Improving the Cultural Competence Level of Community Nurses through an Intervention

Special Article – Community Healthcare

J Fam Med. 2016; 3(9): 1088.

Improving the Cultural Competence Level of Community Nurses through an Intervention

Kouta C*, Vasiliou M and Raftopoulos V

Department of Nursing, School of Health Sciences, Cyprus University of Technology, Cyprus

*Corresponding author: Christiana Kouta, Department of Nursing, School of Health Sciences, Cyprus University of Technology, 15 Vragadinou Street, 3041, Limassol, Cyprus

Received: September 20, 2016; Accepted: October 13, 2016; Published: October 17, 2016


Background: Cultural competent care seems to improve quality of care. Community nurses and otherhealth care professionals should have the knowledge and skills in understanding and dealing with immigrant patients/ clients while caring in the community.Training interventions aimed for health professionals, to meet the diverse needs of patients, have been suggested to be effective in increasing the knowledge and capability of addressing cultural issues. Measuring the effect of a study abroad program is one way to determine its impact on developing nurses’ cultural competence.

Aim: ?he paper aims to present the cultural competence level of community nurses in Cyprus, before and after a cultural competence workshop as an intervention.

Method: A quasi-experimental design was used in this study, participating two groups with pre-test and post-test to investigate culturally competence related factors. Between pre-test and post-test an intervention (a cultural competent training workshop) was held with 92 community nurses from a total of 170 that participated in the larger study. The intervention training was based on the Papadopoulos, Tilki and Taylor Model (PTT).

Results: After intervention 25% of community nurses who participated in the workshop improved their cultural competence level based on the Culturally Competent Tool of the PTT Model.

Conclusions: The findings indicated that this particular training intervention seemed to be effective as it increased nurses’ cultural competence levels.

Keywords: Cultural competence; Cultural awareness; Cultural knowledge; Cultural sensitivity; Cultural competence training intervention


The ethnic demography in the Cypriot society is constantly evolving and cultural diversity is increasing. The most recent statistics showed that, in 2011, there were 173.009 foreign citizens comprising of 68 different nationalities living permanently in Cyprus with a total of 2.626 still remaining stateless or unknown [1].

This multiplicity of various nationalities is changing Cyprus into a multicultural country and it is posing new challenges for the health care system. In order to minimize the health disparities related to the cultural backgrounds of patients, health care professionals should improve their cultural competence [2]. This can be defined for example “as the on-going process in which the health care provider continuously strives to achieve the ability to effectively work within the cultural context of the client (individual, family, community)” [3].

Educational and training interventions aimed for health professionals, to meet the diverse needs of patients, have been suggested to be effective in increasing the knowledge and capability of addressing cultural issues [4,5]. Beach et al. [6] conducted a systematic literature review of 34 intervention programs designed to improve the cultural competence of health care providers. According to their literature review cultural competence education does promote and enhance the cultural knowledge, attitudes and skills of health professionals. However, they mentioned that there is a lack of evidence that the cultural competence training would improve patient outcome and they suggested that future research should pay more attention to the effects of cultural competence training from a patient’s point of view [6]. Measurements of effectiveness and a description of the program’s content and format are essential in determining a study’s strength [5].

Culture and Cultural Competence

Health care professionals should have knowledge of the influence of culture in the care processes when encountering immigrant patients/clients. The concept of culture has to be integrated in all aspects of nursing care and there are multiple definitions for culture to consider. Hall [7] gives a broad definition of culture by saying that it is “the study of relationships between elements in a whole way of life”, rather than the practice or a simple description of morals and modes of thinking in societies. Multiculturalism in health care refers to the dissimilarities brought on by patient’s cultural, national and ethnical background as well as the different social reality experienced by the patient. The underlying assumption in this final project was that every individual is culturally unique and it is important to acknowledge that there is as much diversity within the cultural groups as there is between them [8].

Cultural competence is viewed as an on-going process by both Papadopoulos and Campinha-Bacote [9,3], however, the latter emphasizes the requirement of health care providers to see themselves as becoming more culturally competent rather than already being culturally competent. To achieve this level, they must first and foremost be aware of their own attitudes, beliefs and practices on cultural matters. When encountering different views of the culturally diverse patients who do not share the same opinions and values, the health care professional must be prepared and willing to adjust these attitudes and behaviour [10].

The most important tools for health care professionals in multicultural encounters are professional knowledge, understanding, sensitivity and interaction skills. Respecting both the patient and the patient’s values are intertwined in the encounters [11]. When discussing different care options with the patients, the primary starting point is respect for the patient’s cultural beliefs, customs, life, values and following the patient’s own will. Even though the decisions in health care are often made together with the family of the patient, it is still important to stress that the patient’s own will and wishes will be heard. As the number of different cultures encountered is increasing at speed, it is becoming more challenging for a nurse to obtain culture specific knowledge [11].

This poses new challenges to cultural competence education as well. It is important to begin teaching the cultural competency attitudes and skills at the beginning of curricular studies. This should include learning to assess diverse patients´ needs and increase understanding of their problems. Early introduction to cultural issues may help the future health care professionals to become more culturally competent and patient-focused as they start practising their profession [11].

Nowadays, nurses care for culturally diverse patients, thus nursing requires culturally competent practitioners. Academics and/ or nurse educators that are responsible for preparing nurses, who will provide culturally appropriate care, need effective approaches for teaching transcultural nursing. Experiential learning, an important dimension of cultural competence, has been well-recognized as a method for changing attitudes. Study abroad programs can provide nurses with this type of learning [12].

Many nurse educators believe that discussing different cultures with nurses often highlighted important differences; unfortunately, in many instances, this resulted in reinforcing stereotypes. That is, individuals from a specific culture were discussed as homogenous. To date, nursing continues to refine both the importance of and the method for teaching cultural competence. Knowing that diversity exists and being “sensitive” to cultural differences have evolved today into the process of cultural competence [12].

In addition to models, several instruments have been developed that measure one of more of the dimensions considered a part of cultural competence. However, some of these measures may not be useful if educators are seeking a comprehensive measure of cultural competence. In this study the Cultural Competence Assessment Tool (CCA Tool) by Papadopoulos and Lees [13], based on Papadopoulos, Tilki and Taylor model (PTT model), is used. It measures all dimensions of cultural competence. Nurse educators should be aware that some tools may be more appropriate for use or specifically designed for nurses, rather than healthcare providers in general [12- 14].

Papadopoulos, Tilki and Taylor Model (PTT model)

The model refers to the nurse’s capacity to provide effective health care that takes into consideration the patient’s cultural beliefs, behaviours and needs in the nursing process. The model includes four components of cultural competence: 1) cultural awareness, 2) cultural knowledge, 3) cultural sensitivity and 4) cultural practice (Figure 1). Further, the PTT model emphasized the need for nurses to have both culture-specific and culture-generic competence. Culturespecific competence refers to the knowledge and skills that would enable nurses to understand the values and cultural prescriptions that relate to a particular ethnic group and operate within a particular culture. Culture-generic competence is defined as the acquisition of knowledge and skills that are applicable across ethnic groups [15]. Apart from these areas, they also emphasized the need for nurses to promote anti-oppressive and anti-discriminatory practice. To provide this knowledge and skills with structure and to facilitate learning, the following stages were proposed. A conceptual map is provided for each stage as a guideline but can be modified to suit the type and level of nurses.

Citation:Kouta C, Vasiliou M and Raftopoulos V. Improving the Cultural Competence Level of Community Nurses through an Intervention. J Fam Med. 2016; 3(9): 1088. ISSN: 2380-0658