This research study sought to test possible new predictor variables and scales of ICS.
The results of the study show that background setting and prior cultural exposure both have an effect on ICS abilities. These findings stand as evidence in further support of contact theory.
As previously noted, healthcare providers exposed to diverse cultural groups had an effect on their intercultural competency (Bartunek, 2011). Furthermore, according to the logical assumption like the adage “A rising tide lifts all ships” one might simply assume that an increase in ICC would signal an increase in ICS. This assumption is no longer necessary because this study has shown that the variables deeply rooted in contact theory were also valid predictors of ICS.
This study was also interested in testing the reliability of the ICS scale published by Chen and Starosta (2000). However, the scale did not behave as it should have according to their validation. As previously noted researchers have already noted some weakness in this scale and suggested that some dimensions might need to be merged (Fritz and Chen, 2000). The original validation by its publishers of the scale revealed five principle components together accounted for 37.3% of variance (Chen &Starosta, 2000). Those dimensions are Interaction Engagement (22.8%), Respect for Cultural Differences (5.2%), Interaction Confidence (3.9%), Interaction Enjoyment (3.0%), and Interaction Attentiveness (2.3%). (Chen &Starosta, 2000) During the course of this research the scale reduced down to 3 principle components accounting for 63.3%
of variance. These components were labeled as follows to best reflect the new combinations of items: Respect for Cultural Differences (50.3%), Interaction Surety (7.6%), and Interaction Presence (5.4%).
The results of this study revealed a vast divergence from the originally established grouping of items into dimensions. The most pronounced of these instances is the original author’s dimension labeled interaction engagement. This dimension accounted for 22.8% of all variance in the original study. However the factor analysis of this study depressed 3 of those 7
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items from the now strongest component, respect for cultural differences, into the weakest one—
interaction presence.
Of those three items there seems to be a clear explanation for two of them as to why they now load alongside items measuring respect for cultural differences. Firstly, item IntEnga_24 is worded such that it is unclear as to the topic of the item. This item states “I have a feeling of enjoyment towards differences between my culturally-distinct counterpart and me” which could easily be misconstrued by a respondent as to pertaining towards either “enjoyment” or “cultural differences.” The second item, IntEnga_13—“I am open-minded to people from different cultures”— might exist in this new dimension because its wording is also closely related to item CultDiff_2—“I think people from other cultures are narrow minded.” Item IntEnga_13 also had a low factor loading in its originally validated dimension of .51which suggests that in the original study it could have had a relatively strong secondary loading in another dimension as was the case in this study with it loading into Respect for Cultural Differences at .658 and Interaction Surety at .463.
This study proposed 7 hypotheses for testing predictors of ICS. Three of the hypotheses were not accepted. The first two rejected hypotheses were H2-2 and H2-3 which were attempting to measure and test two dimensions of prior exposure, narrative experience and language study, as predictors of ICS. Both of these scales were based on evidence in the literature however neither successfully performed as predictors of ICS. In the case of narrative experience, this may be because the scale only had three items or the items failed to measure the degree to which respondents experienced stories and narratives of different cultures. This dimension also had a high correlation with ICS (r = .294, p < .01) suggesting another relationship exists between these factors. This could also be explained by the low average score for this sample group in this dimension, 1.4 out of 5, which indicates that these students don’t have enough opportunities provided to them by their schools or themselves for experience of cross-cultural narratives.
The second prior exposure dimension was language study which was intended to establish the foreign language abilities of the respondents. This measure showed no correlation or predictive qualities with regards to ICS. This is likely due to the design of the measure
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because language ability has been shown to have an effect on ICC (Fernandez et al., 2004). This dimension’s failure is perhaps due in part to the structure of the items. The items were worded to measure a quantity of language classes and not performance levels in those classes or languages.
Furthermore, high performance in foreign language courses is not strongly encouraged in high schools and academia in this region so high scores on these items may not actually represent extensive language ability.
The last hypothesis to be rejected was H3 which explored the relationship between gender and ICS. However, gender equality has increased greatly in the last ten to twenty years, especially in the nursing industry, therefore the literature supporting that gender shows a marked difference in cross-cultural abilities may no longer be relevant.
It should be noted that new insights into the nature of the variable Intended Work Setting have come to light in the course of this research. This variable was measured using a single categorical response item. However, in interviews with nursing educators and practitioners in a related qualitative study revealed a chronological error in the design of the item. As the item is currently written, it does not specify as to when during the nursing students’ subsequent careers they should refer to while responding such as near, middle, or distant future. When asked about intended work settings and cultural competency nursing subject matter experts responded overwhelmingly that nursing students intend to find a job anywhere they can right out of school.
Following this force nurses are then predominately driven to seek jobs either offering specialization or further academic opportunities (Vaughan and Yeh, 2013).
Practical Implications
In the beginning of the study the researcher wondered if simple background data, which would be easily collectable by nursing education institutions, could help predict students’ ICS abilities. Understanding those abilities can help institutions better model their cultural curriculum to balance efficiency and effectiveness. Several implications can be drawn from the study. Firstly, the study has shown that nursing students hailing from urban areas or large cities will score higher on ICS scales than students from rural areas. This information can be useful for
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healthcare institutions seeking to fill positions requiring high cross cultural abilities.
Furthermore nursing schools can use this measure to better plan their curriculum to match their incoming student population’s pedagogical abilities with regards to cultural enrichment. For instance, a nursing school located in a large city will not have to invest in cultural training programs and courses as much as rural nursing school to increase their students’ cross cultural abilities.
Secondly, according to the results, students seeking nursing positions in non-rural areas may already have higher ICS abilities than their counter-parts. Therefore in the specialization and career path planning decisions for nursing students, institutions may take into account that nurses seeking jobs in non-rural areas may not need as comprehensive cultural coursework as nurses seeking rural based positions.
Thirdly, prior cultural experiences were strongly predictive of high ICS scores. Although this dimension queried experience abroad, most of the items measured experiences which could be obtained locally by cultivating cross-cultural relationships or attending community cultural events such as holiday, religious, music, and art festivals. Nursing institutions wishing to increase their students’ ICS abilities without arranging for expensive experiences abroad may be able to do so by organizing cultural enrichment events or partnering with local cultural organizations to host opportunities to increase the cross cultural interactions experienced by the students.
These implications represent the contributions of this study. Firstly, this study has validated a simple piece of background information to be useful as a predictor of ICS. Secondly, this study has shown that occupational aspirations can also be used as indicators of traits such as intended work environment and ICS abilities. Thirdly, the study provided evidence that the intercultural benefits arising from cross-cultural contact are not relegated only to individuals living immersed in different cultures but can be attained through localized activities and experiences. It should also be noted that the mean score for the dimension narrative experience was very low 1.4 on a 5 point scale. This indicates that the students are either not seeking out stories about other cultures or do not have much access to them. Nursing schools should
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endeavor to encourage their students to read more books and watch more movies about other cultures to increase their understanding of other cultures’ worldviews. This can be done through book/movie clubs and mandatory reviews of such narrative material.
Research Implications
As the results showed, a nursing student’s background setting was a viable predictor of ICS abilities. Because these two variables are significantly related there does exist a definite relationship between the two suggesting that environments with higher cultural interactions will have an effect on ICS abilities. The relationship is further support for contact theory because it shows that increased levels of cross cultural contact via one’s background setting will provide an increase in cross cultural abilities. Further research in this area is needed to investigate the nature of the relationship between them. Most likely, students hailing from non-rural areas are predisposed for having better cross cultural skills because their environment provides more contact opportunities than the environments of their rural counterparts.
Many nursing schools are adopting new methods for cultural instruction like short term immersion trips abroad. Such methods are expensive and available to a small portion of the student body. The traditional and most common form of cultural instruction is to accompany text book and curriculum materials with the reading of books and viewing of films produced from various cultural perspectives. The rejection of Hypothesis 2-2 showed that although there is a relationship between cross narrative experience it does not appear to predict students’ ICS abilities.
Conclusions
The objective of this study was to investigate predictors of ICS in nursing students. After statistical analysis it was found that some heretofore unexamined background data are positively related to ICS abilities. However not all data theorized to have predictive capabilities proved so.
For instance, cross narrative experience did not prove to have predicative qualities although it was significantly correlated with ICS scores.
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Limitations of the Study
The scope of this study is restricted to investigating possible predictors of ICS existing in background & demographic data of nursing students. The background and demographic data being collected is restricted to respondent’s gender, community setting, prior cultural exposure, and intended work setting. No other information such as ethnicity or socio-economic status is solicited.
The study is also delimited by the certification level of the nurses. This study focuses only on nursing students seeking Associates Degree in Nursing or (ADN) certification and Bachelors of Nursing (BSN). At the completion of either degree, nursing students will sit the exam for the same level of certification, Registered Nurse (RN). Students seeking certifications such as Licensed Practitioner Nurse (LPN) which is a lower certification to RN’s, or Nurse Practitioner (NP), a higher certification, are a small percentage of the nursing population and so do not fall within the purview of this study.
This study sought to research specific predictors of ICS: community setting, gender, prior exposure, and intended work setting. These are predictors that have not been extensively examined in combination by prior researchers.
A limitation of this study is the collection method. The instrument, being a self-report survey, is susceptible to a small degree of common method variance. This is because the source providing data for both predictor and criterion variables is the same individual which is known as common rater effects (Podsakoff et al., 2003). Another contributor to common method variance is the consistency motif. This occurs because respondents will answer questions in such a way to
“maintain consistency between their cognitions and attitudes” (Podsakoff et al., 2003). This means that respondents involuntarily may start to internalize what the questionnaire is “getting at”
or “looking for” and mark all their responses according to this internalized assumption. This situation can result in a drop in accuracy because the survey might not actually be measuring the respondent but just collecting responses according to the participant’s assumption of the survey.
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This study is also limited by the equivalency of the two levels of nursing degrees represented by the sample. RN degrees are generally two year certifications, while BSN degrees are two years of general college credits with an emphasis in chemistry and biology followed by a two year RN certification.
This will limit the degree of generalizability to similar cities and nursing programs in this region of the country. The results are possibly only generalizable to areas of the nation containing an equivalent level of diversity in the population. The region of the study is not a major point of entry for immigration such as the areas in the US north east with more populous metropolitan areas. The study was also conducted through written English which although it is informally the official language of the healthcare industry could still skew results with regards to nursing students for whom English is not their first language.
Future Research Suggestions
Future research in this area could be conducted in many forms. Simply conducting the same survey in various regions of the country could yield different results because some sections of the country are more urbanized than others while other sections may traditionally experience higher levels of immigration thus skewing diversity levels. The study could also be translated into non-English languages prevalent in the research area such as Spanish. The average age of the sample was 31 years of age indicating that many of the participants already have work experience in other fields. Future research should include scales measuring not only the level of prior work experience but also attempt to capture their exposure to culturally diverse work conditions. An expansion of the research model might also include periodic follow up measuring of respondents after entering the work force to compare occupational performance against previous ICS scores, track the increase or decrease of ICS overtime, and test if career paths are related to ICS abilities.
Related research might also include examining the cultural curriculum of nursing schools and its relationship with the dimensions of prior cultural exposure. For instance it is common practice in nursing schools to accompany culture curriculum with books offerings a unique
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cultural viewpoint such as The Spirit Catches You by Anne Fadiman. This study showed that ICS is not affected by cross narrative experience. However, this sample’s group average score for this dimension was quite low being 1.4 on a 5 point scale. Future research could involve requiring the students to increase that score through participating in monthly book and movie review clubs and then reassessing their ICS levels after a period of time.
Research focusing on the interactions of the prior exposure dimensions can help answer questions about attaining higher levels of ICS. Further investigation into what kind of activities, duration of those activities, and frequency can best affect a respondent’s mindset towards other cultures would increase understanding to what actually raises ICS abilities and therefore give insight to designing better classes for teaching cross culture competencies.
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