University of Oulu

Ashlee Oikarainen, Kristina Mikkonen, Amanda Kenny, Marco Tomietto, Anna-Maria Tuomikoski, Merja Meriläinen, Jouko Miettunen, Maria Kääriäinen, Educational interventions designed to develop nurses’ cultural competence: A systematic review, International Journal of Nursing Studies, Volume 98, 2019, Pages 75-86, ISSN 0020-7489,

Educational interventions designed to develop nurses’ cultural competence : a systematic review

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Author: Oikarainen, Ashlee1; Mikkonen, Kristina1; Kenny, Amanda2;
Organizations: 1Research Unit of Nursing Science and Health Management, Faculty of Medicine, P.O. Box 5000, FI- 90014, University of Oulu, Finland
2Violet Marshman Initiative, La Trobe Rural Health School, La Trobe University, Australia
3Nursing Research Foundation, Finland
4The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
5Oulu University Hospital, P.O. Box 10, 90029, OYS, Finland
6Center for Life Course Health Research, P.O. Box 5000, FI- 90014, University of Oulu, Finland
7Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Finland
8Medical Research Center Oulu, Oulu University Hospital, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
Persistent link:
Language: English
Published: Elsevier, 2019
Publish Date: 2020-06-21


Background: Due to a steady rise in cultural and linguistic diversity in healthcare settings and evident challenges associated with this diversity, there is an urgent need to address cultural competency of nurses. Ongoing, continuing professional development is needed to ensure nurses can provide culturally congruent nursing care.

Objectives: The aim of this systematic review was to identify current best evidence on the types of educational interventions that have been developed to improve nurses’ self-assessed cultural competence and on the effectiveness of these interventions.

Design: A systematic literature review.

Data sources: Four electronic databases (PubMed, CINAHL, Medic, Eric) were searched for studies using a quasi-experimental design or randomised controlled trial published between January 2000 and June 2018.

Review methods: Guidelines from the Centre for Review and Dissemination and the Joanna Briggs Institute guided the review. Two researchers independently assessed the eligibility of the studies by title, abstract and full-text and the methodological quality of the studies. Data tabulation and narrative analysis of study findings was performed.

Results: Six studies met criteria for inclusion in the review. Studies used a quasi-experimental study design (n = 5) and a randomised controlled trial (n = 1). The participants (n = 334) were mainly nurses and interventions were conducted in various healthcare settings. Cultural competence education was offered through traditional contact teaching (n = 5) or web-based modules (n = 1) and ranged from one to 17 hours in length. Learning was enhanced through lectures, group discussions, case studies, reflective exercises and simulations. In two studies, following cultural competence interventions, participants in the intervention group had statistically significantly increased levels of competence in culture-related outcomes when compared to the control group. The four remaining studies did not include control group comparisons. Effect sizes (Cohen’s d) of the studies varied from small (d = 0.22) to very large (d = 1.47).

Conclusions: There continues to be a need for high quality studies investigating educational interventions to develop nurses’ cultural competence. Further research should focus on reporting specific components of interventions that result in an increase in cultural competence.

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Series: International journal of nursing studies
ISSN: 0020-7489
ISSN-E: 1873-491X
ISSN-L: 0020-7489
Volume: 98
Pages: 75 - 86
DOI: 10.1016/j.ijnurstu.2019.06.005
Type of Publication: A1 Journal article – refereed
Field of Science: 316 Nursing
Copyright information: © 2019 Elsevier Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license