FINDINGS
Introduction
The purpose of this descriptive correlational study was to generate data that would
address the impact of the cultural encounter on the cultural competence of baccalaureate
nursing students. The specific aims of this study were: 1) to determine the frequencies of
the demographic and cultural competence measures of baccalaureate nursing students, 2)
to determine if there were significant differences in the cultural competence of first
semester baccalaureate nursing students and final semester baccalaureate nursing students,
and 3) to investigate the association of self-reported cultural awareness, cultural skill,
cultural knowledge, cultural encounter, cultural desire, total cultural competence, year in
school, and academic program credits of baccalaureate nursing students.
This chapter begins with an overview of the analysis of the quantitative data
collected from the three participating schools of nursing, totaling 453 sophomore and senior
baccalaureate nursing students. The overview of the analysis will include the statistical
procedures of the analysis and a description of the demographic characteristics of the
sophomore and senior nursing students who completed the survey. After the presentation
of the results of the nursing students’ responses, the chapter will conclude with a
presentation of the findings as they relate to the specific aims.
Data Analysis Procedures
The researcher utilized data gathered from both the demographic (Appendix B) and
the IAPCC-SV (Appendix A) questionnaires that were administered to sophomore nursing
students within two weeks of beginning the nursing program, and to senior nursing students
at end of their program before two weeks of their graduation day.
The demographic questionnaire and the IAPCC-SV were administered in person by
the principal investigator at each school of nursing. The data was entered and analyzed
using SPSS (Statistical Package for Social Sciences) version 22. Descriptive statistics were
used for the demographic data, including mean, range, standard deviation, and frequency
distribution, and all were assessed for normal distribution. The three specific aims were
examined using independent samples t-test, Pearson product-moment correlation
coefficient, and one-way analysis of variance (ANOVA). Correlation and independent
sample t-tests were chosen to compare cultural competence scores for specific categorical
demographic data of the sophomore and senior nursing student. ANOVA was used to
examine the three schools of nursing and their mean cultural competence scores, as well as
the year in school and the mean cultural competence scores, to determine the amount of
variability (Cronk, 2014; Pallant, 2013).
For this study, the sample size exceeded the required sample of 90 participants
according to Tabachnick and Fidells’formula (2012) of 8m + 50, whereby m equals the
expected numbers of predictors in the model. The assumptions of multicollinearity and
singularity were met in this study, because the independent variables were not highly
correlated (r=.9 or above), nor were any of the independent variables a combination of the
other independent variables.
The assumptions of outliers, normality, linearity, homoscedasticity, and
independence of residuals can be examined through the histogram, the Normal
Probability Plot (P-P) of the Regression Standardized Residual, as well as the scatterplot.
The histogram for this study would suggest normality:
Figure 3: Histogram of Standardized Residuals
The Normal P-P Plot for this study would suggest no deviations from normality
based upon the diagonal line from the bottom left to the top right of the graph (Pallant,
2013):
Figure 4: Normal P-P plot of the standardized residuals
The scatterplot of the standardized residuals should appear roughly rectangular in
shape, with most scores at the zero point and concentrated in the center (Figure 5). If there
were deviations from the center one would assume some violation of the assumption of
homoscedasticity and independence of the residuals. However, with large samples it is
expected there will be a number of outlying residuals; therefore it may not be necessary to
take any action as a result (Pallant, 2013). In the scatterplot below (Figure 6) most scores
are concentrated at the center and around the zero point. Although there are outliers,
because the sample is large this researcher did not take any action and believes the
assumptions have not been violated. (Pallant, 2013).
Figure 5: Reference Scatterplot of Standardized Residuals
Figure 6: Scatterplot of Standardized Residuals
Demographic Data
The demographic questionnaire contained questions to gather specific information
from the sophomore and senior nursing students at the three schools of nursing. The
questionnaire included questions on age, gender, marital status, ethnicity, religion, if they
had a previous college degree, if they had taken a previous course on culture, if they had
traveled outside of the United States, if they had lived outside of the United States, and for
seniors only, if they had participated in an immersion experience while in the nursing
program.
Results Reported For Each Specific Aim
The following pages will be divided by each individual specific aim and report of
the statistical tests and corresponding analysis for each aim.
Specific Aim #1: To determine the frequencies of the demographic and cultural
competence measures of baccalaureate nursing students.
The population of the study consisted of 252 sophomore nursing students and 230
senior nursing students from the three schools of nursing (Table 4). The actual sample
consisted of 245 sophomore nursing students and 208 senior nursing students from the three
nursing schools. This equated to a 93.9% participation rate, with 36.7% of the sample from
48 Hour Program, 41.4% of the sample from 45 Hour Program, and 21.9% of the sample
from 30 Hour Program.
Table 4
Participation by Academic Program and Year in School
_________________________________________________________________
School
Year on School
n
%
48 Hour Program
Sophomore
90
19.9
Senior
76
16.8
45 Hour Program
Sophomore
102
22.5
Senior
86
18.9
30 Hour Program
Sophomore
53
11.7
Senior
46
10.2
Note: N=453 100 %
Overall Sample Demographic
The statistics for the overall sample will be discussed first. The entire sample was
made up of students who ranged in age from 18 years to 41 years old, with 86.6% of the
sample in the 18-22 year old range. The remaining sample was divided as follows: 9.7%
in the 23-27 year old range, 2.7% in the 28-32 year old range, and 1% in the 33-41 year old
range. The mean age of sophomores was 19.84 (SD = 1.66) and of seniors was 22.70 (SD
= 2.94). One student did not provide their age on the questionnaire. Table 5 provides data
on the reported student age.
Table 5
Age of Sample
Age Range
n
%
Age in years
18-22
390
86.3
23-27
44
9.7
28-32
13
2.9
33-41
5
1.1
Note: N=452 100 %
The sample for this study was made up of approximately 9% male and 91% female;
one student did not provide their gender. The reported marital status of the sample for the
study was made up of 84.8% single nursing students, 13.2% married students, 0.7%
divorced students, and 1.1% other (dating, engaged, widowed).
One student did not provide data on marital status (Table 6).
Table 6
Gender and Marital Status of Baccalaureate Nursing Students By Year in School
Sophomore Seniors
(n = 244) (n = 208)
________________ _________________
Variable n % n %
Gender
Male 24 9.8
15 7.2
Female 220 89.8
Marital Status
192 92.3
Single 215 88.1
169 81.3
Married 24 9.8
36 17.3
Divorced 2 0.8
1 0.5
Other 3 1.2 2 1
The study sample consisted of 8.1% ethnically diverse students between the three
schools of nursing. There were two students who did not provide their ethnicity on the
demographic questionnaire. The religion of the sample was quite homogenous, though the
majority of the sample was Catholic (30.9%), Christian (38.9%), and Lutheran (15.9%).
The remaining students in the sample were “other Christian”, such as
Methodist, Orthodox, Presbyterian, and Seventh Day Adventist (6.4%), and “other
nonChristian”, such as agnostic, atheist, and “none” (7.5%). Two students did not provide
data on their religion (Table 7).
Table 7
Ethnicity and Religion By Year in School of Baccalaureate Nursing Students
Sophomore
(n = 243)
Seniors
(n = 208)
________________
________________
Demographic Variable n %
n %
Ethnicity
American Indian/
Alaskan Native 1 0.4
1
0.5
Asian 5 2.1
5
2.4
Black 7 2.9
3
1.4
Caucasian 223
91.8
190
91.3
Hispanic 4
1.6
2
1.0
Other 3
1.2
7
3.4
Religion
Catholic 72
29.6
68
32.7
Christian 93
38.3
83
39.9
Lutheran 40
16.5
32
15.4
Other Christian 21
8.6
8
3.8
Other non-Christian 17 7.0 17 8.2
The demographic questionnaire asked students if they had obtained a previous
college degree. There were 431 students who did not have a previous degree (95.1%),
twenty-one students who had a previous degree (4.6%), and one student did not provide
the data for that question. Of the 450 students who supplied the data about whether they
had taken a previous course on culture, 314 students (70%) had taken a course on culture
prior to this study and 136 students (30%) had not taken a course on culture. Three students
did not provide data for this question.
The questionnaire also asked students whether they had ever lived outside of the
U.S. or traveled outside of the U.S. Of the 451 students who answered both questions, 393
students (86.8%) had never lived outside of the U.S., 58 students (13.2%) had lived outside
of the U.S., 361 students (79.7%) had traveled outside of the U.S., and 90 students (19.9%)
had never traveled outside of the U.S. The final question on the questionnaire was for
senior nursing students only and asked whether they had participated in an international
immersion experience during their nursing program. Of the 207 senior nursing students
(one student did not supply data for this question), 116 students (55.7%) had not
participated in an immersion experience, while 91 students (43.7%) had participated in an
immersion experience during their nursing program (Table
8).
Table 8
Other Demographic Variables By Year in School of Baccalaureate Nursing Students
Sophomore
(n = 244)
Seniors (n
= 208)
________________
_______________
Demographic Variable n %
n %
Previous Degree
Previous Degree 11 4.5
10
4.8
No Previous Degree 233 95.5
198
95.2
Course on Culture
Course
137
56.0
177
86.0
No Course
107
44.0
29
14.0
Lived outside of U.S.
Lived
31
12.7
27
13.0
Not Lived
213
87.3
180
87.0
Traveled outside of U.S.
Traveled
184
75.4
177
85.5
Not Traveled
60
24.6
30
14.5
International Immersion Experience (Seniors Only)
Experience
91
44.0
No Experience 116 56.0
Specific Aim #2: To determine if there were significant differences in the cultural
competence of first semester baccalaureate nursing students and final semester
baccalaureate nursing students.
Mean Cultural Competence and Demographic Data
Independent-samples t-tests were conducted to compare cultural competence scores
for specific categorical demographic data. There were significant differences in the mean
scores on some of the demographic data, including previous course on culture, previous
college degree, traveled outside of the United States, and lived outside of the United States.
Previous Course on Culture. Taking a previous course on culture compared to not
taking a previous course on culture showed statistically significant differences in mean
scores from sophomore to senior year, with a magnitude of the mean differences indicating
a medium effect.
Table 9
Previous Course on Culture and Mean Cultural Competence Score
M
SD
t
p
Previous Course
61.64
5.79
4.47**
.000
No Previous Course 59.98 5.83
Note: ** significance = p < .001
Previous Degree. Those students who had a previous college degree showed
statistically significant differences in their mean scores from sophomore to senior year,
with the magnitude of the mean differences indicating a medium effect.
Table 10
Previous Degree and Mean Cultural Competence Score
M
SD
t
p
Degree
64.48
5.93
2.93*
.004
No Degree
60.61
5.91
Note: *significance = p < .05
Lived Outside of U.S. There was also a significant difference in mean scores from
sophomore to senior year, for those students who had lived outside of the United States and
those students who had not. The magnitude of the mean difference indicated a medium
effect.
Table 11
Lived Outside of United States and Mean Cultural Competence Score
M
SD
t
p
Lived outside of U.S. 64.68
5.65
5.50*
.000
Not lived outside of U.S. 60.21 5.66
Note: ** significance = p < .001
International Travel. Finally, there was a significant difference in the mean scores
from sophomore to senior year, for those students who had traveled outside of the United
States and those who had not, with the magnitude of the mean difference showing a small
effect.
Table 12
Traveled Outside of United States and Mean Cultural Competence Score
M SD
t
p
Traveled outside of U.S. 61.15 5.99
Not Traveled outside of U.S. 59.35 5.63
2.58*
.01
Note: *significance = p < .05
IAPCC-SV Cultural Competence Levels
The IAPCC-SV is divided into four different levels of cultural competence:
culturally incompetent, culturally aware, culturally competent, and culturally proficient.
Overall, the self-report for the sophomore group produced scores indicating 49% (n = 119)
were culturally aware, 50% (n = 123) were culturally competent, and 1 % (n =3) were
culturally proficient (Figure 7). The senior group scored 34% (n = 71) as culturally aware,
65% (n = 135) as culturally competent, and 1% (n = 2) as culturally proficient.
No one in either group scored as culturally incompetent (Figure 8).
Figure 7: Sophomore Cultural Competence Level (n=245)
Figure 8: Senior Cultural Competence Level (n=208)
A t-test comparison of the mean cultural competence scores (total score and
construct score) by year in school was performed (Table 13). Three of the constructs were
statistically significant including cultural awareness, cultural knowledge, and cultural
encounter. Furthermore, the overall mean cultural competence score was statistically
significant from sophomore to senior year. However, cultural skill and cultural desire were
not statistically significant from sophomore to senior year.
Table 13
Comparison of Mean Cultural Competence Scores by Year in School
Construct of Model
M
SD
t
p
Cultural Awareness
-3.67**
.000
Sophomore
10.25
0.95
Senior
10.56
0.84
Cultural Skill
-1.71
no significance
Sophomore
8.05
1.37
Senior
8.27
1.38
Cultural Knowledge
-7.94**
.000
Sophomore
12.61
2.17
Senior
14.14
1.89
Cultural Encounter
-3.11*
.002
Sophomore
15.02
1.84
Senior
14.14
1.89
Cultural Desire
-.07
no significance
Sophomore
13.68
1.88
Senior
14.14
1.89
Overall CC Score
-4.71**
.000
Sophomore
59.63
5.85
Senior 62.22 5.81
Note: significance = *p = < .01, **p = < .001; N=453
Another interesting finding was the result of the cultural competence scores for the
sophomore and senior nursing students (Table 14). The overall scores showed an increase
in the mean cultural competence scores from the sophomores to the seniors at each of the
three schools, though 45 Hour Program had only a minimal increase.
Table 14
Mean Cultural Competence Score By Academic Program and Year in School
School
Sophomore Senior
M SD n M SD n
48 Hour Program
59.61 6.29 90
63.14 5.33 76
45 Hour Program
60.23 6.09 102
60.34 6.14 86
30 Hour Program
58.47 4.30 53
64.17 4.98 46
Note: N=453
The mean scores of the constructs by school and year in school are shown in Table
15. Of the five constructs, cultural knowledge had the greatest increase from sophomore
to senior year.
Table 15
Mean Cultural Competence Construct Score by Academic Program and Year in
School
48 Hour Program 45 Hour Program 30 Hour Program
Construct Scores Construct Scores Construct Scores
Sophomore Senior Sophomore Senior Sophomore Senior
(n=90) (n=76) (n=102) (n=86) (n=53) (n=46)
________________________________________________________________________
Cultural Competence Construct
Cultural Awareness 10.28 10.64
10.27
10.42
10.16 10.70
Cultural Skills 7.97 8.37
8.11
7.94
8.07 8.72
Cultural Knowledge 12.44 14.33
12.84
13.56
12.45 14.93
Cultural Encounter 15.07 15.87
15.31
15.21
14.38 15.83
Cultural Desire 13.81 13.93
13.70
13.31
13.43 14.00
Note: N=453
The mean scores for 48 Hour Program and 30 Hour Program increased from
sophomore to senior year in all five constructs. However, 45 Hour Program’s mean scores
increased from sophomore to senior year in only two constructs: cultural awareness and
cultural knowledge, while actually decreasing in their mean scores in the other three
constructs: cultural skill, cultural encounter, and cultural desire.
ANOVA was then used to examine the three schools of nursing and the differences
in their mean cultural competence scores in order to determine the amount of variability
(Cronk, 2014; Pallant, 2013). ANOVA calculation indicated the cultural competence mean
scores were not significantly different between the three schools of nursing: F (2, 450) =
1.23, p = .28 (Table 16). Post-hoc comparisons using Tukey HSD test also indicated that
the mean scores for 30 Hour Program (M = 61.12, SD = 5.45), 45 Hour Program (M =
60.29, SD = 6.10), and 48 Hour Program (M = 61.24, SD = 5.97) were not statistically
significant (Pallant, 2013).
Table 16
ANOVA of Mean Cultural Competence Scores by Academic Program
Cultural Competence
Construct M
SD
F
p
Overall Cultural Competence Score
1.23
.28
30 Hour Program 61.12
5.45
45 Hour Program 60.29
6.10
48 Hour Program 61.24 6.10
Note: N=453
Specific Aim #3: To investigate the association of self-reported cultural awareness,
cultural skill, cultural knowledge, cultural encounter, cultural desire, total cultural
competence, year in school, and academic program credits of baccalaureate nursing
students.
The investigation began by using Pearson product-moment correlation coefficient
to examine the correlation of the cultural competence constructs, the total cultural
competence score, and the year in school; this was done for each individual school.
Table 17
30 Hour Program Correlation Matrix of Cultural Competence Constructs, Total
Cultural Competence Score, and Year in School
CA
CK CS CE
CD CC Year
CA
1
CK
.25*
1
CS
.27**
.61** 1
CE
.41**
.54** .47** 1
CD
.28*
.22* .13 .31**
1
CC
.54**
.81** .68** .80**
.60** 1
Year
.30**
.58** .31** .41** .16 .53** 1
Note: Significance ** p = <.01, *p = <.05
Table 17 illustrates the findings for 30 Hour Program and shows there were medium to
large correlations between the four of the constructs, the total cultural competence score,
and the year in school suggesting a fairly strong relationship. There appeared to be no
correlation between cultural desire and year in school (Pallant, 2013).
For 45 Hour Program, there were medium to large correlations between the five
constructs and the total cultural competence score, suggesting a fairly strong relationship.
Table 18
45 Hour Program Correlation Matrix of Cultural Competence Constructs, Total
Cultural Competence Score, and Year in School
CA
CK CS CE
CD CC Year
CA
1
CK
.24**
1
CS
.22**
.58** 1
CE
.37**
.51** .51** 1
CD
.44*
.36** .34 .62**
1
CC
.54**
.78** .72** .84**
.77** 1
Year
.08
.17* -.06 -.05 -.10 .01 1
Note: Significance ** p = <.01, *p = <.05
There was also a small correlation between cultural knowledge and year in school.
However, there appeared to be no correlation between the other four constructs (cultural
awareness, cultural skill, cultural encounter, cultural desire), cultural competence and year
in school (Pallant, 2013).
For 48 Hour Program, there were medium to large correlations between the
five constructs and the total cultural competence score, suggesting a fairly strong
relationship (Table 19). There was a large correlations between cultural desire and
year in school, and medium correlations between year in school and cultural
knowledge and year in school and cultural encounter. There were small correlations
between year in school and cultural awareness and cultural competence. However,
there appeared to be no correlation between the cultural skill and year in school
(Pallant, 2013).
Table 19
48 Hour Program Correlation Matrix of Cultural Competence Constructs, Total
Cultural Competence Score, and Year in School
CA
CK CS CE
CD CC Year
CA
1
CK
.31**
1
CS
.21**
.60** 1
CE
.30**
.46** .42** 1
CD
.43*
.26* .29** .59**
1
CC
.53**
.79** .72** .79**
.71** 1
Year
.21**
.41** .13 .21** .66** .29** 1
Note: Significance ** p = <.01, *p = <.05
Next, Pearson product-moment correlation coefficient was used to examine
the correlation of the cultural competence constructs, the total cultural competence
score, year in school, and school (Table 20). There were medium to large
correlations between the five constructs and the total cultural competence score,
suggesting a fairly strong relationship. There was a medium correlation between
cultural knowledge and year in school and cultural desire and year in school. There
was also a small correlation between cultural encounter and year in school, and
cultural competence and year in school. However, there appears to be no correlation
between cultural skill and year in school. (Pallant, 2013).
