CORRELATES OF CULTURAL SELF-AWARENESS AND TURNOVER INTENTION

OF STAFF NURSES IN MULTICULTURAL DIVERSE ENVIRONMENT

Submitted By:

HAMOUD L. UTO

MAN-DL, AY 2022-2023

Wesleyan University Cabanatuan City, Philippines

Thesis Writing

Dr. John Jason M. Villaroman

Adviser

September 2022
This is to certify that the master’s thesis entitled “CORRELATES OF CULTURAL
SELF-AWARENESS AND TURNOVER INTENTION OF STAFF NURSES IN
MULTICULTURAL DIVERSE ENVIRONMENT” prepared and submitted by
HAMOUD L. UTO in partial fulfillment of the requirements for the degree of Master of
Arts in Nursing has been examined, accepted, and approved.

John Jason M. Villaroman, PhDNed, RN

Adviser

The Members of the Evaluation Panel that met on ____ 2022, for the Oral Defense of the
student endorsed acceptance of this master’s thesis as partial fulfillment of the
requirements for the degree of Master of Arts in Nursing

WILFREDO C. RAMOS, EdD, RN

Chairman
GLENN A. GUIRA, PhD, RN
Member
JAN RAINIER C. BALARIA, PhD, RN, RM
Member

This master’s thesis is hereby officially accepted and approved as partial fulfillment of the
requirements for the degree of Master of Arts in Nursing

WILFREDO RAMOS, EdD, RN

Dean, College of Nursing and Allied Medical Sciences
 CERTIFICATION OF PROOF-READING

This is to certify that the master’s thesis entitled CORRELATES OF CULTURAL SELF-
AWARENESS AND TURNOVER INTENTION OF STAFF NURSES IN
MULTICULTURAL DIVERSE ENVIRONMENT” has been reviewed and evaluated
grammatically. The manuscript has been run through Original and has a Similarity Matrices
of Index (SMI) of __%, which passes the requirements of the College of Nursing and Allied
Medical Sciences.

This certification is issued to Mr. Hamoud L. Uto in compliance to the completion of her
study for the degree Master of Arts in Nursing

Given this ____th day of _____2022.

MICHAELA JENNARINE DL. CRUZ,

PhD
Language Expert
 COPYRIGHT STATEMENT

(1) The author of this thesis (including any appendices) owns any copyright in it (the
“Copyright”), and he/she has given Wesleyan University-Philippines the right to use such
Copyright for any administrative, promotional, educational, and/or teaching purposes.

(2) Only the abstract page of this thesis may be physically reproduced without prior
permission. While a full digital copy of the thesis may be accessed and downloaded
through the WU-P Institutional Repository, printing the PDF in full or in extracts will be
upon the written approval of the writer or the College Dean of the Degree Program of the
thesis.

(3) The ownership of any patents, designs, trademarks, and any all other intellectual
property rights except for the Copyright (“the Intellectual Property Rights”), which may be
described in this thesis, may not be owned by the author and may be owned by third
parties. Such Intellectual Property Rights and Reproductions cannot and must not be made
available for use without the prior permission of the owner(s) of the relevant Intellectual
Property Rights and/or Reproductions.

DECLARATION
No portion of the work referred to in the thesis has been submitted in support of an
application for another degree or qualification of this or any other university or other
institutes of learning.

Hamoud L. Uto September 2022

ABSTRACT
The researcher surveyed to determine the significant association between the socio-
demographic profiles of the respondents, and the level of cultural awareness of staff nurses
together with the level of turnover intention in a multicultural diverse environment. The
study made use of a self-evaluated questionnaire. The questionnaire was evaluated by a
panel of experts. A pilot study will be conducted on 10 respondents. Descriptive statistics
such as percentage, weighted mean, and Pearson's Chi-Square were used.

Staff nurses' cultural competency is something that needs to be taken seriously on a global
scale. Increased awareness of one's cultural features will make staff nurses knowledgeable
and avoid conflict which conflict will eventually resort to turnover intentions. To increase
their understanding of cultural differences, professionals working at various healthcare
system levels will need to receive cultural competence training. it showed a negative
correlation between the respondents' sociodemographic characteristics and the staff nurses'
cultural awareness. It implies that these socio-demographic factors have no bearing on the
staff nurses' awareness of other cultures. On the other hand, there is a link between staff
nurses' intentions to leave the profession and cultural awareness.

These results demonstrated the necessity of staff nurse training given their propensity to
quit their jobs as a result of minor cultural differences that cause conflict at work. Staff
nurses demonstrate sufficient cultural knowledge and a sense of accountability to own their
mistakes and learn from them in a multiethnic environment. Staff nurses do not need to
provide patients with diverse ethnic backgrounds with distinct care. Together, they provide
nursing services to people of all ages, political beliefs, and nationalities, including high-
ranking officials and regular people. Based on their intentions to leave their current jobs,
the majority of respondents indicated a little propensity to quit their professions. Staff
nurses' plans to quit their jobs can predict the behaviors that are associated with turnover.

Keywords: Turnover, Cultural Awareness, Multicultural, Staff Nurses, Cultural

Competence

ACKNOWLEDGMENTS
 The researcher would like to offer his sincere appreciation and gratitude to

everyone who contributed to the success of this research in any form.

First and foremost, he is eternally thankful to the Almighty God for showering him

with insight, strength, knowledge, blessings, and guidance throughout his research and for

making this study possible.

He would also like to thank his family and friends for their unwavering support,

motivation, and belief in him throughout the entire process. He could not have done it

without their constant prodding of her back.

His deep gratitude goes to his thesis advisor, Dr. John Jason M. Villaroman, for

his interest and guidance during this academic endeavor. His timely insights, suggestions,

and excitement allowed her to complete this thesis.

He would also like to convey his gratitude to the panel members, Dr. Wilfredo C.

Ramos, EdD, RN, Dr. Glenn A. Guira, Ph.D., RN, and Dr. Jan Rainier C. Bavaria,

PhD, RN, RM, for their assistance and contribution to the success and reliability of his

research. From the proposal defense to the final defense, their suggestions, encouragement,

and excellent direction have considerably contributed to the advancement of this research.

In addition, he would like to thank Dr. Ali G. Mamaclay, Ph. D., his statistician,

for patiently examining his data and addressing his never-ending statistics queries. He is

especially grateful to Dr. Michaela Jennarine DL. Cruz, Ph. D., his language expert, for

her prompt review and advice on making his study professional and acceptable.
 The researcher would also like to extend his gratitude to all Prince Mohammad Bin

Abdulaziz Hospital staff nurses in the Kingdom of Saudi Arabia for their aid, support, and

collaboration to complete his study.

Finally, he would like to thank his Nursing Education and Research Department for

providing him with numerous opportunities that made this study feasible. When they were

aware that he was preparing for a defense, they accommodated him by granting him

additional time and assigning his minimal work. He highly appreciates the motivation and

consideration that they have given him.

He may not remember everyone who assisted him along the way, but he will

always be grateful. This is history and the success of everyone's efforts. He hopes that this

study will be used in the future to broaden understanding among staff nurses.

DEDICATIONS
 This study is dedicated to my cherished parents, who have been a consistent source

of inspiration and encouragement as I work to achieve my objective.

I also dedicate this achievement to my future self. You have finally achieved

success, and this is only the beginning of your great future. Continue believing in yourself,

and do not be afraid to fall; there will always be people to help you up.

Lastly, to the Almighty Allah, who provided me with the knowledge and fortitude

to move forward.

“mudz”

TABLE OF CONTENTS
CERTIFICATION OF PROOF-READING III
COPYRIGHT STATEMENT IV
ABSTRACT AND KEYWORDS V
ACKNOWLEDGMENTS VI
DEDICATIONS VIII
LIST OF TABLES XI
LIST OF FIGURES XII
LIST OF ABBREVIATIONS XIII

CHAPTER 1. INTRODUCTION 1
Rationale 1
Review of Related Literature 2
Cultural Diversity 3
Cultural Self Awareness 6
Turnover Intention 8
Synthesis 12
Theoretical Framework 13
Conceptual Framework 15
Statement of the Problems 16
Research Hypothesis 17
Significance of the Study 17
Definition of Keywords 18

CHAPTER 2. METHODOLOGY 19
Research Design 19
Research Locale 20
Sampling Procedures 21
Scope and Delimitations 21
Research Instrument 22
Data Gathering Procedures 23
Data Analysis 24

CHAPTER 3. RESULTS AND DISCUSSION

Presentation, Analysis, and Interpretation of Data 28
1. Socio-Demographic Profile of the Respondents 28
2. Cultural Competence Self-Assessment Checklist 34
3. Turnover Intention of Staff Nurses 38
4. Significant association between socio-demographic profile and
level of cultural awareness of staff nurses in Mulala’s culturally diverse
environment in Prince Mohammad Bin Abdulaziz Hospital, in the
 Kingdom of Saudi Arabia 40
5. Significant relationship between the level of cultural self-awareness and
turnover intention of the staff nurses in a multicultural diverse environment
in Prince Mohammad Bin Abdulaziz Hospital, in the Kingdom of 43
Saudi Arabia.
6. Enhancement training program can be offered based on the results of the study 46

Proposed Enhancement Training Program of the Researcher 46

Summary 48
Conclusions 50
Recommendations 51

REFERENCE MATERIALS 52
BIBLIOGRAPHY 52
APPENDICES 55
Appendices A. Research Questionnaire 55
CURRICULUM VITAE 61

LIST OF TABLES

Table 1: The verbal interpretation of the weighted mean 25

Table 2: Socio-Demographic Profile of the Respondents According to Age 28
 Table 3: Socio-Demographic Profile of the Respondents According to Sex 29
Table 4: Socio-Demographic Profile of the Respondents According to Nationality 30
Table 5: Socio-Demographic Profile of the Respondents
According to Highest Educational Attainment 30
Table 6: Socio-Demographic Profile of the Respondents
According to Length of Service 31
Table 7: Socio-Demographic Profile of the Respondents
According to Area of Assignment 32
Table 8. Cultural Competence Self-Assessment Checklist 34
Table 9: Turnover Intention Of Staff Nurses 38
Table 10: Correlation between socio-demographic profile and
level of cultural awareness of staff nurses in Prince Mohammad
Bin Abdulaziz Hospital 40
Table 11: Correlation table between the level of cultural self-awareness
and turnover intention of the staff nurses in Prince Mohammad
Bin Abdulaziz Hospital 43
Table 12: Enhancement Training Program Ranked by Priority 46

LIST OF FIGURES

Figure1: Schematic diagram of Theoretical Framework of the Study 14

Figure 2: Schematic Diagram of the Conceptual Framework of the Study 15
Figure 3: The Map of Prince Mohammad Bin Abdulaziz Hospital (PMBAH) 20

LIST OF ABBREVIATIONS

CCC Critical Cultural Competence

ER Emergency Room

HEA Highest Educational Attainment

ICU Intensive Care Unit

KSA Kingdom Of Saudi Arabia

LMIC Low And Middle-Income Countries

NICU Neonatal Intensive Care Uni

OPD Out Patient Department

OR Operating Room

PICU pediatric intensive care unit

PMBAH Prince Mohammad Bin Abdulaziz Hospital

SPSS Statistical Package for the Social Sciences

TIS Turnover Intention Scale

US DHS OMH United States Department of Human Services Office of Minority

Health

CHAPTER 1. INTRODUCTION

Rationale
 Nowadays, the healthcare environment has become more diverse as we are also in the

process of globalization. It is a great challenge as a healthcare worker to be in an environment

where your culture is different. Nurses work in a very busy and stressful environment, and being

in an area where cultural diversity is prominent is indeed a great challenge. Cultural awareness

is all about recognizing and understanding that we all have different values shaped by our

diverse cultural backgrounds. What we consider to be normal behavior in one country can be

entirely different in another. By being respectful of others and accepting people's opinions,

rights, and feelings – even when they are different from our own – we allow ourselves to

develop more successful personal and professional relationships and benefit from cultural

diversity.

Despite the fact that a large number of nurses are deployed each year, certain hospitals

continue to have nursing shortages.One of the main reasons is that many nurses choose to leave

nursing and pursue a different career path, such as that of a businessman or businesswoman.

Some nurses also choose to transfer to another hospital due to some circumstances they

experienced in their current organization or institution. However, there are few studies if the

diverse culture is a factor in the nurses' turnover intentions. Culture encompasses behaviors,

beliefs, values, and symbols that are passed along by communication from one generation to the

next. On the other hand, education is the process of cultivating human potential in a person so

that he or she can contribute to their own personal growth as well as those of others. Cultural

self-awareness refers to the awareness of how culture has influenced oneself (Lu et al., 2018).
 People must develop a collective self-understanding of themselves, an understanding of

how they think, feel, do things, and relate to others in their family, community, and society. This

also includes understanding their aspirations toward their total well-being. In an educational

environment where many cultures are represented, it is important that the environment is

inclusive and every culture is embraced. Training programs on how to cope in a new and diverse

environment in ways that develop strong, culturally relevant interpersonal skills have been

missing in many institutions (Iskandarova et al. 2017). Cultural awareness and cultural

competence have become important skills in higher education as populations continue to grow in

diversity around the world.

Nurses’ cultural self-awareness is very important for every institution. The high turnover

intention should also be given attention as nurses are exposed to culturally diverse environments

due to globalization. This issue greatly needs to be addressed. This study aims to understand the

level of cultural awareness of the nurses and their intention to turnover intention. Moreover, this

study seeks to determine the relationship between the cultural self-awareness and the intention

of turnover of staff nurses in a multicultural, diverse environment.

Review of Related Literature

The following are the relevant literature and studies that will guide this study.

Cultural Diversity

With the rapid development of society, more and more cross-cultural began to integrate

into our local culture. Nursing students should not only learn nursing knowledge but also learn

how to meet the cultural needs of different patients under cross-culture backgrounds. Leininger
(1978) was the first person who put forward the theory of cross-cultural nursing, and guided

nursing students to understand cross-cultural knowledge. Nursing students often helped others

when they enter the profession. They often wanted to take part in tasks, serve, study abroad or

develop their cultural competence. The nursing students could understand that every culture had

its advantages and should be discovered, valued, and understood as the best medical care for

patients (Wright, 2011). Therefore, the nursing students learned and gained experience in a

cross-cultural background, and people of different local could get better quality of care in future

clinical.

Before 2010, there was little research about cross-cultural nursing learning in the world

(Allen, 2010). In the early stage, only two studies talked about the effect of integrating cross-

cultural nursing into the three-year nursing course (Felder, 1990; Hagey & Mackay, 2000). Then

Allen began to study the contents of learning regarding cross-cultural care for nursing students

in 2010 (Allen, 2010). With the increasing frequency of international exchanges and the

improvement of medical standards, the demand for cross-cultural patients would become more

complex and harsher. The scope of cross-cultural nursing education was not extensive, and

limited resources were only from the Western or a few domestic resources to determine which

teaching strategies and content were most suitable for the development of culture (Lenny &

Peng, 2014). Nursing students acquired early cross-cultural knowledge when they received

nursing education, which enriched knowledge and laid a good foundation for clinical work,

therefore, exploring the nursing students' learning experience under the cross-cultural
background could improve the learning effect of nursing students and promote the quality of

nursing care in cross-cultural nursing in the future (Wittmann-Price et al., 2010).

According to the study by (Erni Tanius, et al., 2018), they identified the level of cultural

diversity and its impact on interaction level as well as turnover status. They determined the

correlation among the variables as well as identified if there is a significant difference between

age and educational levels with cultural diversity levels. The data was collected from 100

respondents by using a questionnaire survey and analyzed using SPSS. Meanwhile, descriptive,

statistics and correlation coefficients were used to answer the objective of the study. The result

indicated that there is a significant correlation between cultural diversity and turnover status, the

highest alert on cultural diversity is among respondents at age 21 to 30 years old. It is also

confirmed that there is a significant difference between respondents’ educational level and their

knowledge of cultural diversity and interaction level. The study recommended that manager

needs to manage diversity appropriately otherwise the turnover is unavoidable.

Another study by Azinge, F. (2019), demonstrates that an organization venerates the

diversity that exists in people of different backgrounds. However, when employees from diverse

cultural backgrounds and beliefs come together in the workplace, challenging cultural issues

often arise that can create distrust and discrimination. Cultural diversity in healthcare is a

significant agenda item in human resource management leading to continuous attention in

research and practice. Minorities are vulnerable to biases and prone to low assessment ratings by

human resources personnel and peers. Cultural diversity in the healthcare industry could lead to

bias, prejudice, and stereotyping and can prevent healthcare employees from achieving shared
goals in the workplace. The purpose of this qualitative case study was to explore the leadership

strategies of health care managers from Los Angeles California organized, controlled, and

supervised employees from culturally diverse backgrounds. The conceptual frameworks for this

study were Leininger’s transcultural nursing theory and equity theory. Data were collected by

telephone interviews with the health care managers who managed diverse cultural employees and

supplemented with relative documents. Investigative triangulation and member checking were

used to validate the transcribed data, which were subsequently coded into themes. The key

themes that emerged were experienced management, hiring process, cohesion, training program

policies, effects on productivity and intimidation between groups, and strategies for job

satisfaction. The findings may help to reduce discriminatory behaviors among health care

employees in the United States and elsewhere and might help to increase harmony in the

workplace.

Cultural diversity often leads to misunderstandings, clashes, conflicts, ethnocentrism,

discrimination, and stereotyping due to the frequent intersection of many variables, such as

differences in traditions, behaviors, ethical and moral perspectives, conceptions of health and

illness, and language barriers. The root of the issue is related to the way people conceptualize

differences and the unique cultural and historical circumstances that have shaped different

groups’ heritages. In this study, therefore, we aimed to investigate the perceptions of critical

cultural competence (CCC) of registered nurses working in various hospitals across the province

of British Columbia, Canada (Almutairi et al. 2017).

Cultural Self Awareness

Nurses face particular challenges when caring for immigrant patients who are from

different cultural backgrounds. They need to be able to adapt their caring strategies to respond to

the cultural needs of their patients. Culture in this context is defined as the shared beliefs, values,

ideas, language, communication, and norms of a group of people. Moreover, cultures are

dynamic and undergo constant change, so nurses need to be flexible and responsive.

Several studies have identified that migrants often experience poorer quality of care in

contrast to the majority population. Nurses, alongside other healthcare professionals, often lack

the necessary knowledge and skills to respond to the needs of people from different cultural

backgrounds to their own. Communication difficulties, in particular, present major obstacles in

cross-cultural care encounters, i.e., an encounter between a nurse and a patient who are from

different cultural backgrounds.

The study of Gillson et al., (2019), which is the findings of cultural diversity in

Baccalaureate Nursing Education: An Overview Teaching and learning about culturally

competent practice in pre-licensure nursing programs are needed to ensure a culturally competent

health care workforce. The following is a scenario the author employed to teach cultural

competency and congruency in a baccalaureate level nursing program within a small, private,

university that contained a very diverse student population with 69% of students being from a

racial or ethnic minority group (Houston Baptist University, 2018). Exploration of cultures

within the community can help students to get outside of their comfort zone and expand their

cultural views.
 The study of Boyle (2019), which is the interdisciplinary hospice team members,

including nurse practitioners, registered nurses, licensed vocational nurses, hospice home health

aide assistants, social workers, chaplains, and physicians, must provide culturally congruent care

to all hospice recipients (United States Department of Human Services Office of Minority Health

[US DHS OMH], 2018). The purpose of this clinical scholarly project was to determine if the

cultural self-awareness competency of the hospice interdisciplinary team members will improve

after taking the web-based cultural diversity module. The project took place at a small hospice

agency in Southern California and used a pre-and post-test design with the Cultural Competency

Assessment tool analysis revealed that the participant's cultural awareness and sensitivity

improved post-intervention by 6.6%. The finding supports the use of an online cultural self-

awareness module in promoting culturally competent care. With the right education tool, the

hospice interdisciplinary team members can importer their levels of cultural competency, which

is a necessary step in the hospice clients receiving culturally congruent care at the end of life.

The study of Henderson et al., (2018) also aims to conduct a concept analysis on cultural

competence in community healthcare. Clarification of the concept of cultural competence is

needed to enable clarity in the definition and operation, research, and theory development to

assist healthcare providers in better understanding this evolving concept. Rodgers’ evolutionary

concept analysis method was used to clarify the concept's context, surrogate terms, antecedents,

attributes, and consequences and to determine implications for further research. Articles from

2004 to 2015 were sought from Medline, PubMed, CINAHL, and Scopus using the terms

“cultural competency” AND “health,” “cultural competence” OR “cultural safety” OR “cultural

knowledge” OR “cultural awareness” OR cultural sensitivity OR “cultural skill” AND “Health.”

Articles with antecedents, attributes, and consequences of cultural competence in community

health were included. The 26 articles selected included nursing (n = 8), health (n = 8),

psychology (n = 2), social work (n = 1), mental health (n = 3), medicine (n = 3), and

occupational therapy (n = 1). Findings identify cultural openness, awareness, desire, knowledge,

sensitivity, and encounter antecedents of cultural competence. Defining attributes are respecting

and tailoring care aligned with clients’ values, needs, practices, and expectations, providing

equitable and ethical care, and understanding. Consequences of cultural competence are

satisfaction with care, the perception of quality healthcare, better adherence to treatments,

effective interaction, and improved health outcomes. An interesting finding is that the

antecedents and attributes of cultural competence appear to represent a superficial level of

understanding, sometimes only manifested through the need for social desirability. What is

reported as critical in sustaining competence is the career’s capacity for a higher level of moral

reasoning attainable through formal education in cultural and ethics knowledge. Our conceptual

analysis incorporates moral reasoning in the definition of cultural competence. Further research

to underpin moral reasoning with antecedents, attributes, and consequences could enhance its

clarity and promote a sustainable enactment of cultural competence.

Turnover Intention

Turnover intention is presently defined assess an act of voluntary departure or transfer of

members of the organization, exploring other jobs, thinking about turnover, or an individual

nurse's decision for leaving a nursing unit and perhaps even leave the facility. The intention to
leave a job is “a deliberate and conscious determination to quit the organization”. Scholars term

turnover intention as “person‟ own expected probability (subjective) that they are quitting the

organization permanently at some spot in the close to future” (Liu & Low, 2011). Turnover

intention is currently understandable as an employee’s preference to quit his or her organization

refers to that an employee is unable to remain in the organizational part (Lacity et al., 2008).

Bodla & Hameed (2008) suggested that the employees' turnover will have significant costs or

risk of losing social assets. The research also found the measurement of the employees' turnover

intention, which is an uncontrollable and controllable force. Five var variables are identified,

which are satisfaction with management, satisfaction with salary, satisfaction with working

conditions, job stress, and, organizational commitment. According to Jeffrey (2007), if the

mistrust of management is pervasive and disappointment among workers would lead to

decreasing job tenure, and increasing turnover intention. As a result, the employer should not

lose sight of this factor. While the researchers who are conducting research want to perfectly

know turnover behavior, in authenticity, it is frequently complicated to empirically observe the

behavior. While in reality, researchers generally survey recent workers and turnover intention is

to ask them.

Intentions to leave a job are a consistent predictor of turnover behaviors. Considerable

empirical proof supports the theory that attitude affects behavior more than behavior affects

attitude (Lacity et al., 2008). Based on the above definitions, turnover intention can be defined

as the wish of workers to intentionally choose to leave the recent organization shortly. Intention

to leave is one of the antecedents of actual turnover. Several antecedents have been identified by
many scholars for turnover intention. These include irritation with jobs, violation of the

psychological contract, and organizational commitment (Orvis et al., 2008). The determinants of

employee turnover have great application to the employee who is thinking about quitting, also

for the executive who is faced with the lack of employee stability, In the orientation and

guidance of new employees, and the issue of organizational output and high costs involved

(Siong, Mellor, Moore & Firth, 2006; Firth et al., 2004). According to Lehane and McCarthy

Tyrrell (2007), intentions are the most direct determinant of exact behavior.

To study by Majeed (2021), explored the influence of leader emotional intelligence on

the working culture prevailing in teams that ultimately impacts nurses’ intent to leave the job.

Global shortages of nursing professionals have been concerning issues of extreme vitality in the

delivery of superior services. Though the state‐of‐the‐art system provides relief, the hospital

management continued worrying about losing highly skilled nursing professionals due to a

higher level of emotional exhaustion exhibiting progressive turnover. A survey technique was

employed for data collection from nurses. Further data were analyzed by structural modeling in

light of 313 substantial responses using Smart PLS. The findings revealed that leader emotional

intelligence impulses critical constructive effects by fulfilling the needs of nurses and has an

impact on their turnover intentions simultaneously. The research provides an empirical lens of

leadership and culture, which noticeably explain turnover intention. This study affirmed solid

connections between the leader's emotional intelligence, team culture, and turnover intentions.

Implications for nursing management. The study provides valuable insight for health

management organizations to focus on factors that decrease the turnover intention of nurses.
Considering With the global shortage of nurses, nursing management must consider crucial

aspects of the work environment and plan interventions to restrain nursing turnover intentions.

Another study by Gunasekara (2019), seeks to explore the impact of occupational stress

on the turnover intention of women bankers in Galle district private banks in Sri Lanka. There is

an empirical knowledge gap in the Sri Lankan context on the impact of occupational stress on the

turnover intention of women bankers. The main objective of this research is to identify the

impact of occupational stress on the turnover intention of women bankers in Galle district private

banks in Sri Lanka. The data were collected from a convenient sample of 100 women bankers

from 05 selected private banks which referred to the collection of information from the

employees who were conveniently available to provide it. Data are collected from a structured

questionnaire which consisted of 7 questions regarding demographic variables and 17 questions

regarding occupational stress and 10 questions regarding turnover intention on 05 points Likert

scale. Data were analyzed using univariate analysis, correlation analysis, and simple regression

analysis with the SPSS (version 22.0). According to the findings of the study, there was a

positive association between workload, working conditions, salary, social image, and supervisory

support with employee turnover among the women bankers in selected private sector banks.

Therefore study concluded that there is an impact of occupational stress on the turnover intention

of women bankers. The management has to develop appropriate strategies to reduce occupational

stress to minimize turnover intention.

Synthesis
 Care for patients who are immigrants and come from varied cultural backgrounds

presents unique challenges for nursing staff. A culturally competent workforce must be ensured,

which calls for the teaching and learning of culturally competent practice in pre-licensure

nursing programs. Cultural diversity and turnover status are significantly correlated, with

respondents between the ages of 21 and 30 showing the highest level of awareness of this

relationship. One of the factors that precede real turnover is the intention to depart. According to

Jeffrey (2007), decreased job longevity and increased turnover intention would result from

widespread employee dissatisfaction and management mistrust. Findings showed that a leader's

emotional intelligence has a significant positive influence by meeting nurses' needs and

influencing their desire to leave the profession.

A body of research has been presented to support the study's claim. Cultural self-

awareness is the understanding of how one's own identity has been shaped by culture (Lu et al.,

2018). Education is the process of developing a person's potential so that they can contribute to

their own growth and the progress of others. Additional research by F. Azinge (2019)

exemplifies how an organization values diversity among employees from various origins. A

concept analysis of cultural competency in community healthcare is the goal of the study by

Henderson et al. (2018).Further research to underpin moral reasoning with antecedents,

attributes, and consequences could enhance its clarity and promote a sustainable enactment of

cultural competence. The study of Majeed (2021) explored the influence of leader emotional

intelligence on the working culture prevailing in teams that ultimately impacts nurses' intent to

leave the job.

 This body of study indicates the pressing need for staff nurses to get training to improve

their cultural sensitivity. One of the components that come before real turnover is the desire to

depart. Widespread employee discontent and management mistrust would lead to a decline in job

length and an increase in turnover intention. The findings showed that a leader's emotional

intelligence has a significant positive effect on meeting nurses' needs and influencing their

readiness to leave the profession.

Theoretical Framework

The study was based on Campinha-Bacote’s Model of Cultural Competence. The model

considers cultural competence not as a consequence brought about by certain factors, but as a

process. The concept of cultural competence can be defined as a process in which the nurse

attempts to achieve greater efficiency and the ability to work in a culturally diverse environment

while caring for the patient, whether an individual, a family, or a group. To achieve cultural

competence, a nurse must undertake a process of developing the capacity to deliver efficient and

high-quality care, a process that encompasses five components. The first involves cultural

awareness, a process in which healthcare professionals consciously acknowledge their cultural

backgrounds, which helps them avoid biases toward other cultures. The second component is

cultural skill, defined as the ability to obtain the necessary information from patients via

culturally appropriate conduct and physical assessment. The third component is cultural

knowledge, a process in which healthcare professionals open their minds to understand

variations in cultural and ethnic traits as they relate to patient attitudes toward illness and health.
The fourth component is cultural encounters during which stereotyping is avoided through the

interaction between healthcare professionals and members of different cultures. During this

process, reliance on over-reliance, on conventional views is discouraged. The fifth and last

component is cultural desire, which is the driving force for becoming educated, skilled,

competent, and aware of culture; it also presumes a willingness to have trans-cultural

interactions.

This theory is relevant to the study since it stresses the value of cultural competency in

healthcare professionals. He possesses cultural awareness in addition to this cultural

competency. It entails critically analyzing one's cultural and professional background as well as

doing a self-examination of one's prejudices against other cultures.

Figure 1. Schematic diagram of Theoretical Framework of the Study

 Conceptual Framework

The schematic diagram shows how the researcher approached the phenomenon being

investigated. This framework shows the interplay of the independent and dependent variables.

The independent variables will be the socio-demographic profile and the level of cultural

awareness of the respondents. The dependent variable will be the turnover intention of the

respondents to their work. The relationship between both variables will also be studied.

Based on the result of the study, enhancement training will be conducted among the staff

nurses of PMBAH, which will help them be equipped with the cultural competencies that will

help them in the diverse nature of their work.

INDEPENDENT VARIABLE DEPENDENT VARIABLE

Socio-Demographic Data:
1. Age
2. Sex
3. Nationality
4. Highest educational attainment
5. Length of Service Turnover Intention
6. Area of Assignment

Level of Cultural Awareness

Enhancement Training

Figure 2. Schematic Diagram of the Conceptual Framework of the Study

 To answer research question 1, the study identified the respondents’ socio-demographic

profiles. The level of cultural self-awareness of the staff nurses in a multicultural, diverse

environment in Prince Mohammad Bin Abdulaziz Hospital, the Kingdom of Saudi Arabia, was

determined through question number two (2). The extent of the turnover intention of staff nurses

in a multicultural, diverse environment in PMBAH was also determined by question number

three (3).

Similarly, the research hypotheses in research questions five (5) and six (6) determined

the significant associations between socio-demographic profile and level of cultural awareness of

staff nurses, as well as the significant relationship between the level of cultural self-awareness

and turnover intention of staff nurses in a multicultural diverse environment. 

Statement of the Problem:

This study seeks to determine the relationship between cultural awareness and turnover

intention of staff nurses in a multicultural diverse environment in Prince Mohammad Bin

Abdulaziz Hospital, in the Kingdom of Saudi Arabia. Specifically, the study seeks to find

answers to the following:

1. What is the socio-demographic profile of the respondents in terms of;

A. Age;

B. Sex;

C. Nationality;

D. Highest educational attainment;

 E. Length of service; and

F. Area of assignment?

2. What is the level of cultural self-awareness of the staff nurses in a multicultural

diverse environment in Prince Mohammad Bin Abdulaziz Hospital, the Kingdom of

Saudi Arabia?

3. What is the extent of the turnover intention of staff nurses in a multicultural diverse

environment in Prince Mohammad Bin Abdulaziz Hospital, in the Kingdom of Saudi

Arabia?

4. Is there a significant association between socio-demographic profile and level of

cultural awareness of staff nurses in Mulala’s culturally diverse environment in

Prince Mohammad Bin Abdulaziz Hospital, in the Kingdom of Saudi Arabia?

5. Is there a significant relationship between the level of cultural self-awareness and

turnover intention of the staff nurses in a multicultural diverse environment in Prince

Mohammad Bin Abdulaziz Hospital, in the Kingdom of Saudi Arabia?

Hypotheses

1: There is no significant relationship between the socio-demographic profile and the

turnover intention of the respondents.

2: There is no significant relationship between the level of cultural self-awareness and

the turnover intention of the respondents.

Significance of the Study

The following are the beneficiaries of this study:

The Society. This study will provide information to society regarding the importance of cultural

self-awareness and its relation to the turnover intention of the healthcare worker.

Nurses. This study can be a voice to emphasize the importance of cultural self-awareness in the

nursing profession.

Respondents. The results of this study will help enlighten the respondents on what factors help

influence their attitude toward cultural awareness and hopefully, they will be to gain more

knowledge.

Future Researchers. This study will serve as a handy reference for other researchers who

would embark on a similar study in the future, especially certain aspects that may not be derived

from the said study. They can gain new perspectives by being aware of the study.

Definition of Terms

Awareness. The state of being conscious of something. More specifically, it is the ability

to directly know and perceive, feel, or be cognizant of events.

Cultural Awareness. Being cognizant, observant, and conscious of similarities and

differences among and between cultural groups. This study will be measured using a tool.
 Culture. A way of life of a group of people--the behaviors, beliefs, values, and symbols

that they accept, generally without thinking about them, and that are passed along by

communication and imitation from one generation to the next.

Turnover Intention. The act of voluntary departure or transfer of members of the

organization, exploring other jobs, or thinking about turnover. It is an individual nurse’s

decision for leaving a nursing unit and perhaps even leave the facility. In this study, turnover

intention refers to the decision of nurses working in PMBAH to leave the hospital where he /she

works for good or the decision to transfer to other hospitals.

CHAPTER 2. METHODOLOGY

Research Design

This research adopted the quantitative design, descriptive- correlational approach.

Descriptive quantitative research design emphasizes accumulating information about a specified

subject from a considerable number of individuals at a peculiar time (Lodico, Spagentle, and V,

gentle, 2010). Thus, selected Nurse in Prince Mohammad Bin Abdulaziz Hospital will be

considered, their cultural self-awareness and turnover intention. Furthermore, the study also

used a correlational research design to determine the extent of the relationship between two or

more variables i.e., the sociodemographic profile of respondents, there their cultural self-

awareness, and turnover intention. Correlational Research Design attempts to determine whether

a relationship exists between two or more quantifiable variables and if there is a significant
relationship between two variables (Bombita, et.al. 2016). Hence, the relationship between the

profile of respondents, cultural self-awareness, and turnover intention. Overall, this study used a

descriptive-correlational

quantitative study.

Research Locale

Figure 3. The Map of Prince Mohammad Bin Abdulaziz Hospital(PMBAH)

PMBAH is the fifth National Guard Health facility in the Kingdom of Saudi Arabia after

Riyadh, Jeddah, Dammam, and Al Ahsa. It is a fully serviced facility with a 215-bed capacity,
located at the foot of Mount Uhud on Prince Naif Road; PMBAH is only minutes away from

Prince Mohammad Bin Abdulaziz Airport and the Holy Mosque – Al Masjid Al Nabawi.

National Guard hospitals are renowned for their high-quality evidence-based patient care

practices. There are tremendous opportunities for staff growth and development, as well as very

active in-house training and education through lectures, seminars, and workshops which are

regularly scheduled by the Academic Affairs, Training, and Development, and Nursing

Education Departments. In addition, more specialized courses and patient training on specialized

equipment are arranged in collaboration or sponsored by external providers.

National Guard Health Affairs gives high regard to the welfare of its workforce;

orientation and induction are given to new staff to ensure they are competent, confident, and

supported through mentorship and preceptorship to mold them into the workforce. Furthermore,

benefits and rewards are very encouraging to the staff. 

Sampling Procedures

There are an estimated 347 total staff nurses in Prince Mohammad Bin Abdulaziz

Hospital. A sample size of 183 was used applying the Raosoft formula. The margin of error is

5% with a 95% confidence level. Simple random sampling was utilized in selecting the

respondents. Simple random sampling refers to a variety of selection techniques in which

sample members are selected by chance, but with a known probability of selection. In this study,

descriptive statistics were applied for the analysis of the demographic data. Descriptive statistics
show the characteristics of a data set. Inferential statistics test a hypothesis or assess whether the

data are generalizable or not. Data were analyzed using the Statistical Package for the Social

Sciences (SPSS) software. Mean and standard deviation were the statistical analysis methods

applied to the responses of students about different coping strategies.

Scope and Delimitations

This study sought to determine the cultural self-awareness and turnover intention of the

select nurses of Prince Mohammad Bin Abdulaziz Hospital (PMBAH). Factors affecting cultural

self-awareness and turnover intention were limited only to the ones listed in the research

instrument. The study was conducted from the 10th of July to the 15th of July 2022.

Only a sample size of 183 nurses was chosen to participate in the study to facilitate the

conduct of the study and so as not to disrupt the regular working hours of the nurses and the

operations of the hospital in general.

The Research Instrument

The researcher administered a self-evaluated questionnaire which consist of three parts.

The first part determines the socio-demographic profile of the respondents. These include the

age, sex, nationality, length of service, and area of assignment of the respondents.

The second part is adapted from the Greater Vancouver Island Multicultural Society

Cultural Competence Self-Assessment Checklist. This self-assessment tool is designed to

explore individual cultural competence. Its purpose is to consider skills, knowledge, and

awareness of self in interactions with others. At the end of each section, the researcher will add

up the number of times respondents have checked that column. Multiply the number of times

respondents checked “Never” by 1, “Sometimes/Occasionally” by 2, “Fairly Often/Pretty well”

by 3, and “Always/Very Well” by 4. The more points, the more culturally competent the

respondent is.

The third part of the questionnaire is modified, from Roodt’s Turnover Intention Scale

(TIS-6). This questionnaire assesses the respondent’s intention to quit their job. It is composed

of 19 items, in checklist form, 1- No, not at all, 2- To a slight extent, 3- To some extent, 4-, Yes,

to a large extent.

Data Gathering Procedures

A series of steps were administered before conducting the study. This is to ensure that the

process is in order.

After carefully examining and reviewing the text, the researcher asked the Dean of the

Graduate School of Wesleyan University Philippines for permission and approval to set the

proposal defense date. The researcher completed and submitted the accepted research proposal

and the letters required for carrying out the study after the proposal defense. Additionally,

following the Dean's approval, the researcher sent a second letter of permission and consent to
request the hospital's management's cooperation in conducting the study and the involvement of

their staff nurses.

Before preparing the presentation, the researcher gave the adviser a copy of the study to

check for quality and relevance. The final presentation was checked again for completeness of

writing after the adviser gave his approval. It was sent for grammatical and anti-plagiarism

testing following the adviser and panel's acceptance. The researcher sent the paper's final draft to

the designated editor. After making the necessary revisions, the researcher submitted the

completed manuscript to the research panel and advisor for binding approval. Participants

received an email or personal survey forms, and this will be collected during or the day after the

distribution of the questionnaire.

Data Analysis

The researcher carefully analyzed the data gathered. The researcher will use Simple

Frequency Counting, Percentage a, and Ranking, Weighted, M, and Pearson r in analyzing the

data. The data that will be gathered will be presented in a table and figures.

The simple percentage is used to determine the profile of the respondents. The data was

analyzed using the formula:

Percentage (%) = f/N X 100

Where;

F= is the frequency of the response,

N= is the total number of respondents,

 100= is constant to do away with decimal points in the value.

P= Percentage

The weighted mean was used to determine the rank of the reasons for the choice made by

the respondents.

Formula: I NFI (xi)

N
∑ni=1 (xi*wi)
Wm=
Where; ∑ni=1wi

Wm= weighted mean

∑= Frequency

Xi= Score points

N= Number of respondents

To get the weighted range: (4-1) 0.75

4
Table 1. The verbal interpretation of the weighted mean:

Score Numerical Interpretation Numerical Interpretation Mean

Points (Cultural Competence) (Turnover Intention) Range
1 Always (Very well) Yes, to a large extent 3.25 - 4.00
2 Often (Pretty well) To some extent 2.50 - 3.24
3 Sometimes (Occasionally) To slight extent 1.75 - 2.49
4 Never No, not at all 1.00 - 1.74

Pearson Chi-squares. This is a statistical tool that is commonly used for testing

relationships between categorical variables.

Formula:

❑ 2
(f 0−f e )
❑❑ =∑ ❑
❑ fe

Where:

fo = the observed frequency

fe = the expected frequency if NO relationship existed between the variables

Reliability and Validity:

The instrument of this study has undergone validity and reliability tests. The expert panel,

including the researchers’ adviser, assessed the content validity of the research instrument to

improve and see possible corrections. In general, content validity is the measurement property

that assesses whether items are comprehensive and adequately reflect the participant's

perspective for the population of interest. It provides evidence that the conceptual framework,

the content of items, and the overall measurement approach were consistent with the perspective,

experience, and words of the participants (Brod, Pohlman, and Tesler, 2016). Experts validated

the questionnaire.

A pilot study was conducted on 10 respondents. Those 10 respondents were no longer

included in the actual study. This ensured the reliability of the instrument. Instrument reliability

was a way of ensuring that any instrument used for measuring experimental variables gave the

same results every time. Reliability concerns the extent to which a measurement of a

phenomenon provides stability and consists of stable results (Carmines and Zeller, 1979).
Reliability is also concerned with repeatability. For example, a scale or test is said to be reliable

if a repeat measurement made by it under constant conditions gives the same result (Moser and

Kalton, 1989).

Using Cronbach's Alpha Reliability with a value of 0.77%, the content validity of the

questions in the self-evaluated questionnaires was analyzed, and it was concluded that the

questions provide an acceptable value.

Ethical Considerations

This research study followed several considerations that were purposely performed so as

not to defame its respondents. It has complied with ethical considerations in researching as all

participants were given verbal and written informed consent which the researcher has explained

to them for the purpose and process that needs to be undertaken during the study including the

duration. They were also informed that they could withdraw from the study anytime without any

punishment and no money or award was tied to their participation.

Moreover, participants were informed that all the information taken remained

confidential and there was no personal identifying information on the survey instrument, and the

results of the study were to be taken and placed inside sealed envelopes to prevent any accidental

viewing by other parties and only the researcher had an access to the gathered data. There was no

risk to the participants for participating since the writing of their names was optional thus

anonymity was protected. It also explained that there was no immediate benefit from

participating but the only probable long-term benefit in the sense that with their responses staff

nurses can be able to understand the reason turnover intention in their field. Furthermore, the
researcher has consulted the ethics committee in the institution for clearance to affirm that this

research complied with the ethical standards required.

CHAPTER 3. RESULTS AND DISCUSSION

The socio-demographic traits of the respondents, the level of staff nurses' cultural

awareness, and the staff nurses' plans to leave the field are all covered in this chapter. This

chapter will also present the relationship between socio-demographic factors, the level of self-

awareness of staff nurses working in a multicultural environment, and the intention of those staff

nurses to leave their current position. These conclusions are supported by survey data. The

research questions, hypotheses, descriptive statistics, and conclusions from Chapter 1 are

reviewed in this chapter. It details the study's conclusions, implications, and limitations. Also

included are recommendations for a further research study.

Presentation, Analysis, and Interpretation of Data

1. Socio-Demographic Profile of the Respondents

Table 2. Socio-Demographic Profile of the Respondents

According to Age
 Age Frequency Percentage
25-30 67 36.61
31-35 57 31.15
36-40 39 21.31
41-45 12 6.56
46-50 7 3.83
51-55 1 0.55
Total 183 100.00
Age. Out of 183 respondents, about 67 or 36.61% belonged within the age range of 25-30

years old, followed by 57 or 31.15%within the 31-35 age bracket, and 39 or 21.31% within the

age bracket of 36-40 years old. This result implies that most of the respondents who have

cultural awareness and turnover intentions who are working in a multi-culturally diverse

environment were 25-30 years old; however, the numbers are very close to the 31-35 age

bracket. This also revealed that the mean age of the respondents was 33 years old. This result can

be associated with the majority of respondents who were identified to be in the service for 8-11

years already.

Table 3. Socio-Demographic Profile of the Respondents

According to Sex

Sex Frequency Percentage

Male 77 42.08
Female 106 57.92
Total 183 100.00
 Sex. The distribution of the respondents according to their sex characteristics showed that

out of 183 respondents, 106 (57.92%) are female, and 77 (42.08%) are male. This means that

more female nurses participated in the study compared to male nurses.

A lot of factors appear to have an impact on turnover intention. Numerous research

looked into how demographic factors including age, gender, and marital status affected nurses'

intentions to leave their employers. It was shown that younger nurses had greater levels of

turnover intention. Other researchers found that certain age groups, such as 25-44 and 30-44, had

greater levels of turnover intention. Literature also reveals that certain demographic traits, such

as male nurses, single nurses, and highly educated nurses, are present among nurses who were

considering leaving their employers. Mrayyan (2008) looked into the factors that influence a

nurse's decision to remain in a hospital in Jordan. Age was shown to be positively correlated with

nurses' intention to remain by Mrayyan (2008).

Table 4. Socio-Demographic Profile of the Respondents

According to Nationality

Nationality Frequency Percentage

Filipino 75 40.98
Malaysian 61 33.33
Egyptian 16 8.74
Jordanian 19 10.38
Saudi 11 6.01
Albanian 1 0.55
Total 183 100.00
 Nationality. The distribution of the respondents according to their nationality showed that

out of 183 respondents, 75 (40.98%) were Filipinos. On the other hand, the lowest respondent to

participate in the survey was Albanian, Saudi, Jordanian, Egyptian, and Malaysian. This only

means that most of the respondents who were culturally aware and had high turnover intentions

were Filipinos.

Table 5. Socio-Demographic Profile of the Respondents

According to Highest Educational Attainment

Highest Educational Attainment Frequency Percentage

Diploma In Nursing 56 30.60
Bachelor's Degree Graduate 109 59.56
Master's Degree Units 16 8.74
Doctorate Degree Units 2 1.09
Master's Degree Graduate 0 0.00
Doctorate Degree Graduate 0 0.00
Total 183 100.00

Highest Educational Attainment. The distribution of the respondents according to their

highest educational attainment revealed that 109 (59.56%) of the respondents having turnover

intentions hold a Bachelor's Degree; 56 (30.60%) have a Diploma in Nursing, and 16 (8.74%)

have a Master's Degree units. This result implied that most of the respondents having turnover

intentions hold a Bachelor's Degree.

Table 6. Socio-Demographic Profile of the Respondents

 According to Length of Service

Length of Service Frequency Percentage

3 years and below 9 4.92
4-7 years 43 23.50
8-11 years 67 36.61
12-15 years 36 19.67
16-19 years 19 10.38
20 years and above 9 4.92
Total 183 100.00

Length of Service. The distribution of the respondents according to their length of service

as staff nurses revealed that 67 (36.61%) of the staff nurses have 8-11 years of experience; 43

(23.50%) have 4-7 years of experience and 36 (19.67%) have 12-15 years. The result revealed

that most of the respondents have 8-11 years of experience as staff nurses and that they already

had a turnover intention.

It appears that turnover intention is a multistage process including elements of

psychology, cognition, and behavior. Within the first year of hiring, nurses experience the

highest rate of turnover (Flinkman, 2013). Personal and family duties, the work environment,

and the quality of the working life are the primary stated causes of nurses quitting their jobs.

Aside from these factors, there are corporate culture, stress at work, unreasonable job demands,

clinical competence, leader effectiveness, and promotion systems. Nurse identity,

communication, engagement, and conflict management readiness are important retention factors

(Moreland et al., 2015).

 A further finding of the study was that professional identity and staff nurses' age and

years of experience showed statistically significant positive connections. In both situations, there

were statistically significant inverse relationships between staff nurse age and years of

experience, and turnover intention. Between professional identity and intention to leave among

staff nurses in various sectorial contexts, there was a statistically significant negative association

(Hassan & El-Hosany, (2018).

Table 7. Socio-Demographic Profile of the Respondents

According to Area of Assignment

Area of Assignment Frequency Percentage

ER 59 32.24
WARD 61 33.33
ICU 22 12.02
OPD 14 7.65
OR 13 7.10
PICU 8 4.37
NICU 2 1.09
HEMODIALYSIS 4 2.19
Total 183 100.00

Area of Assignment. The distribution of respondents according to their area of

assignment showed that 61 (33.33%) of the staff nurses were assigned to a ward; 59 (32.24%) of

the staff nurses respondents were assigned to the ER; while 22 (12.02%) were assigned to the

ICU. This result implied that most of the respondents were assigned to the Ward Area which
means that they were giving their utmost service to those less fortunate patients confined to the

Ward Area.

One of the biggest issues facing low and middle-income countries (LMICs) in the

assignment of work is an uneven nursing workforce mix, which has a detrimental impact on

employment results (job dissatisfaction, higher staff turnover, and poor quality of care delivery).

According to studies (Heinen, van Achterberg, & Schwendimann, et al., 2013), RN turnover

intentions are greater in LMICs than in high-resource nations, but the reverse is not true. If this

phenomenon is not successfully addressed, health care professionals may face several difficulties

on a worldwide scale in the future. The work environment's domains have an impact on nurses'

turnover intentions, and burnout mediates this link. This data supports a previous study's

conclusion that the nurse-physician relationship, nursing leadership, staffing, and resource

sufficiency, as well as the nursing foundation for high-quality treatment, are all connected to

RNs' intentions to quit their current positions.

2. Cultural Competence Self-Assessment Checklist

Table 8. Cultural Competence Self-Assessment Checklist

  Awareness of the staff nurses in a multicultural Mean SD Verbal

diverse environment Description
1 I view human difference as positive and a cause for 3.27 0.60 Always
celebration
2 I have a clear sense of my own ethnic, cultural, and 3.27 0.56 Always
racial identity
3 I am aware that to learn more about others I need to 3.34 0.57 Always
understand and be prepared to share my own culture
4 I am aware of my discomfort when I encounter 3.30 0.64 Always
differences in race, color, religion, sexual orientation,
language, and ethnicity
5 I am aware of the assumptions that I hold about people 3.32 0.63 Always
 of cultures from my own
6 I am aware of my stereotypes as they arise and have 3.36 0.63 Always
developed personal strategies for reducing the harm they
cause.
7 I am aware of how my cultural perspective influences 3.36 0.62 Always
my judgment about what is 'appropriate’, ‘normal’, or
‘superior’ behaviors, values, and communication styles.
8 I accept that in cross-cultural situations there can be 3.35 0.63 Always
uncertainty and that uncertainty can make me anxious. It
can also mean that I do not respond quickly and take the
time needed to get more information.
9 I take any opportunity to put myself in places where I 3.37 0.61 Always
can learn about differences and create relationships.
10 I’m aware of the impact of the social context on the lives 3.37 0.63 Always
of the culturally diverse population, and how power,
privilege, and social oppression influence their lives.
11 I will make mistakes and will learn from them. 3.39 0.61 Always
Overall Weighted Mean 3.33 0.37 Always

Knowledge of the staff nurses in a multicultural diverse Mean SD Verbal

environment Descriptio
n
1 I will recognize that my knowledge of certain cultural 3.34 0.69 Always
groups is limited and commit to creating opportunities to
learn more.
2 I will listen to their answers before asking another 3.25 0.65 Always
question.
3 I know that differences in color, culture, ethnicity, etc. are 3.27 0.61 Always
important parts of an individual's identity which they value
and so do I. I will not hide behind the claim of 'color
blindness.
4 I recognize that cultures change over time and can vary 3.20 0.59 Often
from person to person, as does attachment to culture
5 I recognize that achieving cultural competence involves a 3.33 0.62 Always
commitment to learning over a lifetime
6 I recognize that stereotypical attitudes and discriminatory 3.31 0.64 Always
actions can dehumanize, and even encourage violence
against individuals because of their membership in groups
that are different from myself
7 I continue to develop my capacity for assessing areas 3.27 0.65 Always
where there are gaps in my knowledge
 8 I recognize that people have intersecting multiple identities 3.21 0.68 Often
drawn from race, sex, religion, ethnicity, etc. and the
importance of each of these identities varies from person
to person.
9 I acknowledge both inter-cultural and intracultural 3.31 0.64 Always
differences
10 I’m aware that everyone has a culture, and my own culture 3.19 0.65 Often
should not be regarded as a point of reference to assess
which behavior is appropriate or inappropriate
Overall Weighted Mean 3.27 0.38 Always

Numerical interpretation legend:

Always (Very well) 3.25 - 4.00

Often (Pretty well) 2.50 - 3.24
Sometimes (Occasionally) 1.75 - 2.49
Never 1.00 - 1.74

Awareness. The level of cultural awareness of staff nurses in the multicultural diverse

environment as to awareness obtained an overall weighted mean of 3.33 which was verbally

described as "always," or "very well." The highest mean in this indicator was item "I will make

mistakes and will learn from them," with a mean of 3.34 verbally described as "always," while

the lowest mean was item "I view human difference as positive and a cause for celebration," and

"I have a clear sense of my own ethnic, cultural and racial identity," both got a mean of 3.27

which was verbally described as "always." This result implies that the respondents’ level of

cultural awareness in a multicultural diverse environment is very well that they have the sense of

responsibility to own up to their mistakes and learn from them.

This claim was supported by the study of Gillson et al., (2019), which is the findings of

cultural diversity in Baccalaureate Nursing Education: An Overview Teaching and learning

about culturally competent practice in pre-licensure nursing programs are needed to ensure a
culturally competent health care workforce. The following is a scenario the author employed to

teach cultural competency and congruency in a baccalaureate level nursing program within a

small, private, university that contained a very diverse student population with 69% of students

being from a racial or ethnic minority group (Houston Baptist University, 2018). Exploration of

cultures within the community can help students to get outside of their comfort zone and expand

their cultural views.

Knowledge. The level of cultural awareness of staff nurses in multicultural diverse

environments as to knowledge obtained an overall weighted mean of 3.27 which was verbally

described as "always," or "very well." The highest mean in this indicator was item "I will

recognize that my knowledge of certain cultural groups is limited and commit to creating

opportunities to learn more.," with a mean of 3.39 verbally described as "always," while the

lowest mean was item " I'm aware that everyone has a culture, and my own culture should not be

regarded as a point of reference to assess which behavior is appropriate or inappropriate I'm

aware that everyone has a culture, and my own culture should not be regarded as a point of

reference to assess which behavior is appropriate or inappropriate," got a mean of 3.19 which

was verbally described as "often." This result implies that most of the staff nurse respondents

about their level of knowledge in multicultural diverse environments as to knowledge are okay.

They always acknowledge the idea that their knowledge of the topic is limited and that these

limitations will create opportunities for them to learn more in their chosen field.

Several studies have identified that migrants often experience poorer quality of care in

contrast to the majority population. Nurses, alongside other healthcare professionals, often lack
the necessary knowledge and skills to respond to the needs of people from different cultural

backgrounds to their own. Communication difficulties, in particular, present major obstacles in

cross-cultural care encounters, i.e., an encounter between a nurse and a patient who are from

different cultural backgrounds (Gillson et al., (2019).

A higher degree of moral thinking, which is possible via formal education in cultural and

ethical knowledge, is described as being crucial to maintaining competency in the field. The

results show that cultural openness, awareness, desire, knowledge, sensitivity, and interaction

are the precursors of cultural competence as well as its effects. The observation that these

qualities may only show up as a result of the desire for social acceptability raises important

questions about how deep these understandings are (Henderson et al., 2018).

3. Turnover Intention of Staff Nurses

Table 9. Turnover Intention Of Staff Nurses

Turnover Intention
Verbal
Intention to Quit Mean SD
Description
1. Do you have intentions to quit your job? 2.23 0.94 To slight extent
2. Do you have thoughts about leaving your 2.08 0.91 To slight extent
organization/hospital?
3. Do you have thoughts about leaving your profession? 2.07 0.92 To slight extent
4. Is your gender a reason for thinking about changing your 1.95 0.96 To slight extent
job?
5. Is your age a reason for thinking about changing your 1.93 0.95 To slight extent
work?
6. Is your marital status a reason for your thought about 1.96 0.98 To slight extent
changing your job?
7. Is the year of your service a reason for thinking about 2.01 0.93 To slight extent
quitting your work?
8. Is the poor promotion opportunities a reason for your 2.01 0.92 To slight extent
thoughts about changing your job?
 Turnover Intention
Verbal
Intention to Quit Mean SD
Description
9. Is the lack of opportunities for personal growth a reason to 2.08 0.93 To slight extent
change your job?
10. Is poor recognition of your work a reason to change your 2.08 0.95 To slight extent
work?
11. Is the lack of responsibility a reason to change your job? 1.96 0.97 To slight extent
12. Is the lack of achievement a reason to change your job? 1.92 0.93 To slight extent
13. Is the lack of supervision from your management or 1.95 0.98 To slight extent
supervisors a reason for you to change your job?
14. Is your salary a reason to quit or change your job? 1.92 0.91 To slight extent
15. Are the hospital policies a reason to leave your job? 2.08 1.00 To slight extent
16. Is the physical working condition a reason to change 2.11 0.99 To slight extent
your work?
17. Is your poor relationship with others a reason to leave 1.99 0.99 To slight extent
your hospital or change your job?
18. Is the lack of job security a reason to change your work? 2.03 1.04 To slight extent
Overall Weighted Mean 2.02 0.63 To slight extent

Numerical interpretation legend:

Yes, to a large extent 3.25 - 4.00

To some extent 2.50 - 3.24
To slight extent 1.75 - 2.49
No, not at all 1.00 - 1.74

Turnover Intention. The turnover intentions or intention to quit of staff nurses obtained

an overall weighted mean of 2.02 which was verbally described as "Too slight extent." The

highest mean in this indicator was item " Do you have intentions to quit your job?, "with a mean

of 2.23 verbally described as "Too slight extent," while the lowest mean was item " Is the lack of

achievement a reason to change your job?," and " Is your salary a reason to quit or change your

job" both got a mean of 1.92 which was verbally described as "Too slight extent." This result

implies that most of the staff nurses were asked if they have intentions to quit their job. This
simply means that these staff nurses had the intention to quit their job but to a slight content.

They are not that eager to quit their job.

Intentions to leave a job are a consistent predictor of turnover behaviors. Considerable

empirical proof supports the theory that attitude affects behavior more than behavior affects

attitude (Lacity et al., 2008). Based on the above definitions, turnover intention can be defined

as the wish of workers to intentionally choose to leave the recent organization shortly. Intention

to leave is one of the antecedents of actual turnover. Several antecedents have been identified by

many scholars for turnover intention. These include irritation with jobs, violation of the

psychological contract, and organizational commitment (Orvis et al., 2008). The determinants of

employee turnover have great application to the employee who is thinking about quitting, and

also to the executive who is faced with a lack of employee stability. In the orientation and

guidance of new employees, and the issue of organizational output and high costs involved

(Siong, Mellor, Moore & Firth, 2006; Firth et al., 2004). According to Lehane and McCarthy

Tyrrell (2007), intentions are the most direct determinant of exact behavior.

In addition, A study by Majeed (2021) explored the influence of leader emotional

intelligence on the working culture prevailing in teams that ultimately impacts nurses' intent to

leave the job. The research provides an empirical lens of leadership and culture, which

noticeably explain turnover intention. The study provides valuable insight for health

management organizations to focus on factors that decrease the turnover intention of nurses.
4. The a significant association between socio-demographic profile and the level of cultural

awareness of staff nurses in Mulala’s culturally diverse environment in Prince Mohammad

Bin Abdulaziz Hospital, in the Kingdom of Saudi Arabia.

Table 10. Correlation between socio-demographic profile and level of cultural awareness of

staff nurses in Prince Mohammad Bin Abdulaziz Hospital

    Aware Knowledge
Age Pearson Correlation 0.057 -0.03
  Sig. (2-tailed) 0.445 0.691
  N 183 183
Sex Pearson Correlation -0.065 -0.002
  Sig. (2-tailed) 0.38 0.974
  N 183 183
Nationality Pearson Correlation 0.064 -0.017
  Sig. (2-tailed) 0.386 0.818
  N 183 183
HEAtt Pearson Correlation -0.021 -0.036
  Sig. (2-tailed) 0.78 0.63
  N 183 183
LOService Pearson Correlation 0.056 0.008
  Sig. (2-tailed) 0.455 0.912
  N 183 183
AreaofAss Pearson Correlation -0.013 -0.067
  Sig. (2-tailed) 0.866 0.37
  N 183 183
*. Correlation is significant at the 0.05 level (2-tailed).
**. Correlation is significant at the 0.01 level (2-tailed).

The same statistical analysis was performed on the obtained data to establish a significant

correlation between the socio-demographic profile and the level of cultural awareness of staff

nurses in KSA. Age does not significantly correlate with the level of cultural awareness of staff

nurses in multicultural diverse environments in terms of awareness (r=0.057) and knowledge (r=-
0.030). This meant that age had nothing to do with the cultural awareness of staff nurses in a

multicultural diverse environment in terms of awareness and knowledge. The hypothesis of no

significant relationship is accepted. This result indicates that age and cultural awareness are

variables that are not related at any point which will not make any changes to the interplay of

variables. Sex does not significantly correlate with the level of cultural awareness of staff nurses

in multicultural diverse environments in terms of awareness (r=-0.065) and knowledge (r=-

0.002). This meant that sex does not influence the cultural awareness of staff nurses in

multicultural diverse environments in terms of awareness and knowledge. The hypothesis of no

significant relationship is accepted. This result indicates that it exhibited no significant

relationship with cultural awareness. The nationality of the respondents exhibited a weak

correlation (r = 0.064**) with the cultural awareness of the staff nurses. Higher Educational

Attainment revealed a significantly negative correlation (-0.021**) with the cultural awareness

of the staff nurses and a marginally negative correlation (r = 0.036**). There was a weak positive

correlation between the length of service (r = 0.056**) and the cultural awareness (r = 0.008) of

the staff nurses, same with the area of assignment (r = -0.013**) which exhibited a weak

negative correlation between the cultural awareness (r = -0.067**).

These results revealed that socio-demographic profile had no significant correlation with

the cultural awareness of the staff nurses at KSA. When caring for patients who are new

immigrants and come from diverse cultural backgrounds, nurses encounter unique obstacles. To

meet the cultural demands of their patients, they must be able to modify their caregiving

techniques. A group of people's common views, values, concepts, language, communication, and
conventions are referred to as their culture in this context. Additionally, because cultures are

dynamic and always changing, nurses must be adaptable and sensitive. Staff nurses collaborate

to offer the best care possible to everyone, regardless of their demographic profile. They work

together to give nursing services to individuals from all walks of life, ideologies, and

nationalities, including high-ranking officials and regular people.

People must develop a collective self-understanding of themselves, an understanding of

how they think, feel, do things, and relate with others in the family, community, and society, and

their aspirations towards total well-being. In an educational environment, where many cultures

are represented, it is essential that the environment is inclusive and every culture is embraced.

Training programs on how to cope in a new diverse environment in ways that develop strong,

culturally relevant interpersonal skills have been missing in many institutions (Iskandarova et al.

2017). Cultural awareness and cultural competence have become important skills in higher

education as populations continue to grow in diversity around the world.

5. The significant relationship between the level of cultural self-awareness and turnover

intention of the staff nurses in a multicultural diverse environment in Prince Mohammad

Bin Abdulaziz Hospital, in the Kingdom of Saudi Arabia.

Table 11. Correlation table between the level of cultural self-awareness and turnover

intention of the staff nurses in Prince Mohammad Bin Abdulaziz Hospital

    Turnover Intention
Awareness Pearson Correlation -.155*
  Sig. (2-tailed) 0.037
  N 183
Knowledge Pearson Correlation -0.058
   Sig. (2-tailed) 0.436
  N 183
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).

The level of cultural self-awareness of staff nurses in multicultural diverse environments

as compared to their turnover intention yielded a negative correlation score of r=-.155. This

means that the lower the level of cultural awareness as to awareness the respondents have, the

most likely a greater turnover intention. The hypothesis of no significant relationship is rejected.

This result indicates that cultural awareness was one of the driving forces of staff nurses to look

for another environment to work in.

The level of cultural awareness of staff nurses in multicultural diverse environments as to

knowledge was not significantly correlated with the extent of the turnover intention of staff

nurses (r=-0.058). This meant that the cultural awareness of knowledge had nothing to do with

the turnover intention of the respondents. The hypothesis of no significant relationship is

accepted. This result indicates that the knowledge of staff nurses does not cloud their judgment

to leave their work.

Numerous predictors of nurses' intention to leave the profession have been identified and

are generally divided into individual and organizational variables. They point to unfavorable

work environments and deteriorating labor conditions that have been made worse by the

pandemic. Additionally, it appears that nurses' intentions to leave the profession depend greatly

on their cultural sensitivity and understanding of multicultural environments. In this situation, it

is important to keep in mind that several elements could interact, heighten, or weaken their
respective impacts. As a result, it is necessary to presume that many of the above components are

interrelated. However, these elements present possibilities for preventative actions and highlight

which nurses would most benefit from them.

Understanding that every one of us has unique values molded by our varied cultural

origins is at the heart of cultural awareness. The norms of one nation may be quite different from

those of another. We enable ourselves to gain from cultural variety by showing respect for others

and recognizing people's beliefs, rights, and sentiments, even when they differ from our own.

As the patient population utilizing healthcare services becomes more diverse, healthcare

providers will need to make major modifications to their care delivery models. In a 2014 study,

the National Conference of State Legislatures identified differences in the cultural composition

of the country and the healthcare workforce. People of color made up over 25% of the population

of the country at the time of the research, but only 10% of the medical workforce. According to

the study, expanding diversity in the medical field may have two separate positive effects on the

health of patients from varied cultural backgrounds.

Additionally, it is simpler for professionals to establish cultural competency when teams

of health care experts represent the variety of their patients. This promotes more open

communication between patients and doctors. Additionally, patients often feel safer in settings

where diverse teams collaborate well. Programs that train the next generation of health care

workers are where the process of increasing the cultural diversity of the nursing workforce

begins. A doctor of nursing practice degree, for example, can help nurses get ready to deliver
fair, inclusive care that encourages a healthier, less stressful experience for patients and their

families (Regis College, 2021).

Geographic origin, migratory status, race, language, dialect, religion, shared traditions,

values, and symbols; literature, folklore, and music; food preferences; settlement and

employment patterns; politics and homeland; institutions serving and maintaining the group; and

internal and external perceptions of distinctiveness are a few examples of the many factors that

contribute to cultural differences among employees (Glazner, 2008).

Moreover, establishing training programs, inviting speakers from diverse populations to

speak, establishing a cultural diversity council, inviting coworkers to share their cultural

traditions, committing to value and respect diversity in all areas, collaborating with organizations

in the field, and identifying cultural competency as an organizational goal are all ways to

improve the organization's cultural competency (Romeo, 2007). Occupational health nurses

dealing with employees should welcome them in a culturally acceptable way and pronounce their

names correctly. Inquiring about matters that could be forbidden to particular cultural groups

while avoiding making assumptions is crucial. The occupational health nurse should speak

clearly and concisely, avoiding jargon and slang. They must also comprehend the significance of

nonverbal cues and be conscious of touch and personal space. The nurse must still communicate

with the staff directly while utilizing an interpreter, not via the interpreter (Williamson, 2007).

Proposed Enhancement Training Design of the Researcher

DEIB: A CAPACITY BUILDING AMONG STAFF NURSES

 Diversity, Equity, Inclusion, and Belonging (DEIB), is a training designed to capacitate

staff nurses working in a multicultural environment. The training aims to acquire knowledge of

various cultural practices and views of the world, to develop communication skills to promote

and achieve interaction among cultures, and to ensure a positive attitude is displayed toward

differences and various cultures. This training will also promote the development of more

culturally competent practices and helps nurses share information that allows them to adjust

approaches to care. The topic to be discussed during the training was based on the responses of

the staff nurse (McElvaine, 2021).

Table 12. Enhancement Training Proposal

Training Topics Training Objectives Desired Outcomes Person Involved

1. Culture and  To respect and Create a more Staff Nurse, Resource

multiculturalism in value variety in productive work Speaker, Hospital
KSA culture environment as your Managers
 To aid in the employees are
development of equipped to better
the attitudes, communicate and
abilities, and trust each other.
information
necessary to
function across
cultural
boundaries.
2. Intercultural  To be able to Understand cultural Staff Nurse, Resource
management skills evaluate and differences in Speaker, Hospital
comprehend communication and Managers
communication their impact on the
behavior in work environment
scenarios
involving cross-
cultural
communication
 Training Topics Training Objectives Desired Outcomes Person Involved

better.
 To become aware
of and prevent
cultural
misconceptions
3. Multiculturalism  To help nurses  Accurately assess Staff Nurse, Resource
and cross-cultural comprehend patient conditions Speaker, Hospital
communication in patients more  Successfully Managers
nursing practice fully and better explain medical
meet their needs. issues to patients
 To educate  Give patients
patients about crucial
medical matters. instructions about
medications
 Educate patients
about a diagnosis
or prognosis

4. Nursing care based  To encourage the  Hiring of Staff Nurse, Resource

on trans-cultural provision of interpreters Speaker, Hospital
nursing and cultural relevant,  Overcoming Managers
safety culturally communication
appropriate, high- barries
quality, and safe  Provide quality
healthcare to health care
patients from
similar or
different cultural
backgrounds.

A strict code of ethics that includes a commitment to giving each patient and the

communities they work with the best care is followed by all staff nurses. The code outlines the

principles and obligations that each nurse must uphold to guarantee that all patients, regardless of

race, gender, age, ability, or socioeconomic status, receive the same superior level of care. To
achieve this goal, nurses must comprehend the true value of cultural diversity in the nursing

profession.

Recognition and appreciation of the existence of differences in attitudes, beliefs,

thoughts, and priorities in the health-seeking behaviors of various patient populations; reflects

the nursing profession's contract with society and our obligation to act by a strong code of ethics,

i.e., to be aware of our attitudes, beliefs, thoughts, and priorities in providing care to individual

patients, families, communities, and populations.

Thus, this capacity-building training of staff nurses will help staff nurses to be more focused and

stay longer in their workplace instead of resorting to leaving their current job and looking for

another that is more convenient for them.

CORRELATES OF CULTURAL SELF-AWARENESS AND TURNOVER INTENTION

OF STAFF NURSES IN MULTICULTURAL DIVERSE ENVIRONMENT

Summary

The following findings were made to determine the self-awareness and turnover

intentions of staff nurses in a multicultural diverse environment;

1. This study found no significant relationship between the staff nurses' cultural awareness

and their socio-demographic characteristics, including age, sex, nationality, higher

educational attainment, length of service, and area of assignment. Staff nurses do not

have to treat patients differently when caring for those from different cultural

backgrounds. Staff nurses work together to provide everyone with the best care possible

regardless of their changing demographics. Together, they provide nursing services to

 people of all ages, political ideologies, and nationalities, including both high-ranking

officials and everyday citizens.

2. The study's findings indicate that staff nurses in a multicultural environment have

acceptable cultural awareness and a sense of accountability to admit their errors and

grow from them. However, the results regarding the staff nurses' knowledge of a

multiculturally diverse workplace indicated that it is acceptable, indicating that the

respondents consistently acknowledge that their understanding of this environment is

limited and that these limitations will present opportunities for them to learn more in

their chosen field.

3. The findings of the study showed that most respondents had a slight intention to quit

their jobs based on their intentions to leave their current positions. Staff nurses'

behaviors associated with turnover are predicted by intentions to quit their job. Lack of

employee stability, a leader's impact on teams' work cultures, which ultimately affect

nurses' intentions to leave their jobs, organizational commitment, and other factors were

some predictors of staff nurse turnover.

4. The findings of the two hypotheses formulated at the beginning of the study revealed the

following decision: Hypothesis 1. There is no significant association between the socio-

demographic profiles of the respondents between the cultural awareness of the staff

nurses. , Hypothesis 2. There is a significant relationship between the level of cultural

awareness and turnover intentions of staff nurses in a multicultural diverse environment.

 5. Capacity-building training among staff nurses was designed to help and prevent staff

nurses to leave their work. This training design will help them understand the diversity

of the nature of their work and how they could be able to cope with the diversity of the

environment. The following topics were prevalent during the survey given on the topics

they wanted to include in the training. These are the following: 1. Demonstrating cultural

competence in nursing practice; 2. Multiculturalism and cross-cultural communication in

nursing practice; 3. Nursing care is based on trans-cultural nursing and cultural safety;

and 4. Intercultural management skills.

Conclusions

There is a global need to focus on the cultural competency of healthcare practitioners.

The findings of this study suggest that becoming more conscious of one's cultural characteristics

can be beneficial for facilitating cross-cultural interactions in a healthcare setting, enhancing

nurses' cultural competence, and having a significant impact on staff nurses' intentions to leave

their jobs. Staff nurses noted that the training will be advantageous on several levels and that the

topic of cross-cultural care will be facilitated by the small group size and motivational

presentations. To deepen their understanding of cultural variations and how patients from diverse

cultural backgrounds are treated, professionals working at all levels of the healthcare system will

need to undergo cultural competency training in the future.

Accepting cultural diversity and cultivating cultural competency are essential

components of effective work environments, impacting many aspects of the environment such as
leadership, teamwork, and professional practice. The choice to provide cultural competency

training demonstrates a recognition of the crucial need for focused attention on this issue. As a

result, nurses, organizations, and individuals within the wider health system may use this

collection of evidence-based practices to promote cultural competency while attempting to build

healthy work environments. Professionals working at all levels of the healthcare system will

need to acquire cultural competency training in the future to improve their awareness of cultural

differences and how patients from diverse ethnic backgrounds are handled. As a result, capacity

building was created to meet the needs of every staff nurse.

Additionally, it showed a negative correlation between the respondents'

sociodemographic characteristics and the staff nurses' cultural awareness. It implies that these

socio-demographic factors have no bearing on the staff nurses' awareness of other cultures. On

the other hand, there is a link between staff nurses' intentions to leave the profession and cultural

awareness. Links that connect the two variables have been discovered. This suggested that staff

nurses' desire to work in a different setting was motivated in part by their awareness of cultural

differences.

Recommendations

The recommendations from this study's findings regarding staff nurses' intention to leave

their jobs in a multicultural environment and correlates of their cultural self-awareness are

presented in this section. The recommendation made below could influence clinical practice,

hospital policy, continuing nurse education, and future studies. The following recommendations
have been made as a result of this study: Utilize the proposed training design to help staff nurses

in their everyday dealings at work. This will give them enough knowledge to understand the

nature of their work.

1. To integrate culturally competent behaviors into their daily interactions, nurses must

practice their awareness, attitude, and knowledge by repeating them. These actions must

be displayed through appropriate body language and effective verbal exchange.

Nonverbal cues like gestures, for example, can have very different meanings across

cultural boundaries.

2. The researcher recommends hospital administrators train staff members at various levels

of the healthcare system in cultural competence so they are more aware of cultural

differences and how to treat patients from different cultural backgrounds.

3. Future research should compare traditional long-term training, like the one used in the

current study, to shorter training and Web-based learning platforms to determine the most

practical method for enhancing healthcare professionals' cultural competence.

 References:

Almutairi, A. F., Adlan, A. A., & Nasim, M. (2017). Perceptions of the critical competence of

registered nurses in Canada. BMC Nursing, 16(1),-55-60.

Asegid, A. (2014, February 24). Factors Influencing Job Satisfaction and Anticipated Turnover

among Nurses in Sidama Zone Public Health Facilities, South Ethiopia. Hindawi.Com.

https://www.hindawi.com/journals/nrp/2014/909768/

Asegid, A., Belachew, T., & Yimam, E. (2014). Factors Influencing Job Satisfaction and

Anticipated Turnover among Nurses in Sidama Zone Public Health Facilities, South

Ethiopia. Nursing Research and Practice, 2014, 1–26.

https://doi.org/10.1155/2014/909768

Ayalew, F. (2015, December 30). Factors Affecting Turnover Intention among Nurses in

Ethiopia: Long. Longwoods.Com.

https://www.longwoods.com/content/24491//factors-affecting-turnover-intention-among

nurses-in-Ethiopia

Azinge, F. (2019). Cultural Diversity in the Health Care Industry: A Case Study (Order No.

22616571). Available from ProQuest Central. (2287021612).

Boyle, M. H. (2019). Cultural Competency in Hospice Care: An Effect of Online Cultural

Diversity Training in Hospice Interdisciplinary Teams as Measured by the Cultural

 Competence Assessment Survey (Order No. 22622369). Available from ProQuest Central.

(2315539620).

Gillson, Suzanne, M .S .N., R.N., & Cherian, Nisha, M.S.N., R.N. (2019). The Importance Of

Teaching Cultural Diversity In Baccalaureate Nursing Education. Journal of Cultural

Diversity, 26(3), 85-88.

Gunasekara, V. M. (2019). Impact Of Occupational Stress On Turnover Intention Of Women

Bankers: AnEmpiricall Research On Galle District Private Sector Banks In Sri

Lanka. International Journal on Global Business Management & Research, 8(2), 33-43.

Henderson S., Horne M, Hills R., Kendall E. (2018). Cultural Competence In Healthcare In The

Community: A Concept AnalysisBritishe Journal Of Pharmacology, 26(4), 590-603

Iskandarova, S., & Griffin, O. (2017). Making the Invisible Visible: Exploring Cultural

Differences of Faculty Working on a Multicultural Team. American Society for

Engineering Education-ASEE.

Iqbal, S., Ehsan, S., Rizwan, M., & Noreen, M. (2014). The impact of organizational

commitment, job satisfaction, job stress, and leadership support on turnover intention in

educational institutes. International Journal of Human Resource Studies, 4(2), 181.

https://doi.org/10.5296/ijhrs.v4i2.5906

Labrague, L. J., Gloe, D., McEnroe, D. M., Konstantinos, K., & Colet, P. (2018). Factors

influencing turnover intention among registered nurses in Samar Philippines. Applied

Nursing Research, 39, 200–206. https://doi.org/10.1016/j.apnr.2017.11.027

Lu, C., & Wan, C. (2018). Cultural Self-Awareness as Awareness of Culture's Influence on the

Self: Implications for Cultural Identification and Well-Being. Personality &sociall

psychology bulletin, 44(6), 823–837. https://doi.org/10.1177/0146167217752117

Majeed, N., & Jamshed, S. (2021). Nursing turnover intentions: The role of leader emotional

intelligence and team culture. Journal of Nursing Management, 29(2), 229-239.

http://dx.doi.org/10.1111/jonm.13144

Vroom, V.H., Deci, E.L., Penguin (1983). Management and Motivation.

https://www.ifm.eng.cam.ac.uk/research/dstools/vrooms-expectancy-theory/

Yoon, S. J. (2020). The factors affecting on Turnover Intention of Nurses. The Factors Affecting

turnover Intention of Nurses, 2(1), https://doi.org/10.37506/v20/il/2020/mlu/194569

 APPENDICES

SURVEY QUESTIONNAIRE

CORRELATES OF CULTURAL SELF-SELF-AWARENESS TURNOVER INTENTION

OF STAFF NURSES WITHIN CULTURALLY DIVERSE ENVIRONMENT

PART I: SOCIO-SOCIO-DEMOGRAPHIC

DIRECTION: This is a demographic form that will help us get to know a little bit about your

background. Please complete the following information by checking the parenthesis that applies

to you.

A. Age: ______
B. Sex:
o Male
o Female

C. Nationality: _______
D. Highest educational attainment:
o Diploma in Nursing
o Bachelor’s degree in nursing
 o Master’s degree units
o Doctorate
o Master’s degree graduate

o Doctorate graduate

E. Length of Service: _____

F. Area of Assignment:
o Ward
o ER
o ICU
o OPD
o OR
o Others: ___

PART II: CULTURAL COMPETENCE SELF-ASSESSMENT CHECKLIST

Please select one response for each question.

Always (Very well) 3.25 - 4.00
Often (Pretty well) 2.50 - 3.24
Sometimes (Occasionally) 1.75 - 2.49
Never 1.00 - 1.74

Awareness 1 2 3 4
Value diversity I view human difference as positive
and a cause for celebration
Know myself I have a clear sense of my own
ethnic, cultural and racial identity
Share my culture I am aware that in order to learn more
Awareness 1 2 3 4
about others I need to understand and
be prepared to share my own culture
Be aware of areas of I am aware of my discomfort when I
encounter differences in race, color,
religion, sexual orientation, language,
and ethnicity
Check my I am aware of the assumptions that I
assumptions hold about people of cultures from
my own
Challenge my I am aware of my stereotypes as they
stereotypes arise and have developed personal
strategies for reducing the harm they
cause.
Reflect on how my I am aware of how my cultural
culture informs my perspective influences my judgement
judgment about what are ‘appropriate’,
‘normal’, or ‘superior’ behaviors,
values, and communication styles.
Accept ambiguity I accept that in cross-cultural
situations there can be uncertainty
and that uncertainty can make me
anxious. It can also mean that, I do
not respond quickly and take the time
needed to get more information.
Be curious I take any opportunity to put myself
in places where I can learn about
difference and create relationships.
Awareness 1 2 3 4
Aware of social I’m aware of the impact of the social
justice issues context on the lives of culturally
diverse population, and how power,
privilege and social oppression
influence their lives.
Gain from my I will make mistakes and will learn
mistakes from them.

Knowledge 1 2 3 4
Assess the limits of I will recognize that my knowledge
my knowledge of certain cultural groups is limited
and commit to creating opportunities
to learn more.
Ask questions I will really listen to their answers
before asking another question.
Acknowledge the I know that difference in color,
importance of culture, ethnicity etc. are important
difference parts of an individual’s identity which
they value and so do I. I will not hide
behind the claim of ‘color blindness’.
Understand the I recognize that cultures change over
influence culture time and can vary from person to
can have person, as does attachment to culture
Commit to life-long I recognize that achieving cultural
learning competence involves a commitment
to learning over a lifetime
Understand the I recognize that stereotypical attitudes
impact of racism, and discriminatory actions can
 Awareness 1 2 3 4
sexism, dehumanizing, even encourage
homophobia violence against individuals because
of their membership in groups which
are different from myself
Know my I continue to develop my capacity for
limitations assessing areas where there are gaps
in my knowledge
Awareness of I recognize that people have
multiple social intersecting multiple identities drawn
identities from race, sex, religion, ethnicity, etc.
and the importance of each of these
identities vary from person to person.
Inter-cultural and I acknowledge both inter-cultural and
intracultural intracultural differences
differences
Point of reference to I’m aware that everyone has a
assess appropriate culture, and my own culture should
behavior not be regarded as a point of
reference to assess which behavior is
appropriate or inappropriate
1 pt. x 2 pt. x 3 pt. x 4 pt. x

PART III: TURN OVER INTENTION

Instruction: Please select one response for each question.

Yes, to a large extent 3.25 - 4.00

 To some extent 2.50 - 3.24
To slight extent 1.75 - 2.49
No, not at all 1.00 - 1.74
IV. INTENTION TO QUIT 1 2 3 4

1. Do you have intentions to quit your job?

2. Do you have thoughts about leaving your

organization/hospital?
3. Do you have thoughts about leaving your profession?

4. Is your gender a reason for thinking about changing your

job?
5. Is your age a reason for thinking about changing your
work?
6. your marital status a reason for your thoughts about
changing your job?
7. Is the year of your service a reason for thinking about
quitting your work?
8. Is the poor promotion opportunities a reason for your
thoughts of changing your job?
9. Is the lack of opportunities for personal growth a reason to
change your job?
10. Is the poor recognition on your work a reason to change
your work?
11. Is the lack of responsibility a reason to change your job?

12. Is the lack of achievement a reason to change your job?

IV. INTENTION TO QUIT 1 2 3 4

13. Is the lack of supervision from your management or

supervisors a reason for you to change your job?
14. Is your salary a reason to quit or change your job?

15. Are the hospital policies a reason to leave your job?

16. Is the physical working condition a reason to change your

work?
17. Is your poor relationship with others a reason to leave your
hospital or change your job?
18. Is the lack of job security a reason to change your work?

Thank you for your participation.

HAMOUD L. UTO
Kaumpurnah Zone II. Isabela Citv
Basilan, Philippines
Cellphone No.+966531801149
Email: hudgelatiputo@gmail.com
utoha@ngha.med.sa
Current Location: Madinah, Saudi Arabia

PERSONAL DETAILS
Age:34
Date of Birth: February 11, 1988
Birthplace: Basilan
Citizenship: Filipino
Civil Status: Single
Religion: Islam

SUMMARY OF QUALIFICATIONS

Masters of Art in Nursing (MAN)

ongoing
Wesleyan University-Philippines
2022

Emergency Medical Technician

Golden Success-Bright Center
Card Number: 08-32-185
2011

Bachelor of Science in Nursing

Universidad de Zamboanga
Zamboanga City, Philippines
April 2008

Professional Regulation Commission – Nurse, Philippines

Registration no: 0545036
Valid until: February 11, 2023

Saudi Commission for Health Specialist - Nurse

Registration no: 13MN0020753
Valid until: August 31, 2023
Pediatric Advanced Life Support Provider
American Heart Association
Valid until: March 2023

Advanced Cardiovascular Life Support ProvidelProvider

American Heart Association
Valid until: January 2023

Basic Life Support Provider

American Heart Association
Valid until: September 2022

Dataflow Verification Case Number: S004-VR-13-018517

PROFESSIONAL EXPERIENCE

February 2013 - up to the resent

Staff Nurse I Specialty-A
Emergency Department
National Guard Health AftairsAffairs
Prince Mohammad Bin Abdulaziz Hospital
Madina AlMunawwarah,Kingdom of Saudi Arabia

March 2009 - August 2012

Staff Nurse
Emergency Room
Basilan General Hospital
(100-bed capacity)
Isabela city, Basilan, Philippines

DUTIES AND RESPONSIBILITIES

ED STAFF NURSE:
 Properly assess and provide immediate care based on nursing standards.
 Demonstrates knowledge and clinical assessment skills appropriate to the clinical area.
 Provides leadership and resource role in the provision of patient care
 Works with all health care team members in activities designed for the improvement
of patient care outcomes.
 Anticipates and acts to maintain a safe environment.
  Serves as a professional role model, teacher, and resource person.
 Orient clients and significant others on admission procedures.
 Carried out stat orders and documented actions taken.
 Diligently performs daily routine duties and responsibilities.
 Prepare properly clients direct for OR/ICU/L&D.
 Able to assess and initiate CPR/defibrillation and cardioversion as needed.
 Observe infection control measures in all nursing procedures.
 Report working on time.

ED TEAM LEADER:
 Gives concise bedside reports to incoming shift leaders according to ISBAR.
 A reviews staff ratio of incoming shifts and arranges overtime/float as required.
 Plans for patient/ unit coverage at all times. Designates breaks and meal reliers
according to patient acuity and staff workload.
 Makes nursing rounds at the start and throughout the shift to get an overview of
patient and patient therapy.

TYPES OF PATIENTS CARED

 Seizure Disorders
 Shock (Hypovolemic Shock, Cardiogenic Shock, Septic Shock, Systemic
 Inflammatory Response Syndrome (SIRS)
 Sepsis and Severe sepsis

SKILLS AND PROFECIENCIES

 Excellent communication skills: verbal and written
 Excellent interpersonal skills, professional attitude, and motivation to produce
consistently high-quality work.
 Ability to manage multiple priorities in a fast-paced environment.
BLS. ACLS. PALS Provider
 Cardiopulmonary arrest patients
 Motor vehicular accident patients
 Acute Respiratory Failure
 Acute Respiratory Distress Syndrome (ARDS)
 Chronic Respiratory Failure
Infections (Aspiration Pneumonia. Bacteremia)
 Acute Renal Failure
 Bleeding and Clotting diseases
 Diabetic Ketoacidosis
 Multiple Organ Dysfunction Syndrome
 Stroke patients
  Cardiac dysrhythmia

PROCEDURE PERFORMED

 Vital signs taking and monitoring

 Intravenous cannulation
 Foley Catheter insertion
 Nasogastric tube insertion
 Medication administration
 Blood transfusion
 Wound Care
 NGT and PEG feeding
 Assisting in Central Line Insertion
 Assisting in Arterial Line Insertion
 Arterial Pressure Monitoring
 Assisting in Intubation and Extubation
 ABG taking and Interpretation
 Mechanical Ventilator Care/Monitoring
 Assisting in Vascular Catheter Insertion
 BiPAP/noninvasive Ventilation monitoring
 Assisting, Removal, and Care of Chest tube drain
 Tracheostomy Care
 Suctioning
 Cardiopulmonary Resuscitation
 Defibrillation
 Cardioversion
 Transcutaneous Pacing
 Electrocardiogram
 Nebulization
 Peri-operative Care
 Assisting in preparing procedures such as:
X-ray
Ultrasound
CT scan
MRI
Colonoscopy/Endoscopy

TRAINING AND WORKSHOPS

Pediatric Advanced Life Support

American Heart Association
Saudi-German Hospital, KSA
March 2023

Advanced Cardiovascular Life Support Course

American Heart Association
Saudi-German Hospital, KSA
January 2023

Basic Life Support Course

NGHA - Madinah, KSA
September 2022

Blood and Blood products Administration Workshop

NGHA - Madina, KSA
June 2022

Basic Medication and Safety Course

NGHA, Madina, KSA
January 2021

Moderate Sedation Course

NGHA = Madinah, KSA
May 16, 2018

ECG Workshop
NGHA - Madinah, KSA
January 29, 2018

Communication in Health Care settings

NGHA – Madinah, KSA
July 11, 2017

Trauma Course
NGHA-Madina, KSA
May 01, 2016

Triage Workshop
NGHA - Madinah, KSA
February, 2014