More identified racial and ethnic minorities have enriched cultural complexity in the US. The accreditation of nursing education has urged researchers to conduct evidence-based research to recognize factors such as societal biases and stereotyping or limited cultural sensitivity and competence contribute to health care inequities in order to develop strategies for increasing workforce diversity in health care providers. Given the need for decreasing the health disparity and preparing the nursing students with cultural competence, nursing faculty have focused on exploring the strategies to implement cultural diversity activities for the curriculum. While providing culturally competent nursing care starts with the preparedness of effective learning activities for students, faculty have struggled with what approaches can produce desired learning outcomes of multicultural activities within the education process.
The purposes of this study were to identify the essential factors that can influence the development of cultural competence in undergraduate nursing students in order to develop effective teaching strategies. The significance of this study is to provide evidence regarding student learning outcomes of cultural competence through curriculum across an academic semester and to identify the essential components influencing student cultural competence for nursing faculty members to consider designing effective learning activities.
This comparative and predictive quantitative study was conducted in a university by sending 200 email invitation letters to all nursing students including ASN and BSN 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 consisting of five subscales of cultural awareness, cultural desire, cultural knowledge, cultural skill, and cultural encounters was used to collect data from undergraduate nursing students. In order to prevent “test bias,” all nursing students were randomly assigned into either an experimental group or a comparison group. The experimental group completed the IAPCC-SV© at the beginning and the end of the semester, respectively; and the comparison group completed the self-administered evaluation of cultural competence via the IAPCC© only at the end of the semester in a selected nursing course in 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 using the Statistical Package for the Social Science (SPSS) for Windows, version 22. Summary statistics were used to describe the demographic data and the level of cultural competence. Pearson r correlation and independent t-test were used to examine the associations between cultural competence and the variables relevant to students’ cultural learning experience and the differences in cultural competence between pretest and posttest as well as between the experimental and comparison groups. Hierarchical multiple regression was employed to determine what significant factors influence the development of cultural competence in undergraduate nursing students. The p level was set at .05 for statistical testing.
In total, 106 nursing students participating at the beginning of the semester consisted of 85 (80.2%) females and 21 (19.8%) males and 166 participants including 133 (80.1%) females and 33 (19.9%) males voluntarily participated in this study at the end of the semester. The majority of students were White, non-Hispanic, had a healthcare related job, had continuing education or previous course work relevant to cultural competence. The level of cultural competence among the participating students was 61.70 (SD = 5.80) at the beginning of the semester and 62.24 (SD = 5.63) for the end of the semester, which both indicated a culturally competence level based on the Campinha-Bacote’s (2007) definition. The cultural competence level was increased from the beginning of the semester compared to the end of semester but was no statistically significant difference. The results also indicated no significant differences in cultural competence between the experimental and the comparison groups at the end of semester for all nursing students. Hierarchical multiple regression using the stepwise and enter solutions was computed to identify six significant predictors for cultural competence including experience interacting to people who have different ethnic backgrounds, having continuing education relevant to cultural competence, and the four subscales of cultural desire, cultural knowledge, cultural skill, and cultural encounters (Adjusted R2=.98, F=1353.05, p<.001). The four subscales explained 78% of the variance in the level of cultural competence and the strongest influencing factor was the cultural desire among participating undergraduate students (50.1% of the variance).
Cultural desire is the healthcare providers’ aspiration and motivation to engage in the process of becoming culturally competent. Cultural encounter is demonstrated when the healthcare providers directly interact with patients from diverse backgrounds. It is suggested that faculty need to search opportunities to engage students in caring for patients with diverse cultures in clinical practice and to immerse students in the lived experiences to reflect their culturally competent care. In turn, students’ desire to obtain cultural knowledge and skills may be triggered in a learning environment that is full of culturally diverse context. Future research may focus on testing learning strategies that can increase students’ desire and exposures to persons with other cultures and identify what factors causing students’ discomfort with people from diverse cultural background.