Development and Cross-Validation of the Short Form of the Cultural Competence Scale for Nurses

Psychometric evaluation of the Chinese version of the BENEFITS-CCCSAT based on CTT and IRT: a cross-sectional design translation and validation study

Background

The importance of culturally competent care in multicultural environments is increasingly recognized; however, effective tools to assess nursing students' cross-cultural competence remain limited. This study aimed to validate the BENEFITS-CCCSAT for Chinese nursing students.

Methods

The original BENEFITS-CCCSAT was translated, back-translated, culturally adapted, and pre-tested using the Brislin model to form a Chinese version. A combined approach of classical test theory (CTT) and item response theory (IRT) was then used for multidimensional validation.

Results

The CTT analysis showed that the C-BENEFITS-CCCSAT had a Cronbach's α coefficient of 0.80, dimension reliability values ranging from 0.700 to 0.905, a test-retest reliability value of 0.881, and a scale-level content validity index (S-CVI) value of 0.928. The criterion-related validity value was 0.619. The confirmatory factor analysis (CFA) indicated a good model fit (CMIN/DF = 1.071, RMSEA = 0.08), with factor loadings ≥0.50. The Rasch analysis showed an item reliability value of 1, person reliability values ranging from 0.76 to 0.89, item separation index values ranging from 17.37 to 60.34, and person separation index values ranging from 1.76 to 2.89. The information-weighted fit statistic mean square (infit MNSQ) and outlier-sensitive fit statistic mean square (outfit MNSQ) values for all items ranged from 0.86 to 1.27. Overall, the scale demonstrated good reliability and validity for the Chinese nursing students.

Conclusion

The 25-item C-BENEFITS-CCCSAT demonstrates good reliability and validity and can be applied in educational settings to assess students' ability to provide culturally competent care. Future studies should test the scale in culturally diverse populations to further determine its applicability and generalizability.

Development of a lesbian, gay, bisexual, and transgender cultural competence scale for nurses in South Korea: a methodological study

PURPOSE

This study was conducted to develop a cultural competence scale for nurses regarding the lesbian, gay, bisexual, and transgender (LGBT) community and to test its validity and reliability.

METHODS

The study adhered to the 8-step process outlined by DeVellis, with an initial set of 25 items derived through a literature review and individual interviews. Following an expert validity assessment, 24 items were validated. Subsequently, a preliminary survey was conducted among 23 nurses with experience caring for LGBT patients. Data were then collected from a final sample of 322 nurses using the 24 items. Item analysis, item-total score correlation, examination of construct and convergent validity, and reliability testing were performed.

RESULTS

The item-level content validity index exceeded .80, and the explanatory power of the construct validity was 63.63%. The factor loadings varied between 0.57 and 0.80. The scale comprised five factors: cultural skills, with seven items; cultural awareness, with five items; cultural encounters, with three items; cultural pursuit, with three items; and cultural knowledge, with three items; totaling 21 items. Convergent validity demonstrated a high correlation, affirming the scale's validity. Internal consistency analysis yielded an overall reliability coefficient of 0.97, signifying very high reliability. Each item is scored from 1 to 6 (total score range, 21-126), with higher scores reflecting greater cultural competence in LGBT care.

CONCLUSION

This scale facilitates the measurement of LGBT cultural competence among nurses. Therefore, its use should provide foundational data to support LGBT-focused nursing education programs.

Psychometric Validation of the Nursing Professional Competence Scale Among Italian Nurses and Albanian Nursing Students

Background and Purpose: The main aim of this study has been the psychometric validation of an Italian translation of the Nurse Professional Competence Scale-Short Form (I-NPCS-SF), testing its validity and reliability. Methods: A multiphase design was used for the I-NPCS-SF translation and psychometric validation: (a) cultural and linguistic validation, (b) content and face validity, and (c) construct validity. Results: The I-NPCS-SF showed adequate linguistic translation, cultural adaptation, and content validity. Confirmatory factor analysis supported a four-factor structure of the I-NPCS-SF, in explaining data obtained from nurses and nursing students. Conclusions: The I-NPCS-SF demonstrated evidence of validity and reliability in measuring four professional competencies. Having an appropriate tool to be applied in the Italian context for professional competence self-assessment constitutes an essential step in measuring professional competencies.

The moderating effect of cultural competence educational needs on the relationship between transcultural self-efficacy and cultural competence in Korean public health nurses

BACKGROUND

In an increasingly multicultural society, cultural competence and transcultural self-efficacy of public health nurses is important for providing culturally congruent care for client from diverse cultural background. To improv this, it is needed tailored and effective educational program based on the cultural competence educational needs. This study investigated the moderating effect of cultural competence educational needs on the relationship between transcultural self-efficacy and cultural competence.

METHODS

This cross-sectional study recruited 217 public health nurses in Korea using convenience sampling from August 2018 to January 2019. A direct questionnaire was used to collect data. Study variables were analyzed using descriptive statistics, correlation, and the Hayes PROCESS macro (Model 1) moderation model.

RESULTS

The mean scores for transcultural self-efficacy, cultural competence educational needs, and cultural competence were 62.33 ± 11.08, 58.19 ± 15.08, and 97.96 ± 17.09, respectively. Transcultural self-efficacy and cultural competence educational needs were positively associated with cultural competence. In the tested model, cultural competence educational needs had a conditional moderating effect on the relationship between transcultural self-efficacy and cultural competence. The positive association between transcultural self-efficacy and cultural competence was significant at low, medium, and high levels of cultural competence educational needs and stronger for those with high needs.

CONCLUSIONS

Cultural competence educational needs may be an important determinant of cultural competence among public health nurses. To effectively increase cultural competence, transcultural self-efficacy should be increased by education programs tailored by cultural competence educational needs.

Spanish adaptation and validation of the Cultural Competence Assessment Tool (CCATool) for undergraduate nursing students

AIM

To analyse and validate a contextually adapted version of the Papadopoulos' Cultural Competence Assessment Tool (CCATool) for Spanish undergraduate nursing students.

BACKGROUND

Globalization has driven and intensified international migration. Thus, nurses must treat patients of many different cultural origins. Accordingly, both cultural competence and an appropriate tool with which to evaluate it are required.

METHODS

The CCATool questionnaire was adapted for use in a Spanish context and was evaluated through a questionnaire completed by 262 undergraduate nursing students. Seven days later, the same students completed the questionnaire, without any intervention, and a subgroup of 144 students completed the questionnaire for a third time after taking a course in Transcultural Care. The reliability, sensitivity and stability of the questionnaire were assessed.

RESULTS

The reliability of the questionnaire obtained an adequate Cronbach's alpha of 0.81. Stability was assessed at seven days, using the intraclass correlation coefficient, which showed good/excellent results. Moreover, the questionnaire was able to detect the changes related to the nursing educative programme, thus highlighting a good sensitivity of the tool.

CONCLUSION

Cultural competence is an essential element of nurses' education, and instruction in this area should begin as soon as possible. In addition, an appropriate evaluation system is required. For this purpose, the present study describes and analyses a valid, reliable tool for use with undergraduate nursing students in Spain.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Health and education policies must be sensitive to the ethnic and cultural differences of the patients who are cared for, and address the situations that cause difficulties in care. Hospitals and health centres must offer good care to patients from diverse cultures, so one of the necessary situations is the training and evaluation of the cultural competence of health professionals.

Developing and psychometric properties of the caring behaviors assessment tool-patient version-short form

PURPOSE

To develop and examine the psychometric properties of the caring behaviors assessment tool-patient version-short form (CBAP-SF) based on Human Caring Theory to evaluate caring behaviors by patients.

METHODS

This methodological study was conducted with 400 patients. The data were analyzed with SPSS 23.0 and LISREL 8.80.

FINDINGS

It was found that the scale with 27 items had good fit indices. The Cronbach's α was 0.96 for the scale and 0.77-0.94 for the subdimensions. Also, the item-total score correlation of the scale was 0.531-0.847.

PRACTICE IMPLICATIONS

The CBAP-SF was a valid and reliable tool to evaluate caring behaviors by patients.

E-learning cultural competence for public health workers: A feasibility and pilot study

OBJECTIVE

To describe the development, feasibility, and preliminary efficacy of a seven-module e-learning for enhancing cultural competence of public health workers.

DESIGN

The study was based on the framework of the new Medical Research Council; a mixed methods design was used.

SAMPLE

A four-week pilot cluster-randomized controlled trial was conducted with 39 public health workers and 74 migrants in South Korea. Feasibility and preliminary efficacy were assessed according to initiation, retention, adherence, usability, acceptability, individual and organizational cultural competence, and migrant trust and satisfaction. Quantitative data were collected at baseline, 4 weeks, and 12 weeks. Focus group interviews were conducted with eight public health workers at 12 weeks.

RESULTS

Initiation, retention, and adherence rates were high. Participants agreed on acceptability, but exhibited mixed results on usability. Participants were satisfied with "well-structured content," "authentic case stories and videos," "increased interest in migrant care," and "opportunity for self-reflection." However, "flawless and trouble-free system," "screen design for easy navigation," "instructor's expertise," and "more situational cases and videos" were desired. Statistically significant differences were observed for individual cultural competence, migrant trust, and satisfaction.

CONCLUSION

Generally, the intervention seems feasible and has preliminary efficacy, yet usability improvement is necessary for full-scale randomized controlled trials.

Effect of a mobile app-based cultural competence training program for nurses: A pre- and posttest design

BACKGROUND

Importance of providing culturally competent nursing care and cultural competence training for nurses has increased due to diversification of the cultural backgrounds of patients in South Korea. Currently there is little cultural competence training provided to nurses in South Korea.

OBJECTIVES

This study aimed to develop and evaluate a mobile app-based cultural competence training program for nurses working at a tertiary teaching hospital in South Korea.

DESIGN

A one group pre- and posttest intervention design.

SETTINGS

A tertiary teaching hospital in South Korea.

PARTICIPANTS

A total of 49 nurses participated in the study.

METHODS

A mobile app-based cultural competence training program for nurses was developed using the five stages of the ADDIE instructional model. Cultural competence scores were compared between pre- and posttest using the paired t-test. The differences in cultural competence scores between pre- and posttests were also compared by participant characteristics using analysis of variance, the Kruskal-Wallis test, and the Mann-Whitney-Wilcoxon test.

RESULTS

The mean total score of the nurses increased significantly after participating in the program, from 63.00 to 81.06 (p < 0.001). Comparisons of differences in cultural competence scores between pre- and posttests by participant characteristics revealed that the improvement in cultural competence was greater in those with no experience abroad for longer than 1 month compared to those who had experience abroad for longer than 1 month (p < 0.001) and in those who had never cared for a foreign patient compared to those who had cared for more than three foreign patients per week (p < 0.05).

CONCLUSIONS

The mobile app-based cultural competence training program developed in this study was demonstrated to be effective in improving the cultural competence of nurses in South Korea. Our novel training program can be applied as on-the-job training to improve the cultural competence of nurses.

Cultural competence among pre-graduate nursing students, new graduate nurses, nurse mentors, and registered nurses: A comparative descriptive study

BACKGROUND

Achieving and improving cultural competence in nursing is an ongoing process, beginning in the student period and continuing through the professional career.

OBJECTIVES

The present study aims to compare pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors in Taiwan in terms of their respective levels of cultural competence, and to determine associated influencing factors.

DESIGN

A comparative cross-sectional study.

SETTINGS

Three universities and three hospitals (one regional hospital and two teaching hospitals) in Taiwan.

PARTICIPANTS

A total of 756 nurses/students (103 pre-graduate nurses, 321 newly graduated nurses, 101 registered nurses, and 231 nurse mentors).

METHODS

The Cultural Competence Scale for Pre-Graduated Students to Licensed Professionals was used to measure the cultural competence level. One-way analysis of variance and hierarchical regression analysis were used for statistical analysis.

RESULTS

For overall cultural competence and the subscales of knowledge, awareness, and skills, the pre-graduate students scored lower than the other three groups. Experience of caring for patients from diverse cultures and countries significantly influenced the cultural competence of all four groups. Ability to speak fluent English and receiving cultural competence education during nursing education only significantly influenced the cultural competence of the pre-graduate and new graduate nurses. Current job position and primary practice setting significantly influenced the cultural competence of the registered nurses and nurse mentors.

CONCLUSION

Pre-graduate students, newly graduated nurses, registered nurses, and nurse mentors have differing levels of cultural competence and differing influencing factors. Cultural competence education that accords with the influencing factors for each nursing position would continuously cultivate nursing staff's 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.

Development and evaluation of the psychometric properties of a brief parenting scale (PS-7) for the parents of adolescents

This study aimed to develop a seven-item brief parenting scale (PS-7) based on the original parenting scale (PS) and various other shortened versions and with a better factor structure for the parents of adolescents. The scale was tested with a sample of 3,777 parents (2,205 mothers and 1,572 fathers). Confirmatory factor analysis was used to evaluate the dimensionality of the different versions of the PS. Only the PS-7 with a two-factor structure, i.e., laxness (three items) and overreactivity (four items), showed a good model fit based on a representative sample of parents of junior secondary school students. Overall, the results suggest that PS-7 is comparable to the original PS and possesses good psychometric properties in terms of internal consistency, factorial validity, construct validity, criterion validity and discriminant validity. The abbreviated parenting scale also provides a reliable and cost-effective method for assessing parental practices for treatment and assessing treatment outcomes.

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.