Osmancevic Selvedina, Steiner Laura Maria, Großschädl Franziska, Lohrmann Christa, Schoberer Daniela
Institute of Nursing Science, Medical University of Graz, Neue Stiftingtalstraße 6, 8010 Graz, Austria.
Ente Ospedaliero Cantonale Ticino, Viale Officina 3, 6500 Bellinzona, Switzerland; University of Applied Sciences of Southern Switzerland SUPSI, via Violino 11, 6928 Manno, Switzerland.
Int J Nurs Stud. 2025 Jul;167:105079. doi: 10.1016/j.ijnurstu.2025.105079. Epub 2025 Apr 2.
The growing need to provide culturally competent nursing care has increased the importance of implementing and evaluating cultural competence interventions in healthcare settings. Previous research showed that increasing healthcare professionals' cultural competence can reduce racism and inequalities and enhance their ability to navigate cultural diversity. Whilst some evidence shows that educational interventions can improve cultural competence of healthcare professionals, a summary of this evidence is lacking, especially regarding the effectiveness of such interventions on nurses' cultural competence and patient-related outcomes.
In this systematic review, the effectiveness of cultural competence interventions on nurses' levels of cultural competence and patient-related outcomes is assessed.
A systematic review and a meta-analysis were conducted.
We searched in MEDLINE, Embase, CINAHL, PsychINFO, ERIC and CENTRAL up to September 2023 for studies using a quasi-experimental or experimental design. We used the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guideline for methodological and reporting guidance. Two researchers independently assessed the eligibility of the studies and their methodological quality. We assessed the quality of experimental studies using the Revised Cochrane Risk of Bias Assessment Tool for Randomized Trials (RoB 2), and the quality of quasi-experimental studies with the Risk of Bias in Nonrandomized Studies - of Interventions tool (ROBINS-I).
Overall, 17 studies, three randomised controlled trials and 14 pre-test/posttest studies, were included in this review. Of these 17 studies, 12 provided sufficient, appropriate data for inclusion in the meta-analysis. Cultural competence interventions were offered through education and training (including lectures, presentations, case studies, discussions, or various reflection activities) or technology-based applications and support (mobile app, online database, or web-based training). Education and training were shown to slightly increase nurses' levels of cultural competence, with a low certainty of the evidence. Technology-based applications and support may increase nurses' levels of cultural competence, but the evidence is very uncertain. No pooling of studies was possible for the patient-related outcomes.
Education and training can improve the level of nurses' cultural competence; therefore, they should be offered as continuing education for nurses. However, our confidence in the underlaying evidence for cultural competence interventions is low due to the imprecision and risk of bias of included studies; thus, the results should be interpreted with caution. Despite the growing interest in and body of research on nurses' cultural competence interventions, our review indicates a significant lack of studies examining the impact of such interventions on patient-related outcomes.
提供具有文化胜任力的护理服务的需求不断增加，这提高了在医疗环境中实施和评估文化胜任力干预措施的重要性。先前的研究表明，提高医疗专业人员的文化胜任力可以减少种族主义和不平等现象，并增强他们应对文化多样性的能力。虽然一些证据表明教育干预可以提高医疗专业人员的文化胜任力，但缺乏对此类证据的总结，尤其是关于此类干预措施对护士文化胜任力和患者相关结局的有效性。
在本系统评价中，评估文化胜任力干预措施对护士文化胜任力水平和患者相关结局的有效性。
进行了系统评价和荟萃分析。
我们在截至2023年9月的MEDLINE、Embase、CINAHL、PsychINFO、ERIC和CENTRAL中检索了采用准实验或实验设计的研究。我们使用《Cochrane干预措施系统评价手册》和PRISMA指南进行方法学和报告指导。两名研究人员独立评估研究的纳入资格及其方法学质量。我们使用修订后的Cochrane随机试验偏倚风险评估工具（RoB 2）评估实验研究的质量，使用非随机干预研究中的偏倚风险工具（ROBINS-I）评估准实验研究的质量。
总体而言，本评价纳入了17项研究，其中3项随机对照试验和14项预测试/后测试研究。在这17项研究中，12项提供了足够、合适的数据以纳入荟萃分析。文化胜任力干预措施通过教育和培训（包括讲座、演示、案例研究、讨论或各种反思活动）或基于技术的应用和支持（移动应用程序、在线数据库或网络培训）提供。教育和培训显示可略微提高护士的文化胜任力水平，但证据的确定性较低。基于技术的应用和支持可能会提高护士的文化胜任力水平，但证据非常不确定。对于患者相关结局，无法进行研究合并。
教育和培训可以提高护士的文化胜任力水平；因此，应将其作为护士的继续教育提供。然而，由于纳入研究的不精确性和偏倚风险，我们对文化胜任力干预措施的基础证据的信心较低；因此，对结果的解释应谨慎。尽管对护士文化胜任力干预措施的兴趣和研究不断增加，但我们的评价表明，显著缺乏研究此类干预措施对患者相关结局影响的研究。
