Home Health Care Management & Practice
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Cultural Competence of North Carolina Nurses: A Journey From Novice to Expert
Tammy M. Lampley, Kimberly E. Little, Rebecca Beck-Little and Yu Xu
Home Health Care Management Practice 2008; 20; 454 originally published online Mar 6, 2008;
DOI: 10.1177/1084822307311946
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http://hhc.sagepub.com/cgi/content/abstract/20/6/454
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Cultural Competence of North Carolina Nurses
A Journey From Novice to Expert
Home Health Care
Management & Practice
Volume 20 Number 6
October 2008 454-461
© 2008 Sage Publications
10.1177/1084822307311946
http://hhcmp.sagepub.com
hosted at
http://online.sagepub.com
Tammy M. Lampley, MSN, RN
Kimberly E. Little, MSN, RN
Cabarrus College of Health Sciences, Concord, North Carolina
Rebecca Beck-Little, PhD, RN
Gardner-Webb University, Boiling Springs, North Carolina
Yu Xu, PhD, RN, CTN
University of Nevada at Las Vegas
This study reports the survey findings of self-reported cultural competence of a convenience sample of 66 registered nurses
of varying ages, gender, ethnicity, educational backgrounds, and experience in North Carolina. Campinha-Bacote’s model of
cultural competence and Benner’s model of clinical skills acquisition serve as the conceptual frameworks. The process
of cultural competence among health care professionals, developed by Campinha-Bacote, is used to measure cultural competence in participants. In addition to descriptive statistics, bivariate analysis of variance was conducted to compare means
of cultural competence scores of different groups. Findings indicate that level of education, nursing experience, and continuing education are factors that promote cultural competence, whereas gender and race/ethnicity have no bearing. In addition, qualitative data generated four themes: language or verbal communication barrier, religious beliefs, different health
beliefs and behaviors, and culturally inappropriate nonverbal communication. Implications of these findings for nursing
education, practice, and future research are elaborated.
Keywords: culture; language; nursing; education; competence
T
he U.S. demographics have shifted dramatically.
According to the projection by the U.S. Bureau of the
Census, minorities we know today will constitute more than
half of the U.S. population by 2050. Therefore, providing culturally competent care has become not only an economic
necessity but also a moral imperative. As early as in the
1990s, major U.S. nursing organizations recognized the need
to prepare nurses to provide nursing care to patients in an
increasingly diverse society (American Nurses Association,
1994; National League for Nursing, 1996; Pew Health
Professions Commission, 1998). In addition, the Joint
Commission on Accreditation of Healthcare Organizations
(1994) guidelines require accredited institutions to provide
culturally competent care. In 2000, the federal government
published the National Standards for Culturally &
Linguistically Appropriate Services, mandating that health
care providers ensure such services during operational hours
at the point of care. For the purpose of this study, cultural
competence is defined as a set of skills and behaviors that
enable the nurse to work effectively within the cultural context of a client (i.e., individual, family, or community).
454
The Institute of Medicine (2002) documented evidence of unequal treatment received by racial or ethnic
minorities in health care and made recommendations to
eliminate this disparity. Evidence suggests that the concordance (i.e., match) between health care providers
and patients increase access to health care services and
patient satisfaction. Furthermore, it has been indicated
that cultural competence education and training are
linked with improved patient outcomes (Fortier &
Bishop, 2003). Finally, it has been documented that
cultural competence and culturally competent nursing
workforce have positive effects on the elimination of
health disparities (Brach & Fraser, 2000). This finding
is very significant considering that elimination of
health disparities is one of the two overarching goals of
Healthy People 2010. According to the National
Institutes of Health (2001), “Health disparities are differences in the incidence, prevalence, mortality, and
burden of diseases and other adverse health conditions
that exist among specific population groups in the
United States.”
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Lampley et al. / Cultural Competence of North Carolina Nurses 455
Review of the Literature
Perceived Cultural Competence
Studies conducted in different practice settings indicate
that nurses felt that they were less confident and inadequately prepared to provide culturally competent care to
patients from diverse cultures regardless of the nurses’ educational and demographic backgrounds (Bernal & Froman,
1987; Joseph, 1997; Kardong-Edgren et al., 2005; Murphy
& Clark; 1993; Peterson, Whitman, & Smith, 1997). A
number of studies (Boi, 2000; Kirkham, 1998; Murphy &
Clark, 1993; Peterson et al., 1997) suggest that providing
culturally competent care is complex and challenging. The
most frequently indicated challenges include communication and deficit of knowledge of health beliefs and behaviors of people from other cultures. One of the cited
contributing factors is the lack of educational preparation
in cultural diversity and competence (Boi, 2000; Joseph,
1997; Kirkham, 1998; Murphy & Clark, 1993).
Factors Influencing Cultural Competence
Rosemarie (2005) reviewed barriers to providing cultural competent care by nurse clinicians despite endorsement by major nursing organizations, government and
accreditation standards, and proposed training and/or
education as the major intervention to improve cultural
competence. The identified barriers include, but are not
limited to, lack of awareness, knowledge and skills; lack
of organizational support; limited content and exposure
to cultural diversity in formal nursing education;
ethnocentrism; and prejudice.
Several studies (Jones, Cason, & Bond, 2004; Joseph,
1997; Kardong-Edgren et al., 2005; Majumdar, Browne,
Roberts, & Carpio, 2004; Schim, Doorenbos, & Borse,
2005) attempt to identify the facilitators for cultural
competence. The identified factors include content on
cultural diversity in nursing preparation, nursing experience and exposure, continuing education, level of educational attainment, and so on. In addition, contextual
factors such as the setting of health care, support of colleagues, institutional climate, foundation of education,
and presence of racism affect cultural competence
behaviors of nurses (Kirkham, 1998). Jones et al. (2004)
found that educational intervention such as providing
workshops on cultural diversity addressing different values and belief systems, communication patterns, and so
on is an effective measure to improve cultural competence behaviors among nurse faculty.
This literature review indicates that research on cultural competence of nurses is limited. Nurses in general
were not confident in providing cultural competent care
because of a host of factors, including inadequate content on cultural diversity in their nursing curricula, lack
of knowledge on health beliefs and behaviors of people
from other cultures, and challenge in communication.
These challenges have resulted in the lack of congruence
between the health beliefs and behaviors of nurses and
those of the patients they serve. The current study is an
effort to contribute to the knowledge base by examining
the effects of a number of variables on nurse’s perceived
level of cultural competence.
Conceptual Frameworks and Linkages
Campinha-Bacote’s Model of
Cultural Competence
Campinha-Bacote’s (1998) model of cultural competence (the process of cultural competence in the delivery
of health care services) served as the overall conceptual
framework for this study. The model defines cultural
competence as a process in which the health care professional continually strives to achieve the ability to effectively work within the cultural and context of a client
(individual, family, or community). It has cultural awareness, cultural knowledge, cultural skill, and cultural
encounters as the four constructs of cultural competence.
Campinha-Bacote (2006) defines the four constructs
as follows:
• Cultural awareness is defined as the process of
conducting a self-examination of one’s own biases
toward other cultures and the in-depth exploration
of one’s cultural and professional background.
• Cultural knowledge is defined as the process in
which the health care professional seeks and
obtains a sound information base regarding the
worldviews of different cultural and ethnic groups
and biological variations, diseases and health conditions, and variations in drug metabolism found
among ethnic groups.
• Cultural skill is the ability to conduct a cultural
assessment to collect relevant cultural data regarding the client’s presenting problem and accurately
conducting a culturally based physical assessment.
• Cultural encounter is the process of face-to-face
interactions and other types of interface with
clients from culturally diverse backgrounds to
modify existing beliefs about a cultural group and
to prevent possible stereotyping.
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456 Home Health Care Management & Practice
According to Campinha-Bacote, the four components
are inherently related. Essentially, through cultural encounters, cultural awareness is raised, cultural knowledge and
cultural skills acquired, and consequently, cultural competence is developed. Campinha-Bacote advocates a focus on
becoming culturally competent as a lifelong undertaking,
characterized by humility, curiosity, seeking cross-cultural
encounters, and building cross-cultural skills. From
Campinha-Bacote’s perspective, the process of becoming
culturally competent is continuous, never ending; with each
effort and experience one is becoming more competent.
Benner’s Model of Clinical Skills Acquisition
Based on her groundbreaking research, Benner (1984)
established a model describing the stages of clinical skills
acquisition of nurses moving from a novice to expert
level of competence on a continuum from “advanced
beginner,” to “competent,” “proficient,” and finally
“expert” clinician. With operationalized indicators, she
described the characteristics of each stage that can be
used to guide and evaluate clinical skills attainment.
Benner’s “From Novice-to-Expert Model” has been
widely validated and accepted in nursing. It still needs to
be determined via study and research whether a novice
nurse can be culturally competent.
Conceptual Linkages of the Two Models
Although the concepts used in the last two levels of
cultural competence in Campinha-Bacote’s model was
essentially the same as in Benner’s, there was no published documentation to suggest that Campinha-Bacote
borrowed these concepts from Benner in conceptualizing
her model of cultural competence. It is intuitively innovative to conceptually link the two models for a number of
reasons. First, both models describe the stages or proficiency levels of a competency or skill that make the
transfer possible. Second, both models have identified
four stages or levels, further enabling the pairing of the
competency development. Third, to the authors’ knowledge, such an effort to build the conceptual linkage
between the two models has never been attempted.
Consequently, at the operational level, Benner’s stages of
novice to expert were paired with the stages of the
Inventory for Assessing the Process of Cultural
Competence Among Healthcare Professionals (IAPCC).
Participants’ scores in the “culturally incompetent” range
were categorized as “novice.” Scores within the “culturally aware” range were matched with “advanced beginner.” Scores that fell within the “culturally competent”
range were paired with “competent.” Scores within the
“culturally proficient” range was linked to “proficient.”
By establishing a conceptual linkage between each corresponding stage in either model, the researchers deem
that such approach is an innovative way to explain the
development of cultural competence, thus making a contribution to the knowledge base on cultural competence.
Method
Sampling
Cross sectional survey design was used for this study. A
convenience sample was obtained from working nurses in
North Carolina. They were either students in a university
attending RN-BSN or BSN-MSN programs or employed
in an educational institution or a health care agency.
Instruments
Two instruments were used to collect data: the
Background Variables Data Sheet (BVS), and the
IAPCC. The BVS was an eight-item demographic survey
developed by the researchers that requested information
on age, gender, ethnicity, educational background,
amount of inclusion of culture content in basic nursing
program, continuing education on culture and cultural
diversity, and years of nursing experience. In addition,
the BVS also requested information on the encounter of
a “paradigm case.” A paradigm case is defined as a clinical experience that stands out and alters the way one
perceives and understands future clinical situations.
Paradigm cases create new clinical understanding and
open new clinical perspectives and alternatives.
Participants were asked (a) “Have you experienced a
significant event (i.e., “paradigm case”) in your career
while caring for a patient of a different culture?” (b)
“Did this experience shape or change the way in which
you provided care to your patients?” and (c) “Has an
experience caring for a patient of a different culture
encouraged you to act for the patient and his or her cultural beliefs? If so, how has this affected you?”
Qualitative data from these replies provided the
researchers with the necessary information to determine
the existence of a “paradigm case” and whether or not it
contributed to the development of the “expert” nurse. An
interrater reliability of 95% was achieved by two
researchers (T.M.L. and K.E.L.) in a trial analysis of 10
of the 20 descriptive surveys.
The IAPCC is a 20-item instrument developed by
Josepha Campinha-Bacote that measures the level of cultural competence of health care professionals. The
IAPCC is composed of statements addressing the four
constructs of Campinha-Bacote’s model of cultural competence: cultural awareness, cultural knowledge, cultural
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Lampley et al. / Cultural Competence of North Carolina Nurses 457
skill, and cultural encounters. It is a 4-point Likert-type
scale. Scores ranged from 20 to 80, indicating whether
health care professionals were culturally incompetent
(20 to 39), culturally aware (40 to 59), culturally competent (60 to 74), or culturally proficient (75 to 80). Higher
scores from the IAPCC suggested a higher level of cultural competence. Permission to use IAPCC was
obtained prior to data collection and analysis.
Data Collection and Analysis
On approval of the study from the institutional Research
Review Board and administrative permission to conduct
the study, the survey packets consisting of a consent form
and the two survey instruments with a return envelope were
distributed in a controlled classroom setting to the individuals who agreed to participate. Completed anonymous surveys in sealed envelopes were returned to the researcher
by the participants. Then, collected data were entered into
SPSS 10.0 and the following statistical analyses were conducted: frequency of distributions, one-way analysis of
variance (ANOVA), and independent samples t test. Out of
the 71 completed surveys, 66 (93%) were usable and
included in the data analysis.
In addition, 20 of returned surveys contained qualitative
data and content analysis on these data was performed to
identify potential themes. Inclusion for content analysis
was determined by fulfillment of two criteria. First, the participants must have completed the surveys in full and participants must have answered yes to the following
question: “Have you experienced a significant instance in
your career while caring for a patient of a different culture?” Second, the participants must have described a case
scenario to support their affirmative responses to either of
the following questions: (a) “Did this experience shape or
change the way in which you provided care to your
patients?” or (b) “Has an experience caring for a patient of
a diverse culture encouraged you to act for the patient and
his or her cultural beliefs? If so, how has this affected
you?” A “diverse culture” was operationally defined as a
different culture other than one’s own. The qualitative data
provided the researchers with the necessary information to
determine the existence of a “paradigm case” and if it contributed to the development of the “expert” nurse.
Results
Demographics of Sample
The sample was composed of 71 participants; however,
66 (93.0%) surveys were usable and included in the
data analysis. The majority of the participants were female
(n = 64, 97.0%) and White (n = 61, 92.4%) The most
frequently reported age group of the participants was
evenly distributed between 20- and 30-year-olds (n = 29)
and 31- and 50-year-olds (n = 30), with the least reporting
in the age group of 51 years old and older (n = 7). Half of
the sample (n = 33) reported having an associate degree as
their highest level of nursing education. About one third of
participants (n = 19, 28.8%) had more than 20 years of
nursing experience. A total of 58 (87.9%) participants
reported that their nursing education included content on
cultural diversity either as part of a unit or chapter or
course. A total of 42 (63.6%) of the participants reported
receiving information on cultural diversity as part of their
in-service education on the job.
IAPCC Scores and Relationships
The sample’s IAPCC scores ranged from 39 to 72,
with a mean of 53.05 (SD = 6.26), indicating that the participants as a group was at the level of “cultural awareness” congruent with Benner’s advanced beginner stage.
A total of 10 (15.2%) of the participants scored at the
level of culturally competent and only one (1.5%) scored
at the culturally incompetent level. None of the participants scored culturally proficient, the highest level of
cultural competence (Table 1). Neither race nor gender
appeared to have a significant influence on cultural competence. This finding is consistent with Joseph (1997)
and Kardong-Edgren et al. (2005).
Bivariate Statistical Analysis
Independent sample t tests were conducted to compare the means of IAPCC scores of male and female participants and means of IAPCC scores of African
American and Anglo (White or non-Hispanic) participants. Results of both tests were statistically insignificant. However, the difference from an independent
sample t test comparing the mean IAPCC scores of participants who reported receiving continuing education
related to cultural diversity at the workplace and those
who did not was statistically significant (t = 2.464, p =
.016). The mean IAPCC scores of participants who
reported having received continuing education related to
cultural diversity at the workplace (M = 54.43, SD =
6.00) was significantly higher than those who did not
receive the continuing education (M = 50.63, SD = 6.09).
ANOVA was conducted to evaluate the relationship
between the participants’ years of nursing experience
and the IAPCC mean score. The independent variable
(years of nursing experience) included five levels: less
than 1 year, 1 to 5 years, 6 to 10 years, 11 to 20 years,
and more than 20 years. A significant difference was
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458 Home Health Care Management & Practice
Table 1
Frequency, Percentages, and Classification of Inventory for Assessing the Process of Cultural
Competence Among Healthcare Professionals Scores
Score
Frequency
20 to 39
40 to 59
60 to 74
75 to 80
1
55
10
0
Percentage
Cultural Competence
1.5
83.3
15.2
0.0
Culturally incompetent
Culturally aware
Culturally competent
Culturally proficient
Benner
Novice
Advanced beginner
Competent
Proficient
Table 2
Differences Among Years of Experience Groups on Inventory for Assessing the Process of Cultural
Competence Among Healthcare Professionals Scores
Years of Experiences
<1
1 to 5
6 to 10
11 to 20
> 20
M
SD
<1
51.36
50.47
51.50
52.62
57.11
4.41
6.06
6.75
5.06
6.50
ns
ns
ns
ns
1 to 5
6 to 10
11 to 20
> 20
ns
ns
ns
ns
ns
ns
ns
*
ns
ns
ns
ns
*
ns
ns
ns
NOTE: ns = nonsignificant differences between pairs of means, whereas an asterisk indicates significance using the Tukey’s test.
found between the years of nursing experience and the
mean score of the IAPCC, F(4, 61) = 3.478, p = .013.
Furthermore, follow-up tests were conducted to evaluate
pair-wise differences among the means. There was a significant difference in the mean IAPCC scores between
participants with 1 to 5 years of experience (M = 50.47,
SD = 6.06) and those with more than 20 years of experience (M = 57.11, SD = 6.50), indicating that the extent of
nursing experience was a significant facilitating factor
for cultural competence behaviors (Table 2).
Similarly, ANOVA was performed between the participants’ level of education and the mean scores obtained on
the IAPCC and revealed a significant difference, F(4, 61) =
2.964, p = .026. A follow-up test was also conducted to
evaluate pair-wise differences among the means. Post hoc
comparisons using the Tukey’s honestly significantly different test, a test that assumed equal variances among the
five education groups revealed that participants with a
master’s degree (M = 58.89, SD = 6.60) scored significantly higher than those with either an associate’s degree
(M = 51.94, SD = 5.31) or a bachelor’s degree (M = 51.56,
SD = 5.82), suggesting that the extent of nursing education
was another significant facilitating factor for cultural competence behaviors (Table 3). However, the reason for the
slightly higher IAPCC mean scores for those with an associate degree than those with a baccalaureate degree is
unclear and needs further investigation.
Content Analysis
Content analysis of the 20 (30%) eligible surveys with
written comments on paradigm cases revealed four themes.
Theme 1: Language or verbal communication barrier.
A total of nine participants reported issues with communication and language barriers. For example, one nurse
commented that while completing discharge instructions
for a new Hispanic mother with assistance from a family
member for translation, the husband began to smile
when hearing information about the mother having
received a rubella immunization. The nurse was concerned that the husband’s nonverbal display was incongruent with the information she was relaying about the
rubella. Her suspicion proved to be correct when she
stopped the translator and requested that she ask the
husband what he had understood. The nurse’s concerns
were validated when he reported that his wife had received
depo-provera (for birth control) instead of rubella. Both
types of injections involve 3-month patient teaching but
were very different in their indications. The nurse determined that it was necessary to repeat the teaching to
ensure that it was communicated correctly.
Theme 2: Religious beliefs. Six participants described
instances where patients’ religious rituals or beliefs had
affected them. One nurse wrote,
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Lampley et al. / Cultural Competence of North Carolina Nurses 459
Table 3
Differences Among Educational Background Groups on Inventory for Assessing the Process of
Cultural Competence Among Healthcare Professionals Scores
Educational Background
Diploma
ADN
BSN
MSN
PhD
M
SD
Diploma
54.00
51.94
51.56
58.89
56.50
10.03
5.31
5.82
6.60
2.12
ns
ns
ns
ns
ADN
BSN
MSN
PhD
ns
ns
ns
ns
*
*
ns
ns
ns
ns
ns
*
ns
*
ns
ns
NOTE: ADN = associate’s degree in nursing; BSN = bachelor’s degree in nursing; MSN = master’s degree in nursing;
ns = nonsignificant differences between pairs of means, whereas an asterisk indicates significance using the Tukey’s test.
A Mexican infant was born with defects incompatible with life. It was vital to the mother to have the
baby blessed prior to death. If it was not blessed it
was her belief that he would not go to heaven. I made
it my priority to have the baby blessed. The baby
died hours later after the Father had blessed him.
Another nurse commented on how to care for a client
who conflicted with institutional policy by practicing
religious rituals. The patient wanted to burn a candle in
the hospital room and put fruit behind the door to recognize the “evil auras.” Another nurse described how a
patient’s surgery had to be cancelled because the staff
unknowingly “contaminated” the patient by their touch
as a nonreligious person after cleansing ceremonies by
the priest had been performed. Another nurse described
a situation of serving pork to a patient of Indian origin.
The patient and family were “so offended they became
very upset and hostile over the incident.”
Theme 3: Different health beliefs and behaviors. One
participant related that “Hispanic mothers do not want to
breastfeed their babies for the first 3 days because they
believe that the milk is witch’s milk. As a nurse I respect
that and try to not make them feel bad for not breastfeeding their baby for the first few days.” Another nurse
described the culture-based postmortem care that was
controversial. A Hispanic lady delivered a stillborn via
cesarean section. The family requested that the infant be
taken home and buried beside a tree according to their
tradition. The nurse commented, “Although it was very
common to them, it is offensive to most.” One female nurse
described her inability to complete a genital assessment of
an Indian male patient because of culturally based
requirement for gender match of the patient and the caregiver. Respect of his cultural preference required the
nurse to recruit the assistance of a male coworker to
complete the assessment.
Theme 4: Culturally inappropriate nonverbal communication. Participants also offered descriptions of culturally
inappropriate care. One of the nurses responded that while
caring for a patient of a different culture the patient
became offended when the nurse touched her hand.
Another nurse described an incident that exemplified a different form of culturally inappropriate nonverbal communication. The nurse tried to make direct eye contact with a
Laotian child while he kept looking down and away from
the nurse. Subsequent to a discussion with a coworker
familiar with the culture of this patient, the nurse learned
that it was the patient’s way of showing respect.
Discussion and Conclusions
This study suggested that the majority of the sampled
nurses were not culturally competent. As a group, the sampled nurses were at the level of “cultural awareness” in the
“advanced beginner” stage. On the other hand, this study
indicates that level of educational attainment, years of
nursing experience, and continuing education contributed
to the improvement of cultural competence of the sampled
nurses. These findings appear consistent with the published
literature (Jones et al., 2004; Joseph, 1997; KardongEdgren et al., 2005; Majumdar et al., 2004; Rosemarie,
2005; Schim et al., 2005) and have direct implications for
nursing education, practice, and research.
Implications for Nursing Education
and Practice
This study reveals a relationship between level of educational preparation and IAPCC scores. Participants with
a master’s degree scored significantly higher than those
with either an associate or baccalaureate degree. This
finding is consistent with other published studies (Bond,
Kardong-Edgren, & Jones, 2001; Kulwicki & Boloink,
1996; Murphy & Clark, 1993). This may be because of
the lack of adequate cultural content or cultural
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460 Home Health Care Management & Practice
encounter in the usually very tight curricula in associate
and baccalaureate degree nursing programs. Examples of
cultural content include, but are not limited to, content
on different health beliefs, values, and practices. Cultural
encounter is the direct clinical experience with patients
of diverse cultural backgrounds. Another explanation is
that graduates from master’s programs are more competent
simply because they have more cultural content and
encounter through higher education. Continued advocacy
for curriculum revision for enhancement of culture remains
a priority, despite the calls from nursing education (Duffy,
2001), regulatory bodies (American Nurses Association,
1994; National League for Nursing, 1996), and think tanks
(Pew Health Professions Commission, 1998).
Data also reveal a relationship between years of nursing experience and the level of cultural competence as
measured by the IAPCC score. One explanation may be
that more experienced nurses have more opportunities
for the occurrence of a paradigm case from which higher
level of cultural competence may have derived. Another
plausible reason is that nurses with more years of experience are more likely to be older and more confident
with their own cultural identity, thus enabling them to
accept and advocate for patients from different cultures.
This finding supports the current literature that it is the
experience of the nurse, either by passage of time or specific encounters with patients that enable the nurse to
develop higher levels of cultural competence.
Furthermore, this study suggests that in-service education is an effective measure to promote cultural competence. This finding is consistent with the literature
reviewed by Rosemarie (2005), who concluded that continuing training or education is effective in increasing the
knowledge and self-efficacy of nurses regarding cultural
competence. Institutions need to take full advantage of
their established channels of continuing education for this
purpose and encourage nurses to participate in these programs. During continuing education sessions, it is critical
to identify and understand the major philosophies and
value differences at the cultural level among different
groups that underline often taken-for-granted assumptions. For example, individualism versus collectivism,
autonomy versus family cohesion, and so on can shed
light on differences in health beliefs and behaviors of
Asian patients such as communication patterns and styles.
Implications for Future Research
There are several implications for future research. First,
a replication study with a larger, nationally representative
sample is indicated to validate the findings of the present
study. Second, an in-depth qualitative study is indicated to
help understand the participants’ experiences in caring for
patients of diverse cultures, particularly regarding feelings,
reactions, and changed perspectives and behaviors related to
their “paradigm case.” Third, utilizing pre-post design to measure the effectiveness of cultural competence interventions is
needed to substantiate evidence-based interventions. For
instance, studies on the effect of cultural diversity training
on cultural competence of nursing staff are called for. Such
outcome studies would substantiate the effect of continuing
education on increased levels of cultural competence.
Fourth, outcome studies comparing quality of care delivered by nurses with varying levels of cultural competence
are necessary given the increasing number of culturally
diverse patients and the current competitive health care
market to improve quality of care and patient outcomes.
Finally, studies on effects of different concentration of cultural groups in various geographic areas and exposure to
different cultures on cultural competence need to be
encouraged.
Limitations of Study
Because of constraints of time and resources, there
were limitations with this study: relatively small sample
size and convenience sampling. Ideally, random sampling of a large, nationally representative sample would
be the choice to ensure the study’s generalizability.
Therefore, interpretation of the study findings should
take these limitations into consideration.
The faces of Americans are changing, and so are those of
patients and care providers. Within this context of the
changing national demographics, providing culturally competent care is not only a necessity for continued agency
accreditation, but also a moral imperative. Based on the
study findings, effective measures to promote cultural competence such as in-service offerings can be designed and
developed to improve quality of care and patient outcomes.
References
American Nurses Association. (1994). Position statement on cultural
diversity in nursing practice. Washington, DC: Author.
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Tammy M. Lampley, MSN, RN, is an adjunct faculty at
Cabarrus College of Health Sciences in Concord, North
Carolina, and a member of Sigma Theta Tau. She is enrolled
in the University of Nevada Las Vegas PhD in Nursing
Program. Her research interests focus on cultural competency,
women’s health, and infertility.
Kimberly E. Little, MSN, RN, is an assistant professor in the
Associate Degree Nursing Program at Cabarrus College of
Health Sciences in Concord, North Carolina, and a member of
Sigma Theta Tau. She is enrolled in the University of Nevada–
Las Vegas PhD in Nursing Program. Her research interests
include cultural competency, benefits of folic acid, and health
care providers' knowledge of such benefits.
Rebecca Beck-Little, PhD, RN, is a professor and dean of the
School of Nursing at Gardner-Webb University, Boiling
Springs, North Carolina. She is a member of Sigma Theta Tau,
and her research interests focus on sleep issues related to the
elderly population.
Yu Xu, PhD, RN, CTN, is an associate professor and PhD in
Nursing program coordinator at the University of Nevada at Las
Vegas School of Nursing and adjunct professor at Bengbu Medical
College, China. He has been a certified transcultural nurse. His
research interests can be broadly categorized into transcultural or
international nursing and comparative nursing education.
Specifically, he is interested in studying issues related to internationally educated nurses in the U.S. nurse workforce. He has made
more than 80 professional presentations at the local, regional,
national, and international levels. He has published 29 full-length
scholarly articles in peer-reviewed nursing journals since 1999 and
has consulted, both nationally and internationally, on retention of
second language or international nursing students, nursing education curriculum, and international nurse training.
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