Cultural competence among nursing students in three countries: A cross-sectional study
Jonas Preposi Cruz, PhD, MAN, BSN, RN; Paolo C. Colet; Joel Casuga Estacio; Helen Shaji John Cecily
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Purpose: The entire world is experiencing the highest human mobility recorded in history as indicated by the steady rise of global migration. Globalization and emigration increases cultural diversity and multiethnicity, which also enriches the cultural diversity in healthcare facilities (Perng & Watson, 2012). Moreover, migrants are often subjected to discrimination, violence and exploitation, which have a great impact to their physical and mental health. Because of this, nurses should be properly trained to provide culturally competent care that is current and responsive to the increasing challenges in the healthcare settings associated with the complexity, volume, speed, diversity and disparity among patients, in order to ensure the realization of every patient's fundamental right to health, regardless of their cultural and religious backgrounds (Cruz, Estacio, Bagtang & Colet, 2016). Thus, this study investigated the cultural competence of nursing students in three countries. It also compared the cultural competence of the students from the three countries and examined the significant predictors of their cultural competence.
Methods: A convenience sample of 723 Bachelor of Science in nursing students from India (n=265), Philippines (n=258) and Saudi Arabia (n=200) was surveyed in this descriptive, cross-sectional study. India and the Philippines have become the leading exporters of nurses to different parts of the globe. Saudi Arabia, on the other hand, has high numbers of migrants and has health care workforce that depends heavily on expatriates. Participants were recruited from nursing schools from each country where the authors have access. Data collection was conducted from January to March 2016. The Cultural Capacity Scale English (Perng & Watson, 2012) and Arabic (Cruz, Colet, Bashtawi, Mesde & Cruz, 2016) versions were used to gather data. A demographic and cultural-related variables information sheet was attached in the questionnaire. Descriptive statistics were used to fully describe the demographic characteristics and cultural-related experiences of the students. Mean (M) and standard deviation (SD) were calculated for cultural competence. ANOVA was used for comparison of cultural competence between countries, with Tukey HSD test for post hoc analyses. Pearson product moment correlation, ANOVA (with Tukey HSD test) and t-test for two independent samples were used to examine the relationship between the demographic and cultural-related variables and the cultural competence, as appropriate. Multiple regression analysis was conducted to identify the significant predictors of cultural competence. 95% confidence intervals were also calculated and reported. All statistical analyses were performed at 0.05 level of significance.
Results: The mean age of the respondents was 20.05±2.19 years. Majority were females (75.8%), had not participated in diversity training (62.2%), had not taken care of culturally diverse patients (59.5%) and were not living in culturally diverse environment (68.2%). Contrarily, majority had experienced taking care of patients with special needs (68.0%).
The overall cultural competence mean score was 66.07 (SD = 15.19). Individually, Indian students had a cultural competence mean score of 64.68 (SD = 17.28), while Filipino and Saudi students had 68.63 (SD = 12.18) and 64.62 (SD = 15.37), respectively. Indian students reported highest competence in teaching and guiding others about planning nursing interventions for diverse clients (M = 3.46, SD = 1.11), while Filipino and Saudi students reported highest competence in understanding the beliefs of different cultural groups (M = 3.61, SD = 0.88) and in using examples to illustrate communication skills with diverse clients (M = 3.45, SD = 1.08), respectively. On the other hand, familiarity in health- or illness-related cultural knowledge or theory received the lowest mean from the Indian (M = 2.86, SD = 1.17) and Saudi (M = 3.01, SD = 0.99) students, while competence in comparing the health or illness beliefs (M = 3.31, SD = 0.79) and identifying the care needs of clients with diverse cultural backgrounds (M = 3.31, SD = 0.77) received the lowest score from the Filipino students. Overall, Filipino students reported higher cultural competence than students from India and KSA (F(2, 720) = 5.75, p = 0.003). Significant differences were also identified in the individual scale-items when students were grouped by country of residence.
Bivariate analyses revealed significant relationship between the demographic characteristics and the cultural competence of the respondents. There was a weak positive correlation between the age and the cultural competence of the students (r = 0.18, p <0.001). Furthermore, the cultural competence significantly vary between academic year level of the students (F(2, 720) = 37.31, p < .001). Tukey HSD test revealed students in the fourth year (M = 72.23, SD = 12.20) of the BSN program had significantly higher cultural competence than students in the third year (M = 62.97, SD = 16.68, p<0.001) and second year (M = 62.17, SD = 14.46, p < .001). On the other hand, analyses have shown that cultural-related variables were significantly associated with the cultural competence of the respondents. Specifically, students who had attended diversity training in the last 12 months (M = 71.50, SD = 16.86) had significantly higher cultural competence than those who had not attended (M = 62.78, SD = 13.04), t = -7.32, p < .001. Students who had experienced providing care to patients from other race or ethnic group in the past 12 months (M = 75.06, SD = 11.17) had likewise higher cultural competence than students who did not have similar experience (M = 59.95, SD = 14.51), t = -15.80, p < .001. Moreover, students living in an environment with people with diverse race/ ethnicity (M = 74.77, SD = 12.74) were culturally more competent than students who were not living in a culturally diverse environment (M = 62.02, SD = 14.53), t = -11.97, p < .001. Finally, those students who had taken care of patients belonging to special population groups in the past 12 months (M= 68.01, SD = 15.23) reported higher cultural competence than those without similar experience (M = 61.94, SD = 14.278), t = -5.10, p < .001.
A multiple regression analysis was conducted to identify the significant predictors of cultural competence among the students in this study. The multiple regression analysis revealed country of residence, gender, academic level, experience of taking care of diverse patients and living in culturally diverse environment as significant predictors of the students’ cultural competence (F (10, 712) = 41.36, p < .001), accounting for approximately 35.9% of the total variance of cultural competence (R2=0.367; Adjusted R2=0.359). Specifically, being a student from the Philippines and India increased the cultural competence by 6.84 (95% CI = 4.23-9.45, p < .001) and 5.88 (95% CI = 2.97-8.79, p < .001), respectively, than being students from Saudi Arabia. Being male student increased the cultural competence by 2.33 (95% CI = 0.04-4.63, p = .046) than being female students. Furthermore, being in the fourth year of the BSN program increased the cultural competence by 5.23 (95% CI = 2.43-8.02, p < .001) than being in the second year. Lastly, having experienced providing care for a patient from other race or ethnic group in the past 12 months and living in an environment with people with diverse race/ ethnicity increased the cultural competence by 13.61 (95% CI = 11.39-15.84, p < .001) and 6.25 (95% CI = 3.95-8.56, p < .001), respectively, than those students who did not have similar experiences.
Conclusion: The findings suggest that the cultural competence of the nursing students from the three countries had varying levels. This implies that appropriate interventions must be planned and implemented to address the specific needs of students from each country. The significant factors that were identified in this study should also be taken into consideration in planning educational intervention to ensure the development of cultural competence among the students. Moreover, assessment of cultural competence development among students should also be done regularly to monitor their progress. Lastly, cultural diversity and cultural competence should be incorporated in both classroom and clinical courses of the students throughout the nursing program to ensure a continuous development of their cultural competence.
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship
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