Cultural competence in nursing

Abstract: The overall aim of this thesis is to explore, analyze and clarify how cultural competence is understood. This is explored from the perspective of nurses, nursing students, nurse educators, and nurse researchers in relation to the Swedish care context. The field of transcultural nursing and cultural competence was founded in the United States in the 1950s in response to an increased awareness of cultural diversity arising from immigration. In Sweden an interest in transcultural nursing and cultural competence has emerged only recently and therefore knowledge in this area is quite sparse. In Study I, an instrument for measuring cultural competence was translated, adapted and evaluated for use in Sweden. By following guidelines in the literature, this process was carefully laid out and the content and internal structure of the instrument was evaluated. The findings indicated that the instrument did not meet appropriate validity and reliability levels, and the evaluation of the content indicated a weak relation between the instrument and the constructs. Therefore, it was concluded that the instrument could not be used in Sweden. In Study II, the aim was to analyze the core components found in the descriptions of the most frequently cited theoretical frameworks of cultural competence. Nine theoretical frameworks of cultural competence were analyzed using a documentary analysis method. The data were analyzed using qualitative content analysis. The findings revealed four themes that characterized cultural competence: an awareness of diversity among human beings; an ability to care for individuals; nonjudgmental openness for all individuals and; enhancing cultural competence as a longterm continuous process. In Study III, the aim was to identify the core components of cultural competence from a Swedish perspective. The Delphi technique was used and 24 experts took part in the study. The first round was conducted with qualitative interviews and was followed by three rounds with questionnaires. In total, consensus was reached on 118 core components that were grouped into five categories, with 17 associated subcategories. These categories are: cultural sensitivity; cultural understanding; cultural encounter; understanding of health, ill-health and healthcare; and social and cultural context. In the final study, Study IV, qualitative interviews were conducted with 10 nursing students, five with an immigrant background and five with a Swedish background, to explore their experiences of communication in cross-cultural care encounters. The interviews were analyzed using the framework approach. Four themes were identified: conceptualizing cross-cultural care encounters; difficulties in communication; strategies employed; and factors influencing communication. The synthesis of the findings from the four studies is illustrated in Figure 1 as the common patterns in the constituent elements of cultural competence in the Swedish context, which are identified as: the nurse s cultural awareness, personal beliefs and values; cultural assessment; and cross-cultural communication. The thesis concludes that transcultural nursing and cultural competence is about nurses being able to take the patient s cultural background, beliefs, values and traditions into consideration in nursing care. Cultural competence should not only be employed when caring for immigrants or ethnic minority groups, but also in encounters with all patients.