Longitudinal assessment of cultural competencies in nursing education : insights from students and nurse educators

Abstract

Aim: This study aims to evaluate the cultural competencies of undergraduate nursing students and nurse educators and identify associated factors. Design: Observational, descriptive, longitudinal study conducted in Malta. Method: Online questionnaires, based on the Cultural Competence Assessment Scale measuring self-perceived competence and reflections on international experiences, were administered to students during each of the 3 years of an undergraduate nursing programme and once to nurse educators. Descriptive and inferential statistics were applied to examine cultural competence levels and their associations with demographic and experiential factors. Results: A total of 43, 38 and 34 students participated across the three programme years, respectively, alongside 19 nurse educators (response rates: 51.8% and 70.4%, respectively). Third-year students demonstrated very good cultural competence with a mean score of 78.24 (out of 100), while educators recorded a slightly lower mean of 73.26. Leisure time abroad before higher education significantly influenced cultural awareness in both first- and third-year students, while age was positively correlated with cultural awareness among final-year students. For educators, doctoral qualifications were associated with higher cultural awareness, and greater teaching experience correlated with more competent behaviours. Cultural competence improved progressively across the programme, suggesting clinical exposure and maturity play important roles. The inclusion of educators provided a broader perspective, showing that while awareness was strong, behaviour-based competencies require further support. Patient or Public Contribution: Developing cultural competence is expected to improve patient care, safety and communication in increasingly diverse healthcare contexts.