Cultural competence and racist attitudes of direct patient care registered nurses in a Midwestern state

Abstract

Racism has been implicated as one of the causes of health disparities in non-White population groups in the United States. The purpose of this study was to explore and describe cultural competence and racist attitudes of direct patient care registered nurses (DPC RNs) in a Midwestern state. The researcher hypothesized that racist attitudes impacted cultural competence, compromised the nurse-patient interaction, and potentially led to less than optimal patient outcomes.

Critical Social Theory and Leininger's Theory of Culture Care Diversity and Universality served as the framework for this quantitative, descriptive correlational dissertation research. Cultural competence was measured with the Cultural Competence Assessment (CCA) instrument and racist attitudes were measured with two subscales of the Quick Discrimination Index (QDI). These instruments, with the Marlowe-Crowne Social Desirability Scale-C, were administered to participants using Survey Monkey, a secure, web-based survey site.

Results suggest that DPC RNs in this sample possess a less than optimal level of cultural competence and that racist attitudes are present at a level that requires acknowledgement and attention by the discipline of nursing, particularly nursing education. Further, as age of the RN increased, cultural competence increased as did racist attitudes. These older RNs displayed cultural competence but with underlying racist attitudes. Cultural competence education alone has not addressed the issue of racism in nursing. Results demonstrated a weak correlation between cultural competence and racist attitudes: over the complete sample of RNs, as cultural competence increased, racist attitudes decreased. This finding implies that cultural competence education has some impact on racist attitudes but not at the level necessary to eliminate racism in nursing.

Nurse educators in the academic setting are encouraged to facilitate curricular changes based upon the principles of social justice. This includes all types of discrimination but with a focus on racism—individual, cultural, and institutional—in particular. Nurse educators in the practice setting are called upon to consistently and intentionally include racism and antiracism content in the required continuing education offerings related to cultural competence and transcultural nursing.