Cultural Competence Nursing Care and Its Associated Factors Among Nurses in Northern Ethiopia: A Mixed Method Study Design

Abstract

Background:

Cultural competence comprises understanding the values, beliefs, traditions, and customs of diverse groups. Nurses working with a culturally diverse population are fronting challenges principally due to the coexistence of multicultural and multiethnic societies.

Objective:

To assess cultural competency nursing care and its associated factors among nurses working in Amhara Regional State Referral Hospitals, Ethiopia, 2021.

Methods:

Institution-based mixed method study design was conducted at selected referral hospitals in Amhara Regional state Ethiopia from April 1 to May 30, 2021. A simple random sampling technique was used to select 543 participants for quantitative and purposive sampling for qualitative study. Data were collected using a self-administered Nurse Cultural Competence Scale Questionnaire, and semi-structured questions for in-depth interviews. Data were entered into Epi data version 4.6 and exported to SPSS version 25 analysis. Descriptive statistics independent t-test and one-way analysis of variance with multiple linear regression analysis were used for data analysis. Qualitative data were analyzed using thematic analysis using open code software.

Results:

A total of 543 participants were involved in this study making a response rate of 95.02% and seven participants for qualitative until data saturation was involved. More than half (54.5%) were female. The overall cultural competence nursing care of mean score was 3.39 (0.61) out of a total possible score ranging from 1 to 5 which indicates a moderate level of cultural competency. The language barriers, lack of organizational support, cultural difference, and health care provider-related factors were the main identified themes in qualitative results.

Conclusion and Recommendation:

The overall cultural competence was at a moderate level, among four subscales cultural sensitivity was the highest. The language barrier and lack of training were the major barriers to culturally competent nursing care.

Keywords:

• culture
• cultural competence
• nursing care
• cultural diversity
• Ethiopia

Abbreviations

ANOVA, analysis of variance; CCC-PRE-R, Clinical Cultural Competency Questionnaire – Revised; CCQN, Cultural Competency Questionnaire for a Nurse; CLAS, culturally and linguistically appropriate services; CSA, Central Statistical Agency; CSRH, compressive specialized hospital; IAPCCR-R, Inventory for Assessing the Process of Cultural Competence-revised; NCCSQ, Nurse Cultural Competence Scale Questionnaire; PTTM, Papadopoulos Tilki and Taylor’s model; RH, referral hospital; SPSS, Statistical Package for Social Science; UoGCSH, University of Gondar Comprehensive Specialized Hospital.

Data Sharing Statement

The raw data are available from the corresponding author on reasonable request, the summary of data is presented in the manuscript.

Ethical Approval and Consent

The study was performed based on the ethical standards put down under the declaration of Helsinki. The ethical clearance was obtained from the school of nursing research and ethical review committee on behalf of the University of Gondar research and ethical review committee with reference No-S/N 164/7/2013. Official permission letters were obtained from each selected referral hospital. After understanding the purpose of the study, a signed written informed consent was obtained from the study participants, which ensured that no identities were known by the investigators, and any response of the participants was anonymized. Confidentiality of participants’ information was kept.

Acknowledgments

Our deepest gratitude goes to University of Gondar for all expenses of this research work and to the study participants who participated in the research. The authors also would like to give great appreciation to data collectors and supervisors for their contributions to this paper.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Funding

The study was supported by the University of Gondar College of Medicine and Health Sciences. The funder did not have a further role in the design, data collection, analysis, drafting, manuscript, preparation, or publication of this paper.

Disclosure

The authors report no conflicts of interest for this work.