An assessment of cultural competence of community public health nursing in Liffeyside Health Service Area, Dublin

This study aimed to investigate the cultural competence and transcultural nursing experiences of community nurses in a local health service area in response to increasing demographic change and cultural diversity. In response to a dearth of evidence-based transcultural nursing research in the Irish context, this work-based project primarily explored practice, service delivery and professional development within an individual and localised service context. The study was informed by my own professional role as a Clinical Nurse Specialist working with asylum seekers in the Health Service Executive organisation. A flexible research design was employed, using a mixed methodology of quantitative and qualitative methods. To determine levels of cultural competence, quantitative data was collected and analysed using a specialised cultural competence assessment tool (CCAT Survey Questionnaire) and software. A total population of 44 nurses (N=44) were surveyed in Liffeyside health service area. 54.4% (n=24) completed and returned the CCAT survey. It revealed that nurses in this study were ‘culturally aware’ in accordance with the specific assessment criteria used. The main findings from the study stem predominantly from the qualitative research and the interpretative analysis, in which a number of themes and sub-themes emerged. Qualitative methods consisted of semi-structured individual interviews using a purposive sample from the community nursing population of the area. This allowed for more in-depth exploration of nurses’ transcultural experiences. Nurses tended to be unfamiliar with the professional discipline and practice of transcultural healthcare. Community nurses mostly acquired their transcultural knowledge from their work but tended to undervalue this type of knowledge. Overall, community nurses appeared interested in offering culturally competent care and were aware of the importance of developing and maintaining therapeutic relationships with ethnic minority service users. Although keen to offer an equality of service, the data demonstrated personal, professional and organisational barriers that led to tensions and ambiguity that impacted on nurses’ capacity to further develop their cultural competence. When working with ethnic minority clients, nurses appeared conflicted and complacent at times. In the main, nurses were content to ‘just get by’. Nurses were uneasy with some aspects of working with cultural diversity, for example, in the area of the use of language and terminology and this appeared to affect their confidence in addressing issues. A reluctance by nurses to name, acknowledge and challenge racism as a specific form of discrimination within the community nursing service was evident. Opportunities to improve and build on the development of cultural competence within this environment were identified. A number of practical suggestions for nurses and management are recommended, including practical guidelines, structured formal transcultural placements, education and interdisciplinary collaborative work and research.

Professional Doctorate in Health.