Cultural Competence and Ethics Among Nurses in Primary Healthcare: Exploring Their Interrelationship and Implications...

Background/Objectives: Cultural diversity in healthcare settings is rapidly increasing, posing complex ethical and communication challenges for nurses. Competence in navigating cultural differences, alongside ethical sensitivity, is essential to delivering patient-centered care. This study aimed to examine the relationship between nurses' cultural competence-measured as transcultural self-efficacy-and their knowledge, attitudes, and practices concerning healthcare ethics in primary care settings in Greece. Methods: A cross-sectional study was conducted with 492 nurses using validated Greek versions of the Transcultural Self-Efficacy Tool (TSET-Gr) and the Nurses' Ethics Questionnaire (NEQ-Gr). Descriptive and inferential statistics were used to assess correlations and predictive relationships between demographic variables, cultural self-efficacy subscales, and ethical constructs. Results: Nurses demonstrated moderate to high levels of cultural self-efficacy and ethical sensitivity. Affective self-efficacy was the highest-rated subscale and showed strong positive associations with ethical knowledge (r = 0.27, p < 0.001) and ethical attitudes (r = 0.23, p < 0.001). Multivariable linear regression analysis revealed that higher educational attainment significantly predicted both practical (b = 0.12, p = 0.045) and affective self-efficacy (b = 0.15, p = 0.002), as well as better ethical knowledge and attitudes. Notably, more years of experience were associated with lower self-perceived cultural competence. Nurses working in multicultural regions reported more favorable ethical orientations. Conclusions: Cultural competence, particularly emotional readiness to engage with cultural diversity, is a significant predictor of ethical awareness and behavior in nursing practice. Investment in continuous professional development, education, and supportive work environments is essential for cultivating both ethical sensitivity and culturally responsive care.