Cultural Competence Among Italian Nurses: A Multicentric Survey

Growing ethnic and cultural diversity is widely recognized (Schim, Doorenbos, & Borse, 2005; Schim, Doorenbos, Miller, & Benkert, 2003). The increasing number of people moving from one country to another (OECD, 2011) highlights the need for culturally competent health care. Healthcare organizations have to face complex differences in patients' communication styles, attitudes, expectations, and worldviews, multiple languages, different socioeconomic classes, gender, and sexual orientation have become equally important (Abrums & Leppa, 2001; Fortier & Bishop, 2003). Health professionals need to be adequately trained and prepared to care for immigrant patients (European Intercultural Workplace, 2007). Cultural competence in nursing is defined as the incorporation of personal cultural diversity experience, awareness, and sensitivity into everyday clinical practice (Schim & Doorenbos, 2010; Schim, Doorenbos, Benkert, & Miller, 2007). In addition to sensitivity to self and others, competence behaviors are dependent on personal exposure, work experience with people from different ethnical groups, and awareness of individual and group similarities and differences (Schim, Doorenbos, & Borse, 2006). Providing culturally competent care has been associated with improved provider-client communication (Kelly & Papadopoulos, 2009), higher satisfaction with care (Bussema & Nemec, 2006), and health status improvement, as full comprehension of health status, adherence to medications and lifestyle recommendations, and appropriate utilization of the health system (Fortier & Bishop, 2003; Weech-Maldonado et al., 2012).Research suggests that cultural competence training impacts intermediate outcomes such as knowledge, attitudes, and skills of health workers (Beach et al., 2005), and patients' satisfaction (Beach et al., 2006). Nurses who regularly practice culturally competent care can effect positive healthcare changes for clients (Casillas et al., 2014; Leininger & McFarland, 2006; van Ryn, 2002), while the lack of knowledge can lead to prejudice and discrimination (Betancourt, Green, Carrillo, & AnanehFirempog, 2003; Fortier & Bishop, 2003; Hamilton & Essat, 2008), difficulties in planning care, and participation to the individualized care process (Helms & Cook, 1999). The lack of knowledge can also lead to a misinterpretation of patients' needs, with risks for diagnostic and therapeutic errors (Alpers & Hanssen, 2014; Canto et al., 2000; Dias, Gama, Gargaleiro, & Martins, 2012). Several studies among nurses showed a positive correlation between educational training and cultural competence in different multi-ethnic countries such as the United States and Canada (Delgado et al., 2013; Doorenbos & Schim, 2004; Schim et al., 2005, 2006; Starr & Wallace, 2009, 2011; Weech-Maldonado et al., 2012), the United Kingdom (Gerrish, 2001), Switzerland (Casillas et al., 2014), and Sweden (Berlin, Johansson, & Tornkvist, 2006; Berlin, Nilsson, & Tornkvist, 2010). Recently, in Italy, the number of immigrants has been increasing, and foreign residents account for 8% of the entire registered Italian population (OECD, 2013). It is becoming increasingly common and frequent for Italian nurses to establish relationships with patients with different cultural backgrounds (Manara, Isernia, & Buzzetti, 2013), but no studies have been carried out to assess Italian nurses' cultural competence. This study was aimed at evaluating the level of cultural competence among Italian nurses.MethodsDesignA multicentric, cross-sectional study was carried out from September 2013 to May 2014.Sample SizeThe primary end point of the study was to assess nurses' cultural competence. Because we did not know the percentage of participation and in order to ensure that all Italian areas (North, Center, South, and Islands) were represented, we estimated that 450 questionnaires per area would be sufficient to ensure an adequate assessment (Doorenbos & Schim, 2004; Schim et al. …