Causal Model of Cultural Competence and Behavior among Nurses in Thailand’s International Hospitals

Main Article Content

Thanida Khongsamai
Ungsinun Intarakamhang

Abstract

Thailand is recognized as an international medical hub and so it is important for its nurses to have appropriate cultural care behaviors to provide care for patients from different countries and cultures. This study aimed to examine the causal model and identify the causal variables affecting the cultural competence and cultural care behavior of professional nurses working in international hospitals in Bangkok, Thailand. The study was based on structural equation modeling analyses of the data collected from 451 registered nurses, selected by stratified random sampling. The data were collected using a set of questionnaires, based on five instruments using six-point rating scales, with the confidence level ranging from 0.67 to 0.94. The results showed that the assumption of a causal relationship model fitted with the empirical data (SRMR = 0.078, RMSEA = 0.072, GFI = 0.97 NFI = 0.97, CFI = 0.97, c2/df = 3.35). The factors related to the nurses’ cross-cultural experience and cultural attitudes had a direct effect on their cultural competence, (β = 0.22, 0.88, p < .05). Also, their perceived organizational support and cultural competence had a direct effect on the nurses’ cultural care behavior (β = 0.11, 0.63, p < .05). This model could explain 84% of the variance in the cultural care behavior of the nurses in the data set. It was revealed that appropriate cultural care behaviors can be developed by increasing cultural competence and from having perceived organizational support. This research recommends that organizations should support training courses to enhance the experience and attitudes of nurses regarding their cultural competence and cultural care behaviors.

Article Details

How to Cite
Khongsamai, T., & Intarakamhang, U. (2020). Causal Model of Cultural Competence and Behavior among Nurses in Thailand’s International Hospitals. The Journal of Behavioral Science, 15(2), 54-69. Retrieved from https://so06.tci-thaijo.org/index.php/IJBS/article/view/209327
Section
Research Articles

References

Ahn, J. W. (2017). Structural Equation Modeling of Cultural Competence of Nurses Caring for Foreign Patients. Asian Nursing Research, 11(1), 65-73. https://doi.org/10.1016/j.anr. 2017.03.001
Alpers, L. M., & Hanssen, I. (2014). Caring for ethnic minority patients: A mixed method study of Nurses’ self – assessment of cultural competency. Nurse Education Today, 34(6), 999-1004. https://doi.org/10.1016/j.nedt.2013.12.004
Amiri, R., & Heydari, A. (2017). Nurses’ experiences of caring for patients with different cultures in Mashhad, Iran. Iranian Journal of Nursing and Midwifery Research, 22(3), 232-236. https://doi.org/10.4103/1735-9066.208156
Almutairi, A. F, Adlan, A. A., Nasim, M. (2017). Perception of critical cultural competence of registered nurses in Canada. BMC Nursing, 16(1), 47. https://doi.org/10.1186/s12912-017-0242-2
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall, Inc.
Bernal, H., & Froman, R. (1993). Influences on the cultural self-efficacy of community health nurses. Journal of Transcultural Nursing, 4(2), 24-31. https://doi.org/10.1177/1043659693 00400205
Braunhi1. (2019, December). CEO world magazine has revealed the 10 countries with the best health care system, 2019. This was out of 89 countries. Toluna20 Influencer. https://au.toluna.com/opinions/4878592/Ceoworld-Magazine-has-revealed-the-10-countries-with-the
Cai, D. Y. (2016). A concept analysis of cultural competence. International Journal of Nursing sciences, 3(3), 268-273. https://doi.org/10.1016/j.ijnss.2016.08.002
Cai, D. Y., Kunaviktikul, W., KlunKlin, A., & Sripusanapan, A. (2017). Identifying the essential competence component of cultural competence in a Chinese nursing context: A qualitative study. Nursing and Health Sciences, 19(2), 157-162. https://doi.org/ 10.1111/nhs.12308
Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare service: A model of care. Journal of Transcultural Nursing, 13(3), 181-184. https://doi.org/10.1177/10459602013003003
Chiangkhong, A., Intarakamhang, U., Duangchan, P., & Macaskill, A. (2019). Effectiveness of health literacy through transformative learning of glycaemia control in diabetic adults. The Journal of Behavioral Science, 14(3), 49-61. https://so06.tci-thaijo.org/index.php/IJBS/article/view/172168
Chantarasenanon, C. (2010). Kānphatthanā bǣp wat samatthana chœ̄ng watthanatham samrap nakrīan matthayommasưksā [Development of a cultural competence scale for secondary school students] (Doctoral dissertation). Chulalongkorn University. http://cuir.car.chula.ac.th/bitstream/123456789/21291/1/chutinan_ch.pdf
Chunrat, P. & Jumpamool, A. (2018). Factors influencing transcultural nursing competency of nurses working in Srinagarind Hospital, Khonkaen University. Journal of Nursing and Health Care, 36(3), 23-32. https://he01.tci-thaijo.org/index.php/jnat-ned/article/view/150570?PageSpeed=noscript
Cruz, J. P., Estacio, J. C., Bagtang, C. E., & Colet, P. C. (2016). Predictors of cultural competence among nursing students in the Philippines: A cross-sectional study. Nurse Education Today, 46(November), 121-126. https://doi.org/10.1016/j.ecns.2014.01.004
Department of Health Service Support. (2015). Summary report of the performance in accordance with the medical hub policy, fiscal year 2015. http://hss.moph.go.th/fileupload_doc/2017-12-18-1-17-37017764.pdf.
Department of Health Service Support. (2017). Summary report of Thailand development policy to be an international medical hub for the 2017 fiscal year. http://hss.moph.go.th/fileupload_doc/2017-12-18-1-17-37017766.pdf
Farber, J. E. (2015). The relationship between cultural experience and perceived transcultural self- efficacy of nurse faculty (Doctoral dissertation). Faculty of the school of nursing, Widener University.
https://search.proquest.com/docview/1680835312?pq-origsite=gscholar
Garneau, A. B., & Pepin J. (2015). A constructivist theoretical proposition of cultural competence development in nursing. Nursing Education Today, 35(11), 1062-1068. https://doi.org/10.1016/j.nedt.2015.05.019
Giger, J. N., & Davidhizar, R. (2002). The Giger and Davidhizar transcultural assessment model. Journal of Transcultural Nursing, 13(3), 185-188. https://doi.org/10.1177/10459602013003004
Gunawan, J., Aungsuroch, Y., & Fisher, M. L. (2018). Competence-based human resources management in nursing: A literature review. Nursing Forum and Independent Voice for Nursing, 54(1), 91–101. https://doi.org/10.1111/nuf.12302
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis (7th ed.). Pearson Education International.
Hickling, F. W. (2012). Understanding patients in multicultural settings: A personal reflection on ethnicity and culture in clinical practice. Ethnicity & Health, 17(February- April), 203-216. http://dx.doi.org/10.1080/13557858.2012.655266
Higginbottom, G. M., Safipour, J., Yohani, S., O’Brien, B., Mumtaz, Z. Paton, Patricia., Chiu, Y., Barolia, R. (2016). An ethnographic investigation of the maternity healthcare experience of immigrants in rural and urban Alberta, Canada. BMC Pregnancy and Childbirth, 16(20), 1-15. https://doi.org/10.1186/s12884-015-0773-z
Jernigan, V. B. B., Hearod, J. B., Tran, K. Norris, K. C., & Buchwald, D. (2016). An examination of cultural competence training in us medical education guided by the tool for assessing cultural competence training. Journal of Health Disparities Research and Practice, 9(3), 150-167. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5091804/
Joint Commission International. (n.d.). Pathway to JCI accreditation. Retrieved May 8, 2020, from https://www.jointcommissioninternational.org/accreditation/pathway-to-accreditation/
Kardong-Edgren, S., Schlosser, S., Jones, M. L., Jones, M. E., & Strunk, P. (2005). Cultural attitudes, knowledge, and skills of nursing faculty toward patients from four diverse cultures. Journal of Professional Nursing, 21(3), 175-182. https://doi.org/10.1016/j.profnurs.2005.04.001
Kline, R. B. (2016). Prince multiples and practices of Structural Equation Modeling (4th ed.). The Guildford Press.
Leininger, M. M. (1991). Culture Care Diversity & universality: A theory of Nursing. National League for Nursing Press.
Leininger, M. M. (1999). What is transcultural nursing and culturally competence care? Journal of Transcultural Nursing, 10(1), 9. https://doi.org/10.1177/104365969901000105
Leininger, M. (2001). Founder's focus: Certification of transcultural nurses for quality and safe consumer care. Journal of Transcultural Nursing, 12(3), 242. https://doi.org/10.1177/104365960101200310
Luengarun, P., Wannasontad, S., & Chitviboon, A. (2012). Kānphatthanā bǣp wat phrưttikam kāndūlǣ yāng ʻư̄a ʻāthō̜n khō̜ng naksưksā phayābān [The Development of Nursing Students’ Caring Behavior Scales]. Journal of Nursing and Education, 5(2), 90-103. https://he01.tci-thaijo.org/index.php/JNAE/article/view/3191/2738
McGuire, W. J. (1985). Attitudes and attitude change. In G. Lindzey & E. Aronson (Eds.), The handbook of social psychology (3rd ed., Vol. 2, pp. 233–346). Random House.
Odhiambo, N., Murray- Garcia, J., & Ackerman-Barger, K. (2019). Exploring nursing knowledge of Black American Diversity. Journal of Cultural Diversity, 26(2), 69-75.
Phokha, K. (2009). A study of professional nurses' perception on cultural congruent end of Life care, tertiary hospitals under the jurisdiction of the Ministry of Public Health (Master’s thesis). Faculty of Nursing Chulalongkorn University, Bangkok, Thailand.
Pimthong, S. (2014). Antecedents of Employee Retention of the University Academic Staffs in Thailand (Research Report). Behavioral Science Research Institute, Srinakarinwirot University, Thailand. http://bsris.swu.ac.th/upload/saran25582.pdf
Schumacker, R. E., & Lomax, R. G. (2010). A beginner’s guide to structural equation modelling. Routledge.
Sillapaprommas, K. (2004). Patčhai dān čhit laksana læ sathānakān thāng sangkhom khō̜ng phayābān čhittawēt thī kīeokhō̜ng kap phrưttikam kānphayābān čhittawēt thī mī čhariyatham [Psychological and Social- situational correlates of ethical psychiatric nursing practices in professional] (Master’s thesis). Graduate School, Srinakharinwirot University.
Siriphan, S. (2012). Kānphatthanā rūpbǣp kān rīan kānsō̜n thī nēn samatthana thāng watthanatham khō̜ng naksưksā phayābān [Develop and evaluate the achievement of cultural – based teaching student nurse] (Master’s thesis). Sukhothai Thammathirat University. https://opac01.stou.ac.th/cgi-bin/koha/opac-detail.pl?biblionumber=130508
Songwathana, P., & Siriphan, S. (2015). Thai nurses’ cultural competency in caring for clients living in a multicultural setting. Pacific Rim International Journal of Nursing Research, 9(1), 19-31. https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/18965
Tavallali, A. G., Kabir, Z. N., & Jirwe, M. (2014). Ethnic Swedish Parents’ experiences of minority ethnic nurses’ cultural competence in Swedish paediatric care. Scandinavian Journal of Caring Sciences, 28, 255-263. https://doi.org/10.1111/scs.12051
Thiposot, S. (2013). Kānraprū kān sanapsanun čhāk ʻongkān khō̜ng phanakngān thī mī phon tō̜ kān tingā nakha ʻong thurakit khō̜ng thanākhān [Perceived organizational support affecting job Performance of employees in banking business] (Master thesis). Faculty of Business Administration Rajamangala University of Technology Thanyaburi. http://www.repository.rmutt.ac.th/bitstream/handle/123456789/2187/142536.pdf?sequence=1
Uzun, O., & Sevinc, S. (2015). The relationship between cultural sensitivity and perceived Stress among nurses working with foreign patients. Journal of Clinical Nursing, 24(23-24), 3400– 3408. https://doi.org/10.1111/jocn.12982
Wiruchchai, N. (1999). Mōdēnlitrēn: Sathiti wi rap kānwičhai [LISREL model: Statistical analysis for research] (3rd ed.). Chulalongkorn University Printing.
Wu, Y., Larrabee, J. H., & Putman, H. P. (2006). Caring behaviors inventory: A reduction of the 42-item instrument. Nursing Research, 55(1), 18-25. https://doi.org/10.1097/00006199-200601000-00003