Effects of a Cultural Competence Education Program for Nursing Students in Taiwan

Background: Cultural competent care is an essential ability for nursing students in current Taiwanese global context. However, little is known about nursing students’ knowledge, attitude, skill and behavior of cultural competence. Moreover, the creative cultural competence courses were designed and aimed to build up the nursing students’ abilities on cultural competence care in clinical setting. The effects of educational intervention are eagerly concerned and require to be evaluated.      

Purpose: The purpose of this study was to investigate the effectiveness of a selective course on enhancing nursing student’s knowledge, attitude, skill and behavior of cultural competence.

Methods: A quasi-experimental study was conducted using the mixed method for data collection and analysis. A total of 105 nursing students were recruited from 2-year programs offered by two medical technology universities in Southern Taiwan. The students were assigned to the experimental group (n = 51) and control group (n = 54) according to university. This study was conducted from August 2012 to July 2013. The educational intervention consisted of a 36-hour course entitled Cultural Competence Care that was expected to achieve the five course objectives: 1. Prioritize the social and cultural factors that affect health in designing and delivering care across multiple contexts; 2. Use relevant data sources and best evidence in providing culturally competent care; 3. Promote achievement of safe and quality outcomes of care for diverse populations; 4. Transform systems to address social justice and health disparities; and 5. Participate in continuous cultural competence development. Data were simultaneously collected from both groups pre- and post- the education intervention using structured questionnaires. The questionnaire consists of a demographic profile, the Cultural Competence Assessment Instrument-Chinese version (CCA-CV), the dilemma associated with cultural care, and a self-assessment after complete the course. The CCA-CV included two sub-dimensions which are cultural awareness and sensitivity, and cultural competence behavior.

Results: The experimental group was composed of 2 males and 49 females and the control group comprised 54 females, all of whom were grade 2 students. In the experimental and control groups, 96.1% and 94.3% of the students, respectively, had never taken a cultural competence course; 92.2% and 30.2% of the students in experimental group and control group, respectively, believed that offering cultural competence courses is necessary. The percentages of students who were unfamiliar with the word “cultural competence” were 62.5% in the experimental group and 96.2% in the control group; 39.2% and 51.9% of the students in the experimental group and control group, respectively, had experience in caring for people in culturally diverse populations, such as the aborigines or new immigrants. The three major problems encountered when caring for culturally diverse populations are communication difficulties, unfamiliarity with patients’ needs, and a lack of health education brochures with their native language. For both groups used in this study, identifying patient requirements is the task that requires the most assistance when caring for people in culturally diverse populations. In comparison of the pre-test scores between the two groups, there are no significant differences in the scores of CCA-CV and the scores of self-assessment of the course. Regarding cultural competence, the students in experimental group produced significantly higher posttest scores on cultural awareness and sensitivity (p = .02), and cultural competence behavior (p = .03) than the students in control group. The post-test scores of self-assessment of the course on ‘’basic knowledge’’ (p <.001), ‘’important theme’’ (p <.01), ‘’stereotype of the medical decision-making’’ (p <.01), and ‘’clinical practice skills’’ (p <.01) for experimental group were significantly higher than the post-test results for the same items in the control group. All scores of cultural competence behavior and a self-assessment of the course in the pre- and post- test results for the experimental and control group demonstrated statistical significance (see table1). Qualitative analysis of collected data is done in terms of cultural knowledge, affection, skill and behavior, all benefiting from course-related activities.

 

Table 1. The pre- and post scores of cultural competence and a self-assessment for the course
Item	Experimental Group Mean ± SD		Control Group  Mean ± SD				Within group pretest - posttest			Between groups  Pb
							Experimental Pa		Control Pa
Pre-test (n =51 in Experimental; n = 54 in Control)
Cultural Competence(CCA-CV)
Cultural awareness and sensitivity	58.35±5.81		57.57±5.05							.46
Cultural competence behavior	65.25±17.67		68.33±14.61							.33
Self-assessment of the course
Basic knowledge	54.37±10.13		55.48±11.61							.60
Important theme	48.16±10.16		48.17±9.64							1.00
Stereotype of medical decision	44.76±10.35		46.49±10.92							.41
Clinical practices skills	42.86±12.14		54.38±8.59							.41
Post-test  (n =44 in Experimental; n = 47 in Control)
Cultural Competence
Cultural awareness and sensitivity		59.48±4.85		57.12±4.68	.41			.30		.02*
Cultural competence behavior		78.96±9.50		74.10±11.10	.00**			.001**		.03*
Self-assessment of the course
Basic knowledge		67.04±8.21		61.07±9.80		.00**		.001**		.00*
Important theme		56.21±6.99		52.16±8.10		.00**		.01*		.01*
Stereotype of medical decision		54.51±8.26		50.05±8.17		.00**		.02*		.01*
Clinical practices skills		54.38±8.59		49.16±9.16		.00**		.008**		.01*
*p<.0.05, **p<0.01; pa Paired-T test, pb Independent-T test

Conclusions: Applying this cultural competence course in nursing students can improve the cultural knowledge, attitude, skill and behavior of cultural competence. This study suggests that nursing students need to be educated regarding the cultural competence with diversity population. The researchers recommended the results could be used as a reference in incorporating the cultural competence concept into nursing education.