Cultural competence is a set of congruent behaviours, attitudes, and policies that come together in a system, agency, or amongst professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations . The ultimate goal of cultural competency in nursing care is to reduce health disparity and to provide optimal nursing care to the patient regardless of their race, ethnic background, the native language spoken and religious or cultural belief . Nurses are working in a culturally diverse population, mainly because of immigration and globalization in western countries . Medical tourism is another reason for cultural diversity. In Thailand, India, Singapore, and Malaysia, medical tourists are the primary sources of patients' cultural diversity . However, Ethiopian nurses are facing a culturally diverse population predominantly due to the co-existence of multicultural and multiethnic society in the country. Ethiopia is the second-largest African country following Nigeria with one of the most ethnically diverse nations with more than 80 ethnic groups, each with their language, norms, belief, and religion in the world . Besides, Ethiopia is the second-largest refugee-hosting country in Africa, with more than 800,000 refugees from neighboring countries .
Studies have indicated that there are considerable shreds of evidence on unequal treatment and the existence of health inequalities or disparities in healthcare among a culturally diverse population. Delivering culturally competent care is a powerful tool to eliminate these disparities in the health status of people of different cultural, racial, and ethnic backgrounds [7, 8]. As a result of this, globally, cultural competence in nursing care has gained attention and is now recognized by health policymakers, care administrators, academicians, nurses, and nursing researchers as a strategy to eliminate health disparities [2, 9, 10].
In 2016, the American Nursing Association recognized cultural competence and included it for the first time in the scope and standards of nursing practice . American academy of nursing (AAN) has also developed universally applicable guidelines for implementing culturally competent care, which can serve as a resource for nurses in various roles. However, lack of clarity around the concept of culture, inadequate recognition, and the scarcity of research-based outcomes of cultural competence that provide evidence of efficient strategies are still the limited implementation of cultural competence in nursing practice . Besides, the study shows that many nurses have given minimal or no attention to monitoring the cultural competency of their own and members, even if the standard of culturally congruent nursing care. In nursing practice and other guidelines for implementing culturally competent care persuaded them to be culturally relevant .
Therefore, assessing the level of cultural competence among nurses and taking appropriate action is one strategy to increase the cultural competency of nurses in nursing practice. Many studies exist that examine the cultural competency of nurses. However, the majority of these studies have been conducted in the United States, Canada, UK, and Australia, while only a few studies were conducted in Africa. The findings of these studies were inconsistent in which cultural competence of nurses was low in South Africa, Israel, Taiwan, and Thailand [4, 14–16], moderate in Italia and Iran [17, 18] and high in the USA and Saudi Arabia [19, 20]. These studies also showed that different factors could influence the cultural competence of nurses, such as level of education, nurses' year of experience, one's ethnicity age, sex, and frequency of caring for culturally diverse clients [4, 15, 16, 20].
Despite the existence of a diverse socio-cultural society that needs nurses to be culturally competent, cultural competence among nurses is not studied. Therefore, this study investigated the level of cultural competence and its influencing factors among nurses working in tertiary hospitals.
Papadopoulos, Tilki, and Taylor (PTT) model guided this study. PTT model is one of the nursing theories that facilitate understanding of current nursing care practices and patients' demand for nursing care regardless of their cultural, religious, and linguistic background. It describes the nurses' capacity to provide effective nursing care that takes the patient's cultural beliefs, behaviours into consideration. According to this model, to be culturally competent, every nurse must pass through four stages of the PTT model. These stages are cultural awareness (first stage), cultural knowledge (second stage), cultural sensitivity (third stage), and cultural skill (fourth stage. These four sub-constructs of cultural competence have been commonly recognized and used in different studies [16, 22, 23]. Therefore, the present study also used the four sub-constructs of the PTT model for developing cultural competence.