Evaluation of an educational intervention to increase cultural competence among registered nurses.

Abstract:The purpose of this two group intervention study (N=94) was to determine if RNs who participated in "culture school" improved levels of cultural competence to a greater extent than RNs who attended nursing informatics classes. The Giger and Davidhizar Transcultural Assessment Model/Theory (GDTAMT) was the study's theoretical foundation (Giger & Davidhizar, 1995). A sample of 94 participants, was identified from a randomized group of all Jefferson County, Alabama RNs. Randomly assigned participants (stratified by race) experienced 8.5 hours of either culture school or nursing informatics classes and completed survey tools in three phases (preintervention, immediate post intervention, three week follow-up). The Cultural Self-Efficacy Scale (CSES) by Bernal and Froman (1987), knowledge base questions by Rooda (1990), and demographic profiles were used. Concepts empirically measured using these tools were analyzed by transcultural nursing experts for their congruence with GDTAMT. Using repeated measures analyses of covariance (race), significant differences between groups for both scales were found. Culture school participants demonstrated significantly more cultural self-efficacy and cultural knowledge, and these improvements remained during phase three. Further research is recommended to allow for greater generalizability of findings, an examination of client perceptions, and actual nurse behaviors. Keywords: Cultural Competence, GIger-Davidhizar Transcultural Assessment Model and Theory (GDTAMT), Culture School, Cultural Knowledge, Registered Nurses, Repeated Measures ANOVA, Cultural Self Efficacy Scale (CSES) As the population in the United States becomes increasingly diverse, nurses will need greater skill in working with people with diverse beliefs, attitudes, values, and behaviors (O'Connor, 1996). All persons have ethnicity, and all persons bring to any interaction a set of beliefs and behaviors that are rooted in their family, ethnic, and cultural backgrounds. All persons deserve to have their ethnicity valued by nurses who provide culturally competent care. As a process, not an end point, cultural competence is the ability to care for each individual, or group, with a sensitivity, respect, and empathy for culturally linked beliefs, values, attitudes, and behaviors. When implemented, culturally competent care has the power to increase client and provider satisfaction with the relationship, the demonstrated care, and importantly, the health outcomes (O'Connor, 1996). No matter what the cultural background of the nurse, that nurse will need cultural competence when caring for all clients and client groups. STATEMENT OF THE PROBLEM AND STUDY SIGNIFICANCE The specific problem investigated was the potential lack of ability by nurses in caring for clients from diverse cultures. This problem includes the need for additional skill, sensitivity, and capability on the part of nurses as they implement culturally competent care. Leininger wrote in 1989 of a great crisis in nursing, "most nurses are unprepared to function effectively with migrants and cultural strangers. It is difficult for nurses to interpret cultural behavior to know how best to help alien patients" (p. 251). She added that this ineptness caused nurses to feel helpless and therefore experience a lack of self-efficacy in their care. Because nurses are the largest healthcare work-force, nurses needed to be responsive to the changing ethnicity of America (Meleis, 1992). Unfortunately, according to O'Connor (1996) there is no single set of criteria for implementing and sustaining cultural competence. Two studies demonstrating the lack of culturally competent nursing assessments were performed by Hart (1994) and Sharma (1988). Hart found that although pediatric nurse subjects worked with culturally diverse clients and client groups, cultural assessment forms were not available and cultural assessments were not performed. …