Cultural Competence and Decision-Making of Nurse Leaders in a University Hospital in the Kingdom of Saudi Arabia

Abstract

The migration of health workers creates a disparity in workforce distribution. In Saudi Arabia, the total nursing workforce is 185,693 with only 36.7% comprising of Saudi nurses (The Public Administration of the Ministry of Health, 2017). In the institution where the study was conducted, the Nursing Service is composed of eight different nationalities. The nurse leaders have varying experiences in leadership positions, working overseas, and working in a diverse workforce. This creates a challenge for the nurse leaders to ensure that their decision will benefit the organization, patients, and nurses. This prompted the researcher to explore the relationship between cultural competence and quality of decision-making of nurse leaders in a university hospital in the Kingdom of Saudi Arabia.

A descriptive correlational design was utilized in this study. A total of 122 respondents completed a survey using the Cultural Competence Assessment (CCA) Instrument (Schim et al., 2003) and Decision Making Quality Scale (DMQS) (Hollen, 1994). Data analysis was conducted using the IBM Statistical Product and Service Solutions (SPSS) version 22.0.

The cultural awareness and sensitivity (CAS) (M=5.46, SD=0.54), cultural competence behavior (CCB) (M=5.00, SD=1.03), and overall cultural competence score (CCA) (M = 5.23, SD = 0.62) of nurse leaders were on a moderately high level. Almost three-fourths of the nurse leaders adhere to quality decision-making criteria (n=91 or 74.6%), with a mean DMQS score of 16.6 (SD=3.11) indicating adherence to the seven (7) quality decision-making criteria. The cultural awareness and sensitivity (CAS) is not significantly related to the demographic profile with exception of CAS and Arab American/Middle eastern race/ethnicity (p=0.00, x2=14.37) which was found to have a significant relationship. The cultural competence behavior

(CCB) is not significantly related to the demographic profile except for the years of nursing experience in Saudi Arabia and CCB (p=0.00, r=0.26) and years of experience in a leadership position and CCB (p=0.05, r=0.18) which were found to have a significant relationship. The quality of the decision-making of nurse leaders is significantly related to the years of nursing experience in Saudi Arabia (p=0.05, r=0.18) but not to other demographic profile. Quality of decision-making (DMQS) is significantly related to cultural awareness and sensitivity (CAS) (p=0.04, r=0.19) and cultural competence behavior (CCB) (p=0.00, r=0.32).

Nurse leaders who share similar cultural beliefs and practices with their environment understand better how their cultural expressions affect their interactions with others. As nurse leaders are more exposed to the diverse culture where they are working, the more they put into practice culturally competent behaviors. Consequently, nurse leaders with cultural awareness and sensitivity and who demonstrate culturally competent behaviors adhere to the quality decision-making criteria, and the greater the exposure to a specific culture, the more they can apply decision-making skills as required by specific situations.