupational therapists in English-speaking countries.

"Cultural awareness requires more than theoretical education" - Nursing students' experiences

Cultural awareness in healthcare providers is considered one of the most important factors in improving the efficiency and quality of care in a diverse population. Thus, education in cultural awareness needs to be an essential component in nursing education. This study, which uses a qualitative design, aimed to investigate cultural awareness in nursing students in Sweden. Focus groups were used to collect data from 12 students. Three categories were identified as follows after qualitative data analysis of the interviews: 1) desire to learn, 2) learning by doing and 3) caring beyond boundaries. The result clearly indicates that students are willing to learn more about how to care for people with different cultural backgrounds. However, this learning is not always available in official lecture-based education. In fact, most awareness about cultural aspects of healthcare is developed from practice and informal education. Finally, the result also revealed the importance of nurses being able to see the individual beyond the culture, and being aware of their own prejudice. In conclusion, education offers limited opportunities for nursing students to become culturally aware. Nursing education can be improved by strengthening both theoretical and practical tasks involving cultural awareness.