Cultural competence and humility in U.S. nursing fundamentals textbooks: A qualitative content analysis

Abstract

Background

Cultural competence is a part of nursing curricula, but little is known about how cultural competence is presented in educational materials.

Aim

The purpose of this study was to examine cultural competency and humility in introductory nursing textbooks.

Method

The authors conducted a directed qualitative content analysis of 11 culture and diversity chapters in 10 nursing fundamentals textbooks.

Results

All chapters discussed cultural awareness, cultural knowledge, and cultural skill, while most also discussed cultural encounters, cultural desire, and cultural humility. The clearest examples of cultural competence in practice were cultural awareness, knowledge, skill, and encounters. Cultural desire was presented as internal motivation nursing students needed to cultivate on their own. Cultural humility was presented as recommendations to challenge structural racism and implicit bias.

Conclusions

The focus on awareness, knowledge, and skill mirrors previous findings about teaching competency in nursing materials. Although all textbooks called for learning about patient diversity, the examples provided were almost exclusively about race/ethnicity, especially patients from non-U.S. countries with limited English proficiency, which can limit nursing students’ education of diversity.