Cultural competence among ICU nursing staff: an explanatory sequential mixed-methods study

Objective To understand the cultural competence of ICU nurses by adopting an explanatory sequential mixed-methods design, and to analyze its influencing factors, so as to provide directions for improving the cultural competence of ICU nurses.

In July 2025, 238 ICU registered nurses from three comprehensive tertiary hospitals in Shanghai were enrolled using cluster sampling. Data were collected using a general information questionnaire, the Cultural Intelligence Scale (CQS), and the revised Inventory for Assessing the Process of Cultural Competency (IAPCC-R). A total of 204 nurses completed valid questionnaires, with an effective response rate of 85.71%. Multiple linear regression and Pearson correlation analysis were performed to identify influencing factors. In August 2025, 22 ICU nurses who met the eligibility criteria were selected by purposive sampling for semi-structured in-depth interviews, and data were analyzed using Colaizzi's 7-step method.

The mean score of cultural competence among 204 ICU nurses was 74.42, indicating a moderate level. Among them, 68 cases (33.33%) had a high level of cultural competence, 134 cases (66.18%) had a medium level, and 2 cases (0.98%) had a low level. Particularly, cultural knowledge and cultural contact were identified as the two weakest dimensions. Multiple linear regression analysis showed that cultural intelligence, foreign language proficiency, and professional title were influencing factors of cultural competence among ICU nursing staff (P < 0.05). Pearson correlation analysis revealed a strong positive correlation between cultural intelligence and cultural competence (r = 0.79, p < 0.001).Qualitative findings further explained the underlying reasons for the moderate overall level and weak dimensions observed in the quantitative results, including fragmented acquisition of cultural knowledge, insufficient and unguided cultural contact experiences, inadequate organizational support, and cross-cultural communication barriers.The qualitative research extracted five themes: cultural awareness, cultural knowledge, cultural skills, cultural contact, and cultural willingness. Integrated analysis of quantitative and qualitative results found that the two complemented each other in explaining the current situation and influencing factors of ICU nursing staff's cultural competency.

To enhance the cultural competence of ICU nursing staff, targeted training should focus on the two weakest dimensions: cultural knowledge and cultural contact. A structured, scenario-based training system is recommended to improve cultural competence sustainably, so as to provide high-quality nursing services for patients with cultural care needs.