ارتباط شايستگي فرهنگي پرستاران با رفتارهاي مراقبتي آنها در مراكز آموزشي درماني وابسته به دانشگاه علوم پزشكي ايران

The Correlation between the Cultural Competence of Nurses with their Care Behaviors in the Teaching Health Centers Affiliated to Iran University of Medical Sciences

زمينه و هدف: جامعه ايراني به لحاظ تاريخي داراي بافت چند قوميتي، فرهنگي، زباني و مذهبي بوده، كه اين امر در ميان مراجعين نظام خدمات سلامت نيز به چشم مي‌خورد. با توجه به اهميت مراقبت، به عنوان مهم‌ترين جزء اقدامات پرستاري و از سويي وجود تفاوت‌هاي فرهنگي در كشور ايران، و اين كه بيماران از شهرهاي مختلف كشور با فرهنگ‌هاي متفاوت به مراكز درماني در شهرهاي بزرگ از جمله تهران مراجعه مي‌كنند و پرستاران بايد در برنامه‌ريزي مراقبت پرستاري اطلاعات ضروري در مورد وضعيت فرهنگي، اجتماعي و قوميتي بيمار به عنوان بخشي از حرفه پرستاري داشته باشند، ضروري به نظر رسيد كه پژوهشي با هدف تعيين ارتباط شايستگي فرهنگي پرستاران با رفتارهاي مراقبتي آن‌ها در مراكز آموزشي درماني وابسته به دانشگاه علوم پزشكي ايران در سال 1398 انجام شود. روش بررسي: اين مطالعه مقطعي از نوع همبستگي با مشاركت 200 پرستار شاغل در مراكز آموزشي درماني وابسته به دانشگاه علوم پزشكي ايران در شهر تهران كه به صورت چند مرحله‌اي خوشه‌اي انتخاب شدند، انجام شد. جمع آوري داده‌ها با استفاده از پرسشنامه شايستگي فرهنگي Perng و Watson و پرسشنامه رفتارهاي مراقبتي CBI-42 از ابتداي آبان ماه تا آخر دي ماه 1398 انجام شد. داده‌ها پس از جمع آوري، با استفاده از نرم افزار SPSS نسخه 16 با آزمون تي مستقل، ANOVA و ضريب همبستگي پيرسون مورد تحليل آماري قرار گرفتند. يافته‌ها: ميانگين نمره شايستگي فرهنگي پرستاران 02/15 ± 27/66 و ميانگين نمره رفتارهاي مراقبتي پرستاران 43/0 ± 28 /5 بود. بيشترين نمره ميانگين شايستگي فرهنگي مربوط به بعد حساسيت فرهنگي (50/60) وكمترين نمره ميانگين مربوط به بعد دانش فرهنگي (25/56) بود. كمترين نمره ميانگين رفتارهاي مراقبتي مربوط به بعد احترام قائل شدن براي ديگري (09/5) و بيشترين نمره ميانگين مربوط به بعد دانش و مهارت حرفه‌اي (43/5) بود. به طور كلي بين شايستگي فرهنگي پرستاران مورد پژوهش و رفتارهاي مراقبتي آن‌ها ارتباط معني‌دار ضعيفي وجود داشت. همچنين بين تمامي ابعاد رفتارهاي مراقبتي و شايستگي فرهنگي به غير از دانش و مهارت و حساسيت فرهنگي (058/0P=) ارتباط معني‌دار آماري مشاهده شد (05/0>P). همچنين يافته‌ها نشان داد كه افرادي كه در بخش اورژانس كار مي‌كنند سطح شايستگي فرهنگي بالاتري دارند و افراد متأهل داراي سطح بالاتر رفتارهاي مراقبتي هستند. نتيجه‌گيري كلي: نتايج مطالعه حاضر نشان داد كه بين شايستگي فرهنگي پرستاران و رفتارهاي مراقبتي آنها ارتباط معني‌دار ضعيفي وجود دارد. پيشنهاد مي‌شود با تقويت آنها از طريق آموزش‌هاي آكادميك و ضمن خدمت باعث بهبود ارائه مراقبت‌هاي پرستاري به مددجويان شد.

Background & Aims: Culture is a behavioral pattern that grows over time as a mental consequence through social and religious structures and artistic manifestations. Culture encompasses the values, beliefs, and norms of a particular group, which are learned and shared to guide thinking, decision-making, and actions in modeling approaches. Historically, the Iranian community has a multi-ethnic, cultural, linguistic, and religious context, which is also observed among the clients of the healthcare system. With the integration of the global economy, the number of the clients from various cultural backgrounds and characteristics of health, cultural activities, health needs, and expectations has also increased in all industrialized countries. In addition, the growth of international exchanges and number of manpower transfers and migration, the need for nursing with cultural knowledge has been created. A culturally qualified nurse has acquired a strong foundation in cultural attitudes, cultural knowledge, and cultural skills. Nurses are often equipped with all the influential factors in cultural competence to provide care to a wide variety of patients with diverse cultural backgrounds. Therefore, such nurses are able to assess the cultural needs of the clients, plan an appropriate care program, and provide skilled cultural care under any circumstances. Care is the foundation of the nursing profession and considered an important component of the quality health care that meets the health needs of patients. The care behaviors of nurses encompass all their actions, cognitions, feelings, thoughts, perceptions, movements, gestures, looks, and actions by which the client is cared for, and these behaviors must be ethical. The differences in the care behaviors of nurses from one institution to another or one country to another have led nursing researchers to investigate the influential factors in the motivations and determinants of care behaviors. In addition, the process of nursing care provision is influenced by the conditions of their work environment and community culture. Given the importance of care as the most important component of nursing practices, the cultural differences in Iran, and the facts that patients from different cities with different cultures refer to medical centers in large cities (including Tehran) due to the lack of adequate medical facilities and nurses should have the necessary information about the cultural, social, and ethnic status of patients as part of the nursing profession for the planning of nursing care, the present study aimed to assess the correlation between the cultural competence of nurses and their care behaviors in the teaching medical centers affiliated to Iran University of Medical Sciences in 2019. Materials & Methods: This cross-sectional, correlational study was performed with the participation of the nurses working in the teaching medical centers affiliated to Iran University of Medical Sciences in Tehran, Iran. In total, 200 nurses were selected via multistage cluster sampling. At the first stage, the medical centers were divided into two categories of general and specialized, and in the next stage, three centers were selected from among the general medical centers, and three centers were selected from among the specialized centers randomly. The sample size of treatment center was divided by the proportion of the nurses, and based on random allocation in each treatment center, the samples were selected from the nurses. Data were collected using a self-report demographic form, the cultural competence questionnaire by Perng and Watson, and the caring behaviors inventory (CBI-42) in a self-report manner during November 2019-January 2020. Data analysis was performed in SPSS version 16. To achieve the specific goals and accurate responses to the research questions, we used descriptive statistics (tables), central indicators (mean), dispersion indices (standard deviation), and inferential statistics (independent t-test, ANOVA, and Pearson's correlation-coefficient). The significance level was set at P<0.05, and it was assumed that due to the sufficient sample size, the study population had normal distribution. Results: The mean score of the cultural competence of the nurses was 66.27 ± 15.02, and the mean score of the care behaviors of the nurses was 5.28 ± 0.43. The highest mean score of cultural competence belonged to the cultural sensitivity dimension (60.50), and the lowest mean score belonged to the cultural knowledge dimension (56.25). The lowest mean score of the care behaviors belonged to the dimension of respecting others (5.09), and the highest mean score was observed in the dimension of professional knowledge and skills (5.43). In general, a weak, significant correlation was observed between the cultural competence of the nurses and their care behaviors. In addition, significant correlations were observed between all the dimensions of the care behaviors and cultural competence (P<0.05), except for the dimensions of cultural knowledge, skills, and sensitivity (P=0.058). The findings also indicated that the emergency department nurses had higher cultural competence, and the married nurses had better care behaviors. Conclusion: Cultural competence is a major foundation of clinical nursing, and more attention to cultural competence plays a pivotal role in better and more competent patient care. According to the results, the cultural competence level of the nurses had a weak, significant correlation with their care behaviors. Therefore, it could be concluded that enhancement in one of these factors leads to the improvement of the other. Considering that each of these factors is an important component of nursing care, their improvement through academic and inservice training could enhance the provision of nursing care to the patients, while also facilitating the relationship of nurses with patients.