Factors That Influence the Development of Cultural Competence in Undergraduate Nursing Students

Saturday, 29 July 2017

Hsiu-chin Chen, PhD, EdD
Francine B. Jensen, MSN, ADN, BS (Zoology)
Gary Measom, PhD
Sean Bennett, MS
Nyree Dawn Nichols, MS
Linda Wiggins, BSN
Adam Anderton, BSN
Department of Nursing, Utah Valley University, Orem, UT, USA


With increasing immigration and expanding globalization in the US, by 2050 minorities will represent half of the total population according to the United States Census Bureau 2010 data. As the US demographic patterns have shifted toward increasing diversity, it is imperative that health care providers be well prepared to provide culturally competent care to the patients. In recognition of the increasing diversity in consumers of health care, cultural competence in the delivery of nursing care provided by nursing education to effectively prepare nursing graduates to become more aware of culture-related nursing care throughout the nursing curricula is an expectation of accrediting bodies, such as the Accreditation Commission for Education in Nursing (ACEN). However, a considerable knowledge gap regarding how nursing students enact the concept of culturally competent care and the ability to envision effective ways of tailoring nursing education to integrate culture learning into curriculum still remain a challenge.

The purposes of this study were to assess the cultural competence level and to identify the essential factors that influence the development of cultural competence in undergraduate nursing students. The significance of this study is to provide evidence regarding student learning outcomes of cultural competence through curriculum across an academic semester and to map out the essential components influencing the development of cultural competence for nursing faculty members to develop cultural material for enhancing their teaching.


This correlational and predictive quantitative study recruited 169 undergraduate nursing students from a university by sending 200 email invitation letters to all nursing students for participation. Before collecting data, approval was granted by the university institutional review boards. Each student was fully aware of the objective of the study and participated voluntarily in this study. The IAPCC-SV© tool developed in 2007 by Campinha-Bacote based on the Process of Cultural Competence in the Delivery of Healthcare Services Model was used to collect the data of the level of cultural competence including the five subscales of cultural awareness, cultural desire, cultural knowledge, cultural skill, and cultural encounters among undergraduate nursing students. The participating students completed the demographic survey and the self-administered evaluation of cultural competence via the IAPCC-SV in a selected nursing course at the end of fall semester 2015. The IAPCC-SV© tool has 20 items and is a 4-point Likert type scale scoring from 4 = strongly agree to 1 = strongly disagree. All data using double entry were analyzed with the Statistical Package for the Social Science (SPSS) for Windows, version 22. Summary statistics were used to identify the demographic data and the level of cultural competence. Multiple regression was employed to determine what significant factors influencing the development of cultural competence in undergraduate nursing students. The significance level was set at .05.


The 169 respondents consisted of 133 (80.1%) females and 33 (19.9%) males with three missing demographic data. The majority of students were White, non-Hispanic (n = 151, 91%), and had a healthcare related job (n = 123, 74.1%). About 59% (n = 98) of the students reported having continuing education or previous course work relevant to cultural competence, and 55.4% (n = 92) received education in cultural competence. The level of cultural competence among the participating students was 62.24 (SD = 5.63), which indicated a culturally competence level based on the Campinha-Bacote’s (2007) definition. According to item means of each subscale of the IAPCC-SV, the participating students had lowest item mean score on the cultural knowledge (M = 2.77, SD = .40) and the highest item mean score on the cultural desire (M = 3.46, SD = .40). Seven variables were found to significantly correlate with the level of cultural competence, including experience interacting with who have different ethnic backgrounds, having continuing education relevant to cultural competence, and the five subscales. Multiple regression was used to analyze the seven variables using the stepwise solution for predicting the level of cultural competence. The five subscales explained 98% of the variance in the level of cultural competence but the strongest influencing factor was the cultural encounters among participating undergraduate students (67.2% of the variance; Adjusted R2=.672, F=338.92, p<.001).


Cultural encounter is demonstrated when the healthcare providers directly interact with patients from diverse backgrounds. It is suggested that educational interventions to facilitate the development of student cultural competence should engage students in caring for patients from diverse cultures and immerse students in lived experiences to increase cultural knowledge. In turn, improving culturally competent care among nursing students will lead to improved patient outcomes. Further research should focus on identifying cost-effective teaching and learning strategies to increase students’ exposures to persons from other cultures.