Search Results (27)

Background/Objectives: Tuberculosis (TB) treatment adherence remains suboptimal globally, contributing to relapse, transmission, and drug-resistant TB. Adherence is a culturally embedded behavioral process shaped by psychological readiness, social relationships, and structural conditions. This study aimed to validate a culturally grounded counseling model integrating the Sunrise Model of transcultural nursing and the Information–Motivation–Behavioral Skills (IMB) framework for TB treatment adherence in Kupang City, Indonesia. Methods: A cross-sectional study enrolled 172 pulmonary TB patients across all 11 primary healthcare centers in Kupang City (June–September 2025). A validated questionnaire measuring eight transcultural determinants, culturally grounded counseling (mediator), and adherence (outcome) was developed through expert validation, cognitive interviewing, and pilot testing. Structural Equation Modeling–Partial Least Squares (SEM-PLS) tested structural and mediation relationships via bootstrapped indirect effects (p < 0.05). Results: Reliability (CR: 0.842–0.959; ρA: 0.791–0.957), convergent validity (AVE: 0.577–0.921), and discriminant validity (all HTMT < 0.85) were confirmed. The model showed strong explanatory power (R² = 0.649 for adherence; SRMR = 0.074). Culturally grounded counseling was positively associated with adherence (β = 0.245, p = 0.003) and statistically mediated five antecedent–adherence relationships, including full mediation for economic conditions. Cultural values and lifestyle showed the strongest counseling association (β = 0.345, p < 0.001). Conclusions: Cross-sectional evidence supports a culturally grounded counseling model for TB adherence in diverse settings. Causal conclusions require longitudinal and interventional validation. The model offers a foundation for nurse-led intervention development and multi-site validation. Full article

Background: Stunting remains a major public health issue globally and in Indonesia, often linked to inadequate complementary feeding, cultural practices, and limited family empowerment. Objective: This study aimed to develop and evaluate a family empowerment model based on transcultural care theory to improve quality and prevent stunting among children aged 6–24 months. Methods: A cross-sectional explanatory survey was conducted among 324 mother–child pairs from 11 primary healthcare centers in Kediri, East Java. Data were collected using a validated questionnaire covering demographic, educational, technological, economic, and cultural factors, as well as family empowerment and quality. Structural Equation Modeling with Partial Least Squares (SEM-PLS) was applied for hypothesis testing and model development. Results: The model showed moderate explanatory power (R² = 0.223 for family empowerment; R² = 0.115 for complementary feeding quality). Demographic, educational, technological, economic, and cultural factors significantly influenced family empowerment (p < 0.05), which in turn had a strong positive effect on quality (β = 0.340, p < 0.001). Family empowerment mediated the relationship between these factors and quality. Key contributors included knowledge, technology access, income level, and cultural practices. Conclusions: The proposed transcultural care-based family empowerment model effectively improves quality. Strengthening health education, supporting community health volunteers, and integrating culturally sensitive practices, such as encouraging paternal involvement and shared meals, should be prioritized in stunting prevention programs. The model may be adapted for use in similar community settings to enhance program effectiveness. Full article

Background/Objectives: Cultural diversity in healthcare settings is rapidly increasing, posing complex ethical and communication challenges for nurses. Competence in navigating cultural differences, alongside ethical sensitivity, is essential to delivering patient-centered care. This study aimed to examine the relationship between nurses’ cultural competence—measured as transcultural self-efficacy—and their knowledge, attitudes, and practices concerning healthcare ethics in primary care settings in Greece. Methods: A cross-sectional study was conducted with 492 nurses using validated Greek versions of the Transcultural Self-Efficacy Tool (TSET–Gr) and the Nurses’ Ethics Questionnaire (NEQ–Gr). Descriptive and inferential statistics were used to assess correlations and predictive relationships between demographic variables, cultural self-efficacy subscales, and ethical constructs. Results: Nurses demonstrated moderate to high levels of cultural self-efficacy and ethical sensitivity. Affective self-efficacy was the highest-rated subscale and showed strong positive associations with ethical knowledge (r = 0.27, p < 0.001) and ethical attitudes (r = 0.23, p < 0.001). Multivariable linear regression analysis revealed that higher educational attainment significantly predicted both practical (b = 0.12, p = 0.045) and affective self-efficacy (b = 0.15, p = 0.002), as well as better ethical knowledge and attitudes. Notably, more years of experience were associated with lower self-perceived cultural competence. Nurses working in multicultural regions reported more favorable ethical orientations. Conclusions: Cultural competence, particularly emotional readiness to engage with cultural diversity, is a significant predictor of ethical awareness and behavior in nursing practice. Investment in continuous professional development, education, and supportive work environments is essential for cultivating both ethical sensitivity and culturally responsive care. Full article

Introduction: The increasing cultural diversity of patients poses new challenges for nurses. Cultural competence, especially knowledge of the cultural determinants of health and illness, is an important element of professionalism in nursing care. The aim of this study was to analyse nurses’ self-assessment of cultural knowledge, with a focus on the six dimensions of the Giger and Davidhizar model, prior to formal training in this area. Methods: A triangulation method combining qualitative and quantitative analysis was used. The analysis included 353 statements from 36 master’s student nurses. Data were coded according to six cultural phenomena: biological factors, communication, space, time, social structure, and environmental control. Content analysis, ANOVA, Spearman’s rank correlation, and cluster analysis (k-means) were conducted. Results: The most frequently identified that categories were environmental control (34%), communication (20%), and social structure (16%). Significant knowledge gaps were identified in the areas of non-verbal communication, biological differences, and understanding space in a cultural context. Three cultural knowledge profiles of the female participants were distinguished: pragmatic, socio-reflective, and critical–experiential. Conclusions: The cultural knowledge of the participants was fragmented and simplified. The results indicate the need to personalise cultural learning and to take into account nurses’ level of readiness and experience profile. The study highlights the importance of the systematic development of reflective and contextual cultural knowledge as a foundation for competent care. Full article

Background/Objectives: Climate change adversely affects some of the fundamental determinants of health, and children are the population group most vulnerable to exposure to environmental risk factors. The main objective of this study was to validate in the Portuguese context three scales to assess attitudes, knowledge, and skills on children’s environmental health. Methods: A cross-sectional observational study was developed to translate, adapt, and validate the questionnaire consisting of the following three scales: Attitude Scale (SANS_2), knowledge scale (ChEHK-Q), and skills scale (ChEHS-Q). This was carried out in two phases: the translation and adaptation process and the validation process using classical measure theory and item response theory with undergraduate nursing students. Results: We obtained a valid and reliable questionnaire to measure children’s environmental health competence consisting of an attitude scale (α = 0.84), a knowledge scale (Infit = 0.98, Outfit = 0.97, item reliability = 0.98, and people reliability = 0.75), and a skills scale (Infit = 1.00, Outfit = 0.99, item reliability = 0.82, and people reliability = 0.88). The mean score on the attitude scale was 28.15 (5–35) ± 4.61; 14.92 (0–26) ± 4.51 on the knowledge scale; and 42.51 (24–60) ± 6.41 on the skills scale. Conclusions: We found that most Portuguese undergraduate nursing students have very good pro-environmental attitudes and good knowledge and skills in dealing with children’s environmental health. The questionnaire obtained in this study will be useful for comparative studies with other countries and for evaluating the effectiveness of educational interventions. Full article

Background: Cultural competence is central to ensuring effective culturally congruent care to patients and fostering positive work environments, particularly in multicultural settings. Objective: This study aimed to analyse the relationship between cultural competence, the nursing work environment, and the delivery of culturally congruent care in multicultural units of a healthcare organisation in Portugal. Method: This was a quantitative, descriptive, and cross-sectional study, targeting nurses from multicultural units. Data were collected using both online and paper-based questionnaires, which included the Cultural Competence Questionnaire for Help Professionals, the Nursing Work Index—Revised Scale (NWI-R-PT), and a single question assessing nurses’ perceptions of the adequacy of the culturally congruent care they provide. Results: A moderate, positive correlation was identified between cultural competence and the Fundamentals for Nursing, while the nursing work environment was influenced by organisational support, professional category, and unit type. Discussion: The findings suggest that enhancing cultural knowledge and technical skills and reinforcing management support may positively impact culturally congruent care delivery in multicultural settings. Conclusion: This study contributes to nursing knowledge by highlighting the complex interactions between cultural competence and the work environment in Portuguese multicultural healthcare units. Future research should explore the impact of transcultural nursing leadership on multicultural work environments and in the delivery of culturally congruent care. Full article

(1) Background: This article addresses the harmful traditional practice of breast ironing, which primarily affects girls and adolescents in several countries, particularly in Cameroon. The practice involves applying heat and pressure to developing breasts to delay their growth, with the goal of protecting girls from sexual abuse, early pregnancy, and forced marriages. While culturally accepted, breast ironing has severe physical, psychological, and social consequences, including damage to mammary glands, pain, infections, and potential long-term health complications. (2) Methods: A reflective analysis of the topic was conducted through a comprehensive search of various databases (PubMed, Scopus, Google Scholar, and CINAHL) following narrative review methodology. (3) Results: The practice is also examined through the lens of human rights and Madeleine Leininger’s transcultural nursing theory, which promotes respect for cultural traditions in healthcare. However, the authors question whether such a theory can justify practices that violate women’s physical integrity. (4) Conclusions: This study concludes that while cultural beliefs must be considered in healthcare, human rights and the elimination of violent practices, such as breast ironing, must take precedence. Educational campaigns and a more punitive approach in countries where this practice occurs are proposed as essential steps forward. Full article

Background: The belief in the evil eye is defined as the power to cause harm through ‘negative energy’ obtained through a glance. The practice of “medicine of the evil eye or sa mexina de s’ogu” by the “feminas e ominis de mexina” (healers) is so deeply rooted in the Sardinian culture that it influences health practices. Transcultural nursing, conceptualised by Madeleine Leininger, emphasises the importance of providing health care that takes into account patients’ cultural beliefs, practices and values. This study aims to explore, from the perspective of Madeleine Leininger’s transcultural nursing theory, the perception of the “feminas e ominis de mexina” practising “sa mexina de s’ogu”, in order to promote and raise awareness among health professionals of the importance of patients’ beliefs and cultures. Methods: A qualitative phenomenological study was conducted. Data were collected using semi-structured face-to-face interviews. The interviews were transcribed, read thoroughly, and analysed. Results: Fourteen healers were interviewed. Six main themes were extracted: (1) figure of the healer in its social context; (2) dynamics and methodology related to rituals; (3) effects of the Evil Eye; (4) ritual demand; (5) effectiveness of the ritual; and (6) comparison between the ancient and modern world. Conclusions: These findings suggest that healers act as central pillars in the connection between traditional medicine and religious practices. In response to the results obtained, it is essential to train healthcare personnel in transcultural nursing in order to provide care that is respectful and in harmony with the individual’s beliefs, promoting their comfort and well-being, and their health outcomes. Full article

The aim of this research is to explore nurses’ experiences in caring for migrants, regular and non-regular, within outpatient clinics in Italy. Materials and Methods: Thirteen nurses have been interviewed through online semi-structured interviews, conducted with the support of a questionnaire, made by researchers, consisting of open-ended questions on legislative issues, cultural issues, and regarding best practices. Purposive sampling has been used, along with phone and email recruitment. The audio recordings of the interviews were verbatim transcribed, then examined. This study is a qualitative descriptive fundamental research project. Results: Interviewees highlight migrants’ difficulties in accessing care, critical points of legislation, transcultural skills crucial to nurses, and good practices. A total of 105 labels were developed and grouped into 23 categories under 7 themes (Italian legislation and migrants; structural difficulties in assistance; the influence of politics; the work of NGOs and associations; nursing care; winning strategies; and the role of the Family and Community Nurse). Conclusion: The research highlights how access to care for migrants is hindered by legislative, structural, and cultural barriers, with consequences on the NHS (improper accesses to the emergency room, increased workload, and economic expenditure). For the full realization of the right to health, as enshrined by Art. 32 of the Constitution, changes are needed with respect to regulations and professionals’ training. Full article

This study aims to analyze the repercussions of the ongoing COVID-19 pandemic on the health of male immigrants, refugees, and asylum seekers in Brazil. A qualitative study involving 307 adult men living in Brazil during the COVID-19 pandemic was conducted. Data were collected between August 2021 and March 2022 and interpreted based on the Transcultural Nursing Theory. Cultural care repercussions were identified in various dimensions: technological: changes in daily life and disruptions in routine; religious, philosophical, social, and cultural values: changes stemming from disrupted social bonds, religious practices, and sociocultural isolation; political: experiences of political partisanship, conflicts, government mismanagement, a lack of immigration policies, human rights violations, and xenophobia; educational/economic: challenges arising from economic impoverishment, economic insecurity, unemployment, language difficulties, and challenges in academic and literacy development during the pandemic. The persistence of the COVID-19 pandemic in Brazil had significant repercussions for the health of migrant men, resulting in a transcultural phenomenon that requires sensitive nursing care. Implications for nursing: the uniqueness of cultural care in nursing and health, as most of the repercussions found were mostly negative, contributed to the increase in social and health vulnerabilities. Full article

(1) Background: The role of Al-Andalus’s women were the result of Arabization and Islamization in Spain. The 10th to the 14th centuries were a time of significant cultural diversity in the region. Female physicians and midwives were important for providing care to women. Despite existing studies, there is still a lack of focused research on the professionalization of these trades, including their requirements, intervention areas, and treatments. (2) Methods: To address this gap, we conducted a scoping review using the dialectical structural model of care (DSMC). Primary medical and legislative sources were used. (3) Results: two kinds of midwife, or qābila, were discovered, along with a woman physician, or ṭabība, who also acted as a midwife. These professions underwent diverse training and fulfilled duties as obstetricians and pediatricians. Midwives were esteemed members of society and were the sole female professionals who needed qualified training. Their performance in the courts was exemplary. Tools for facilitating childbirth and interventions related to female health were discovered in the study. (4) Conclusions: The patriarchal societies suffer from significant inequality in terms of academic training, knowledge transmission, and healthcare provision. Midwives functioned in segregated domestic and legal spaces and were responsible for providing public care to communities from the 10th to 14th centuries. Full article

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process. Full article

Background: There is broad consensus that assessing and improving the competence of nurses is a crucial element of nursing education and practice. Numerous national and international nursing research studies have used the 35-item Nurse Professional Competence Scale (NPC-SV) to measure the self-reported competence of nursing students and registered nurses. To increase its usage in Arabic-speaking nations, however, a culturally adapted Arabic version of the scale with the same level of quality was necessary. Objectives: The study aimed to develop a culturally adapted Arabic version of the NPC-SV and evaluate its reliability and validity (construct, convergent, and discriminant types). Methods: Methodological descriptive cross-sectional design was utilized. A convenience sampling technique was employed to recruit 518 undergraduate nursing students from three Saudi Arabian institutions. The translated items were appraised by a panel of experts, who considered the content validity indexes. The structure of the translated scale was examined using exploratory and confirmatory factor analysis, structural equation modelling, and the Analysis of Moment Structure method. Results: When utilized with nursing students in Saudi Arabia, the Arabic short version of the Nurse Professional Competence Scale (NPC-SV-A) was shown to be reliable and valid in terms of its content, construct, convergent, and discriminant validity. Cronbach’s alpha for the entire NPC-SV-A scale was 0.89 and varied from 0.83 to 0.89 for each of the six subscales. Exploratory factor analysis (EFA) revealed six significant factors with 33 items that accounted for 67.52 percent of the variance. The scale was congruent with the suggested six-dimensional model, as confirmed by confirmatory factor analysis (CFA). Conclusion: The Arabic version of the NPC-SV, which was reduced to 33 items, showed good psychometric properties, with a six-factor structure accounting for 67.52% of the total variance. When used alone, this 33-item scale can allow for more in-depth evaluations of self-reported competence among nursing students and licensed nurses. Full article

Cultural diversity among patients and healthcare workers in the Portuguese healthcare organizations will increasingly challenge nurse managers to develop favorable nursing work environments and to improve culturally congruent care. Aim: This study aimed to identify nurse managers’ interventions that improve favorable nursing work environments in multicultural nursing teams and culturally congruent care for patients, based on Portuguese nurse leaders’ experience in international settings. Methods: A qualitative and exploratory study was conducted as the first stage of a sequential exploratory mixed study design. A convenience sample of Portuguese nurses with leadership experience of multicultural teams was recruited to participate in one focus group. Qualitative data were recorded and transcribed for content analysis. Text segments were organized into themes and categories with the support of the qualitative software IRaMuTeQ. Results: Nurse managers’ interventions, such as adapting the leadership style, thanking nurses for their work, adjusting the unit to attend to patients’ worship practices, and supporting foreign nurses in learning the local language, were categorized into three main themes and five categories—transcultural nursing leadership assumptions, capitalizing nurses, improving culturally congruent care, team problems and strategies, and improving effective communication. Conclusions: These findings corroborate international studies, advocate for capable nurse managers to lead in a globalized world, and are suitable to develop a transcultural nursing leadership questionnaire. Full article

In line with findings that nurses from minority groups have an important role in making health services accessible to their community, our study aimed to identify the challenges ultra-Orthodox Jewish nurses faced during COVID-19 in their encounters with patients and health staff from other communities, as well as their own community. The ultra-Orthodox community is a highly religious group that maintains isolation from general society, a phenomenon that affected its member experiences during COVID-19. Our research followed sequential explanatory mixed methods. The quantitative phase included a questionnaire completed by 235 female students (111 ultra-Orthodox and 124 non-ultra-Orthodox), followed by a qualitative phase, which included six focus-groups (n = 15). The quantitative analysis showed that the ultra-Orthodox students felt a higher sense of responsibility toward their community. They used their authority and knowledge to guide their community during the pandemic. The qualitative analysis identified two themes expressed as challenges ultra-Orthodox nursing students encountered within their community and with other sections of Israeli society. Our research shows the important role that transcultural nurses play in mediating updated health information otherwise inaccessible to their community, especially in times of crises. It is important to address dilemmas this group faces inside and outside their respective communities. Full article