Developing and validating the Nursing Cultural Competence Scale in Taiwan

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.

The Effects of the Situated Simulation Program on the Cultural Competence of Hemodialysis Nurses: A Quasi-Experimental Study

The rise in the number of hemodialysis (HD) patients underscores the importance of culturally competent HD nurses. This study aimed to examine the effectiveness of a situated simulation program on HD nurses' cultural competence. This was a quasi-experimental pilot study with a total of 40 participants who met the inclusion criteria from an HD center in northern Taiwan. Participants took part in two separate 3 h education programs. The first program focused on the basic concepts of cultural competence, while the second program involved situated simulations utilizing the Gather-Analyze-Summarize (GAS) method of debriefing. The generalized estimating equations (GEEs) were employed to estimate the intervention effect. The baseline scores were divided into low-score and high-score groups using the median score for subgroup analysis. The subgroup analysis revealed that a significant group-time interaction was identified regarding cultural competence and subscale, verifying the situated simulation's immediate effect. In this study, an integration of the GAS method of debriefing and situated simulation teaching was implemented. The results showed that this approach empowered HD nurses with the ability to foster positive attitudes and demonstrate professional expertise in an organized manner when facing similar clinical scenarios in the future.

Hospital Nurses' Experiences of Providing Care for Muslim Patients in the United States

INTRODUCTION

Understanding a patient's culture is imperative to providing holistic patient care. The purpose of the study is to describe and explore the lived experiences of non-Muslim hospital-employed registered nurses providing care for Muslim patients in the United States.

METHOD

This study used a qualitative exploratory research design based on semi-structured interviews utilizing Husserlian phenomenology. A snowball technique was used to recruit the participants.

RESULTS

Ten nurses who cared for hospitalized Muslim patients were interviewed and three major themes emerged from the participants' narratives: Nurse-Patient Relationship, Nurses' Knowledge and Western Health Care Systems, and Family Influence.

DISCUSSION

Muslim patients have cultural expectations and differences that may not be anticipated by nurses, which affects nurses' experiences when providing care. As the Muslim population continues to grow in the United States, there is a need for increased education on culturally congruent care to assure the highest quality of nursing care.

Development and validation of cultural competence assessment tool for healthcare professionals, India

Culture influences an individual's perception of "health" and "sickness". Therefore, cultural competence assessment of healthcare professionals is very important. Existing assessment scales have limited application in India due to the nation's rich cultural diversity and heterogeneous healthcare streams. This study was undertaken to develop and validate a cultural competence assessment tool for healthcare professionals in India. A cross-sectional study using convenience sampling was conducted following all standard steps among 290 healthcare professionals in India. Item reduction was followed by estimation of validity and reliability. Responses were recorded on a five-point Likert scale, ranging from strongly disagree to strongly agree. The resultant tool, named Cultural Competence Assessment Tool-India (CCT-I) showed an acceptable internal consistency (Cronbach's alpha =0.734). Inter-rater agreement was 81.43%. Face, content, and construct validity were demonstrated. There was no statistically significant difference in cultural competence between the healthcare streams based on years of clinical experience. There was statistically significant difference between streams of healthcare (p-value =0.009) and also between dentistry and Ayurveda groups (p-value = 0.003). This comprehensive tool can be used as the first step toward designing cultural competence training of healthcare manpower and the establishment of culturally sensitive healthcare organizations.

Protocol for evaluating external facilitation as a strategy to nationally implement a novel stigma reduction training tool for healthcare providers

Background

Identity Development Evolution and Sharing (IDEAS) is a theatre-based intervention for reducing healthcare provider stigma. IDEAS films are created by collecting narratives from people who have experienced discrimination and healthcare inequity, partnering with professional playwrights to create theatrical scripts that maintain the words of the narratives while arranging them into compelling storylines involving several interviews, and hiring professional actors to perform and record scenes. IDEAS implementation requires a moderator to establish a respectful learning environment, play the filmed performance, set ground rules for discussion, and moderate a discussion between healthcare providers who viewed the film and invited panelists who are members of the minoritized population being discussed. IDEAS’ impact on provider stigma is measured via pre/post Acceptance and Action Questionnaire – Stigma (AAQ-S) data collected from participating providers. The objectives of this manuscript are to provide narrative review of how provider stigma may lead to healthcare inequity and health disparities, describe the conceptual frameworks underpinning the IDEAS intervention, and outline methods for IDEAS implementation and implementation evaluation.

Methods

This manuscript describes a hybrid type 3 design study protocol that uses the Consolidated Framework for Implementation Research (CFIR) to evaluate external facilitation, used as an implementation strategy to expand the reach of IDEAS. CFIR is also used to assess the impact of characteristics of the intervention and implementation climate on implementation success. Implementation success is defined by intervention feasibility and acceptability as well as self-efficacy of internal facilitators. This manuscript details the protocol for collection and evaluation of implementation data alongside that of effectiveness data. The manuscript provides new information about the use of configurational analysis, which uses Boolean algebra to analyze pathways to implementation success considering each variable, within and across diverse clinical sites across the USA.

Discussion

The significance of this protocol is that it outlines important information for future hybrid type 3 designs wishing to incorporate configurational analyses and/or studies using behavioral or atypical, complex, innovative interventions. The current lack of evidence supporting occupational justice-focused interventions and the strong evidence of stigma influencing health inequities underscore the necessity for the IDEAS intervention.

Psychometric evaluation of a nursing competence assessment tool among nursing students: a development and validation study

BACKGROUND

Nursing competence refers to the core abilities that are required for fulfilling one's role as a nurse. A specific instrument comprehensively measuring competence among nursing students has not yet been developed. The purpose of the study was to develop and validate a nursing competence instrument for nursing students in bachelor training.

METHODS

A descriptive and explorative study design was used. Data were collected from students at one medical college in Taiwan in 2020 and 2021. A total of 241 nursing students participated in this study. We developed the initial instrument through systematic review, expert evaluations, and pilot versions. Its validity was then tested using confirmatory factor analysis (CFA) and criterion-related validity, while its reliability was tested using Cronbach's alpha and test-retest analysis.

RESULTS

The final fit indexes of CFA were as follows: chi-square = 860.1 (p < 0.01), normed chi-square = 2.24, SRMR = 0.04, RMSEA = 0.07, CFI = 0.94, and TLI = 0.94. Cronbach's alpha values for the subscales observed ranged from 0.91 to 0.98. The test-retest reliability coefficient for the Nurse Competence Scale was 0.515 (n = 30, p < 0.01).

CONCLUSIONS

The instrument exhibited acceptable psychometric properties, thereby proving itself a valuable tool for evaluating nursing students' competence at bachelor training. Further assessments of its reliability, validity, and generality from mentors' and scholars' views in different contexts and cultures are recommended.

Resilience and Anxiety Among Healthcare Workers During the Spread of the SARS-CoV-2 Delta Variant: A Moderated Mediation Model

INTRODUCTION

The B.1.617.2 (Delta) variant of SARS-COV-2 has caused a surge in COVID-19 cases worldwide, placing a great burden on the health care system under the zero-tolerance epidemic prevention policy in China. The present study aimed to investigate the prevalence of anxiety among health care workers during the spread of the SARS-CoV-2 Delta variant, and to discuss the mediating role of positive coping style between resilience and anxiety, and the moderating role of general self-efficacy.

METHOD

Connor-Davidson Resilience scale (CD-RISC), Generalized Anxiety Disorder Scale (GAD-7), General Self-efficacy Scale (GSES) and Simplified Coping Style Questionnaire (SCSQ) were used in this cross-sectional study among 390 healthcare workers in Jiangsu Province, China. Mackinnon's four-step procedure was applied to test the mediation effect, and Hayes PROCESS macro was conducted to examine the moderated mediation model.

RESULTS

The prevalence of anxiety among Chinese healthcare workers during the spread of the SARS-CoV-2 Delta variant was 41.8%. Male, unmarried, childless and younger subjects reported higher levels of anxiety. Positive coping partially mediated the effect of resilience on anxiety among healthcare workers and the indirect effect was stronger with the increase of general self-efficacy.

CONCLUSIONS

Anxiety was prevalent among healthcare workers during the spread of SARS-CoV-2 Delta variant. This research sheds new light on the potential mechanism underlying the association between resilience and anxiety and provides new insight into the prevention of anxiety among healthcare workers during the spread of the SARS-CoV-2 Delta variant.

Cultural adaptation and validation of the Transcultural Self-Efficacy Tool for use with undergraduate nursing students in Spain

BACKGROUND

The provision of culturally competent care helps reduce healthcare inequalities. There is a positive association between the cultural competence of nursing professionals and patient satisfaction, and also between nurses' self-efficacy and patients' adherence to treatment. While training in this respect is important, the self-assessment of skills should also be addressed.

AIMS

To produce a culturally-validated Spanish-language version of the Transcultural Self-Efficacy Tool (TSET) for use in undergraduate nursing studies, and to evaluate its implementation within the Spanish educational system.

METHODS

This cultural adaptation and psychometric validation study was carried out with student nurses from two universities. International standards were followed for the translation and cultural adaptation of the questionnaire. All students completed the questionnaire twice, the second time 14 days after the first. Those who took the Transcultural Care course at the University of Málaga also completed the questionnaire a third time, after concluding this study subject. The reliability, discriminatory capacity, stability and sensitivity to change of the questionnaire were tested and confirmed, and a confirmatory factor analysis was performed.

RESULTS

A total of 286 students took part in this study. Overall, the TSET obtained a reliability score of 0.978, according to Cronbach's alpha test. In relation to nationality of origin, the discriminatory capacity of the questionnaire was -1.067 (-1815 a -0,320) = 0.005. Stability, assessed at 14 days using the intraclass correlation coefficient, was 0.901 (0.873 a 0.923) <0.001. The before-after sensitivity to change for those who took the Transcultural Care course was 1.820 (1558 a 2083) <0.001.

CONCLUSIONS

This Spanish-language version of the TSET is culturally suitable for the educational context of undergraduate nursing students in Spain, and its psychometric validation was performed with satisfactory results.

Development and testing of the shared decision-making attitudes scale among nurses in Taiwan: a cross-sectional scale development study

OBJECTIVE

Shared decision-making (SDM) enhances medical care, but an appropriate tool for evaluating nursing staff's attitudes towards SDM in clinical practice is lacking. The objective of this study is to develop the Nursing Shared Decision-Making Attitude (NSDMA) scale and verify its psychometric properties.

DESIGN

Instrument design study.

PARTICIPANTS

A sample of 451 nursing staff.

INTERVENTION

This study comprised two phases. In phase 1, qualitative research and expert content validity were adopted to develop the first draft of the scale. In phase 2, Taiwanese nursing staff were recruited through convenience sampling, and the sample was divided into a calibration sample and a validation sample. An objective structured clinical examination of SDM attitudes was administered to 100 nursing staff to determine the scale's cut-off score.

MAIN OUTCOME MEASUREMENTS

Exploratory factor analysis and confirmatory factor analysis were used to obtain the underlying factors of the NSDMA scale; McDonald's omega value was used to determine the reliability; known-group validity was used to test the construct validity; and the receiver operating characteristic curve was adopted to determine the scale's cut-off score.

RESULTS

In total, two factors were identified from the instrument results, which were termed 'empathic communication' and 'mastery learning'. The McDonald's omega value of the overall scale was 0.92. Known-group validity testing was performed based on the staff's participation in SDM courses and experience of SDM, and the results exhibited significant differences (t=5.49, p<0.001; t=2.43, p<0.05). Based on the receiver operating characteristic curve, the optimal cut-off for SDM attitudes was determined as 48.5 points.

CONCLUSIONS

The NSDMA scale enables the evaluation of SDM attitudes among clinical nursing staff and nursing managers; the results may serve as a reference for incorporation of SDM into nursing policy formulation.

Nurse Cultural Competence-cultural adaptation and validation of the Polish version of the Nurse Cultural Competence Scale and preliminary research results

Introduction

Measuring 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.

Purpose

The 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 method

An 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.

Results

Moderate 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<0.001. The four-factor structure is affirmed by the Kaiser criterion and the scree test result.

Conclusions

The NCCS-P psychometric properties were highly reliable and significant because of the opportunity for using them for research in Poland.

Practical implications

The scale can be used in intercultural research for comparing cultural competence of nurses, including Polish ones. This scale facilitates the precise monitoring of cultural competence among nurses and nurse managers, which may help in developing nursing policies geared toward a commitment to expanding cultural competence.

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.