Volume 28, Issue 3 (7-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(3): 163-170 | Back to browse issues page

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Yadollahi S, Ebadi A, MolaviNejad S, Asadizaker M, Saki Malehi A. Evaluation of Cultural Competency in Clinical Nurses: A Descriptive Study. Avicenna J Nurs Midwifery Care 2020; 28 (3) :163-170
URL: http://nmj.umsha.ac.ir/article-1-2127-en.html
1- PhD Student in Nursing Education, School of Nursing and Midwifery, Jundishapur University of Medical Sciences, Ahvaz, Iran
2- Professor, Department of Nursing Management, School of Nursing and Midwifery, Behavioral Sciences Research Center, Lifestyle Research Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
3- Assistant Professor, Department of Nursing, School of Nursing and Midwifery, Nursing Care Research Center for Chronic Diseases, Jundishapur University of Medical Sciences, Ahvaz, Iran
4- Assistant Professor, Department of Nursing, School of Nursing and Midwifery, Jundishapur University of Medical Sciences, Ahvaz, Iran , marziyehasadizaker@gmail.com
5- Assistant Professor, Department of Biostatistics and Epidemiology, School of Health, Jundishapur University of Medical Sciences, Ahvaz, Iran
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Globalization has increased cultural diversity in many countries [1]. This diversity of cultures can be a challenge to provide appropriate care services because lack of knowledge and skills on how to properly and effectively deal with different beliefs and cultural values of patients may cause the necessary communication and interaction between patient and nurse [4].
Caring for patients with diverse cultures has been described by nurses as a complex and challenging issue that is related to multiple individual and situational factors of patients and requires nurses' cultural competency [2].
In the field of health care, cultural competency is defined as the ability to recognize, appreciate and respect the values, preferences and needs of clients [1]. Cultural competency is a skill that enables the nurse to provide nursing care in specific cultural ways in a wide variety of cultures that s/he deals with on a daily basis, and leads to patient satisfaction and positive outcomes in nursing care [12].
Considering the importance of this issue in nursing care on the one hand and the cultural diversity of Iran on the other hand and the few studies that have been done in this field, the present study aimed to investigate the level of cultural competency in nurses working in private and educational hospitals in Ahvaz and Isfahan, considering the multi-ethnicity of these. Awareness of the level of cultural competency of nurses can be helpful in designing educational and managerial planning while serving nurses.


Materials and Methods

This descriptive study was performed on 230 nurses working in educational and private hospitals in Ahvaz and Isfahan, Iran, who were selected by random sampling with inclusion criteria. Data gathering tool was a researcher-made cultural competency questionnaire. Data were analyzed using SPSS 22 (SPSS Inc., Chicago, Ill., USA) by describing and deduction examining like independent samples t-test, ANOVA, and Tukey test.



Of the participants, 67.8% were women and 92.6% had undergraduate degrees. The average work experience was 10 years, and 69.1% of nurses reported experience of working with patients with different cultures. The mean score of nurses' cultural competence was in the average level (104.8±11.58). The results also showed that the mean score of cultural competence was the highest in cultural flexibility dimension (24.46 ± 3.46) and lowest in cultural desire dimension (10.73±3.90) (Tables 1-4).


Table 1. Demographic characteristics of nurses working in Ahvaz and Isfahan hospitals

Demographic characteristics M±SD Range
Age 20.82±34.7 23-62
Work history 29.13±10.7 2-35
  N %
Sex Male 74 32.2
Female 156 67.8
Marital status Single 73 31.7
Married 157 68.3
Education Bachelor 213 92.6
Master 12 5.2
PhD 5 2.2
Experience working outside the city or place of residence Yes 159 69.1
No 71 30.9
Work experience in other countries Yes 4 1.7
No 226 98.3

Table 2. Frequency distribution of cultural competence in nurses working in Ahvaz and Isfahan hospitals

Cultural competence N %
Low (0-49%) 48 20.86
Medium (50-75%) 116 50.43
High (76-100%) 66 28.69
Total 230 100
Score <50: Low cultural competence
Score: 50-75 Medium cultural competence
Score> 75: High cultural competence

Table 3. Frequency distribution of scores by dimensions and total score of the Cultural Competence Questionnaire in nurses working in Ahvaz and Isfahan hospitals
Dimensions Minimum Maximum M SD
Cultural flexibility 15 30 24.46 3.465
Cultural care skills 11 25 21.08 2.558
Cultural cognition 8 25 17.80 3.478
Cultural desire 4 49 10.73 3.909
Intention of cultural care 6 41 15.09 3.007
Cultural assessment skills 5 20 15.65 2.754
The whole questionnaire 78 135 104.8 11.58
Table 4. The level of cultural competence of nurses working in Ahvaz and Isfahan hospitals based on demographic characteristics
Variable Statistics Degree of freedom The significance level
Age F= 9.8 df1=3 P =0.000
Gender t=0.4 df=228 P =0.62
Degree of education F=1.95 df1=2 P =0.14
Work experience F=7 df1=2 P =0.001
Marital status t = -1.8 df=228 P =0.07
Experience working outside the home t =3.28 df=105 P =0.001



Cultural competency was reported to be moderate in half of the clinical nurses participating in this study. The reason for this finding could be the high work experience of the participants or their frequent encounters with patients from different cultures. In this regard, Repo et al. (2017) in a study that examined the cultural competency of nursing graduate students in southern Finland, reported their level of cultural competency as average [17]. Also, in another study conducted in 2016, using both quantitative and qualitative methods, the cultural competency of Texas Nursing faculty members was assessed at an intermediate level [18].
Another result of the present study is the high score of cultural competency in the dimension of flexibility. This was while the lowest score obtained in the dimension, was cultural desire. Cultural competency assessment tools in nurses have different dimensions. The questionnaire used in this study had 6 dimensions of cultural care intention, cultural flexibility, cultural skills, cultural cognition, cultural tendency and cultural evaluation. Cultural flexibility is an implicit feature of cultural competency, which means the ability to adapt to different situations. In particular, flexibility is associated with an intercultural perspective, acceptance, commitment and respect for other cultures [21].
Related studies defined the desire and intention of cultural care to motivate the caregiver to acquire cultural competency by participating in the process of dealing with the patient from a different culture and engaging in the process of acquiring cultural knowledge, awareness and skills [22]. Examination of the results showed that older people, who had more work experience and had experience working with patients from different cultures, had a higher score of cultural competency. These results are in line with studies conducted in this field. In Lin's (2019) study, work experience, continuing education hours related to cultural care in nursing, and the multiplicity of patient care with different cultural backgrounds in nurses had a direct and positive relationship with the level of cultural competency in nurses [24].
In general, it can be said that cultural competency in nurses increases with age, work experience and frequent communication with patients from different cultural backgrounds and acquiring communication skills; however, it is possible to facilitate the acquisition of this feature in graduate and inexperienced nurses by planning, training and providing appropriate clinical conditions.



Due to the expansion of cultural diversity of patients in Iran, the average level of nurses' cultural competence in this study indicated the necessity of increasing the attention and planning of nursing managers to promote nurses' cultural competence.



We would like to thank the esteemed Vice Chancellor for Research of Ahvaz University of Medical Sciences and the sincere cooperation of the management of selected hospitals and the esteemed nursing managers and nurses, without whose cooperation this research would not have been possible. This article is taken from the doctoral dissertation approved by Ahvaz Jundishapur University of Medical Sciences.


Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Original Research | Subject: Nursing
Received: 2020/01/11 | Accepted: 2020/02/5 | Published: 2020/05/30

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