Award Date


Degree Type


Degree Name

Doctor of Philosophy in Nursing



First Committee Member

Lori Candela, Chair

Second Committee Member

Cheryl Bowles

Third Committee Member

Patricia Alpert

Graduate Faculty Representative

LeAnn Putney

Number of Pages



By 2050, current minority groups will comprise almost half of the US population further challenging healthcare providers and nurses to deliver culturally competent care. Numerous organizations have published documents supporting cultural competence and its incorporation into nursing curricula has been encouraged since 1986. However, practicing nurses, specifically those providing care to childbearing women and families, continue to acknowledge their lack of cultural competence. This is concerning as large health disparities exist between culturally diverse women and cultural competence can lead to greater health equality and better client care. Studies have shown face-to-face education increases the cultural competence of healthcare providers; few studies have explored the impact of online education on cultural competence levels and no studies of online socially interactive continuing education (CE) have been conducted with nurses. Therefore, the purpose of this study was to evaluate the effect of two different online CE interventions on the cultural competence level of nurses who care for childbearing women and newborns in the US. The study also explored: the relationship between social desirability and self-reported level of cultural competence, the relationship between level of educational attainment and cultural competence level, and the relationship between having previous cultural diversity training and level of cultural competence. The framework for the study included two existing models: the 3-dimensional puzzle model of culturally congruent care and the instructional strategy framework for online learning environments. The study had an experimental pre- and post-test design using the Cultural Competence Assessment instrument. Three groups of RNs who care for childbearing women and newborns in the US were used: (a) control, (b) socially interactive online CE intervention, and (c) socially isolated online CE intervention. The study began with 249 registered participants, 190 completed the informed consent process, 132 completed the pre-test, and 93 completed the study. Data was analyzed with a RM-ANOVA with a between-groups variable, ANCOVA, and correlation statistics. Major findings indicated socially isolated online cultural competence CE is significantly more effective than not having online cultural competence CE. However, socially interactive online cultural competence CE is not more effective than socially isolated, nor is it significantly more effective than not having online cultural competence CE. Findings also indicated MCSDS scores and the number of previous types of cultural diversity training are positively correlated with CCA scores.


Continuing education; Cultural competence – Study and teaching (Continuing education); Distance education; Family nursing; Instructional design; Nursing; Nurses; Online; Women's health


Adult and Continuing Education and Teaching | Curriculum and Instruction | Curriculum and Social Inquiry | Educational Assessment, Evaluation, and Research | Instructional Media Design | Maternal, Child Health and Neonatal Nursing | Nursing

File Format


Degree Grantor

University of Nevada, Las Vegas




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