Empowerment of Foreign Nurses to Develop Self-efficacy in Culturally Competent Care Delivery


  • Diane Presley University of South Africa, 1 Preller Street, Muckleneuk Ridge Pretoria 0002, South Africa
  • Sheila Mokoboto-Zwane University of South Africa, Pretoria, Private bag X20, Hatfield 0028, South Africa




Background: Utilizing an exploratory, sequential, mixed-method approach, data was collected for an evidence-based educational approach to empower nursing staff from diverse cultural backgrounds to acquire the knowledge, skills, and attitudes necessary for the successful provision of culturally competent care. Methods: The Transcultural Self-Efficacy Tool (TSET) and the competence and confidence model were used to measure the influence of cultural competence education on transcultural self-efficacy (TSE) perceptions (n = 92). This mixed-methods inquiry utilized focus group inquiry prior to and after utilizing the TSET for the development of education and training. Results: Qualitative and quantitative data were triangulated with the themes and care statements from the qualitative focus group data, which explored relationships between the quantitative data of the TSET domains. Empowerment is demonstrated by the ability to deliver culturally competent care and achieve positive outcomes in clinical practice effectively and confidently. Conclusion: Empowering TSE may be influenced by the planned education and training of professional nurses. Educational outcome research can demonstrate the impact of cultural education and training programs on empowerment and meeting patient needs with culturally competent nursing skills.


Culturally Competent Care, Educational Interventions, Transcultural Self-Efficacy, Workforce Diversity


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Andrews, M., Backstrand, J. R., Boyle, J. S., Campinha-Bacote, J., Davidhizar, R. E., Doutrich, D., ... & Zoucha, R. (2010). Chapter 3: Theoretical basis for transcultural care. Journal of Transcultural Nursing, 21(4_suppl), 53S-136S. http://dx.doi.org/10.1177/1043659610374321

Antón-Solanas, I., Rodríguez-Roca, B., Vanceulebroeck, V., Kömürcü, N., Kalkan, I., Tambo-Lizalde, E., ... & Subirón-Valera, A. B. (2022). Qualified Nurses’ Perceptions of Cultural Competence and Experiences of Caring for Culturally Diverse Patients: A Qualitative Study in Four European Countries. Nursing Reports, 12(2), 348-364. https://doi.org/10.3390/nursrep12020034

Bandura, A. (1989). Regulation of cognitive processes through perceived self-efficacy. Developmental psychology, 25(5), 729. https://doi.org/10.1037/0012-1649.25.5.729

Bandura, A., Rumsey, M., Walker, C., & Harris, J. (1994). Regulative function of perceived self-efficacy. Personnel selection and classification, 261-271. https://doi.org/10.1016/j.cognition.2019.104114

Black, B. P. (2019). Professional nursing: Concepts and challenges. 9th edition. Philadelphia: Saunders.

Bit-Lian, Y., Bakar, R. A., & Saeidin, S. (2020). The Perceived Cultural Barriers to Effective Communication Towards Patient Among Non-Saudi Registered Nurses of a Public Hospital, The Kingdom of Saudi Arabia. The Malaysian Journal of Nursing (MJN), 11(4), 41-53. https://doi:10.31674/mjn.2020.v11i04.004

Campinha-Bacote, J. (2019). Cultural Competemility: A Paradigm Shift in the Cultural Competence versus Cultural Humility Debate--Part I. Online Journal of Issues in Nursing, 24(1). https://doi.org/10.3912/OJIN.Vol24No01PPT20

Creswell, J. W., & Creswell, J. D. (2017). Research DESIGN: Qualitative, Quantitative, and Mixed Methods Approaches. Sage publications.

Douglas, M. K., Rosenkoetter, M., Pacquiao, D. F., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., ... & Purnell, L. (2014). Guidelines for implementing culturally competent nursing care. Journal of Transcultural Nursing, 25(2), 109-121. http://dx.doi.org/10.1177/1043659614520998

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

Jeffreys, M. R. (2000). Development and psychometric evaluation of the transcultural self-efficacy tool: A synthesis of findings. Journal of Transcultural nursing, 11(2), 127-136. https://doi.org/10.1177/104365960001100207

Jeffreys, M. R. (2015). Jeffreys's Nursing universal retention and success model: overview and action ideas for optimizing outcomes A–Z. Nurse Education Today, 35(3), 425-431. https://doi.org/10.1016/j.nedt.2014.11.004

Jeffreys, M. R. (2016). Teaching cultural competence in nursing and health care: Inquiry, action and innovation. 3rd edition. New York: Springer.

Jeffreys, M. R. (2019). Evidence-Based Updates and Universal Utility of Jeffreys' Cultural Competence and Confidence Framework for Nursing Education (and Beyond) Through TIME. Annual review of nursing research, 37(1). https://doi.org/10.1891/0739-6686.37.1.43

Jeffreys, M. R., & Smodlaka, I. (1998). Exploring the factorial composition of the transcultural self-efficacy tool. International Journal of Nursing Studies, 35(4), 217-225. https://doi.org/10.1016/S0020-7489(98)00034-0

Kurt, Y., Özkan, Ç. G., Öztürk, H., Görgöz, M., Karlı, İ., Çetinkaya, C., ... & Birinci, K. (2020). Evaluation of Student Nurses’ use of the Internet and Technology in Education and Self-Efficacy Perceptions of Computer Use. The Malaysian Journal of Nursing (MJN), 12(2), 28-37. https://doi.org/10.31674/mjn.2020.v12i02.005

Leininger, M. (1998). Special research report: dominant culture care (EMIC) meanings and practice findings from Leininger's theory. Journal of Transcultural Nursing, 9(2), 45-48. https://doi.org/10.1177/104365969800900207

Leininger, M. M. (1985). Transcultural care diversity and universality: a theory of nursing. Nursing & health care: official publication of the National League for Nursing, 6(4), 208-212. https://doi.org/10.1177/089431848800100408

Leininger, M. M., & McFarland, M. R. (2006). Culture Care Diversity and Universality: A Worldwide Nursing Theory. Jones & Bartlett Learning.

Nashwan, A. J. (2023). Culturally competent care across borders: Implementing culturally responsive teaching for nurses in diverse workforces. International Journal of Nursing Sciences. https://doi.org/10.1016/j.ijnss.2023.09.001

Purnell, L. (2019). Update: The Purnell theory and model for culturally competent health care. Journal of Transcultural Nursing, 30(2), 98-105. https://doi.org/10.1177/1043659618817587

Purnell, L. D., & Fenkl, E. A. (2019). Transcultural diversity and health care. Handbook for Culturally Competent Care, 1-6.

Ramsden, I. (2005). Towards cultural safety. Cultural safety in Aotearoa New Zealand, 2-19. http://dx.doi.org/10.1017/cbo9781316151136

Renz, S. M., Carrington, J. M., & Badger, T. A. (2018). Two strategies for qualitative content analysis: An intramethod approach to triangulation. Qualitative health research, 28(5), 824-831. https://doi.org/10.1177/1049732317753586

Rovito, K., Kless, A., & Costantini, S. D. (2022). Enhancing workforce diversity by supporting the transition of internationally educated nurses. Nursing Management, 53(2), 20. https://doi.org/10.1097%2F01.NUMA.0000816252.78777.8f

Shen, Z. (2015). Cultural competence models and cultural competence assessment instruments in nursing: a literature review. Journal of Transcultural Nursing, 26(3), 308-321. https://doi.org/10.1177/1043659614524790

Wafa'a, F., Alhurani, J., Alhalal, E., Al-Dwaikat, T. N., & Al-Faouri, I. (2020). Nursing empowerment: How job performance is affected by a structurally empowered work environment. JONA: The Journal of Nursing Administration, 50(12), 635-641. https://doi.org/10.1097/NNA.0000000000000951



How to Cite

Presley, D. ., & Mokoboto-Zwane, S. (2023). Empowerment of Foreign Nurses to Develop Self-efficacy in Culturally Competent Care Delivery. The Malaysian Journal of Nursing (MJN), 15(2), 114-124. https://doi.org/10.31674/mjn.2023.v15i02.013