The Cultural Competence Education Resource Toolkit - Springer

The Cultural Competence Education Resource Toolkit

This toolkit consists of three sets of tools and a total of 21 distinct tools. The three sets of tools are: Resources forAcademic Settings; Resources for Health Care Institutions; and Resources for Professional Associations. Takentogether, the tools provide a comprehensive set of materials for planning, implementing, and evaluating culturalcompetence education strategies and programs. These tools may be used alone or in conjunction with other toolsand will be of use to a broad range of readers at all levels: nurses, educators, administrators, association leaders,managers, researchers, students, and other health care providers. The tools and this book will enable you toachieve optimal cultural competence.

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Any use of the toolkit or portions of the toolkit beyond individual, personal use (such as within an institutional settingand/or in a research study) will require purchase of a license. See below.

• Individual Personal use: This toolkit is available for review and individual personal use to all purchasers of thebook, Teaching Cultural Competence in Nursing and Health Care, Second Edition, by Marianne R. Jeffreys, EdD, RN.

• Educational use: $250 per year

• All other uses (Corporate/Institutional/Government): $500 per year (one license per site)

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Teaching Cultural Competence in Nursing and Health CareSecond Edition

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Cultural CompetenceEducation Resource

Toolkit

Marianne R. Jeffreys, EdD, RN

The

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EJeffreys, EdD,ffreys, E

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HOW TO USE THE TOOLKITWelcome to the Cultural Competence Education Resource Toolkit. Used in conjunction with Teaching Cultural Competencein Nursing and Health Care, 2nd Edition, the toolkit contains a wealth of hands-on, user-friendly resources that helps takenurses, educators, administrators, professional association leaders, managers, educators, students, and other healthcare providers from their own starting point toward the pinnacle—optimal cultural competence. Appropriate for alllevels and settings (academic, health care institutions, employee education, professional associations, and continuingeducation), the book and toolkit end the struggle to find ready-to-use materials for planning, implementing, andevaluating cultural competence education strategies and programs. Toolkit items correspond with the seven essentialsteps for optimal cultural competence development: (1) self-assessment; (2) active promotion; (3) systematic inquiry;(4) decisive action; (5) innovation; (6) measurement; and (7) evaluation.

Take the next step. Find your setting and discover the toolkit resources best for you:

Resources* for Academic Settings

Item # Item Name

1. Transcultural Self-Efficacy Tool (TSET)3. Cultural Competence Clinical Evaluation Tool—Student Version (CCCET-SV)4. Cultural Competence Clinical Evaluation Tool—Teacher Version (CCCET-TV)7. Clinical Setting Assessment Tool—Diversity and Disparity (CSAT-DD)8. Demographic Data Sheet—Undergraduate (DDS-U)9. Demographic Data Sheet—Nurses (DDS-N)

10. Self-Assessment Tool—Academic (SAT-A)13. Active Promoter Assessment Tool—Academic (APAT-A)15. Systematic Inquiry: Academic (SI-A)18. Personal Coding Cover Page for Anonymity and Matching Questionnaires19. Sample Permission Letter20. Cultural Competence Documentation Log21. Research Report Template

Resources* for Health Care Institutions

Item # Item Name

1. Transcultural Self-Efficacy Tool (TSET)2. Transcultural Self-Efficacy Tool-Multidisciplinary Health Provider (TSET-MHP)5. Cultural Competence Clinical Evaluation Tool—Employee Version (CCCET-EV)6. Cultural Competence Clinical Evaluation Tool—Agency Evaluator Version (CCCET-AEV)7. Clinical Setting Assessment Tool—Diversity and Disparity (CSAT-DD)9. Demographic Data Sheet—Nurses (DDS-N)

11. Self-Assessment Tool—Health Care Institutions (SAT-HCI)14. Active Promoter Assessment Tool—Health Care Institutions/Professional Associations (APAT-HCIPA)16. Systematic Inquiry: Health Care Institutions (SI-HCI)18. Personal Coding Cover Page for Anonymity and Matching Questionnaires19. Sample Permission Letter20. Cultural Competence Documentation Log21. Research Report Template

*Items may be used alone or in conjunction with other toolkit items for specified settings. See Teaching CulturalCompetence in Nursing and Health Care, 2nd Edition for more details.


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Resources* for Professional Associations

Item # Item Name

1. Transcultural Self-Efficacy Tool (TSET)2. Transcultural Self-Efficacy Tool-Multidisciplinary Health Provider (TSET-MHP)5. Cultural Competence Clinical Evaluation Tool—Employee Version (CCCET-EV)6. Cultural Competence Clinical Evaluation Tool—Agency Evaluator Version (CCCET-AEV)9. Demographic Data Sheet—Nurses (DDS-N)

12. Self-Assessment Tool—Professional Associations (SAT-PA)14. Active Promoter Assessment Tool—Health Care Institutions/Professional Associations (APAT-HCIPA)17. Systematic Inquiry: Professional Associations (SI-PA)18. Personal Coding Cover Page for Anonymity and Matching Questionnaires19. Sample Permission Letter20. Cultural Competence Documentation Log21. Research Report Template

*Items may be used alone or in conjunction with other toolkit items for specified settings. See Teaching CulturalCompetence in Nursing and Health Care, 2nd Edition for more details.

TOOLKIT ITEMS OVERVIEW1. Transcultural Self-Efficacy Tool (TSET)

� An 83-item questionnaire designed to measure and evaluate learners’ confidence (transcultural self-efficacy)for performing general transcultural nursing skills among diverse client populations

� Consistently high estimates of validity and reliability for subscales and total� Requested by researchers worldwide in multiple health disciplines for use with students, nurses, and other

health professionals� May be used alone or in conjunction with other toolkit items� EASY SCORING: Self-Efficacy Strength (SEST) refers to the average strength of self-efficacy perceptions within

a particular dimension (subscale) of the construct. Calculate by totaling subscale item responses and dividingby the number of subscale items, resulting in the mean score. For example:

Cognitive Subscale Practical Subscale Affective Subscale

Formula

Item Response Sum# of Subscale Items

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SEST = 5.6 SEST = 6.5 SEST = 7.0

� Evaluation of TSE perceptions may be used for a variety of purposes targeting the individual and/or groups.The purposes are to:� Develop a composite/baseline of learners’ needs, values, attitudes, and skills concerning transcultural nurs-

ing (or health care)� Identify general transcultural skills perceived with more confidence (or those as less difficult or stressful)� Identify general transcultural skills perceived with less confidence (or those as more difficult or stressful)� Identify differences within groups� Identify differences between groups� Identify at-risk individuals (low confidence or overly confident)� Evaluate the effectiveness of specific teaching interventions� Assess changes in transcultural self-efficacy perceptions over time

� Supplementary book resources: Chapters 3, 4, and 5, and TSET Research Exhibits in chapters 6 and 10.


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2. TSET-Multidisciplinary Healthcare Provider (TSET-MHP) Version

� An 83-item questionnaire adapted from TSET to measure and evaluate learners’ confidence (transculturalself-efficacy) for performing general transcultural skills among diverse client populations. Items are exactlythe same as original TSET. Directions change “nurse” and “nursing” focus to “health care provider” focus,encompassing nursing and all other multidisciplinary health care provider groups.

� May be used alone or in conjunction with other toolkit items� EASY SCORING: Self-Efficacy Strength (SEST) refers to the average strength of self-efficacy perceptions within

a particular dimension (subscale) of the construct. Calculate by totaling subscale item responses and dividingby the number of subscale items, resulting in the mean score. For example:


Formula

Item Response Sum# of Subscale Items




Application

14025

18228

21030

SEST = 5.6 SEST = 6.5 SEST = 7.0

� Evaluation of TSE perceptions may be used for a variety of purposes targeting the individual and/or groups.The purposes are to:� Develop a composite/baseline of learners’ needs, values, attitudes, and skills concerning transcultural health

care� Identify general transcultural skills perceived with more confidence (or those as less difficult or stressful)� Identify general transcultural skills perceived with less confidence (or those as more difficult or stressful)� Identify differences within groups� Identify differences between groups� Identify at-risk individuals (low confidence or overly confident)� Evaluate the effectiveness of specific teaching interventions� Assess changes in transcultural self-efficacy perceptions over time

� Supplementary book resources: Chapters 3, 4, and 5, TSET Research Exhibits in chapters 6 and 10

3. Cultural Competence Clinical Evaluation Tool—Student Version (CCCET-SV)

� An 83-item questionnaire adapted from the TSET, containing three subscales measuring different dimensionsof clinical cultural competence behaviors as perceived by the student:� Extent of culturally specific care (Subscale 1)� Cultural assessment (Subscale 2)� Culturally sensitive and professionally appropriate attitudes, values, or beliefs including awareness, ac-

ceptance, recognition, appreciation, and advocacy necessary for providing culturally sensitive professionalnursing care (Subscale 3).

� Used to determine baseline information, identify areas of strengths, weaknesses, and gaps, and to evaluatechange following educational intervention and/or increased exposure to culturally diverse clients and/or in-creased exposure to the clinical topic/area not previously available. Used together with CCCET-TV (Studentsand teachers independently complete the CCCET at the end of the clinical experience). May be used withother toolkit items

� Content validity index high (0.91) as rated by three internationally recognized experts in transcultural nursing� Descriptive statistics (frequency and percent) for individual and aggregate data. Compare with teacher ratings.� Results can be used to guide educational changes.� Supplementary book resources: Chapters 4 and 5


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4. Cultural Competence Clinical Evaluation Tool—Teacher Version (CCCET-TV)

� An 83-item questionnaire adapted from the TSET, containing three subscales measuring different dimensionsof student’s clinical cultural competence behaviors as rated by the teacher or preceptor:� Extent of culturally specific care (Subscale 1)� Cultural assessment (Subscale 2)� Culturally sensitive and professionally appropriate attitudes, values, or beliefs including awareness, ac-

ceptance, recognition, appreciation, and advocacy necessary for providing culturally sensitive professionalnursing care (Subscale 3).

� Used to determine baseline information, identify areas of strengths, weaknesses, and gaps, and to evaluatechange following educational intervention and/or increased exposure to culturally diverse clients and/or in-creased exposure to the clinical topic/area not previously available. Used together with CCCET-SV (studentsand teachers independently complete the CCCET at the end of the clinical experience). May be used withother toolkit items

� Content validity index high (0.91) as rated by three internationally recognized experts in transcultural nursing� Descriptive statistics (frequency and percent) for individual and aggregate data. Compare with student

ratings� Results can be used to guide educational changes.� Supplementary book resources: Chapters 4 and 5

5. Cultural Competence Clinical Evaluation Tool—Employee Version (CCCET-EV)� An 83-item questionnaire adapted from the TSET, containing three subscales measuring different dimensions

of clinical cultural competence behaviors as perceived by the employee:� Extent of culturally specific care (Subscale 1)� Cultural assessment (Subscale 2)� Culturally sensitive and professionally appropriate attitudes, values, or beliefs including awareness, accep-

tance, recognition, appreciation, and advocacy necessary for providing culturally sensitive professional nurs-ing care (Subscale 3).

� Used to determine baseline information, identify areas of strengths, weaknesses, and gaps, and to evalu-ate change following educational intervention and/or increased exposure to culturally diverse clients and/orincreased exposure to the clinical topic/area not previously available. Used together with CCCET-AEV (em-ployees and agency evaluators independently complete the CCCET at the end of the clinical orientation orpreceptor experience). May be used with other toolkit items

� Descriptive statistics (frequency and percent) for individual and aggregate data. Compare with agency evalu-ator ratings.

� Results can be used to guide educational changes.� Supplementary book resources: Chapters 4 and 5

6. Cultural Competence Clinical Evaluation Tool—Agency Evaluator Version (CCCET-AEV)� An 83-item questionnaire adapted from the TSET, containing three subscales measuring different dimensions

of employee’s clinical cultural competence behaviors as rated by the agency evaluator:� Extent of culturally specific care (Subscale 1)� Cultural assessment (Subscale 2)� Culturally sensitive and professionally appropriate attitudes, values, or beliefs including awareness, accep-


� Used to determine baseline information, identify areas of strengths, weaknesses, and gaps, and to evaluatechange following educational intervention and/or increased exposure to culturally diverse clients and/or in-creased exposure to the clinical topic/area not previously available. Used together with CCCET-EV (employeesand agency evaluators independently complete the CCCET at the end of the clinical orientation or preceptorexperience). May be used with other toolkit items

� Descriptive statistics (frequency and percent) for individual and aggregate data. Compare with employeeratings.

� Results can be used to guide educational changes.� Supplementary book resources: Chapters 4 and 5


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7. Clinical Setting Assessment Tool—Diversity and Disparity (CSAT-DD)

� Used to gather demographic information about the clinical setting, diversity, and disparity� Can be used to describe clinical setting characteristics (frequency and percent)� Can be used to create comparison groups based on select demographic categories for comparing scores and

data on the TSET, CCCET, CSAT-DD, and other assessment tools� Results can guide future clinical interventions to eliminate health disparities, student and staff placements,

and educational interventions with students and staff� Supplementary book resources: Chapter 4

8. Demographic Data Sheet—Undergraduate (DDS-U)

� Used to gather demographic information from undergraduate (pre-licensure) students� Can be used to describe sample characteristics (frequency and percent)� Can be used to create comparison groups based on select demographic categories for comparing scores and

data on the TSET, CCCET, CSAT-DD, and other assessment tools� Supplementary book resources: Chapters 4 and 5

9. Demographic Data Sheet—Nurses (DDS-N)

� Used to gather demographic information from nurses working in clinical agencies and/or enrolled in RN-BSand graduate (master’s and doctoral) programs

� May be used to describe sample characteristics (frequency and percent)� May be used to create comparison groups based on select demographic categories for comparing scores and

data on the TSET, CCCET, CSAT-DD, and other assessment tools� Supplementary book resources: Chapters 4 and 5

10. Self-Assessment Tool—Academic (SAT-A)

� Used to help individual faculty member, administrator, and the organization assess various dimensions thatcan impact upon cultural competence in the academic setting

� May be used individually and/or in groups� May be used alone or in conjunction with other toolkit items� Self-assessment should conclude with a listing of strengths, weaknesses, gaps in knowledge, goals, commit-

ment, desire, motivation, and priorities.�

11. Self-Assessment Tool—Health Care Institutions (SAT-HCI)

� Used to help individual staff nurse, nurse manager, nurse educator, nurse executive, administrator, and theorganization assess various dimensions that can impact upon cultural competence in the health care setting


ment, desire, motivation, and priorities.� Supplementary book resources: Chapter 10 and 10.2

12. Self-Assessment Tool—Professional Associations (SAT-PA)

� Used to help individual members, elected officers, administrators, association leaders, and the organizationassess various dimensions that can impact upon cultural competence in the professional association


ment, desire, motivation, and priorities.� Supplementary book resources: Chapter 13, 13.2

13. Active Promoter Assessment Tool—Academic (APAT-A)

� Used to help individuals, groups, and organizations� Appraise values, beliefs, and actions concerning cultural competence development


Supplementary book resources: Chapter 6, Figure1.2 and 6.2Table

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� Determine whether or not one is an optimal active role model in cultural competence development within

� Identify factors restricting cultural competence development� Plan and coordinate future active promoter actions toward achieving optimal cultural competence

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� May be used alone or in conjunction with other toolkit items� Supplementary book resources: Chapter 6 and Table 6.1

14. Active Promoter Assessment Tool—Health Care Institutions/Professional Associations (APAT-HCIPA)

� Used to help individuals, groups, and organizations� Appraise values, beliefs, and actions concerning cultural competence development� Determine whether or not one is an optimal active role model in cultural competence development within

the health care institution or professional association� Identify factors restricting cultural competence development� Plan and coordinate future active promoter actions toward achieving optimal cultural competence

� May be used individually and/or in groups� May be used alone or in conjunction with other toolkit items� Supplementary book resources: Chapters 10 and 13, Figure 10.3, Exhibit 13.1

15. Systematic Inquiry: Academic (SI-A)

� Offers a user-friendly quantitative and qualitative approach for systematic appraisal decisions, correspondingactions, notations/reflections, prioritization, and future planning

� Used to help individuals, groups, and organizations examine how visible (or invisible) cultural competencydevelopment is actively present:� Overall within the curriculum� Specifically at the individual course level� Via outside connections to supplementary resources.

� The systematic inquiry is guided by two additional questions:� To what degree is cultural competence an integral component within the academic setting?� How do all the cultural components fit together?

� May be used individually or in groups� May be used alone or in conjunction with other toolkit items. (Recommended to use prior to Toolkit Item

20—Cultural Competence Documentation Log.) Results serve as a valuable precursor to informed decisions,responsible actions, and new diagnostic–prescriptive innovations targeting faculty and student developmentin the overall goal of achieving optimal cultural competence

� Supplementary book resources: Chapter 6 and Figure 6.3

16. Systematic Inquiry: Health Care Institutions (SI-HCI)

� Offers a user-friendly quantitative and qualitative approach for systematic appraisal decisions, correspondingactions, notations/reflections, prioritization, and future planning.

� Used to help individuals, groups, and organizations examine how visible (or invisible) cultural competencydevelopment is actively present:� Overall within the institution� Specifically at the individual unit (site) level� Via outside connections to supplementary resources.

� The systematic inquiry is guided by two additional questions:� To what degree is cultural competence an integral component within the HCI?� How do all the cultural components fit together?


20—Cultural Competence Documentation Log.) Results serve as a valuable precursor to informed decisions,responsible actions, and new diagnostic–prescriptive innovations targeting staff development and improvedpatient care outcomes in the overall goal of achieving optimal cultural competence



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17. Systematic Inquiry: Professional Associations (SI-PA)

� Offers a user-friendly quantitative and qualitative approach for systematic appraisal decisions, correspondingactions, notations/reflections, prioritization, and future planning.

� Used to help individuals, groups, and organizations examine how visible (or invisible) cultural competencydevelopment is actively present:� Overall within the association� Specifically at the membership level� Via outside connections to supplementary resources.

� The systematic inquiry is guided by two additional questions:� To what degree is cultural competence an integral component within the professional association?� How do all the cultural components fit together?


20—Cultural Competence Documentation Log.) Results serve as a valuable precursor to informed decisions,responsible actions, and new diagnostic–prescriptive innovations targeting staff and membership developmentin the overall goal of achieving optimal cultural competence


18. Personal Coding Cover Page for Anonymity and Matching Questionnaires

� Used to match questionnaires and assessment tools while protecting respondent’s anonymity� Attach to front page of questionnaire, questionnaire packet, or assessment tool

19. Sample Permission Letter

� Provides a sample for prospective educators and researchers� Adapt letter according to study purpose and need� Mail one copy to Springer Publishing Company and one copy to Dr. Marianne R. Jeffreys.

20. Cultural Competence Documentation Log

� User-friendly log to assist institutions in documenting cultural competence plans, actions, and evaluations.� Use after Toolkit Systematic Inquiry Assessment Tool.

21. Research Report Template

� User-friendly template to assist individuals and institutions report data generated from assessment tools andquestionnaires in toolkit

� Provides a guide for presentations, publications, future research, and cultural competence interventions� Supplementary book resources: TSET Research Exhibits in chapters 6 and 10


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I T E M 1

Transcultural Self-Efficacy Tool (TSET)

DESCRIPTIONAn 83-item questionnaire designed to measure and evaluate learners’ confidence (transcultural self-efficacy) for per-forming general transcultural nursing skills among diverse client populations. It has been requested by researchersworldwide in multiple health disciplines for use with students, nurses, and other health professionals. The new TSET-Multidisciplinary Healthcare Provider version should be used with multidisciplinary groups (see Toolkit Item 2).

INSTRUCTIONS FOR RESEARCHERS(1) Detach this cover sheet before photocopying or posting online and administration to sample.(2) Review information about TSET, administration, uses, and scoring in Teaching Cultural Competence in Nursing

and Health Care: Inquiry, Action, and Innovation (2010) before study design and data collection.(3) Please be sure that all respondents return the questionnaire.(4) Send reliability and validity test results and study results (see Toolkit Item 21) to:

Dr. Marianne R. Jeffreys, The City University of New York College of Staten Island, Nursing Department,2800 Victory Boulevard, Staten Island, New York 10314, USA.

EASY SCORINGSelf-Efficacy Strength (SEST) refers to the average strength of self-efficacy perceptions within a particular dimension(subscale) of the construct. Calculate by totaling subscale item responses and dividing by the number of subscaleitems, resulting in the mean score. For example:


FormulaItem Response Sum# of Subscale Items




Application14025

18228

21030

SEST = 5.6 SEST = 6.5 SEST = 7.0

Use scores to compare subscale scores within and between groups to determine effectiveness of cultural compe-tence educational intervention(s) as seen by statistically significant differences in scores.

Longitudinal comparison within groups(1) TSET pretest → Cultural Competence Educational Intervention → TSET post-test

Comparison between groups(2) TSET pretest → Cultural Competence Educational Intervention → TSET post-test

TSET pretest (Control Group) → TSET post-test

Cross-sectional comparison between groups(3) TSET administration to novice group (before cultural competence educational intervention)

TSET administration to advanced group (after cultural competence educational intervention)


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PURPOSESEvaluation of transcultural self-efficacy (TSE) perceptions may be used for a variety of purposes targeting the individualand/or groups. The purposes are to:

� Develop a composite/baseline of learners’ needs, values, attitudes, and skills concerning transcultural nursing(or health care)

� Identify general transcultural skills perceived with more confidence (or those as less difficult or stressful)� Identify general transcultural skills perceived with less confidence (or those as more difficult or stressful)� Identify differences within groups� Identify differences between groups� Identify at-risk individuals (low confidence or overly confident)� Evaluate the effectiveness of specific teaching interventions� Assess changes in transcultural self-efficacy perceptions over time

ADDITIONAL INFORMATIONResearchers seeking to group individuals into low efficacy, medium efficacy, and high efficacy groups for the purposeof identifying at-risk individuals and tracking changes should consult standard statistical methods and literature forguidance. The study purpose and sample may guide method selection for group categorization.

Self-Efficacy Level (SEL) refers to the number of items perceived at a specified minimum level of confidence.For example, SEL had been used to identify individuals with “low efficacy” and then track SEL changes followingtreatment interventions. The study purpose and sample may guide the selected definition of the minimum confidencelevel; however this scoring calculation is no longer recommended due to consistently insignificant results with nursingstudents and nurses. (See previously published studies and Chapter 4.)

SUPPLEMENTARY RESOURCESBook Chapters 3, 4, and 5.

TSET Research Exhibits in Chapters 6 and 10.

Jeffreys, M.R. (2000). Development and psychometric evaluation of the Transcultural Self-Efficacy Tool: A synthesis of findings. Journalof Transcultural Nursing, 11(2), 127–136.

Jeffreys, M.R. & Dogan, E. (2010). Factor analysis of the Transcultural Self-Efficacy Tool (TSET). Journal of Nursing Measurement, 18(2),120–139.

Jeffreys, M.R. & Smodlaka, I. (1999). Changes in students’ transcultural self-efficacy perceptions following an integrated approach tocultural care. Journal of Multicultural Nursing and Health, 5(2), 6–12. (Erratum, 2000, 6(1), 20.

Jeffreys, M.R. & Smodlaka, I. (1999). Construct validation of the Transcultural Self-Efficacy Tool. Journal of Nursing Education, 38,222–227.

Jeffreys, M.R. & Smodlaka, I. (1998). Exploring the factorial composition of the Transcultural Self-Efficacy Tool. International Journal ofNursing Studies, 35, 217–225.

Jeffreys, M.R. & Smodlaka, I. (1996). Steps of the instrument-design process: An illustrative approach for nurse educators, Nurse Educa-tor, 21(6), 47–52. (Erratum, 1997, 22(1), 49).


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Throughout your nursing education and nursing career, you will be caring for clients of many different culturalbackgrounds. These clients will represent various racial, ethnic, gender, socioeconomic, and religious groups.

Cultural difference exists in health care needs, caring, and curing practices. Knowing and understanding culturalfactors related to client care helps establish a theoretical foundation for providing culture-specific nursing care.

Part I: Among clients of different cultural backgrounds, how knowledgeable are YOU about the ways cultural factors may influencenursing care? Please use the scale below and mark your response accordingly.

← →Not Totally

Confident Confident

� � � � � � � �

You know and understand the ways cultural factors may influence nursing care in the following areas:

(1) health history and interview � � � � � � � �(2) physical examination � � � � � � � �(3) informed consent � � � � � � � �(4) health promotion � � � � � � � �(5) illness prevention � � � � � � � �(6) health maintenance � � � � � � � �(7) health restoration � � � � � � � �(8) safety � � � � � � � �(9) exercise and activity � � � � � � � �

(10) pain relief and comfort � � � � � � � �(11) diet and nutrition � � � � � � � �(12) patient teaching � � � � � � � �(13) hygiene � � � � � � � �(14) anxiety and stress reduction � � � � � � � �(15) diagnostic tests � � � � � � � �(16) blood tests � � � � � � � �(17) pregnancy � � � � � � � �(18) birth � � � � � � � �(19) growth and development � � � � � � � �(20) aging � � � � � � � �(21) dying and death � � � � � � � �(22) grieving and loss � � � � � � � �(23) life support and resuscitation � � � � � � � �(24) sexuality � � � � � � � �(25) rest and sleep � � � � � � � �


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Part II: The most effective way to identify specific cultural factors that influence client behavior is to conduct a cultural assessment ofeach client. This is best done by interview.

Right NOW, how confident are YOU about interviewing clients of different cultural backgrounds to learn abouttheir values and beliefs?

Rate your degree of confidence or certainty for each of the following interview topics. Please use the scale below andmark your response accordingly.

← →Not Totally

Confident Confident

� � � � � � � �

Interview clients of different cultural backgrounds about:

(26) language preference � � � � � � � �(27) level of English comprehension � � � � � � � �(28) meaning of verbal communication patterns � � � � � � � �(29) meaning of nonverbal behaviors � � � � � � � �(30) meanings of space and touch � � � � � � � �(31) time perception & orientation � � � � � � � �(32) racial background & identity � � � � � � � �(33) ethnic background & identity � � � � � � � �(34) socioeconomic background � � � � � � � �(35) religious background & identity � � � � � � � �(36) educational background & interests � � � � � � � �(37) religious practices & beliefs � � � � � � � �(38) acculturation � � � � � � � �(39) world view (philosophy of life) � � � � � � � �(40) attitudes about health care technology � � � � � � � �(41) ethnic food preferences � � � � � � � �(42) role of elders � � � � � � � �(43) role of children � � � � � � � �(44) financial concerns � � � � � � � �(45) traditional health & illness beliefs � � � � � � � �(46) folk medicine tradition & use � � � � � � � �(47) gender role & responsibility � � � � � � � �(48) acceptable sick role behaviors � � � � � � � �(49) role of family during illness � � � � � � � �(50) discrimination & bias experiences � � � � � � � �(51) home environment � � � � � � � �(52) kinship ties � � � � � � � �(53) aging � � � � � � � �


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Part III: As a nurse who will care for many different people, knowledge of yourself is very important.

Please rate YOUR degree of confidence or certainty for each of the following items. Use the scale below and mark yourresponse accordingly.

← →Not Totally

Confident Confident

� � � � � � � �

(A) About yourself, you are AWARE OF:

(54) YOUR OWN cultural heritage and belief systems � � � � � � � �(55) YOUR OWN biases and limitations � � � � � � � �(56) differences within YOUR OWN cultural group � � � � � � � �

(B) Among clients of different cultural backgrounds,

You are AWARE OF:

(57) insensitive and prejudicial treatment � � � � � � � �(58) differences in perceived role of the nurse � � � � � � � �(59) traditional caring behaviors � � � � � � � �(60) professional caring behaviors � � � � � � � �(61) comfort and discomfort felt when entering a culturally different world � � � � � � � �(62) interaction between nursing, folk, and professional systems � � � � � � � �

You ACCEPT:

(63) differences between cultural groups � � � � � � � �(64) similarities between cultural groups � � � � � � � �(65) client’s refusal of treatment based on beliefs � � � � � � � �

You APPRECIATE:

(66) interaction with people of different cultures � � � � � � � �(67) cultural sensitivity and awareness � � � � � � � �(68) culture-specific health care � � � � � � � �(69) role of family in providing health care � � � � � � � �(70) client’s world view (philosophy of life) � � � � � � � �

You RECOGNIZE:

(71) inadequacies in the U.S. health care system � � � � � � � �(72) importance of home remedies & folk medicine � � � � � � � �(73) impact of roles on health care practices � � � � � � � �(74) impact of values on health care practices � � � � � � � �(75) impact of socioeconomic factors on health care practices � � � � � � � �(76) impact of political factors on health care practices � � � � � � � �(77) need for cultural care preservation/maintenance � � � � � � � �(78) need for cultural care accommodation/negotiation � � � � � � � �(79) need for cultural care repatterning/restructuring � � � � � � � �(80) need to prevent ethnocentric views � � � � � � � �(81) need to prevent cultural imposition � � � � � � � �

You ADVOCATE:

(82) client’s decisions based on cultural beliefs � � � � � � � �(83) culture-specific care � � � � � � � �


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I T E M 2

Transcultural Self-Efficacy Tool—Multidisciplinary HealthcareProvider Version (TSET-MHP)

DESCRIPTIONAn 83-item questionnaire designed to measure and evaluate learners’ confidence (transcultural self-efficacy) for per-forming general transcultural skills among diverse client populations. Items are exactly the same as original TSET.Directions change “nurse” and “nursing” focus to “health care provider” focus, encompassing nursing and all othermultidisciplinary health care provider groups.

The new TSET-Multidisciplinary Healthcare Provider version should be used with multidisciplinary groups. Forlearner groups within the nursing discipline, use the original TSET (Toolkit Item 1).

INSTRUCTIONS FOR RESEARCHERS(1) Detach this cover sheet before photocopying or posting online and administration to sample.(2) Review information about TSET, administration, uses, and scoring in Teaching Cultural Competence in Nursing

and Health Care: Inquiry, Action, and Innovation (2010) before study design and data collection.(3) Please be sure that all respondents return the questionnaire.(4) Send reliability and validity test results and study results (see Toolkit Item 21) to:


EASY SCORINGSelf-Efficacy Strength (SEST) refers to the average strength of self-efficacy perceptions within a particular dimension(subscale) of the construct. Calculate by totaling subscale item responses and dividing by the number of subscaleitems, resulting in the mean score. For example:


FormulaItem Response Sum# of Subscale Items




Application14025

18228

21030

SEST = 5.6 SEST = 6.5 SEST = 7.0

Use scores to compare subscale scores within and between groups to determine effectiveness of cultural compe-tence educational intervention(s) as seen by statistically significant differences in scores.


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Longitudinal comparison within groups(1) TSET pretest → Cultural Competence Educational Intervention → TSET post-test

Comparison between groups(2) TSET pretest → Cultural Competence Educational Intervention → TSET post-test

TSET pretest (Control Group) → TSET post-test

Cross-sectional comparison between groups(3) TSET administration to novice group (before cultural competence educational intervention)

TSET administration to advanced group (after cultural competence educational intervention)

PURPOSESEvaluation of transcultural self-efficacy (TSE) perceptions may be used for a variety of purposes targeting the individualand/or groups. The purposes are to:

� Develop a composite/baseline of learners’ needs, values, attitudes, and skills concerning transcultural nursing(or health care)

� Identify general transcultural skills perceived with more confidence (or those as less difficult or stressful)� Identify general transcultural skills perceived with less confidence (or those as more difficult or stressful)� Identify differences within groups� Identify differences between groups� Identify at-risk individuals (low confidence or overly confident)� Evaluate the effectiveness of specific teaching interventions� Assess changes in transcultural self-efficacy perceptions over time

ADDITIONAL INFORMATIONResearchers seeking to group individuals into low efficacy, medium efficacy, and high efficacy groups for the purposeof identifying at-risk individuals and tracking changes should consult standard statistical methods and literature forguidance. The study purpose and sample may guide method selection for group categorization.

Self-Efficacy Level (SEL) refers to the number of items perceived at a specified minimum level of confidence.For example, SEL had been used to identify individuals with “low efficacy” and then track SEL changes followingtreatment interventions. The study purpose and sample may guide the selected definition of the minimum confidencelevel; however this scoring calculation is no longer recommended due to consistently insignificant results with nursingstudents and nurses. (See previously published studies and Chapter 4).

SUPPLEMENTARY RESOURCESBook Chapters 3, 4, and 5.

TSET Research Exhibits in Chapters 6 and 10.

Jeffreys, M.R. (2000). Development and psychometric evaluation of the Transcultural Self-Efficacy Tool: A synthesis of findings. Journalof Transcultural Nursing, 11(2), 127–136.

Jeffreys, M.R. & Dogan, E. (2010). Factor analysis of the Transcultural Self-Efficacy Tool (TSET). Journal of Nursing Measurement, 18(2),120–139.

Jeffreys, M.R. & Smodlaka, I. (1999). Changes in students’ transcultural self-efficacy perceptions following an integrated approach toculture care. Journal of Multicultural Nursing and Health, 5(2), 6–12. (Erratum, 2000, 6(1), 20.

Jeffreys, M.R. & Smodlaka, I. (1999). Construct validation of the Transcultural Self-Efficacy Tool. Journal of Nursing Education, 38, 222–227.

Jeffreys, M.R. & Smodlaka, I. (1998). Exploring the factorial composition of the Transcultural Self-Efficacy Tool. International Journal ofNursing Studies, 35, 217–225.

Jeffreys, M.R. & Smodlaka, I. (1996). Steps of the instrument-design process: An illustrative approach for nurse educators, Nurse Educa-tor, 21(6), 47–52. (Erratum, 1997, 22(1), 49).


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RESOURCESRESOURCE

Throughout your education and career as health care providers, faculty, or students, you will be caring for clientsof many different cultural backgrounds. These clients will represent various racial, ethnic, gender, socioeconomic, andreligious groups.

Cultural difference exists in health care needs, caring, and curing practices. Knowing and understanding culturalfactors related to client care helps establish a theoretical foundation for providing culture-specific health care.

Part I: Among clients of different cultural backgrounds, how knowledgeable are YOU about the ways cultural factors may influencehealth care? Please use the scale below and mark your response accordingly.

← →Not Totally

Confident Confident

� � � � � � � �

You know and understand the ways cultural factors may influence health care in the following areas:




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Part II: The most effective way to identify specific cultural factors that influence client behavior is to conduct a cultural assessment ofeach client. This is best done by interview.

Right NOW, how confident are YOU about interviewing clients of different cultural backgrounds to learn abouttheir values and beliefs?

Rate your degree of confidence or certainty for each of the following interview topics. Please use the scale below andmark your response accordingly.

← →Not Totally

Confident Confident

� � � � � � � �

Interview clients of different cultural backgrounds about:

(26) language preference � � � � � � � �(27) level of English comprehension � � � � � � � �(28) meaning of verbal communication patterns � � � � � � � �(29) meaning of nonverbal behaviors � � � � � � � �(30) meanings of space and touch � � � � � � � �(31) time perception & orientation � � � � � � � �(32) racial background & identity � � � � � � � �(33) ethnic background & identity � � � � � � � �(34) socioeconomic background � � � � � � � �(35) religious background & identity � � � � � � � �(36) educational background & interests � � � � � � � �(37) religious practices & beliefs � � � � � � � �(38) acculturation � � � � � � � �(39) world view (philosophy of life) � � � � � � � �(40) attitudes about health care technology � � � � � � � �(41) ethnic food preferences � � � � � � � �(42) role of elders � � � � � � � �(43) role of children � � � � � � � �(44) financial concerns � � � � � � � �(45) traditional health & illness beliefs � � � � � � � �(46) folk medicine tradition & use � � � � � � � �(47) gender role & responsibility � � � � � � � �(48) acceptable sick role behaviors � � � � � � � �(49) role of family during illness � � � � � � � �(50) discrimination & bias experiences � � � � � � � �(51) home environment � � � � � � � �(52) kinship ties � � � � � � � �(53) aging � � � � � � � �


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Part III: As a health care provider who will care for many different people, knowledge of yourself is very important.

Please rate YOUR degree of confidence or certainty for each of the following items. Use the scale below and mark yourresponse accordingly.

← →Not Totally

Confident Confident

� � � � � � � �

(A) About yourself, you are AWARE OF:



You are AWARE OF:

(57) insensitive and prejudicial treatment � � � � � � � �(58) differences in perceived role of the nurse � � � � � � � �(59) traditional caring behaviors � � � � � � � �(60) professional caring behaviors � � � � � � � �(61) comfort and discomfort felt when entering a culturally different world � � � � � � � �(62) interaction between nursing, folk, and professional systems � � � � � � � �

You ACCEPT:


You APPRECIATE:

(66) interaction with people of different cultures � � � � � � � �(67) cultural sensitivity and awareness � � � � � � � �(68) culture-specific health care � � � � � � � �(69) role of family in providing health care � � � � � � � �(70) client’s world view (philosophy of life) � � � � � � � �

Among clients of different cultural backgrounds,

You RECOGNIZE:

(71) inadequacies in the U.S. health care system � � � � � � � �(72) importance of home remedies & folk medicine � � � � � � � �(73) impact of roles on health care practices � � � � � � � �(74) impact of values on health care practices � � � � � � � �(75) impact of socioeconomic factors on health care practices � � � � � � � �(76) impact of political factors on health care practices � � � � � � � �(77) need for cultural care preservation/maintenance � � � � � � � �(78) need for cultural care accommodation/negotiation � � � � � � � �(79) need for cultural care repatterning/restructuring � � � � � � � �(80) need to prevent ethnocentric views � � � � � � � �(81) need to prevent cultural imposition � � � � � � � �

You ADVOCATE:

(82) client’s decisions based on cultural beliefs � � � � � � � �(83) culture-specific care � � � � � � � �


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I T E M 3

Cultural Competence Clinical Evaluation Tool—Student Version (CCCET-SV)

DESCRIPTIONAn 83-item questionnaire adapted from the TSET, containing three subscales measuring different dimensions of clin-ical cultural competence behaviors as perceived by the student:

� Extent of culturally specific care (Subscale 1)� Cultural assessment (Subscale 2)� Culturally sensitive and professionally appropriate attitudes, values, or beliefs including awareness, accep-

tance, recognition, appreciation, and advocacy necessary for providing culturally sensitive professional nurs-ing care (Subscale 3)

INSTRUCTIONS FOR RESEARCHERS1. Detach this cover sheet before photocopying or posting online and administration to sample.2. Review information about CCCET, administration, uses, and scoring in Teaching Cultural Competence in Nurs-

ing and Health Care: Inquiry, Action, and Innovation (2010) before study design and data collection.3. Please be sure that all respondents return the questionnaire.4. Send study results (see Toolkit Item 21) to:


EASY SCORINGDescriptive statistics (frequency and percent) for individual and aggregate data.

Compare with teacher ratings on CCCET-TV.

� Use to determine baseline information, identify areas of strengths, weaknesses, and gaps, and to evaluatechange following educational intervention and/or increased exposure to culturally diverse clients and/or in-creased exposure to the clinical topic/area not previously available.

� May be used together with CCCET-TV (students and teachers independently complete the CCCET at the endof the clinical experience).

� Results can be used to guide educational changes.� Supplementary book resources: Chapters 4, 5.


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Throughout your career, you will be caring for clients of many different cultural backgrounds. These clients willrepresent various racial, ethnic, gender, socioeconomic, and religious groups. Culturally specific care requires that youknow, understand, and identify cultural factors related to client care and conduct your nursing practice accordingly.

Part I: For clients of different cultural backgrounds, to what extent did you provide culturally specific care during the clinicalpracticum?

Please use the scale below and mark your response accordingly.

If the opportunity to provide care in the listed area was unavailable, please mark A.If the opportunity to provide care in the listed area was available, but diverse clients were unavailable, mark B.

Area Diverse NotNot Clients At ← →

Available Not Available All Totally� � � � � � � �

During this semester’s clinical practicum, you provided culturally specific care in the following areas: (Mark one choice for each item.)




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Part II: The most effective way to identify specific cultural factors that influence client behavior is to conduct a cultural assessment.

How frequently did you assess clients of different cultural backgrounds about each cultural factor during the clinicalpracticum?

Please use the scale below and mark your response accordingly.If the opportunity to conduct an assessment of the listed area was unavailable, please mark A.If the opportunity to conduct an assessment of the listed area was available, but diverse clients were unavailable,mark B.

Area DiverseNot Clients ← →

Available Not Available Never Always� � � � � � � �

During this semester’s clinical practicum, you assessed clients of different backgrounds about: (Mark one choice for each item.)

(26) language preference � � � � � � � �(27) level of English comprehension � � � � � � � �(28) meaning of verbal communication patterns � � � � � � � �(29) meaning of nonverbal behaviors � � � � � � � �(30) meanings of space and touch � � � � � � � �(31) time perception and orientation � � � � � � � �(32) racial background and identity � � � � � � � �(33) ethnic background and identity � � � � � � � �(34) socioeconomic background � � � � � � � �(35) religious background and identity � � � � � � � �(36) educational background and interests � � � � � � � �(37) religious practices and beliefs � � � � � � � �(38) acculturation � � � � � � � �(39) world view (philosophy of life) � � � � � � � �(40) attitudes about health care technology � � � � � � � �(41) ethnic food preferences � � � � � � � �(42) role of elders � � � � � � � �(43) role of children � � � � � � � �(44) financial concerns � � � � � � � �(45) traditional health and illness beliefs � � � � � � � �(46) folk medicine tradition and use � � � � � � � �(47) gender role and responsibility � � � � � � � �(48) acceptable sick role behaviors � � � � � � � �(49) role of family during illness � � � � � � � �(50) discrimination and bias experiences � � � � � � � �(51) home environment � � � � � � � �(52) kinship ties � � � � � � � �(53) aging � � � � � � � �


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Part III: What affective learning outcomes did you gain as a result of your clinical practicum this semester?

Specifically, to what extent did you develop new, culturally sensitive and professionally appropriate attitudes, values,or beliefs OR further develop culturally sensitive and professionally appropriate attitudes, values, and beliefs aboutthe items below?

For Section A, please use the scale below and mark your response accordingly. (Mark one choice for each item.)

Not To aAt ← → Great

All Extent� � � � � � � �

(A) About Yourself: As a result of this semester’s clinical practicum, you developed a greater AWARENESS OF:


For Section B, please use the scale below and mark your response accordingly. (Mark one choice for each item.)

Diverse Not To aClients At ← → Great

Not Available All Extent� � � � � � � �


As a result of this semester’s clinical practicum, you became MORE AWARE OF:

(57) insensitive and prejudicial treatment � � � � � � � �(58) differences in perceived role of the nurse � � � � � � � �(59) traditional caring behaviors � � � � � � � �(60) professional caring behaviors � � � � � � � �(61) comfort and discomfort felt when entering a � � � � � � � �

culturally different world(62) interaction between nursing, folk, and professional systems � � � � � � � �

As a result of this semester’s clinical practicum, you became MORE ACCEPTING OF:


As a result of this semester’s clinical practicum, you became MORE APPRECIATIVE OF:

(66) interaction with people of different cultures � � � � � � � �(67) cultural sensitivity and awareness � � � � � � � �(68) cultural-specific nursing care � � � � � � � �(69) role of family in providing health care � � � � � � � �(70) client’s world view (philosophy of life) � � � � � � � �


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As a result of this semester’s clinical practicum, you now MORE READILY RECOGNIZE:

(71) inadequacies in the nation’s health care system � � � � � � � �(72) importance of home remedies and folk medicine � � � � � � � �(73) impact of roles on health care practices � � � � � � � �(74) impact of values on health care practices � � � � � � � �(75) impact of socioeconomic factors on health care practices � � � � � � � �(76) impact of political factors on health care practices � � � � � � � �(77) need for cultural care preservation/maintenance � � � � � � � �(78) need for cultural care accommodation/negotiation � � � � � � � �(79) need for cultural care repatterning/restructuring � � � � � � � �(80) need to prevent ethnocentric views � � � � � � � �(81) need to prevent cultural imposition � � � � � � � �

As a result of this semester’s practicum, you became a MORE COMMITTED ADVOCATE FOR:

(82) client’s decisions based on cultural beliefs � � � � � � � �(83) cultural-specific care � � � � � � � �


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I T E M 4

Cultural Competence Clinical Evaluation Tool—Teacher Version (CCCET-TV)

DESCRIPTIONAn 83-item questionnaire adapted from the TSET, containing three subscales measuring different dimensions of clin-ical cultural competence behaviors as rated by the teacher or preceptor:



INSTRUCTIONS FOR RESEARCHERS(1) Detach this cover sheet before photocopying or posting online and administration to sample.(2) Review information about CCCET, administration, uses, and scoring in Teaching Cultural Competence in Nurs-

ing and Health Care: Inquiry, Action, and Innovation (2010) before study design and data collection.(3) Please be sure that all respondents return the questionnaire.(4) Send study results (see Toolkit Item 21) to:



Compare with student ratings on CCCET-SV.


� May be used together with CCCET-SV (Students and teachers independently complete the CCCET at the endof the clinical experience).



S A M

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Ees, or beliefs includbeliefs incluoviding culturally seurally se

osting online and admsting online and adion, uses, and scorin, uses, and

vation (2010)vation (2010) beforebthe questionnaire.he questionnaire.

1) to:University of NewUniversity of New

Island, New York 10New York

y and percent) for inercent) for int ratings on CCCET-ratings on CCC

ne baseline informae baseline informang educational ing educationa

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Throughout one’s nursing career, nurses will be caring for clients of many different cultural backgrounds. Theseclients will represent various racial, ethnic, gender, socioeconomic, and religious groups. Culturally specific carerequires that nurses know, understand, and identify cultural factors related to client care and conduct their nursingpractice accordingly.

Part I: For clients of different cultural backgrounds, to what extent did the student provide culturally specific care?


If the opportunity to provide care in the listed area was unavailable, please mark A.If the opportunity to provide care in the listed area was available, but diverse clients were unavailable, mark B.If you are unable to evaluate the student, please leave item blank.



During this semester’s clinical practicum, student provided culturally specific care in the following areas: (Mark one choice for each item.)




SA M

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How frequently did the student assess clients of different cultural backgrounds about each cultural factor?

Please use the scale below and mark your response accordingly.If the opportunity to conduct an assessment of the listed area was unavailable, please mark A.If the opportunity to conduct an assessment of the listed area was available, but diverse clients were unavailable,mark B.If you are unable to evaluate the student, please leave item blank.

Area DiverseNot Clients ← →

Available Not Available Never Always� � � � � � � �

During this semester’s clinical practicum, the student assessed clients of different backgrounds about: (Mark one choice for each item.)



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Part III: During the clinical practicum experience and/or clinical practicum assignments, to what extent did the student demonstrateor express culturally sensitive and professionally appropriate attitudes, values, or beliefs about the items below?

For Section A, please use the scale below and mark your response accordingly. (Mark one choice for each item.)If you are unable to evaluate the student, please leave item blank.

Not To aAt ← → GreatAll Extent� � � � � � � �

(A) About his/her own culture: As a result of this semester’s clinical practicum, the student developed a greater AWARENESS OF:

(54) HIS/HER OWN cultural heritage and belief systems � � � � � � � �(55) HIS/HER OWN biases and limitations � � � � � � � �(56) differences within HIS/HER OWN cultural group � � � � � � � �

For Section B, please use the scale below and mark your response accordingly. (Mark one choice for each item.)If you are unable to evaluate the student, please leave item blank.




As a result of this semester’s clinical practicum, the student became MORE AWARE OF:



As a result of this semester’s clinical practicum, the student became MORE ACCEPTING OF:


As a result of this semester’s clinical practicum, the student became MORE APPRECIATIVE OF:



AM P

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Not To aClients At ← → Great


As a result of this semester’s clinical practicum, the student now MORE READILY RECOGNIZES:


As a result of this semester’s practicum, the student became a MORE COMMITTED ADVOCATE FOR:



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I T E M 5

Cultural Competence Clinical Evaluation Tool—Employee Version (CCCET-EV)

DESCRIPTIONAn 83-item questionnaire adapted from the TSET, containing three subscales measuring different dimensions of clin-ical cultural competence behaviors as perceived by the employee:

� Extent of culturally specific care (Subscale 1)� Cultural assessment (Subscale 2)� Culturally sensitive and professionally appropriate attitudes, values, or beliefs, including awareness, accep-



ing and Health Care: Inquiry, Action, and Innovation (2010) before study design and data collection.(3) Please be sure that all respondents return the questionnaire.(4) Please send study results (see Toolkit Item 21) to:



Compare with agency evaluator ratings on CCCET-AEV.


� May be used together with CCCET-AEV (employees and agency evaluators independently complete theCCCET at the end of the clinical orientation or preceptor experience).



S A M

P L

Ees, or beliefs, inclubeliefs, incluoviding culturally seurally se

sting online and admsting online and admon, uses, and scoring, uses, and

vation (2010)ation (2010) beforebthe questionnaire.he questionnaire.

tem 21) to:1) to:University of NewUniversity of New

sland, New York 10New York

y and percent) for inercent) for inevaluator ratings onating

ne baseline informate baseline informang educational intg educationaSto the clinicato the clinic

her witer with

Throughout your career, you will be caring for clients of many different cultural backgrounds. These clients willrepresent various racial, ethnic, gender, socioeconomic, and religious groups. Culturally specific care requires that youknow, understand, and identify cultural factors related to client care and conduct your nursing practice accordingly.

Part I: For clients of different cultural backgrounds, to what extent did you provide culturally specific care?


If the opportunity to provide care in the listed area was unavailable, please mark A.If the opportunity to provide care in the listed area was available, but diverse clients were unavailable, mark B.



You provided culturally specific care in the following areas: (Mark one choice for each item.)




SA M

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How frequently did you assess clients of different cultural backgrounds about each cultural factor?

Please use the scale below and mark your response accordingly.If the opportunity to conduct an assessment of the listed area was unavailable, please mark A.If the opportunity to conduct an assessment of the listed area was available, but diverse clients were unavailable,mark B.

Area DiverseNot Clients

← →Available Not Available Never Always� � � � � � � �

You assessed clients of different backgrounds about: (Mark one choice for each item.)



A M P

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xperiencesSS

Part III: What affective learning outcomes did you gain as a result of the cultural competence education program?

Specifically, to what extent did you develop new, culturally sensitive and professionally appropriate attitudes, values,or beliefs OR further develop culturally sensitive and professionally appropriate attitudes, values and beliefs about theitems below?

For Section A, please use the scale below and mark your response accordingly. (Mark one choice for each item).

Not To aAt

← →Great

All Extent� � � � � � � �

(A) About Yourself: As a result of the cultural competence education program, you developed a greater AWARENESS OF:


For Section B, please use the scale below and mark your response accordingly. (Mark one choice for each item.)

Diverse Not To aClients At

← →Great



As a result of the cultural competence education program, you became MORE AWARE OF:



As a result of the cultural competence education program, you became MORE ACCEPTING OF:


As a result of the cultural competence education program, you became MORE APPRECIATIVE OF:



M P L

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ttAt

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M MMS A

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petence education prograetence education progrSproupsroupsS


Diverse Not To aClients At

← →Great


As a result of the cultural competence education program, you now MORE READILY RECOGNIZE:


As a result of the cultural competence education program, you became a MORE COMMITTED ADVOCATE FOR:



L E� ��

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� � � �� E� � �

S A M

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TTED ADVOCATE FORTTED ADVOCATE FOR

PL� � �

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I T E M 6

Cultural Competence Clinical Evaluation Tool—Agency Evaluator Version(CCCET-AEV)

DESCRIPTIONAn 83-item questionnaire adapted from the TSET, containing three subscales measuring different dimensions of clin-ical cultural competence behaviors as rated by the agency evaluator:




ing and Health Care: Inquiry, Action, and Innovation (2010) before study design and data collection.(3) Please be sure that all respondents return the questionnaire.(4) Please send study results (see Toolkit Item 21) to:



Compare with employee ratings on CCCET-EV.


� May be used together with CCCET-EV (employees and agency evaluators independently complete the CCCETat the end of the clinical orientation or preceptor experience).



S A M

P L

Erinrin

values, or beliefs iniefs inr providing culturallprov

posting online and aosting onlination, uses, and scoruses, an

ovation (2010)vation (2010) beforbefrn the questionnairee questionnaire

t Item 21) to:Item 21) to:ty University of Newniversity of New

n Island, New York 1New York

y and percent) for inercent) for inee ratings on CCCETn C

ne baseline informae baseline informang educational intg educationaSto the cliniche clinic

r withr with

Throughout one’s nursing career, nurses will be caring for clients of many different cultural backgrounds. Theseclients will represent various racial, ethnic, gender, socioeconomic, and religious groups. Culturally specific carerequires that nurses know, understand, and identify cultural factors related to client care and conduct their nursingpractice accordingly.

Part I: For clients of different cultural backgrounds, to what extent did the nurse provide culturally specific care?


If the opportunity to provide care in the listed area was unavailable, please mark A.If the opportunity to provide care in the listed area was available, but diverse clients were unavailable, mark B.If you are unable to evaluate the nurse, please leave item blank.



During the designated evaluation period, the nurse provided culturally specific care in the following areas: (Mark one choice per item.)




SA M

P L

EEg areas: (Mark og areas: (Mar

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How frequently did the nurse assess clients of different cultural backgrounds about each cultural factor?

Please use the scale below and mark your response accordingly.If the opportunity to conduct an assessment of the listed area was unavailable, please mark A.If the opportunity to conduct an assessment of the listed area was available, but diverse clients were unavailable,mark B.If you are unable to evaluate the nurse, please leave item blank.

Area DiverseNot Clients ← →Available Not Available Never Always

� � � � � � � �

During the designated evaluation period, the nurse assessed clients of different backgrounds about: (Mark one choice per item.)



SA M

P L

EE�

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L E�� L � � ��

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Part III: During the designated evaluation period, to what extent did the nurse demonstrate or express culturally sensitive andprofessionally appropriate attitudes, values, or beliefs about the items below?

For Section A, please use the scale below and mark your response accordingly. (Mark one choice for each item.)If you are unable to evaluate the nurse, please leave item blank.

Not To aAt

← →Great

All Extent� � � � � � � �

(A) About his/her own culture: As a result of the cultural competence education program, the nurse developed a greater AWARENESS OF:

(54) HIS/HER OWN cultural heritage and belief systems � � � � � � � �(55) HIS/HER OWN biases and limitations � � � � � � � �(56) differences within HIS/HER OWN cultural group � � � � � � � �

For Section B, please use the scale below and mark your response accordingly. (Mark one choice for each item.)If you are unable to evaluate the nurse, please leave item blank.

Not To aClients At

← →Great



As a result of the cultural competence education program, the nurse became MORE AWARE OF:



As a result of the cultural competence education program, the nurse became MORE ACCEPTING OF:


As a result of the cultural competence education program, the nurse became MORE APPRECIATIVE OF:



P L E

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ailable Allailable All ←

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AM

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S Ang, folk, and professionang, folk, and profession

petence education petence educatioS


Not To aClients At

← →Great


As a result of the cultural competence education program, the nurse now MORE READILY RECOGNIZES:


As a result of the cultural competence education program, the nurse became a MORE COMMITTED ADVOCATE FOR:



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I T E M 7

Clinical Setting Assessment Tool—Diversity and Disparity (CSAT-DD)

DESCRIPTIONA demographic tool to collect data about the clinical practicum/agency site, specifically focusing on descriptions ofdiverse client populations (Part I) and clinical problems targeting the 28 focus areas of the Healthy People 2010document (Part II).

The first page gathers information about the type of agency (e.g., private, public, etc.) and whether the instruc-tor/preceptor/agency evaluator completed a college-level course and/or continuing education (CE) units in transcul-tural nursing or cultural competence in health care.

The 15 items in Part I gather information about the demographic makeup of the client population (age, ethnicity,languages spoken, religion, etc.) as well as identifying the most prevalent characteristics represented.

Part II (28 items) identifies the five most frequent focus areas evident in the clinical setting.

INSTRUCTIONS FOR RESEARCHERS(1) Detach this cover sheet before photocopying or posting online and administration to sample.(2) Review information about CSAT-DD, administration, uses, and scoring in Teaching Cultural Competence in

Nursing and Health Care: Inquiry, Action, and Innovation (2010) before study design and data collection.(3) Please be sure that all respondents return the questionnaire.


This tool is intended for descriptive use but could be used to examine the relationship between select variableson the CSAT-DD and other items or scores on the TSET and/or CCCET. Information can be used to evaluate amountand type of exposure of student/learner/nurse to culturally diverse clients and Healthy People 2010 focus areas.

� Supplementary book resources: Chapters 4, 5.


S A M

P L

Epublic, etc.)public, etctinuing educationuing education

makeup of the clientmakeup of the clienvalent characteristiclent c

eas evident in the client in the cl

or posting online andting onlministration, uses, aninistration, uses

and Innovation (2010Innovation (2010turn the questionnaiturn the questio

d percent) for individpercent) for indiviscriptive use but coptive use but

ms or scores on theores on theudent/learner/nurse tudent/learner/nur

book resources: Chbook resourcSS

Preceptor or Clinical Instructor Name:

Clinical Practicum Information

Site or Agency Name:

Address:

Type of agency (Choose one)© Public © Nonsectarian/nonprofit© Private, for profit © Health service© Religious, nonprofit © School© Government agency © Other

(A) Did preceptor/clinical instructor complete a college-level course in transcultural nursingor cultural competence in health care?

© Yes © No

(B) Did preceptor/clinical instructor complete continuing education (CE) units in transculturalnursing or cultural competence in health care?

© Yes © No

The makeup of the client population:

Included in clientpopulation (select allthat apply)

Was most prevalent inclient population (select1 for each item)

1. SexMaleFemale

©©

©©

2. Age groupsInfantsChildrenAdolescentsYoung adultsMiddle-aged adultsOlder adultsElderlyOlder old

©©©©©©©©

©©©©©©©©

3. LanguageEnglish-speakingNon-English-speakingEnglish as a second (other) languageAmerican sign languageBraille

©©©©©

©©©©©

4. Citizenship StatusU.S.- born citizenNaturalized U.S. citizenImmigrantRefugeeUndocumented individual

©©©©©

©©©©©

5. LiteracyAdults able to read and write EnglishAdults able to read and write a language other than EnglishAdults unable to read and write any language

©©©

©©©


PL E

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PL

MPP

Included in clieded in clipopulation (tionthat applyP

S A M

MS



6. Highest Education of AdultsNever attended schoolSome elementary schoolElementary school graduate (grade 8)Some high schoolHigh school graduateSome collegeCollege graduate

©©©©©©©

©©©©©©©

7. Employment Status of AdultsEmployed full-timeEmployed part-timeUnemployed

©©©

©©©

8. Health Insurance StatusUninsuredPrivate insuranceMedicaidMedicareOther

©©©©©

©©©©©

9. Ethnicity or RaceAmerican Indian or Alaskan NativeAsian (Chinese, Filipino, Japanese, Korean, Asian Indian, Thai)Other AsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhite, non-HispanicMultiracialOther

©©©©©©©©©

©©©©©©©©©

10. ReligionsNone (atheist or agnostic)BuddhistChristianHinduJewishMuslimOther

©©©©©©©

©©©©©©©

11. Marital StatusSingleSingle, living with partnerMarriedDivorced or separatedWidowedOther

©©©©©©

©©©©©©

12. Income StatusPovertyLow incomeMiddle-class incomeHigh income

©©©©

©©©©

13. Residential AreaUrbanSuburbanRural

©©©

©©©


L EEE

M P L P

©©

©©©

L©©©©

S A M

©©

MS



14. Type of ResidenceApartmentHouseCondominium or co-opFarmSingle-room occupancy housingLow-income subsidized housingTrailerIndian reservationMilitary basePrisonShelterGroup homeDormitoryHomelessOther

©©©©©©©©©©©©©©©

©©©©©©©©©©©©©©©

15. Health StatusHealthyAcutely ill (physical)Acutely ill (mental)Chronically ill (physical)Chronically ill (mental)Other

©©©©©©

©©©©©©

What was the most frequent focus area during this clinical practicum experience?

Number 1most frequent(Mark 1 from the list)

The 4 nextmost frequent(Mark 4 from the list)

1. Access to quality health services2. Arthritis, osteoporosis, and chronic back pain3. Cancer4. Chronic kidney disease5. Diabetes6. Disability and secondary conditions7. Educational and community-based programs8. Environmental health9. Family planning

10. Food safety11. Health communication12. Heart disease and stroke13. HIV14. Immunization and infectious diseases15. Injury and violence prevention16. Maternal, infant, and child health17. Medical product safety18. Mental health and mental disorders19. Nutrition and overweight20. Occupational safety and health21. Oral health22. Physical activity and fitness23. Public health infrastructure24. Respiratory diseases25. Sexually transmitted diseases26. Substance abuse27. Tobacco use28. Vision and hearing

©©©©©©©©©©©©©©©©©©©©©©©©©©©©

©©©©©©©©©©©©©©©©©©©©©©©©©©©©


S A M

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EP

EE©©©©©©©

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nic back painback pain

ary conditionsary condommunity-based programmunity-based p

h

I T E M 8

Demographic Data Sheet—Undergraduate (DDS-U)

DIRECTIONSAdminister along with other questionnaire(s) to gather demographic information from undergraduate (pre-licensure)students.

INSTRUCTIONS FOR RESEARCHERS(1) Detach this cover sheet before photocopying or posting online and administration to sample.(2) Review information about DDS-U, administration, uses, and scoring in Teaching Cultural Competence in Nursing

and Health Care: Inquiry, Action, and Innovation (2010) before study design and data collection.(3) DDS-U may be adapted to individualize with course numbers, course names, and other desired demographic

data.(4) Please be sure that all respondents return the questionnaire.


� Can be used to describe sample characteristics (frequency and percent)� Can be used to create comparison groups based on select demographic categories for comparing scores and

data on the TSET, CCCET, CSAT-DD, and other assessment tools� Supplementary book resources: Chapters 4, 5.


MP L

Eadministration to sinistration to sring in Teaching Cultuhing Cultu

study design and dastudy design and dabers, course names,, course name

onnaire.onnaire.

ndividual and aggregdividual and aggr

AM cteristics (frequencycteristics (frequ

groups based on seloups based on seT-DD, and other assnd other a

es: Chapters 4, 5.es: Chapters 4, 5.

S A A

Background InformationPlease mark one choice for each item:

(1) Current course enrolled in:© 1 © 4© 2 © 5© 3 © 6

(2) Number of credits this semester:© 3–6 © 12–15© 7–9 © Over 15© 10–12

(3) Sex© Female © Male

(4) Age© Under 25 © 45–49© 25–29 © 50–54© 30–34 © 55–59© 35–39 © 60 and over© 40–44

(5) Which of the following categories bestdescribes you?

© American Indian or Alaskan Native © Hispanic or Latino© Asian (Chinese, Filipino, Japanese,

Korean, Asian Indian, or Thai)© Native Hawaiian or Other

Pacific Islander© Other Asian © White© Black or African American © Multiracial

© Other(6) Is English your first language?

© Yes © No

(7) Do you speak a language other thanEnglish fluently?

© Yes © No

(8) Were you born in the United States?© Yes © No

(9) Previous health care experience:© None© LPN© Other


S A M

P L

En Native ©©, Japanese,Ja

, or Thai)Thai)©©

AmericanAme

©© YesY

© YesYes

e:©© No©©©

I T E M 9

Demographic Data Sheet—Nurses (DDS-N)

DIRECTIONSAdminister along with other questionnaire(s) to gather demographic information from nurses working in clinicalagencies and/or enrolled in RN-BS and graduate (master’s and doctoral) programs.

INSTRUCTIONS FOR RESEARCHERS1. Detach this cover sheet before photocopying or posting online and administration to sample.2. Review information about DDS-N, administration, uses, and scoring in Teaching Cultural Competence in Nurs-

ing and Health Care: Inquiry, Action, and Innovation (2010) before study design and data collection.3. DDS-N may be adapted to individualize with other desired demographic data.4. Please be sure that all respondents return the questionnaire.


� Can be used to describe sample characteristics (frequency and percent)� Can be used to create comparison groups based on select demographic categories for comparing scores and

data on the TSET, CCCET, CSAT-DD, and other assessment tools� Supplementary book resources: Chapters 4, 5.


P L Eadministration to sinistration to s

oring in Teaching Culching Cuoreore study design andand

d demographic dataemographic dnaire.

AM Pvidual and aggregateand ag

ristics (frequency anics (frequency anoups based on selectups based on

DD, and other assess, and other asses

S A MChapters 4, 5.rs 4, 5.

AM

Please mark one choice for each item:

(1) Sex© Female © Male

(2) Age

© Under 25 © 45–49© 25–29 © 50–54© 30–34 © 55–59© 35–39 © 60 and over© 40–44

(3) Which of the following categories bestdescribes you?

© American Indian or Alaskan Native © Hispanic or Latino© Asian (Chinese, Filipino, Japanese,

Korean, Asian Indian, or Thai)© Native Hawaiian or Other

Pacific Islander© Other Asian © White© Black or African American © Multiracial

© Other

(4) Is English your first language?

© Yes © No

(5) Do you speak a language other than Englishfluently?

© Yes © No

(6) Were you born in the United States?

© Yes © No

(7) Are you employed full-time in nursing?

© Yes © No

(8) Are you employed part-time in nursing?

© Yes © No

(9) Health care setting in which you presently work.(If you work in more than one setting, selectyour primary setting)

© hospital (acute care) © school© hospital (chronic care) © occupational health© clinic © school of nursing© nursing home © hospice© home care © veteran’s administration© public health department © military base© Indian health service © college health service© physician’s office © other

(10) Clinical area in which you presently work.(If you work in more than one area, select yourprimary work area.)

© medical-surgical © geriatric© oncology © rehabilitation© psychiatric © substance abuse© obstetrics, maternity, newborn © HIV and AIDS© pediatrics © community health© emergency © palliative care© intensive care © other


©© NN

YesYes

©© Yess

work.elect

©

(11) Nursing position that you currently hold.(If you have more than one position, selectyour primary position.)

© staff RN © nurse entrepreneur© assistant head nurse © research nurse© nurse manager/head nurse © public health nurse© nurse educator © visiting nurse© nurse administrator/supervisor © clinical nurse leader (CNL)© clinical nurse specialist (CNS) © none (unemployed)© nurse practitioner (NP) © other

(12) Nursing position that you would like in thefuture:

© staff RN © nurse entrepreneur© assistant head nurse © research nurse© nurse manager/head nurse © public health nurse© nurse educator © visiting nurse© nurse administrator/supervisor © clinical nurse leader (CNL)© clinical nurse specialist (CNS) © other© nurse practitioner (NP)

(13) How many years have you been licensed as aregistered nurse?

© Under 2 © 20–24© 2–4 © 25–29© 5–9 © 30–34© 10–14 © 35–39© 15–19 © 40 or more

(14) What type of initial nursing program did youcomplete?

© associate degree (university based) © master’s degree© associate degree (hospital based) © other program (foreign)© diploma program (hospital based) © other program (U.S.)© baccalaureate degree

(15) How many years ago did you complete abaccalaureate degree in nursing?

© Currently enrolled in a BS program© Under 5

© Not enrolled in a BS program© 15–19

© 5–9 © 20–25© 10–14 © 25 or more

(16) Did you complete a previous college course intranscultural nursing or cultural competence inhealth care?

© Yes, undergraduate level only © Yes, graduate level only© Yes, undergraduate and graduate level © None

(17) Did you complete continuing educationunits in transcultural nursing or culturalcompetence in health care?

© Yes, inservices at my job only © None© Yes, online or mailed CE only© Yes, conferences only© Yes, 2 or more of the above© All of the above


SA M

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diploma program (hosploma program (hos© baccalaureate degrccalaure

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cultural competence incultural competence in

I T E M 1 0

Self-Assessment Tool—Academic (SAT-A)

USER INFORMATION� Used to help individual faculty members, administrators, and the organization assess various dimensions that

can impact upon cultural competence in the academic setting� May be used individually and/or in groups� May be used alone or in conjunction with other toolkit items� Self-assessment should conclude with a listing of strengths, weaknesses, gaps in knowledge, goals, commit-

ment, desire, motivation, and priorities� Supplementary book resources: Chapter 6, Table 1.2 and Figure 6.2


S A M

P L

Eesses, gaps in knows, gaps in kno

ure 6.2L

Self-Assessment Tool—Academic (SAT-A)

Self-Assessment Question Your Response

1. What are your own cultural values and beliefs (CVB)?

2. What do you know about students’ CVB?

3. How did you know about students’ CVB?

4. What values and beliefs do you expect from students?

5. How do you feel when a student’s CVB are different from yours?

6. What actions do you take when a student’s CVB are different from yours?

7. How do/could different CVB affect the student’s relationship with you,other nursing faculty, nurses, and peers?

You:Other nursing faculty:Nurses:Peers:

8. How do/could different CVB affect the student’s cultural competencedevelopment, academic outcomes, satisfaction, stress, persistence, andretention?

Cultural competence development:Academic outcomes:Satisfaction:Stress:Persistence:Retention:

9. How confident are you about your current knowledge, skills, values, andattitudes when interacting with, teaching, and advising culturally differentstudents?

Interacting with:Teaching:Advising:

10. What is your motivation for engaging in the process of becoming culturallycompetent?

11. What is your level of commitment in developing cultural competence inyourself, peers, administrators, and students?

Yourself:Peers:Administrators:Students:

12. What are your strengths, weaknesses, gaps in knowledge, values, goalsand priorities concerning cultural competence development?

Strengths:Weaknesses:Gaps in knowledge:Values:Goals:Priorities:

13. How confident are you about learning new transcultural nursing skillswhen interacting with, teaching, and advising culturally different students?


14. How confident are you about performing new transcultural nursing skillswhen interacting with, teaching, and advising culturally different students?


15. How confident are you that you will actively advocate for culturalcompetence development in the academic setting?


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I T E M 1 1

Self-Assessment Tool—Health Care Institutions (SAT-HCI)

USER INFORMATION� Used to help individual staff nurse, nurse manager, nurse educator, nurse executive, administrator, and the

organization assess various dimensions that can impact upon cultural competence in the health care setting� May be used individually and/or in groups� May be used alone or in conjunction with other toolkit items� Self-assessment should conclude with a listing of strengths, weaknesses, gaps in knowledge, goals, commit-



L Eesses, gaps in knows, gaps in kno

gure 10.2

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Self-Assessment Tool—Health Care Institutions (SAT-HCI)


1. What are your own1 cultural values and beliefs (CVB)?

2. What do you know about the CVB of health care consumers2?

3. What do you know about the CVB of your peers, supervisors, and othermembers of the health care team3?

Your peers:Supervisors:Other members of the health care team:

4. How did you know about the CVB of others?

5. What values and beliefs do you expect from your peers, supervisors, andother members of the health care team?

Your peers:Supervisors:Other members of the health care team:

6. How do you feel when the CVB of health care consumers are differentfrom yours?

7. What actions do you take when a supervisor’s CVB are different fromyours?

8. How do/could different CVB affect a nurse’s relationship with you, peers,and other members of the health care team?

You:Peers:Other members of the health care team:

9. How do/could different CVB affect a nurse’s cultural competencedevelopment, satisfaction, stress, persistence, and retention?

Cultural competence development:Satisfaction:Stress:Persistence:Retention:

10. How confident are you about your current knowledge, skills, values, andattitudes when interacting with, caring for, and advising culturally differentconsumers?

Interacting with:Caring for:Advising:

11. How confident are you about your current knowledge, skills, values, andattitudes when interacting with, collaborating, and performing your worktasks with culturally different members of the health care team?

Interacting with:Collaborating:Performing work tasks:


13. What is your level of commitment in developing cultural competence inyourself, peers, administrators, and others?

Yourself:Peers:Administrators:Others:

14. What are your strengths, weaknesses, gaps in knowledge, values, goals,and priorities concerning cultural competence development?


1Own refers to individual staff nurses, nurse manager, executive, administrator, educator, or organization.2Health care consumers refer to individual patients, families, and communities.3Other members of the health care team include professional and unlicensed health care providers.


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15. How confident are you about learning new transcultural nursing skillswhen interacting with, caring for, and advising culturally differentconsumers?


16. How confident are you about learning new transcultural nursing skillswhen interacting with, collaborating, and performing your work tasks withculturally different nurses?


17. How confident are you about learning new transcultural nursing skillswhen interacting with, collaborating, and performing your work tasks withculturally different supervisors, administrators, and other members of thehealth team?


18. How confident are you about performing new transcultural nursing skillswhen interacting with, caring for, and advising culturally differentconsumers?


19. How confident are you about performing new transcultural nursing skillswhen interacting with, collaborating, and performing your work tasks withculturally different nurses, supervisors, administrators, and othermembers of the health team?


20. How confident are you that you will actively advocate for culturalcompetence development in the health care setting?


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I T E M 1 2

Self-Assessment Tool—Professional Associations (SAT-PA)

USER INFORMATION� Used to help individual members, elected officers, administrators, association leaders, and the organization

assess various dimensions that can impact upon cultural competence in the professional association� May be used individually and/or in groups� May be used alone or in conjunction with other toolkit items� Self-assessment should conclude with a listing of strengths, weaknesses, gaps in knowledge, goals, commit-



L Epp

esses, gaps in knows, gaps in kno

gure 13.2

S A M

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Self-Assessment Tool—Professional Associations (SAT-PA)


1. What are your own1 cultural values and beliefs (CVB)?

2. What do you know about the CVB of the professional associationmembers?

3. What do you know about CVB of your peers, general members, electedofficers, and other members of the professional association’s (PA)leadership team?

Peers:General members:Elected officers:PA leadership team:

4. How did you know about the CVB of others?

5. What values and beliefs do you expect from your peers, generalmembers, elected officers, and other members of the professionalassociation’s leadership team?

Peers:General members:Elected officers:PA leadership team:

6. How do you feel when the CVB of your peers and general members aredifferent from your own?

You:Peers:

7. What actions do you take when elected officers and other members of theprofessional association’s leadership team’s CVB are different fromyours?

8. How do/could different CVB affect a member’s relationship with you,peers, and other members of the professional association?

You:Peers:Other members of the professional association:

9. How do/could different CVB affect a member’s cultural competencedevelopment, satisfaction, stress, participation, and retention?

Cultural competence development:Satisfaction:Stress:Participation:Retention:

10. How confident are you about your current cultural knowledge, skills,values, and attitudes when interacting with, advising, and mentoringculturally different new members?

Interacting with:Advising:Mentoring:

11. How confident are you about your current cultural knowledge, skills,values, and attitudes when interacting with, collaborating, and performingyour association tasks with culturally different members of theprofessional association?

Interacting with:Collaborating:Performing tasks:


13. What is your level of commitment for facilitating the development ofcultural competence in yourself, peers, general members, electedofficers, and others?

Yourself:Peers:General members:Elected officers:Others:

1Own refers to the individual, nurse manager, executive, administrator, elected officer, educator, or organization/association.


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14. What are your strengths, weaknesses, gaps in knowledge, values, goals,and priorities concerning cultural competence development?


15. How confident are you about learning new transcultural skills wheninteracting with, advising, and mentoring culturally different newmembers?


16. How confident are you about learning new transcultural skills wheninteracting with, collaborating, and performing your association tasks withculturally different members, elected officers, administrators, and othermembers of the professional association’s leadership team?


17. How confident are you about performing new transcultural skills wheninteracting with, advising, and mentoring culturally different newmembers?


18. How confident are you about performing new transcultural skills wheninteracting with, collaborating, and performing your association tasks withculturally different members?


19. How confident are you about performing new transcultural skills wheninteracting with, collaborating, and performing your association tasks withculturally different members, elected officers, administrators, and othermembers of the professional association’s leadership team?


20. How confident are you that you will actively advocate for culturalcompetence development in the professional association?M P

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I T E M 1 3

Active Promoter Assessment Tool—Academic (APAT-A)

USER INFORMATION� Used to help individuals, groups, and organizations

� Appraise values, beliefs, and actions concerning cultural competence development� Determine whether or not one is an optimal active role model in cultural competence development within

the academic institution� Identify factors restricting cultural competence development� Plan and coordinate future active promoter actions toward achieving optimal cultural competence

� May be used individually and/or in groups� May be used alone or in conjunction with other toolkit items� Supplementary book resources: Chapter 6 and Table 6.1


PL E

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P LPL

Part 1 Directions1. Check “yes” or “no” for each value, belief, and action.2. Check “yes” or “no” for each active promoter action.3. Review and reflect.4. Proceed to Part 2.

Values, Beliefs, and Actions Active Promoter of Cultural Competence Development

Yes No Yes No

1. Views cultural competence as important inown life

and shares beliefs with students∗

2. Views cultural competence as important instudents’ education, professionaldevelopment, and future practice

and shares view with students

3. Views own nurse educator role to includeactive involvement in promoting culturalcompetence development among students


4. Routinely updates own knowledge and skillsto enhance cultural competence

and shares relevant information with students

5. Attends professional events concerningcultural competence development

and shares positive and relevant experienceswith students

6. Views professional event participationconcerning cultural competencedevelopment as important in students’education and/or professional development,and future practice


7. Recognizes the significance of offeringincentives to encourage student participationin professional events

and offers incentives to encourage studentparticipation in professional events

8. Maintains professional partnerships focusedon cultural competence development


9. Maintains membership(s) in professionalorganizations whose primary mission iscultural competence development


10. Views student memberships in nursingorganizations/associations (whose primarymission is cultural competence development)as important in students’ education and/orprofessional development, and futurepractice


11. Recognizes the significance of offeringincentives to encourage student participationin memberships in nursingorganizations/associations committed tocultural competence development

and offers incentives to encourage studentparticipation in memberships in nursingorganizations/associations committed tocultural competence development

∗Active promoter/facilitator actions are indicated by italics.


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Yes No Yes No

12. Recognizes actual and potential barriershindering students’ development of culturalcompetence

and initiates strategies to remove barriers

13. Recognizes the significance of implementingstrategies to encourage student developmentof cultural competence

and implements strategies to encouragestudent development of cultural competence

14. Recognizes the significance of evaluatingstrategies implemented to encourage studentdevelopment of cultural competence

and evaluates strategies implemented toencourage student development of culturalcompetence


S A M

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Part 2 Directions1. Use black ink, write down active promoter actions implemented for each item. Include how, what, where,

and when.2. Use another color ink, write down FUTURE active promoter actions planned for each item. Include how,

what, where, when.3. Review and reflect.4. Share and discuss with peers. Plan and coordinate strategies throughout the course, curriculum, and program.


How and/or What Where When

1. Views cultural competence as important in own life andshares beliefs with students∗

2. Views cultural competence as important in students’education, professional development, and future practiceand shares view with students

3. Views own nurse educator role to include activeinvolvement in promoting cultural competence developmentamong students and shares view with students

4. Routinely updates own knowledge and skills to enhancecultural competence and shares relevant information withstudents

5. Attends professional events concerning culturalcompetence development and shares positive and relevantexperiences with students

6. Views professional event participation concerning culturalcompetence development as important in students’education and/or professional development, and futurepractice and shares view with students

7. Recognizes the significance of offering incentives toencourage student participation in professional events andoffers incentives to encourage student participation inprofessional events

8. Maintains professional partnerships focused on culturalcompetence development and shares positive and relevantexperiences with students

9. Maintains membership(s) in professional organizationswhose primary mission is cultural competence developmentand shares positive and relevant experiences with students

10. Views student memberships in nursingorganizations/associations (whose primary mission iscultural competence development) as important instudents’ education and/or professional development, andfuture practice and shares view with students



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11. Recognizes the significance of offering incentives toencourage student participation in memberships in nursingorganizations/associations committed to culturalcompetence development and offers incentives toencourage student participation in memberships in nursingorganizations/associations committed to culturalcompetence development

12. Recognizes actual and potential barriers hinderingstudents’ development of cultural competence and initiatesstrategies to remove barriers

13. Recognizes the significance of implementing strategies toencourage student development of cultural competenceand implements strategies to encourage studentdevelopment of cultural competence

14. Recognizes the significance of evaluating strategiesimplemented to encourage student development of culturalcompetence and evaluates strategies implemented toencourage student development of cultural competence


S A M

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EEEL

I T E M 1 4

Active Promoter Assessment Tool—Health Care Institutions/ProfessionalAssociations (APAT-HCIPA)

USER INFORMATION� Used to help individuals, groups, and organizations

� Appraise values, beliefs, and actions concerning cultural competence development� Determine whether or not one is an optimal active role model in cultural competence development within

the health care institution or professional association� Identify factors restricting cultural competence development� Plan and coordinate future active promoter actions toward achieving optimal cultural competence

� May be used individually and/or in groups� May be used alone or in conjunction with other toolkit items� Supplementary book resources: Chapter 10 and 13; Figure 10.3 and Exhibit 13.1


PL E

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S A M

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Part 1 Directions

(1) Check “yes” or “no” for each value, belief, and action.(2) Check “yes” or “no” for each active promoter action.(3) Review and reflect.(4) Proceed to Part 2.


Yes No Yes No

1. Views cultural competence as important inown∗1 life

and shares beliefs with others∗2

2. Views cultural competence as important inmembers’∗3 education, professionaldevelopment, and future practice

and shares view with others

3. Views own role to include active involvementin promoting cultural competencedevelopment among members


4. Routinely updates own knowledge and skillsto enhance cultural competence

and shares relevant information with others

5. Attends professional events concerningcultural competence development

and shares positive and relevant experienceswith others

6. Views professional event participationconcerning cultural competencedevelopment as important in members’ongoing continuing education, professionaldevelopment, and future practice


7. Recognizes the significance of offeringincentives to encourage members’participation in professional events

and offers incentives to encourage members’participation in professional events

8. Maintains professional partnerships focusedon cultural competence development


9. Maintains membership(s) in professionalorganizations whose primary mission iscultural competence development


10. Views memberships in professionalorganizations/associations (whose primarymission is cultural competence development)as important in members’ continuingeducation, professional development, andfuture practice


11. Recognizes the significance of offeringincentives to encourage members’participation in memberships in professionalorganizations/associations committed tocultural competence development

and offers incentives to encourage members’participation in memberships in nursingorganizations/associations committed tocultural competence development

∗1Own refers to individuals, nurse managers, executive, administrator, elected officer, educator, or organization/association∗2Others refers to unlicensed and licensed members of the health care team & members and elected officers of professional associations∗3Members refers to staff members or association members


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Yes No Yes No

12. Recognizes actual and potential barriershindering the development of culturalcompetence

and initiates strategies to remove barriers

13. Recognizes the significance of implementingstrategies to encourage members’development of cultural competence

and implements strategies to encouragemembers’ development of culturalcompetence

14. Recognizes the significance of evaluatingstrategies implemented to encouragemembers’ development of culturalcompetence

and evaluates strategies implemented toencourage members’ development of culturalcompetence


S A M

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Part 2 Directions

(1) Use black ink, write down active promoter actions implemented for each item. Include how, what, where,and when.

(2) Use another color ink, write down FUTURE active promoter actions planned for each item. Include how,what, where, when.

(3) Review and reflect.(4) Share and discuss with peers. Plan and coordinate strategies throughout the employee orientation, ongoing

employee inservice or continuing education programs, HCI and PA.



1. Views cultural competence as important in own life andshares beliefs with others∗

2. Views cultural competence as important in members’education, professional development, and future practiceand shares view with others

3. Views own role to include active involvement in promotingcultural competence development among staff membersand shares view with others

4. Routinely updates own knowledge and skills to enhancecultural competence and shares relevant information withothers

5. Attends professional events concerning culturalcompetence development and shares positive and relevantexperiences with others

6. Views professional event participation concerning culturalcompetence development as important in members’ongoing continuing education, professional development,and future practice and shares view with others

7. Recognizes the significance of offering incentives toencourage members’ participation in professional eventsand offers incentives to encourage members’ participationin professional events

8. Maintains professional partnerships focused on culturalcompetence development and shares positive and relevantexperiences with others

9. Maintains membership(s) in professional organizationswhose primary mission is cultural competence developmentand shares positive and relevant experiences with others

10. Views memberships in nursing organizations/associations(whose primary mission is cultural competencedevelopment) as important in members’ continuingeducation, professional development, and future practiceand shares view with others



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11. Recognizes the significance of offering incentives toencourage members’ participation in memberships inprofessional organizations/associations committed tocultural competence development and offers incentives toencourage members’ participation in memberships inprofessional organizations/associations committed tocultural competence development

12. Recognizes actual and potential barriers hindering thedevelopment of cultural competence and initiates strategiesto remove barriers

13. Recognizes the significance of implementing strategies toencourage members’ development of cultural competenceand implements strategies to encourage members’development of cultural competence

14. Recognizes the significance of evaluating strategiesimplemented to encourage members’ development ofcultural competence and evaluates strategies implementedto encourage members’ development of culturalcompetence


S A M

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EEEL

I T E M 1 5

Systematic Inquiry: Academic (SI-A)

USER INFORMATION� Offers a user-friendly quantitative and qualitative approach for systematic appraisal decisions, corresponding

actions, notations/reflections, prioritization, and future planning.� Used to help individuals, groups, and organizations examine how visible (or invisible) cultural competency

development is actively present:� Overall within the curriculum� Specifically at the individual course level� Via outside connections to supplementary resources

� The systematic inquiry is guided by two additional questions:� To what degree is cultural competence an integral component within the academic setting?� How do all the cultural components fit together?

� May be used individually or in groups� May be used alone or in conjunction with other toolkit items (Recommended to use prior to Toolkit Item

20—Cultural Competence Documentation Log). Results serve as a valuable precursor to informed decisions,responsible actions, and new diagnostic-prescriptive innovations targeting faculty and student developmentin the overall goal of achieving optimal cultural competence.



e (or in(or

ns:mponent within thet within the

her toolkit items (Retoolkit iteLog). Results serve aLog). Results se

prescriptive innovatescriptive innova

AM cultural competenccultural comp

apter 6 and Figure 6ter 6 and Figure

S A MAM

Systematic Inquiry: Academic Settings

Directions:1. Reflect on the three inquiry questions below as you appraise each component.2. Using the rating scale below, mark your appraisal decision in the space provided.3. Mark the corresponding action for each appraisal decision in the space provided.4. Write comments and details as needed in the “notes” section.5. Prioritize areas for immediate action by marking the priority rank section.6. Review, discuss, and develop cultural competence plan. (Note: Cultural Competence Documentation Log may

be used for documenting cultural competence plans, actions, and evaluations).

Inquiry Questions� To what degree is cultural competence an integral component within the academic setting?� How visible (invisible) is cultural competence development evident?� How do all the cultural components of the curriculum (course/other) fit/blend together?

Rating Scale

Appraisal Decision −→ Corresponding Action Appraisal Decision −→ Corresponding Action

0 = Absent F = Major revisions 4 = Connected attachment C = Continue or integrate1 = Barely visible F = Major revisions 5 = Somewhat integrated B = Integrate consistently2 = Inconsistent E = Integrate consistently 6 = Consistently integrated A = Continue & update3 = Disconnected attachment D = Connect or integrate 7 = Predominant theme A = Continue & update


L Eonn E−→−→− CoEd attachment CC ==

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what integrated Bwhat integrated Bnsistently integratedstent

Predominant themeinant theme

PL

Curriculum

Decision Action PriorityRating Rating Notes Rank

Philosophy

Conceptual framework

Program objectives

Program outcomes

Horizontal threads

Vertical threads

Supplementary Resources


Library resources

Nursing student resourcecenter (NSRC) or NursingNeighborhood

Nursing student lounge

Nursing student club

Sigma Theta Tau chapter

Specialty organizations

Bulletin boards

Web page & discussionboards

Invited guest speakers

Date form completed: Name(s) of evaluator(s):

Date reviewed by curriculum committee: Chairperson, dean, director:

Comments/notes




MP L

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MM MA MAA

MS

AS

AAS ASS

AMM

AS

ASSS

Course


Course outline

Textbooks

Films, videos, movies

Computer-assistedinstruction (CAI)

Journal articles

Web page

Classroom teaching

Online teaching

Nursing skills lab

Preclinical conference

Clinical assignments

Post-clinical conference

Clinical agencies

Immersion experiences

Service learning

Field trip experience

Exam questions

Written assignments

Reading assignments

Oral presentations

Date form completed: Name(s) of evaluator(s):Date reviewed by curriculum committee: Chairperson, dean, director:Comments/notes




PL EEEL

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MM MA

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SA

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I T E M 1 6

Systematic Inquiry: Health Care Institutions (SI-HCI)



development is actively present:� Overall within the institution� Specifically at the individual unit (site) level� Via outside connections to supplementary resources.

� The systematic inquiry is guided by two additional questions:� To what degree is cultural competence an integral component within the HCI?� How do all the cultural components fit together?

� May be used individually or in groups� May be used alone or in conjunction with other toolkit items (Recommended to use prior to Toolkit Item

20—Cultural Competence Documentation Log). Results serve as a valuable precursor to informed decisions,responsible actions, and new diagnostic-prescriptive innovations targeting staff development and improvedpatient care outcomes in the overall goal of achieving optimal cultural competence.



e (or in(or


her toolkit items (Retoolkit iteLog). Results serve aLog). Results se

prescriptive innovatescriptive innovaoal of achievingal of achieving

AM

optimapter 10 and Figureter 10 and Figur

S A MAM

Systematic Inquiry: Health Care InstitutionsDirections:

1. Reflect on the three inquiry questions below as you appraise each component.2. Using the rating scale below, mark your appraisal decision in the space provided.3. Mark the corresponding action for each appraisal decision in the space provided.4. Write comments and details as needed in the “notes” section.5. Prioritize areas for immediate action by marking the priority rank section.6. Review, discuss, and develop cultural competence plan. (Note: Cultural Competence Documentation Log may

be used for documenting cultural competence plans, actions, And evaluations).

Inquiry Questions� To what degree is cultural competence an integral component within the health care institution?� How visible (invisible) is cultural competence development evident?� How do all the cultural components fit/blend together?

Rating Scale




L EE−→→ CoEattachment Ct C ==hat integrated BB

PL istently integratedstently integrated

edominant thememina

S A M

P LPL

Institutional Level


Philosophy & mission

New employee orientation

In-service education

Learning strategies

Newsletter & publications

Library

Website

Bulletin boards

Special events

Committees



Local organizations

Local colleges

Continuing education

Guest speakers


Date reviewed by committee: Supervisor/administrator:

Comments/notes on back or below.




PL EEEL EL

M P L

MA

MA

MA

MAA

MS

A S

AAS

AP

LP

MP

MA

MS

A S ResourcesesourcesS

DecisionSSatingating

Unit/Site Level


In-service education

Learning strategies

Staff meetings

Patient care conferences

Walking rounds and report


Date reviewed by committee: Supervisor/administrator:

Comments/notes




S A M

P L

E

M

EEL

AM P

L

A N

ittee: A

I T E M 1 7

Systematic Inquiry: Professional Associations (SI-PA)



development is actively present:� Overall within the association� Specifically at the membership level� Via outside connections to supplementary resources.

� The systematic inquiry is guided by two additional questions:� To what degree is cultural competence an integral component within the professional association?� How do all the cultural components fit together?


20—Cultural Competence Documentation Log.) Results serve as a valuable precursor to informed decisions,responsible actions, and new diagnostic-prescriptive innovations targeting staff and membership developmentin the overall goal of achieving optimal cultural competence.



e (or in(or


er toolkit items. (Reoolkit iteLog.) Results serve aLog.) Results se

rescriptive innovatioscriptive innovat

AM cultural competenccultural comp

apter 13 and Figureter 13 and Figur

S A MAM

Systematic Inquiry: Professional Associations

Directions:1. Reflect on the three inquiry questions below as you appraise each component.2. Using the rating scale below, mark your appraisal decision in the space provided.3. Mark the corresponding action for each appraisal decision in the space provided.4. Write comments and details as needed in the “notes” section.5. Prioritize areas for immediate action by marking the priority rank section.6. Review, discuss, and develop cultural competence plan. (Note: Cultural Competence Documentation Log may

be used for documenting cultural competence plans, actions, and evaluations).

Inquiry Questions� To what degree is cultural competence an integral component within the professional association?� How visible (invisible) is cultural competence development evident?� How do all the cultural components fit/blend together?

Rating Scale




L EE−→→ CorEd attachment CCwhat integratedwhat integrated

nsistently integratedstent

S A M

P LPredominant themeinant theme

PL

Interpersonal Level


Board or elected officers

Members

Nonmembers or guests



Other professionalassociations

Local colleges

Health care institutions

Guest speakers


Date reviewed by committee: Administrator/association leader:

Comments/notes




MP L

EL EP

LM PM

AM

AM

AM

AAM

SA

SAA

SA

SSA

S SSSM

PM

AM

AS A

Professional Association LevelChapter or Local Level


Philosophy & mission

Bylaws

Membership criteria

Newsletter andpublications

Library

Web site

Meetings

Workshops

Conferences

Special events

Committees

Learning strategies

Networking

Mentoring


Date reviewed by committee: Administrator/association leader:

Comments/notes




PL EEEL

PL

M P

MA

MA

MA

MAA

MS

A S

AAS

ASS

AS SSS

PM

PM

AM

AS

ASS

I T E M 1 8

Personal Coding Cover Page for Anonymity and Matching Questionnaires

USER INFORMATION� Used to match questionnaires and assessment tools while protecting respondent’s anonymity� Attach to front page of questionnaire, questionnaire packet, or assessment tool.


E

S A M

P L

EE

Questionnaire Cover Sheet for Personal Coding System

Purpose: This page will create a unique code that will only be used to match your questionnaires together.Confidentiality: Participants will not be identified using information provided. Respondents will remain anonymous.

Please fill-in the circles below using pen or pencil. Do not use � or on the form.

1. The first 2 letters of your mother’s maiden name (Example: Smith would be SM):2. The month that your mother was born.3. The number of siblings (brothers and sisters) you had when you were 18 years old. (Example: 2 brothers and

1 sister would be 3. If you have 0 siblings, write 0). (If more than 9, please mark 9.)4. The number of brothers who were OLDER than you when you were 18 years old.5. The number of brothers who were YOUNGER than you when you were 18 years old.6. The number of sisters who were OLDER than you when you were 18 years old.7. The number of sisters who were YOUNGER than you when you were 18 years old.

1. 2. 3. 4. 5. 6. 7.

�Jan � � � � �

B B �Feb � � � � �

C C �Mar � � � � �

D D �Apr � � � � �

E E �May � � � � �

F F �Jun � � � � �

G G �Jul � � � � �

H H �Aug � � � � �

I I �Sep

J J �Oct

K K �Nov

L L �Dec

M M

N N

O O

P P

Q Q

R R

S S

T T

U U

V V

W W

X X

Y Y

Z Z


PL EE

ol8 years ol8 years o

L E5.

L E�

� ��

S A M

P��

I T E M 1 9

Sample Permission Letter

USER INFORMATION� Provides a sample for prospective educators and researchers� Adapt letter according to study purpose and need� Mail one copy to Springer Publishing Company and one copy to Dr. Marianne R. Jeffreys.


Eanne Ranne

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P L

EE

Requester’s Name and CredentialsMailing AddressE-mail AddressDate

Permissions EditorSpringer Publishing Company11 West 42nd StreetFloor 15New York, New York 10036–8002

Dear Publisher:

I am writing to request permission to use the Transcultural Self-Efficacy Tool (TSET) and (list other tools ) in my researchstudy. The study addresses (briefly describe nature of study, purpose, sample, etc.).

I have mailed a copy of this request letter to the author:

Dr. Marianne R. JeffreysThe City University of New York College of Staten IslandNursing Department2800 Victory BoulevardStaten Island, New York 10314

I also agree to send Dr. Jeffreys further reliability and validity test results for the TSET (and list other tools) at the above address.

Sincerely,

Signature

Name, CredentialsTitle


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P L

Ee TSET (and list other toSET (and list oth

M

I T E M 2 0

Cultural Competence Documentation Log

USER INFORMATION� User-friendly log to assist institutions in documenting cultural competence plans, actions, and evaluations.� Use after Toolkit Systematic Inquiry Assessment Tool.


S A M

P L

EE

Innovation, Measurement, & Evaluation

Person(s) Date to Measurement EvaluationStrategy or Idea Responsible Resources Needed Implement Plan & Date Plan & Date

1

2

3

4

5

Select one strategy or idea from above. Write out a detailed description of steps and timeline for plan/design,implementation, measurement, and evaluation phases.

Repeat for subsequent prioritized strategies

Plan/Design Steps / Date Implementation Steps / Date Measurement Steps / Date Evaluation Steps / Date

1

2

3

4

5

6

7

8

9

10

11

12


S A M

P L

EL ELdetailed description oetailed description

MS

ation Steps / Datetion Steps / DateMA

MA

SA

SS

I T E M 2 1

Research Report Template

USER INFORMATION� User-friendly template to assist individuals and institutions report data generated from assessment tools and

questionnaires in toolkit.� Provides a guide for presentations, publications, future research, and cultural competence interventions� Supplementary book resources: TSET Research Exhibits 6.1, 6.2, 6.3, 6.4, 6.5, 10.1, 10.2 and Chapters 4

and 5.

DIRECTIONS FOR TSET AND CCCET USERSComplete Research Report Template to send TSET and CCCET* reliability and validity test results and study results to:

Dr. Marianne R. Jeffreys, The City University of New York College of Staten Island, Nursing Department, 2800Victory Boulevard, Staten Island, New York 10314, USA.

Study Title:

Date (month, year) Study Began:

Date (month, year) Ended:

Purpose:

Research Question(s) or Hypotheses:

Study Design:

Sample:

Size:

Type of learner:

Demographics:

Instrument (TSET or TSET-MHP):

TSET Data Collection (When was data collected?)

Pretest:

Posttest:

*Please note that TSET and CCCET can be used together or separately in research studies. TSET and CCCET can be used in conjunction with other assessmenttools within the toolkit.


S A M

P L

Etural comtural com

3, 6.4, 6.5, 10., 6.4, 6.5, 10.

reliability and validy and validYork College of Stateork College of State

or Hypotheseses

SA::

Educational interventions/teaching–learning strategies: (list and describe)

TSET Reliability (Crohnbach’s alpha)

Total TSET:

Cognitive Subscale:

Practical Subscale:

Affective Subscale:

Data Analysis

Results:

Subscale Mean Standard Deviation t-test Significance

CognitivePretestPosttest

PracticalPretestPosttest

AffectivePretestPosttest

(Supplementary [optional] Analyses)If grouping into High, Medium, and Low, describe method used:

Subscale High Medium Low

CognitivePretestPosttest

PracticalPretestPosttest

AffectivePretestPosttest


TSE EST scoresS

L EL ELt-testt

PL L

MP

AM

AM

SA M

LP

MA

MS Aonal] Analyses)ses)

gh, Medium, and Logh, Medium, and L

SSS

Other Instruments:

Other Analyses:

Discussion:

Implications:

Dissemination of Results:

Principal Investigator(s) Name, Credentials, and Title:

Principal Investigator(s) Contact Information:

(a) Mailing Address:

(b) Work Address:

(c) E-Mail Address:

(d) Phone:

(e) Fax:

Other Investigator(s) Name, Credentials, and Title:

Other Investigator(s) Contact Information:

(a) Mailing Address:

(b) Work Address:

(c) E-Mail Address:

(d) Phone:

(e) Fax:

Type of study (doctoral dissertation, master’s thesis, postdoctoral, institutional, other)

Abstract:


S A M

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Ele:

onon M::

toral dissertatiooral disserta

The Cultural Competence Education Resource Toolkit - Springer

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