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Kim, Kim, Kim, Kim, Park, Lee, and Jeong: Development of the Cultural Competence Scale for Registered Nurses (CCS-RN)
Original Article

J Korean Acad Community Health Nurs 2019;30(3):281-294.

Published online: 12 September 2019

DOI: https://doi.org/10.12799/jkachn.2019.30.3.281

Development of the Cultural Competence Scale for Registered Nurses (CCS-RN)

Kyung Won Kim1, Sun-Hee Kim2, Young Hee Kim3, Hyun Kyoung Kim4, Hae Sook Park5, Sun Hee Lee6, Geum Hee Jeong7

1Associate Professor, Department of Nursing, Daegu Haany University, Daegu, Korea

2Associate Professor, College of Nursing, Daegu Catholic University, Daegu, Korea

3Professor, Department of Nursing, Dongguk University, Gyeongju, Korea

4Assistant Professor, Department of Nursing, Kongju National University, Gongju, Korea

5Professor, Department of Nursing, Dongyang University, Yeongju, Korea

6Assistant Professor, Department of Nursing Science, Gimcheon University, Gimcheon, Korea

7Professor, School of Nursing · Research Institute of Nursing Science, Hallym University, Chuncheon, Korea

Corresponding author: Kim, Sun-Hee College of Nursing, Daegu Catholic University, 33 Duryugongwon-ro, 17-gil, Nam-gu, Daegu 42472, Korea. Tel: +82-53-650-4831, Fax: +82-53-650-4392, E-mail: sunhee421@cu.ac.kr

Received 24 January 2019       Revised 24 June 2019       Accepted 1 July 2019

Copyright © 2019 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study is to develop the Cultural Competence Scale for Registered Nurses (CCS-RN) and to examine its validity and reliability.

Methods

The item pool was generated based on related scales, a wide review of the literature, and in-depth interviews with nurses according to Purnell’s cultural competence model. Content validity was verified by nursing experts. Construct validity using exploratory factor analysis, convergent validity using correlation coefficients, discriminant validity, internal consistency reliability, and test-retest reliability were examined.

Results

The CCS-RN consists of a 35-item/7-factor solution with 54.1% of the total variance explained. The convergent validity of CCS-RN was supported. Cronbach’s ⍺ was .94 for the total scale and ranged from .77 to .90 for the seven factors. Test-retest reliability was moderate.

Conclusion

The evaluation of the psychometric properties of the CCS-RN shows that this scale is expected to be a valid and reliable measure of cultural competence among nurses. This scale may be useful for assessing nurses’ own cultural competence and thus contribute to strengthening cultural competence.

Keywords: Cultural competency, Nursing, Psychometrics, Reproducibility of results

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Table 1.
Demographic Characteristics and Characteristics of Clinical Practice (N=326)
Variables Categories n (%) M±SD
Age (year)† 20~29 171 (52.6) 31.69±7.86
30~39 100 (30.8)
≥40 54 (16.6)
Gender Male 12 (3.7)
Female 314 (96.3)
Education Associate degree 79 (24.2)
Bachelor degree 207 (63.5)
Master and doctoral degree 40 (12.3)
Spouse Had 122 (37.4)
Did not have 204 (62.6)
Type of hospital† Advanced general hospital 118 (36.4)
General hospital 149 (46.0)
Hospital 54 (16.7)
Clinic 3 (0.9)
Career (year)† ≤3 92 (28.2) 8.54±7.22
＞3~5 55 (16.9)
＞5~10 67 (20.6)
＞10~20 80 (24.5)
＞20 30 (9.8)
Current position† Staff nurse 249 (77.6)
Charge nurse 42 (13.1)
Head nurse or more 30 (9.3)
Number of multicultural 1~10 275 (84.4)
nursing experiences 11~20 35 (10.7)
≥21 16 (4.9)
Experience of multicultural Yes 100 (30.7)
education in college No 226 (69.3)
Experience of multicultural Yes 21 (6.4)
education in hospital No 305 (93.6)

† Missing data were excluded.

Table 2.
Factor Pattern and Structure Matrix of Cultural Competence Scale for Registered Nurses (N=326)
Items Pattern matrix
 Structure matrix
F1 F2 F3 F4 F5 F6 F7 F1 F2 F3 F4 F5 F6 F7
1 0.20 0.02 0.50 0.10 -0.12 0.03 0.01 0.40 0.37 0.64 0.41 0.13 0.34 0.24
2 0.20 0.16 0.53 0.04 -0.03 -0.09 -0.14 0.41 0.41 0.61 0.38 0.15 0.24 0.13
3 0.28 0.08 0.60 -0.15 -0.08 -0.05 0.01 0.47 0.41 0.64 0.24 0.17 0.31 0.27
4 -0.14 0.13 0.71 -0.05 0.05 -0.02 -0.08 0.20 0.26 0.66 0.32 0.10 0.23 0.11
5 -0.12 -0.18 0.69 0.18 0.11 0.02 0.10 0.19 0.18 0.72 0.47 0.18 0.32 0.24
6 -0.12 -0.16 0.63 0.00 0.01 0.16 0.10 0.15 0.12 0.62 0.30 0.10 0.34 0.23
8 0.67 0.04 -0.05 0.12 -0.08 -0.04 0.08 0.68 0.54 0.29 0.27 0.33 0.35 0.37
11 0.63 0.08 -0.03 0.06 -0.13 0.02 0.04 0.65 0.52 0.28 0.23 0.29 0.35 0.34
12 0.71 -0.05 0.06 -0.11 -0.07 0.09 0.05 0.70 0.48 0.30 0.11 0.34 0.42 0.38
13 0.84 -0.12 0.14 -0.06 0.01 -0.03 -0.07 0.74 0.48 0.36 0.17 0.38 0.35 0.29
14 0.70 -0.05 0.08 0.02 0.07 0.06 -0.03 0.76 0.55 0.38 0.26 0.46 0.46 0.38
15 0.82 -0.04 -0.05 -0.03 -0.07 -0.01 0.09 0.76 0.53 0.25 0.14 0.38 0.38 0.41
16 0.67 -0.19 -0.14 0.07 0.16 0.08 -0.02 0.61 0.37 0.14 0.16 0.46 0.36 0.29
17 0.62 0.10 -0.10 0.10 0.08 -0.06 0.04 0.72 0.59 0.24 0.26 0.46 0.36 0.38
18 0.53 0.10 0.02 -0.02 0.21 0.01 -0.05 0.71 0.57 0.29 0.22 0.53 0.41 0.36
19 -0.07 0.05 0.05 0.06 0.14 0.71 -0.14 0.38 0.36 0.36 0.33 0.41 0.73 0.29
20 0.02 0.08 0.06 -0.07 -0.13 0.79 0.08 0.47 0.43 0.39 0.24 0.31 0.82 0.48
21 0.35 -0.14 -0.07 0.02 0.00 0.57 0.01 0.53 0.36 0.27 0.21 0.39 0.67 0.39
23 0.02 -0.05 -0.03 0.00 0.89 0.05 -0.04 0.47 0.35 0.12 0.17 0.88 0.42 0.36
24 0.28 0.07 0.07 -0.15 0.60 -0.06 0.07 0.65 0.51 0.24 0.11 0.77 0.41 0.46
25 -0.05 0.03 0.03 0.05 0.71 -0.03 0.08 0.41 0.36 0.19 0.22 0.73 0.35 0.38
27 0.04 0.04 -0.02 0.10 0.03 -0.01 0.77 0.48 0.47 0.28 0.24 0.42 0.46 0.83
28 0.11 0.18 0.03 -0.06 0.02 -0.08 0.72 0.55 0.55 0.29 0.15 0.43 0.44 0.83
29 0.00 0.11 0.01 -0.05 0.05 0.37 0.43 0.49 0.48 0.31 0.19 0.44 0.65 0.69
37 0.11 0.15 -0.01 0.57 -0.11 0.01 -0.08 0.27 0.37 0.34 0.62 0.11 0.23 0.08
38 0.07 0.26 0.03 0.52 -0.03 0.02 -0.07 0.37 0.49 0.41 0.65 0.22 0.31 0.17
39 -0.11 -0.03 0.10 0.74 0.06 0.06 0.02 0.18 0.28 0.46 0.78 0.19 0.31 0.15
40 -0.01 -0.20 -0.03 0.86 0.02 -0.06 0.10 0.09 0.15 0.34 0.76 0.12 0.17 0.11
41 0.14 0.21 0.02 0.41 0.01 -0.04 0.02 0.41 0.48 0.36 0.53 0.26 0.28 0.23
42 0.18 0.53 -0.02 0.06 0.17 -0.02 -0.03 0.64 0.72 0.30 0.33 0.49 0.38 0.36
43 0.26 0.59 -0.05 -0.05 0.02 0.11 -0.10 0.68 0.76 0.28 0.26 0.41 0.43 0.34
44 0.01 0.58 -0.05 0.06 0.01 0.22 -0.03 0.53 0.68 0.29 0.33 0.36 0.47 0.35
45 -0.15 0.76 0.02 -0.04 -0.05 0.03 0.09 0.43 0.67 0.26 0.24 0.25 0.31 0.36
46 0.09 0.69 -0.08 -0.04 -0.01 -0.12 0.14 0.54 0.71 0.19 0.20 0.32 0.26 0.40
47 -0.11 0.54 0.16 0.06 -0.01 -0.02 0.06 0.39 0.57 0.37 0.33 0.23 0.29 0.30
Eigen value 9.56 8.26 5.22 4.38 5.44 5.97 5.09
Total variance explained=54.1%
Kaiser-Meyer-Olkin=.92, Bartlett's test of sphericity=6383.45, Degree of freedom=595, p＜.001

F1=biocultural ecology and family; F2=empowerment and intermediation; F3=communication; F4=equality; F5=death rituals; F6=dietary life; F7=spirituality.

Table 3.
Correlation among Cultural Competence Scale for Registered Nurses, Transcultural Self-efficacy, and Ethnocultural Empathy (N=326)
Variables Total CCS-RN
 F1
 F2
 F3
 F4
 F5
 F6
 F7
 TCSE
 AVE
r (p) r (p) r (p) r (p) r (p) r (p) r (p) r (p) r (p)
F1 .63 　 .89
(＜.001)
F2 .88 .41 　 .78
(＜.001) (＜.001)
F3 .70 .41 .54 　 .78
(＜.001) (＜.001) (＜.001)
F4 .67 .23 .58 .44 　 .80
(＜.001) (＜.001) (＜.001) (＜.001)
F5 .73 .35 .57 .55 .52 　 .81
(＜.001) (＜.001) (＜.001) (＜.001) (＜.001)
F6 .59 .48 .35 .34 .23 .28 　 .73
(＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)
F7 .83 .39 .68 .47 .48 .57 .45 　 .82
(＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)
TCSE .66 .51 .54 .41 .35 .41 .54 .55 　
(＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) 　
ECE .56 .39 .41 .39 .35 .36 .49 .49 .60
(＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001) (＜.001)

F1=biocultural ecology and family; F2=empowerment and intermediation; F3=communication; F4=equality; F5=death rituals; F6=dietary life; F7=spirituality; CCS-RN=cultural competence scale for registered nurses; TCSE=transcultural self-efficacy; ECE=ethnocultural empathy; AVE=everage variance extracted.

Table 4.
Item Analysis of Cultural Competence Scale for Registered Nurses (N=326)
Subscale Item no M±SD SE Skewness Kurtosis ITC M±SD
Communication 1 3.91±0.65 0.03 -0.35 0.86 .58 3.93±0.50
2 3.83±0.65 0.03 -0.36 0.80 .56
3 3.48±0.82 0.04 -0.21 -0.09 .56
4 3.96±0.71 0.04 -0.75 1.38 .57
5 4.27±0.59 0.03 -0.26 -0.12 .61
6 4.11±0.76 0.04 -0.73 0.76 .51
Biocultural ecology 8 3.30±0.90 0.05 -0.13 -0.51 .63 3.28±0.64
and family 11 3.46±0.83 0.04 -0.29 0.00 .61
12 3.20±0.90 0.05 0.04 -0.44 .65
13 3.26±0.89 0.05 -0.04 -0.33 .68
14 3.38±0.81 0.04 -0.13 -0.13 .72
15 3.23±0.86 0.05 -0.24 -0.37 .72
16 3.39±0.87 0.05 -0.46 -0.10 .58
17 3.20±0.82 0.04 0.08 -0.40 .68
18 3.12±0.93 0.05 -0.08 -0.41 .67
Dietary life 19 3.93±0.76 0.04 -0.72 1.33 .59 3.58±0.73
20 3.53±1.00 0.05 -0.42 -0.29 .68
21 3.28±0.88 0.05 -0.10 -0.41 .58
Death rituals 23 3.42±0.88 0.05 -0.41 -0.08 .76 3.33±0.75
24 3.09±0.89 0.05 0.06 -0.40 .67
25 3.47±0.82 0.04 -0.31 -0.23 .66
Spirituality 27 3.32±0.89 0.05 -0.21 -0.44 .74 3.30±0.76
28 3.18±0.90 0.05 -0.06 -0.50 .74
29 3.38±0.84 0.04 -0.23 -0.08 .64
Equality 37 3.68±0.70 0.04 -0.14 0.14 .57 3.92±0.50
38 3.85±0.60 0.03 -0.15 0.17 .60
39 4.14±0.62 0.03 -0.18 -0.20 .64
40 4.11±0.64 0.03 -0.23 -0.08 .60
41 3.83±0.77 0.04 -0.28 -0.04 .50
Empowerment and 42 3.13±0.86 0.05 0.16 -0.40 .66 3.26±0.64
intermediation 43 3.22±0.82 0.04 0.06 -0.27 .69
44 3.42±0.77 0.04 -0.20 -0.05 .62
45 3.26±0.90 0.05 -0.10 -0.45 .60
46 3.15±0.91 0.05 -0.13 -0.32 .65
47 3.40±0.85 0.05 -0.38 0.22 .51
Total items 3.51±0.47 0.02 -0.75~0.16 -0.51~1.38 .50~.76

ITC=item-total correlation; ⍺=Cronbach's ⍺ coefficient; Difference in ISC (%)=Percentage of success of item discriminant validity based the differences in item-scale correlations.

Table 5.
Internal Consistency and Test-retest rEliability of Cultural Competence Scale for Registered Nurses (N=173)
Subscales Cronbach's ⍺ (95% CI) Test M±SD Retest M±SD Difference M±SD ICC (95% CI) SEM SDC
Communication .80 3.93±0.50) 3.87±0.47) 0.06±0.42 .61 0.27 0.75
(.77~.83) (.51~.70)
Biocultural ecology .90 3.28±0.64) 3.33±0.63) -0.07±0.50 .70 0.33 0.91
and family (.88~.91) (.62~.77)
Dietary life .77 3.58±0.73) 3.68±0.64) -0.07±0.60 .64 0.39 1.07
(.73~.81) (.54~.72)
Death rituals .84 3.33±0.75 3.50±0.68) -0.13±0.69 .57 0.44 1.21
(.80~.86) (.46~.66)
Spirituality .84 3.30±0.76) 3.38±0.73) -0.07±0.64 .65 0.41 1.15
(.81~.87) (.56~.73)
Equality .80 3.92±0.50) 3.89±0.53) 0.03±0.42 .70 0.27 0.76
(.76~.83) (.61~.77)
Empowerment and .84 3.26±0.64) 3.32±0.64) -0.08±0.48 .73 0.32 0.88
intermediation (.81~.87) (.66~.80)
Total .94 3.51±0.47) 3.55±0.49) -0.04±0.30 .81 0.20 0.56
(.93~.95) (.76~.86)

ICC=intraclass correlation coefficient; SEM=standard error of measurement; SDC=smallest detectable change.

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