The Influence of Clinical Leadership on Nurses’ Cultural Competence in Reducing Patient Anxiety in the Inpatient Ward of Nurul Hasanah Hospital

Yusnaini Yusnaini; Arif Irpan Tanjung; Nandara Priyanti Elna

Authors

Yusnaini Yusnaini Department of Nursing, Universitas Nurul Hasanah Kutacane. Aceh, Indonesia
Arif Irpan Tanjung Department of Nursing, Universitas Nurul Hasanah Kutacane. Aceh, Indonesia
Nandara Priyanti Elna Department of Public Health, Universitas Nurul Hasanah Kutacane. Aceh, Indonesia

Keywords:

Clinical leadership, Cultural competence, Patient anxiety, Nursing, Inpatient care.

Abstract

Healthcare services in Indonesia, as a multicultural country, face challenges in providing culturally sensitive nursing care. Clinical leadership plays a crucial role in developing nurses’ cultural competence to reduce patient anxiety, which can influence the healing process. This study aimed to examine the influence of clinical leadership on nurses’ cultural competence and its role in reducing patient anxiety in the inpatient ward of Nurul Hasanah Hospital. This study employed a quantitative cross-sectional design, involving 120 nurses and 150 patients selected through purposive sampling. Data were collected using the Clinical Leadership Survey, Intercultural Competence Scale in Nursing, and State-Trait Anxiety Inventory (STAI). Data were analyzed using Structural Equation Modeling–Partial Least Squares (SEM-PLS). The results showed that clinical leadership was rated high (mean = 3.82), cultural competence moderate (mean = 3.45), and patient anxiety moderate (mean = 42.8). Clinical leadership had a positive effect on cultural competence (β = 0.687, p < 0.001) and a negative effect on patient anxiety (β = -0.214, p = 0.004). Cultural competence negatively affected patient anxiety (β = -0.478, p < 0.001) and partially mediated the relationship between clinical leadership and patient anxiety (β = -0.328, p < 0.001). Clinical leadership effectively reduces patient anxiety both directly and indirectly by enhancing nurses’ cultural competence. Strengthening clinical leadership and cultural competence may contribute to more culturally responsive and psychologically safe inpatient care.

References

Alkhaled, T. et al. (2022) ‘Navigating the Care between Two Distinct Cultures: a Qualitative Study of the Experiences of Arabic-Speaking Immigrants in Norwegian Hospitals’, BMC Health Services Research, 22(1), pp. 1–42. Available at: https://doi.org/10.1186/s12913-022-07833-6.

Alzahrani, N. (2021) ‘The Effect of Hospitalization on Patients’ Emotional and Psychological Well-Being among Adult Patients: An Integrative Review’, Applied Nursing Research, 61, p. 34544571. Available at: https://doi.org/10.1016/j.apnr.2021.151488.

Al Anwer Ashour, H.M., Banakhar, M.A. and Elseesy, N.A.E. (2022) ‘Clinical Leadership Behaviors among Critical Care Nurses in Private and Governmental Hospital: A Cross-Sectional Survey’, International Journal of Nursing Sciences, 9(3), pp. 357–363. Available at: https://doi.org/10.1016/j.ijnss.2022.06.017.

Cadmus, E. et al. (2024) ‘Nursing Leadership Scope and Standards and Pathway to Excellence’, Nursing Management, 55(6), pp. 7–12. Available at: https://doi.org/10.1097/nmg.0000000000000139.

Carlson, V.M.A. et al. (2021) ‘Psychometric Properties of Leadership Scales for Health Professionals: A Systematic Review’, Implementation Science, pp. 1–22. Available at: https://doi.org/10.1186/s13012-021-01141-z.

Chen, H.C. et al. (2024) ‘Revision and Psychometric Testing of the Intercultural Competence Scale’, Journal of Nursing Measurement, 32(1), pp. 58–68. Available at: https://doi.org/10.1891/JNM-2022-0004.

Gheshlaghi, P.A. et al. (2021) ‘Effect of Family Presence on Pain and Anxiety Levels among Patients during Invasive Nursing Procedures in an Emergency Department at a Public Hospital in Western Iran’, African Journal of Emergency Medicine, 11(1), pp. 31–36. Available at: https://doi.org/10.1016/j.afjem.2020.11.003.

Guibert-Lacasa, C. and Vázquez-Calatayud, M. (2022) ‘Nurses’ Clinical Leadership in the Hospital Setting: A Systematic Review’, Journal of Nursing Management, 30(4), pp. 913–925. Available at: https://doi.org/10.1111/jonm.13570.

Kaihlanen, A.M., Hietapakka, L. and Heponiemi, T. (2019) ‘Increasing Cultural Awareness: Qualitative Study of Nurses’ Perceptions about Cultural Competence Training’, BMC Nursing, 18(1), pp. 1–32. Available at: https://doi.org/10.1186/s12912-019-0363-x.

Kamau, S. et al. (2023) ‘Nurse Leaders’ Experiences of How Culturally and Linguistically Diverse Registered Nurses Integrate into Healthcare Settings: An Interview Study’, International Journal of Nursing Studies, 146, pp. 2–3. Available at: https://doi.org/10.1016/j.ijnurstu.2023.104559.

Kiviniitty, N. et al. (2023) ‘Nurse Leaders’ Perceptions of Competence-Based Management of culturally and Linguistically Diverse Nurses: A Descriptive Qualitative Study’, Nursing Open, 10(9), pp. 6479–6490. Available at: https://doi.org/10.1002/nop2.1899.

Liu, T.T. et al. (2022) ‘A Preliminary Study on the Cultural Competence of Nurse Practitioners and Its Affecting Factors’, Healthcare (Switzerland), 10(4), pp. 1–22. Available at: https://doi.org/10.3390/healthcare10040678.

Manlangit, A.T., Jabonete, F.G. V. and Ridulme, Q.R. (2022) ‘Cultural Competence and Decision-Making of Nurse Leaders in a University Hospital in Saudi Arabia: A Descriptive Correlational Study’, Journal of Nursing Management, 30(5), pp. 1215–1224. Available at: https://doi.org/10.1111/jonm.13631.

Osmancevic, S., Großschädl, F. and Lohrmann, C. (2023) ‘Cultural Competence among Nursing Students and Nurses Working in Acute Care Settings: a Cross-Sectional Study’, BMC Health Services Research, 23, pp. 1–7. Available at: https://doi.org/10.1186/s12913-023-09103-5.

Pelasoja, M. et al. (2025) ‘Leadership in Culturally and Linguistically Diverse Healthcare Workplaces: A Scoping Review’, Journal of Advanced Nursing, pp. 1–14. Available at: https://doi.org/10.1111/jan.16909.

Prosen, M. and Licen, S. (2023) ‘The Development of Cultural Competences in Nursing Students and Their Significance in Shaping the Future Work Environment: a Pilot Study’, BMC Medical Education, 23, pp. 1–9. Available at: https://doi.org/10.1186/s12909-023-04800-5.

Teixeira, G. et al. (2023) ‘Transcultural nursing leadership: A concept analysis’, International Journal of Nursing Studies Advances, 5, pp. 1–29. Available at: https://doi.org/10.1016/j.ijnsa.2023.100161.

Teixeira, G., Lucas, P. and Gaspar, F. (2024) ‘Impact of Nurse Manager’s Attributes on Multi-Cultural Nursing Teams: A Scoping Review’, Nursing Reports, 14(3), pp. 1676–1692. Available at: https://doi.org/10.3390/nursrep14030125.

Thomas, C.L. and Cassady, J.C. (2021) ‘Validation of the State Version of the State-Trait Anxiety Inventory in a University Sample’, SAGE Open, 11(3), pp. 1–10. Available at: https://doi.org/10.1177/21582440211031900.

Yusnaini, Y., Arif, Y. and Dorisnita, D. (2021) ‘Kemampuan Kepemimpinan Klinis Perawat Pelaksana Berdasarkan Pendekatan Clinical Leadership Competency Framework dan Faktor-Faktor Determinannya’, Jurnal Keperawatan Silampari, 4(2), pp. 337–350. Available at: https://doi.org/10.31539/jks.v4i2.1914.