Insert Code Number
1. What I believe about health, illness and preventive
health is strictly based on science.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
2. Some cultural groups believe that supernatural forces
can cause illness.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
3. I feel confident in using a variety of
cultural assessment tools in the healthcare setting.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
4. It is more important for my students to conduct
cultural assessments on ethnically diverse clients than on other
clients.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
5. I do not have time to include cultural
competence in my course content.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
6. I am involved socially with
cultural/racial/ethnic groups, different from my own, outside of my
teaching role and healthcare setting.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
7. Caring for clients who are culturally,
racially, or ethnically diverse is a challenge that I welcome.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
8. Individuals of different
cultural/racial/ethnic groups have perceptions of health, illness, and
preventive health that are no different from my
own.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
9. The same approach should be followed
when caring for all patients, regardless of culture, race, ethnic, or
religious background, or worldview.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
10. I am knowledgeable about variations in
drug metabolism among specific cultural groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
11. Determining the degree of acculturation
of culturally diverse clients is a desirable but not essential part of
conducting a cultural assessment.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
12. I avail myself of professional
development and training opportunities to enhance my knowledge and
skills in the provision of healthcare services to culturally, racially,
and ethnically diverse groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
13. I am aware that biological variations
exist in different cultural, racial, and ethnic groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
14. I use the appropriate communication
style and protocol to communicate with clients who are of different
cultural, racial, and ethnic backgrounds.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
15.There is no difference in food digestion
among ethnic, racial, and cultural groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
16. My students are required to seek
information on acceptable behaviors, courtesies, customs, and
expectations that are unique to culturally, racially, and ethnically
diverse groups served by our program.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
17. When I care for a client, I consider
how the difference between our perceptions of health, illness and preventive
health could affect the outcome of my care.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
18. I am knowledgeable about biological
variations that exist among specific cultural, racial, and ethnic
groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
19. I am knowledgeable of keywords and
phrases needed to communicate effectively with the major groups with
limited English language proficiency that are served by our program.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
20. I seek out clinical opportunities for
my students to care for clients who are culturally, racially, and
ethnically diverse.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
21. I am knowledgeable about diseases that
have a high incidence among cultural, racial, and ethnic groups in our
service area.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
22. I am in contact with individuals, who
provide health services to groups that are culturally, racially, and
ethnically diverse.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
23. I require that students be
knowledgeable about diseases that have a high incidence among clients in
our service area, from diverse cultural, racial, and ethnic groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
24. I am aware of some of the stereotyping
attitudes and preconceived notions and feelings that I have towards
members of other cultural, racial, and ethnic groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
25. I have a clear understanding of the
difference in meaning of the following terms: acculturation,
assimilation, and socialization.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
26. I am confident that I possess the
necessary skills and experience to select and work with appropriate
translators as needed to care for clients with limited English language
proficiency.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
27. I keep abreast of the major health
concerns and issues of culturally, racially, and ethnically diverse
client populations residing in my program's service area.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
28. I attend holiday celebrations within
culturally, racially, and ethnically diverse communities.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
29. My students are expected to demonstrate
knowledge of their clients' worldviews, beliefs, and practices by
incorporating this knowledge in their plans of care.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
30. I am knowledgeable about diseases that
are common in the countries of origin of recent immigrants to our
service area.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
31. When working with clients of limited
English language proficiency, family members are most preferable for
providing interpretation services.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
32. I have spent extended periods of time
(i.e., at least seven consecutive days) living among people from
cultural/ethnic/racial groups different from my own.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
33. I screen books, movies, and other media
sources for negative cultural, racial, or ethnic stereotypes before
using them in my courses or sharing them with clients cared for by me,
or by my students.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
34. I am interested in becoming culturally
competent because it is the politically correct thing to do.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
35. I am personally and professionally
committed to providing nursing care that is culturally competent.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
36. I am personally and professionally
committed to teaching how to provide nursing care that is culturally
competent.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
37. I advocate for the review of my
program's mission statement, goals, policies, and procedures to insure
that they incorporate principles and practices that promote cultural and
linguistic competence.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
38. The administrators of my program should
be the ones responsible for seeking out clinical experiences with
culturally, racially, and ethnically diverse groups in our service area.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
39. I teach my students that the client's
culture is a determining factor in the client's perception of health and
illness and in his or her adherence to the prescribed treatment regimen.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
40. I am knowledgeable about the
socio-economic and environmental risk factors that contribute to the
major health problems of culturally, ethnically, and racially diverse
populations served by my nursing program.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
41. I patronize business in my service area
that are owned by people who are culturally, racially, and ethnically
diverse.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
42. I encourage my students to examine
their attitudes, preconceived notions and feelings towards members of
other cultural, racial, and ethnic groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
43. I know the prevailing beliefs, customs,
norms, and values of the cultural, racial, and ethnic groups, other than
my own, residing in our service area.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
44. I teach my students to recognize
presenting signs and symptoms as they are manifested in individuals who
are culturally, racially, and ethnically diverse.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
45. Additional content on cultural
competence is not necessary in my program's curriculum.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
46. The cultural assessment tool that I use
elicits information about client's dietary practices, health beliefs,
and social organization.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
47. There are more differences within
cultural groups than across cultural groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
48. I am knowledgeable about the population
percentages of the major ethnic groups living in my service area.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
49. I do not feel comfortable asking
questions that relate to the client's cultural/racial/ethnic background.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
50. I teach my students that when working
with clients who are culturally, racially, or ethnically different, they
should become familiar with (each client's) indigenous beliefs and
practices.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
51. I believe that failure to explore my
own culture's influence on the way I think and behave may lead me to
impose my own values and beliefs on my clients.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
52. What I believe about health, illness
and preventive health is influenced by my culture.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
53. I have a clear understanding of the
difference in meaning of the following terms: immigrant, alien resident,
and citizen.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
54. I accept that male-female roles may
vary significantly among different cultures and ethnic groups.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
55. I am confident that I can effectively
assess conditions such as pallor, jaundice, and cyanosis in clients of a
race or ethnicity different from my own.
Strongly Agree
Agree
Undecided
Disagree
Strongly
Disagree
Please, provide the following
information about yourself:
56. How long have you been teaching nursing?
If less than a (one) year, please give the number of months.
Please use numeric characters only (e.g. 5 or 9). Do not type in the
word 'years" or "months." Round numbers down or up to the nearest whole
number.
1.
Months
2. Years
57. What is your age group?
1. 20 to 30 years
2. 31 to 40 years
3. 41 to 50 years
4. 51 to 60 years
5. 61 and above
58. At what level in your nursing
school do you teach? (Please, circle all that apply).
1. Associate
2. Baccalaureate
3. Master's
4. Doctorate
59. Have you resided in a country (of
different culture from your own) for more than six months?
1. Yes
2. No
60. If yes, name of country:
61. What is your racial/ethnic background
classification?
1. American Indian/Alaskan Native
2. African American/African
3. Caucasian
4. Hispanic
5. Asian
6. Native Hawaiian/Pacific Islander
7. Other (Please specify)
62. What is the highest degree you have earned?
1. Bachelor's
2. Master's
3. Doctorate
63. With which school are you
affiliated?
64. What is your nursing specialty area?
(Please check all that apply).
1. Adult health
2. Community Health
3. Child Health and illness
4. Childbearing
5. Psychiatric Nursing
6. Women's Health
7. Nursing Administration
8. Trans-cultural Nursing
9. Gerontology
10. Other (Please list, if necessary)
65. Have you attended/completed any
continuing education program on trans-cultural nursing/cultural competence in the
past five years?
1. Yes
2. No
66. If (item 65, above,) is yes, how many
have you attended?
67. Estimate the percentage of each of the
following groups in your nursing program:
1. American Indian/Alaskan Native
2. African American/African
3. Caucasian
4. Hispanic
5. Asian
6. Native Hawaiian/Pacific Islander
7. Other (Please specify)
68. Do you assess how your
students' cultural beliefs and values influence their attitudes towards
education and learning?
1.
Yes
2.
No
69. Do you evaluate how
your students' cultural beliefs and values influence their learning
styles?
1.
Yes
2.
No
Comments:
THANK YOU VERY MUCH