Cultural competence has been defined as a process rather than an endpoint. In this process, nurses continuously endeavor to acquire information on the cultural content of individuals, families, and society in an effective manner [4, 19, 20]. The present study investigated the degree of cultural competence among nursing educators and faculties at medical sciences universities of the 2nd regional planning of Iran in 2021. Out of 129 nursing educators, 84 (65%) filled out the CDQNE-R questionnaire. The results on the demographics of the respondents showed that none of the participants had received transcultural nursing training. It seems that this subfield has been sensitively neglected at Iranian universities and nursing curricula. The transcultural nursing subfield focuses on examining different cultures with respect to health-disease values and beliefs to provide culture-based care [1].
The results of this study regarding the absence of transcultural nursing education are in line with the findings of the research by Sealey, who reported that only 3% of the participants had majored in transcultural nursing [1]. Leininger introduces the discussion on nursing faculties’ competence in teaching transcultural nursing as the most crucial problem in preparation for encountering challenges rooted in cultural diversity [10]. In a national survey in the United States, Kelly discovered that only 19% of nursing educators had received certifications to participate in a transcultural nursing course. She also suggested incorporating extra postgraduate programs in transcultural nursing in the curriculum to make new nursing educators ready for teaching this topic and playing role models to students [21].
The cultural awareness subscale embarks on recognizing the personal biases, prejudgments, and hypotheses of various individuals in cultural terms. The cultural awareness acquisition process is essential for the progress of cultural competence and is the most significant component in Campinha-Bacote’s cultural competency model [22]. In this research, the highest score belonged to the cultural awareness subscale (4.11), which was expectable since cultural awareness was constantly recognized as the most paramount element of cultural competence regarding past research [19, 23, 24]. In her study in 2003, Sealey aimed to determine the cultural competence of faculty of baccalaureate nursing programs in Louisiana in the United States and estimated the mean score of the cultural awareness subscale at 4.14. This subscale also allocated the highest score to itself in her study [1]. Yates [18] and Siswadi et al. [25] reported the mean score of cultural awareness at 4.36 and 4.28, which were the highest scores among other subscales. Unlike previous studies, the cultural awareness subscale was ranked third after the cultural knowledge and transcultural educational behaviors in Sandra Burns’ quest [26, 27]. The mean score of the cultural awareness subscale was also ranked second after cultural desire in Chen’s study [28]. Using the CDQNE-R instrument, Baghdadi estimated the mean score of the cultural awareness subscale at 35.2, which was smaller than the cultural knowledge subscale [26, 29]. This subscale has been ranked first or second in many studies, highlighting that the examined units agree with their culture and cultural backgrounds.
The cultural knowledge subscale measures the participant educators’ degree of knowledge of cultural competence concepts and is a process through which individuals look for the content of various cultures [22, 30]. The mean score of the respondents in the 11-item cultural knowledge subscale equaled 3.52 ± 0.6.
The review of the literature reveals that cultural knowledge extremely contributes to providing culturally competent care [22, 24, 31, 32]. Cultural knowledge is also significant in engaging nursing students in classes held on cultural diversity [18]. The cultural knowledge subscale equaled 3.75 in Yates’ study and, in line with Sealey’s study, fell into the cultural agreement category [18]. Siswadi et al. [25] reported the mean cultural knowledge score of the examined units at 3.81. In Burns’ study, the highest score belonged to the cultural knowledge subscale (44.60) [26, 27], while the lowest mean score was allocated to this subscale (2.62) in Chen’s study based on the IAPCC-R instrument [28]. Furthermore, cultural knowledge gained the highest score among other subscales in Baghdadi’s study [26, 29]. In the present study, cultural knowledge was ranked fourth among 5 subscales. This result can be due to the lack of sufficient attention to teaching concepts associated with the cultural competence process and transcultural nursing to nurses and nursing educators.
The cultural skills subscale refers to the ability to collect cultural data tied to the current problem of the patient and make a meticulous culture-based physical evaluation [22]. A healthcare provider should know that a patient’s physical, biological, and mental differences can influence the outcomes of the physical evaluation. These differences can manifest in body performance, skin color, observable physical characteristics, and laboratorial results [32].
The mean score of the 8-item cultural skill subscale equaled 3.71 ± 0.60. This result shows that the research units agree on possessing the necessary skills to culturally examine help-seekers and build relationships with nursing students and them. The cultural skill subscale mirrors educators’ convenience in using culture-evaluating tools, communicative styles in interacting with help-seekers with diverse cultures, and efficiency in evaluating culturally different help-seekers [33]. In their study, Jones et al. reported that when they asked nurses, who worked with Mexican help-seekers, what was their main problem as nurses, they referred to establishing effective relationships and linguistic barriers [34]. However, the highest score belonged to the cultural skill after the awareness subscale in this study. In her study, Sealey reported the mean score of the cultural skill subscale at 3.65, which was aligned with the results of the present research. This subscale fell into the agreement category in both studies. That is to say, the research units agreed on possessing skills for collecting information on the cultural background of help-seekers and students and evaluating them culturally. The findings of the study conducted by Yates [18] (mean = 3.79) correspond with the results of Sealey’s and our studies concerning the cultural skill subscale. Siswadi [25] reported the mean score of nursing educators’ cultural skills at Indonesian universities at 3.96, and the cultural skill subscale was ranked fourth in Chen’s study [28]. Marzilli reported the mean score of cultural skill at 3.54, which was the highest among the other subscales [24, 35].
In the present study, the second rank belonged to the cultural skill subscale, showing that the participant faculties were sufficiently prepared to evaluate help-seekers and students culturally. Due to the ever-increasing growth in the diversity of cultural and racial groups in different regions of Iran, it is imperative to attend to linguistic skills, such as the skill to work with different translators, in nursing educators and nurses.
The cultural encounter subscale reflects the interaction of the research units with different racial and cultural groups. The purpose of cultural encounters, as a prerequisite to cultural competence development, is to create a wide spectrum of responses to transcultural situations [36]. Direct interactions with patients of different cultural groups improve or alter individuals’ mindsets about a cultural group and can prevent likely prejudgments [22, 32]. The mean score of the research units in the 6-item cultural encounter subscale equaled 3.38 ± 0.71, indicating that the respondents were doubtful about their level of participation in face-to-face interactions with different cultural, ethnic, and racial groups. This subscale received the lowest score in this research among the other subscales and was the sole index falling into the doubt category. Lower scores may be attributed to the lack of opportunity or tendency to interact with individuals of other cultural groups. The cultural encounter also scored the lowest in Sealey’s study, similar to the present research [1]. In her research, Yates estimated the cultural encounter score at 3.34, which was at the doubt level [18]. Chen also reported the mean score of the cultural encounter subscale at 2.89. This value also fell into the doubt category according to Sealey’s interpretive scale [28]. In line with the results of the present research, the cultural encounter score was the lowest among the other subscales in many of the mentioned studies [25, 27, 29].
Ryan et al. believed that the lack of authentic experiences with diverse cultures is one of the barriers to developing a culture-centered curriculum. They also reported that the students engaged in a cultural interaction experience identified increased awareness of the need for cultural competence, familiarity with personal biases, and the need for perceiving various relational models as the main outcomes of this experience [13]. Considering the results of the study above and the significance of cultural encounters, as reflected by past studies, it is suggested that the chancellors of the Iranian medical sciences universities, nursing faculties, and the nursing managers and directors of the Ministry of Health increase the number of programs where nursing faculties can interact with different racial and cultural groups and pave the way for the participation of nursing faculties in these interactions.
The cultural desire subscale reflects healthcare providers’ motivation for voluntarily engaging in the process of cultural awareness, cultural knowledge, cultural skill, and cultural encounter. In the present research, the mean score of this subscale equaled 3.93 ± 0.54, indicating the participants’ cultural desire and commitment to provide care and teach racially and culturally different individuals. Sealey estimated the mean score of participants’ cultural desire at 3.67, which conformed to the findings of the present research [1]. The results of Yate’s study (mean = 4.10) were also in line with the findings of our and Sealey’s studies. This subscale, with a mean of 4.34, allocated the third rank to itself in Burns’ study [27], while the highest score belonged to the cultural desire subscale among the others in Chen’s study (mean = 3.57) [28].
Cultural desire is an important primary step in providing culturally competent care [18]. The lack of cultural desire can lead to nursing faculties’ non-commitment to accessing a transcultural cultural lesson plan and influence their perceptions, attitudes, and behaviors with individuals with various cultural backgrounds. This, in turn, can impact students’ shaped perceptions and attitudes as well [37, 38].
The transcultural educational behaviors subscale measures to what extent nursing educators have incorporated transcultural nursing concepts into the educational content of the nursing curriculum [18]. In this research, the mean score of the research units in this subscale equaled 3.90 ± 0.55, indicating that the participants agreed with inserting the transcultural nursing concepts into the educational content of their educational and clinical classes. Sealey, in her study, showed that the examined units, with a score of 3.97, agreed with incorporating transcultural nursing concepts into the educational content. Her findings, with a trivial difference, are in line with the results of our study [1]. Yates also reported aligning results with the findings of our and Sealey’s studies and estimated the mean score of participants at 4.06 in this subscale [18]. This result also reflects the agreement of the research units for including transcultural nursing concepts in the nursing curriculum [28].
The attainment of multicultural education calls for faculty members’ cultural competence and their efforts and commitment to planned educational strategies and opportunities that embrace diverse cultural concepts [18]. With respect to the results of the present study and past research, it is suggested that specialized educational courses be incorporated into the academic and clinical teaching content of nursing educators for the purpose of offering approaches that improve the instruction of transcultural nursing concepts.
The results on the relationship between the total cultural competence index and every one of its subscales among nursing educators showed that the maximum effect on the dependent variable was linked to the cultural awareness variable. In similar past studies, only Sealey employed multiple regression analysis to examine the effect size of dependent variables (cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire) on the independent variable (total cultural competence), where the cultural knowledge, cultural skill, cultural encounter, and cultural desire explained 99% of the variance. Unlike her study, where the cultural awareness subscale was excluded from the model according to the analysis process (1), the cultural desire index was omitted from the model in our research.
This study estimated total cultural competence based on the mean scores of the cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire indices in Campinha-Bacote’s cultural competency model [22]. According to this model, total cultural competence falls into the cultural agreement category. That is to say, the participants agreed that they maintained cultural awareness, skill, knowledge, and desire to provide culturally competent care and teach their nursing students how to provide cultural care. The ultimate results of studies by Sealey, Yates, and Siswadi, who also employed this model, were in line with the findings of the present research at the total cultural competence level [1, 18, 25]. In her study, Burns reported the total cultural competence score at 170.9. Considering Ume-Nwagbo’s interpretive scale, the examined units in this study were moderately competent in cultural terms [26, 27]. Likewise, Marzilli estimated the total cultural competence score at 162.3, and Texan nursing educators’ cultural competence was also moderate [35].