Development and Psychometric Evaluation of the Korean Version of the Cultural Competence Scale for Clinical Nurses

The importance of multiculturalism in medical education: a global comparison of perspectives from medical and health professions students at 21 universities

Objectives

This study aims to quantitatively assess the baseline level of self-perceived cultural competency preparedness and skillfulness among medical and health professions students from 21 universities around the world utilizing a previously validated and standardized testing tool.

Design

Cross-sectional study.

Setting

The International Collaboration and Exchange Program (ICEP), a global exchange initiative for junior medical and health professions students spanning 21 universities across four continents.

Participants

A total of 753 students from the 2021 and 2022 ICEP cohorts.

Main Outcome Measures

Students self-evaluated their cultural competency skills on a 5-point Likert-type scale encompassing different areas of competency. Multiple linear regression was performed to identify contributors to cultural competency levels.

Results

Upon rating how skillful they are at interacting with culturally diverse patients, North American students reported the highest scores with a mean of 3.22, while Australian students showed the lowest score of 2.82. When analyzing students' stages of study, those in clinical years of medical schools scored the highest at 3.29. Significant variations were observed in the cultural competency self-rating scores among students based on their respective regions (p < .005) and program types/stages (p < .05). Notably, students in their clinical years of school consistently rated themselves higher compared to their preclinical counterparts (p < .05). Furthermore, students from Europe displayed elevated self-ratings compared to the other regions (p < .005).

Conclusions

Though these participants represent a highly motivated subgroup of students, potentially limiting result generalizability, the findings emphasize that regional differences exist. Given the multifaceted nature of cultural competency, the results suggest that factors such as educational stage, age, and region may influence students' perceived competency levels.

Do individual or organizational factors influence cultural competency of maternal newborn nurses?: a cross-sectional study

PURPOSE

Cultural competency is a very important ability of nurses in women's hospitals in providing nursing care during pregnancy and childbirth. This study explored how multicultural attitudes, multicultural efficacy, intercultural communicative competency, and hospital support for cultural competency influence the cultural competency of nurses in women's hospitals.

METHODS

A cross-sectional correlational study design was used. The study involved 150 nurses from five women's hospitals located in Gyeongsangbuk-do and Gyeongsangnam-do, South Korea. Participants completed a packet of structured self-report questionnaires, which included the Korean version of the Cultural Competence Scale for Clinical Nurses, the Multicultural Attitude Scale Questionnaire, the Intercultural Communicative Competence Questionnaire, the Transcultural Self-Efficacy Scale, and the Organizational Support among Cultural Competence Assessment Instrument. We analyzed the collected data using descriptive statistics, the t-test, one-way analysis of variance, Pearson correlation coefficients, and hierarchical multiple regression analysis.

RESULTS

Among the general characteristics, educational level, religion, and experience with overseas travel were identified as factors influencing cultural competency. In the final model, multicultural attitudes (β=.46, p<.001) and intercultural communicative competency (β=.19, p=.025) emerged as significant individual factors that affected cultural competency. This model accounted for 49.8% of the variance in cultural competency.

CONCLUSION

This study identified multicultural attitudes and intercultural communicative competency as significant individual factors contributing to the cultural competency of nurses in women's hospitals. Therefore, enhancing these nurses' multicultural attitudes and intercultural communicative competency is essential for improving their overall cultural competency.

Ecological predictors of cultural competence among nurses in the neonatal intensive care unit: A cross-sectional descriptive study

Active migration and globalization have led to increased opportunities for critical care nurses to care for patients from diverse racial and cultural backgrounds. This study thus aimed to identify the individual, interpersonal, and organizational factors affecting cultural competence levels among neonatal intensive care unit (NICU) nurses based on an ecological model. This was a cross-sectional descriptive study that included 135 NICU nurses in South Korea. A hierarchical multiple linear regression analysis was conducted using the proposed ecological model, and a regression model for each of the four subdomains of cultural competence was constructed and compared. NICU nurses' cultural competencies were influenced not only by the "necessity of multicultural education" and "ethnocultural empathy" at the individual level but by the "hospital's readiness and support for cultural competencies" at the organizational level. To promote the cultural competence of nurses in critical care settings, environmental and organizational support should be improved, along with developing strategies that focus on nurses' individual characteristics. It is also necessary to investigate the "intersectionality" of the effects of individual and environmental factors on cultural competence.

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.

Psychometric properties of the Persian version of the Cultural Competence Scale in Clinical Nurses

AIM

Cultural competence is a crucial component of nursing competency, and a valid and reliable scale is needed to measure it. This study was conducted to investigate the psychometric properties of the Persian version of the Cultural Competence Scale among Iranian clinical nurses.

DESIGN

A methodological design was used.

METHODS

The scale was translated into Persian, and its content, face and construct validity, and reliability were examined.

RESULTS

Two items with a content validity ratio of 0.6 were removed. In the case of the content validity index, one item with a content validity index lower than 0.70 was removed. The mean content validity index for the scale was reported as 0.99. All 31 items with an impact score index higher than 1.5 were approved. The exploratory factor analysis revealed four factors explaining 59.92% of the total variance. Cronbach's alpha and the intraclass correlation coefficient were calculated at 0.95 and 0.94, respectively.

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.

A multilevel investigation of cultural competence among South Korean clinical nurses

BACKGROUND

There is lack of empirical evidence on whether organisational variables affect the cultural competence of nurses.

AIM

This study aimed to investigate individual and organisational characteristics associated with South Korean clinical nurses' cultural competence.

METHODS

A descriptive cross-sectional research design was used. A convenient sample of 401 clinical nurses from 21 hospitals in South Korea was recruited between November 2015 and February 2016. Multilevel modelling was used to estimate the effects of individual- and organisation-level predictors. Data were analysed using the nlme package in R.

RESULTS

Multilevel modelling indicated that professionalism (β = 0.02, p < 0.001) and foreign language fluency (β = 0.25, p = 0.012) were significant individual-level predictors. Education on foreign patient care was marginally significant at p = 0.069. At the organisational level, nurse-to-patient ratio (β = 0.37, p = 0.038) and organisational cultural competence (β = 0.02, p < 0.001) were significant predictors. In addition, hospital ownership and work environment were marginally significant at p = 0.054 and p = 0.050, respectively. Furthermore, there was a significant cross-level interaction between professionalism and hospital ownership (β = 0.03, p = 0.003).

CONCLUSION

To provide culturally competent care, nurse leaders should recognise the importance of organisational-level factors, such as nurse staffing and organisational cultural competence, and create an environment that is inclusive of diverse patients, as well as promote professionalism among individual nurses.

Developing and validating the Nursing Cultural Competence Scale in Taiwan

Background

Culture influences personal health habits and behavior, and healthcare personnel possess different views of cultural perspectives. Currently, an appropriate instrument to assess cultural competence in clinical practice is limited. The present study aimed to develop and examine the psychometric properties of the Nursing Cultural Competence Scale (NCCS) for clinical nurses.

Methods

Developing and assessing the scale was carried out in two phases: Phase I involved a qualitative research to explore the themes of nurses’ cultural competence and instrument development; Phase II established construct validity of the scale using a sample of 246 nurses in Taiwan. Data from the questionnaire were analyzed using exploratory factor analysis, confirmatory factor analysis, internal consistency and test-retest reliability. Analysis results were used to determine the reliability and validity of the developed scale.

Results

The results showed four factors including cultural awareness ability, cultural action ability, cultural resources application ability, and self-learning cultural ability were generated by exploratory factor analysis, and these factors explained 62.0% of total variance. Cronbach’s α of the Nursing Cultural Competence Scale was .88, and test-retest reliability correlation was .70.

Conclusions

The establishment of the tool will facilitate accurate monitoring of the cultural competence among nurses and nursing managers, which can inform the construction of nursing policies aimed at pledge cultural competence expansion.

Perceptions of the critical cultural competence of registered nurses in Canada

BACKGROUND

Cultural diversity often leads to misunderstandings, clashes, conflicts, ethnocentrism, discrimination, and stereotyping due to the frequent intersection of many variables, such as differences in traditions, behaviours, ethical and moral perspectives, conceptions of health and illness, and language barriers. The root of the issue is related to the way people conceptualise differences and the unique cultural and historical circumstances that have shaped different groups' heritages. In this study, therefore, we aimed to investigate the perceptions of critical cultural competence (CCC) of registered nurses working in various hospitals across the province of British Columbia, Canada.

METHOD

Data were collected using Almutairi's Critical Cultural Competence Scale (CCC Scale) with a random sample of 170 registered nurses. This scale measures four essential multidimensional components of the CCC model: critical awareness, critical knowledge, critical skills, and critical empowerment. Data were analysed using descriptive and inferential statistics (Kruskal-Wallis test).

RESULTS

The data revealed that participants' perceptions of CCC were positive with a mean score of 5.22 out of 7.00 for the total number of items (n = 43) and a standard deviation of 0.54. The mean scores for the CCC subscales ranged from 4.76 (for critical skills) to 5.42 (for critical empowerment). The results indicated a statistical difference in CCC perceptions based on participants' age and country of birth with p = 0.05 < 0.05 and 0.029 < 0.05, respectively.

CONCLUSION

Nurses' age (experience) and country of birth may influence their perceptions of CCC as gaining cultural competence requires exposure to caring for patients from various cultures and countries, and is associated with cultural knowledge and awareness. Therefore, this finding reveals that healthcare organizations must provide ongoing cultural education programs to increase their nursing staff's level of cultural competence so they are better able to deal with the difficulties that might arise during cross-cultural interactions.

Evaluation of the psychometric properties of the Korean version of the Cultural Competence Assessment

AIM

The 25 item Cultural Competence Assessment assesses the cultural competence of multiple types of healthcare providers. This study aimed to examine the validity and reliability of the Korean version of the questionnaire (KCCA) and to determine the need for changes to improve its validity and reliability.

METHODS

Data from 161 hospital nurses were used for the item analysis and to assess the reliability and construct validity of the KCCA before and after the deletion of nine items.

RESULTS

The KCCA did not demonstrate acceptable construct validity and subscale internal reliability. Nine items with high interitem correlations, high modification indices, and relatively lower factor loadings were deleted. The 16 item Modified KCCA showed improved construct validity, convergent and discriminant validity, and reliability.

CONCLUSION

While further psychometric evaluation of the Modified KCCA should be undertaken with larger samples and diverse professionals, the study's data provide evidence that the Modified KCCA might be a more suitable measure for use among Korean healthcare providers.