The Association Between the Nursing Practice Environment and Culturally Competent Behaviors Among Surgical Nurses in Riyadh, Saudi Arabia: A Multicenter Cross-Sectional Study
TL;DR
The nursing practice environment had a moderate positive unadjusted association with Cultural Competence Behaviors, and this association remained statistically significant after adjustment, and this association remained statistically significant after adjustment.
Abstract
Highlights What are the main findings? A moderate positive association was observed between the nursing practice environment and culturally competent behavior scores (ρ = 0.303); the association remained statistically significant after adjustment (B = 1.037, p < 0.001). The staffing and resource adequacy domain received the lowest rating among the nursing practice environment domains. What are the implications of the main findings? Cultural competence initiatives should be supported by effective nursing leadership, adequate staffing and resources, interprofessional collaboration, and culturally appropriate communication support. Longitudinal and intervention studies are needed to clarify causality and determine whether improvements in the practice environment enhance culturally competent care and patient outcomes. Abstract Background/Objectives: Culturally competent nursing care is essential in multicultural settings, but organizational conditions may influence its delivery. This study examined the association between the nursing practice environment and culturally competent behaviors among surgical nurses in Riyadh, Saudi Arabia, and whether this association remained significant after adjustment. Methods: This multicenter cross-sectional study included 422 surgical nurses recruited by convenience sampling from January to March 2026. Participants completed the 31-item Practice Environment Scale of the Nursing Work Index (PES-NWI) and the 14-item Cultural Competence Behaviors (CCB) subscale of the Cultural Competence Assessment. Analyses included descriptive statistics, Cronbach’s alpha, Spearman’s rank correlation, and an adjusted general linear model with heteroscedasticity-consistent type 3 (HC3)-robust standard errors. Results: The mean PES-NWI score was 3.04 ± 0.46; nursing foundations for quality of care had the highest domain score (3.16 ± 0.43), whereas staffing and resource adequacy had the lowest (2.87 ± 0.63). Among the 404 participants with valid CCB scores, the mean CCB score was 4.48 ± 1.53. The PES-NWI composite score showed a moderate positive association with CCB (ρ = 0.303, p < 0.001). The adjusted model was statistically significant (F(14, 389) = 8.28, p < 0.001; R2 = 0.230). Adding the PES-NWI composite score explained an additional 9.1% of the variance in CCB (ΔR2 = 0.091, p < 0.001); the adjusted association remained positive (B = 1.037, HC3-robust standard error = 0.172, 95% confidence interval = 0.699–1.375, p < 0.001). Conclusions: The nursing practice environment had a moderate positive unadjusted association with CCB, and this association remained statistically significant after adjustment. Longitudinal studies are needed to clarify the temporal direction of this relationship.