Cultural Sensitivity and Related Factors among Nurse Educators in Turkey

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1 International Journal of Caring Sciences Setember-December 2017 Volume 10 Issue 3 Page 1374 Original Article Cultural Sensitivity and Related Factors among Nurse Educators in Turkey Hatice Simsek, PhD(c), RN Research Assistant, Ege University Faculty of Nursing, Deartment of Public Health Nursing, Bornova- Izmir, Turkey Ozum Erkin, PhD, RN Research Assistant, Ege University Faculty of Nursing, Deartment of Public Health Nursing, Bornova- Izmir, Turkey Ayla Bayik Temel, PhD, RN Professor, Ege University Faculty of Nursing, Deartment of Public Health Nursing, Bornova-Izmir, Turkey Corresondence: Ozum Erkin, PhD, Ege University Faculty of Nursing, Public Health Nursing Deartment, İzmir/Turkey, ozum.erkin@gmail.com Abstract Objectives: To determine cultural sensitivity and related factors among nurse educators in Turkey. Methods: The study has a descritive and cross-sectional design and was carried out on 152 nurse educators from seven universities in Iİzmir, Turkey. Data were collected with descritive characteristics form and Intercultural Sensitivity Scale in Data were analyzed with Mann Whitney U test, Kruskal Wallis H test, Student s t test and variance analysis. Ethical aroval was obtained. Results: Of 152 nurse educators included in the study, 94.1% were female and the mean age of the articiants was 35.18±9.64 years. The mean score was 78.39±4.96 for Intercultural Sensitivity Scale. There was not a significant difference between the mean scores for the subscales and frequency of communicating through social media, finding cultural care education offered in the faculty curriculum to be satisfactory, willingness to continue academic career abroad, status of knowing a foreign language and articiating in exchange rograms (>0.05). However, the difference between frequency of mass communication tools and resect for cultural differences (<0.05) and interaction enjoyment (<0.05) was significant. Particiating in exchange rograms and resect for cultural differences significantly differed (<0.05). The relations between cultural knowledge and skills and interaction confidence, interaction enjoyment, between having an educational exerience abroad and interaction confidence and between cultural knowledge and skills for communication with nursing students and interaction confidence and interaction enjoyment were significant (<0.05). Conclusions: The samle of Turkish nurse educators has a moderate level of cultural sensitivity. Using mass media tools, articiating in exchange rograms, having educational exerience abroad and cultural knowledge and skills for offering care can have an effect on cultural sensitivity among nurse educators. Strategies directed towards raising awareness should be created to increase cultural sensitivity in nursing deartments. Keywords: Cultural sensitivity, culture, nurse educator, nursing education, Turkey. Introduction There is a raid movement from some geograhical regions to others due to olitical, economic and social effects of globalization, immigration, seeking asylum, natural disasters, unemloyment and attraction of oortunities to have better living conditions (Bayık Temel, 2011). However, health and nursing education still focus on norms and needs of dominant culture although many countries have had cultural diversity (Ruddock & Turner, 2007). This may give rise to inequalities in offering health care (Temel, 2011). The term transcultural nursing, arising from the need to rovide care for eole from different cultures, was first used by Leininger in 1979 (Tortumluoglu, 2004; Temel, 2008). Researchers designing transcultural care models like Burnes- Bolton and Georges (1996), Caminha-Bacote (2002), Giger and Davidhizar (2002), Leininger (1978,1990), Meleis (1996), Purnell and Paulanka (1998) as well as Leininger have

2 International Journal of Caring Sciences Setember-December 2017 Volume 10 Issue 3 Page 1375 created a basis for cultural cometence in nursing education (Anderson et al., 2007; Sevig & Tanrıverdi, 2011). Cultural cometence has been used since 1989 (İz & Temel, 2009). Intercultural communication cometence has three dimensions: i.e. cognitive (cultural awareness), affective (intercultural sensitivity) and behavioral (intercultural dexterity) (Chen & Starosta, 2005). Develoment of these three dimensions allows individuals to get to know their own culture and other cultures, to resect and value cultural differences and to become a global citizen emathizing with other cultures (Eginli, 2011). Intercultural sensitivity forms the affective dimension of cometence in intercultural communication and is defined as an active willingness to create one s own motivation to understand, accet and areciate cultural differences (Chen & Starosta, 2000; Bulduk et al., 2011). So that nurses can meet needs of all individuals with different cultures in a multicultural society, they need to have cultural sensitivity and incororate it into care (Ruddock & Turner, 2007). Cultural cometence is a basic term necessary in offering comrehensive, atient centered care. National League for Nursing Accrediting Commission defines cultural cometence as a necessity in atient care and as a standard in education. Nurses, nurse educators and nursing students have to achieve cultural cometence (Montenery et al., 2013). It is also exected that nursing organizations and schools should lace imortance on and argue for the issue (Kardong-Edgren, 2007). The rimary resonsibility of nurse educators as a role model in raising nurses caable of roviding effective, comrehensive care based on the whole erson aroach and cultural cometence is to devote themselves to intercultural care including all its asects and to be cometent in this area (Montenery et al., 2013). Nurse educators have the otential to create a meaningful effect on nursing students concerning cultural cometence rocess. If nurse educators are reluctant to get involved in cultural awareness, it may not be ossible that students are willing to offer culture sensitive care (Montenery et al., 2013; Von Ah & Cassara, 2013). So that nurses can give care based on cultural cometence, they should be educated by educators having cultural cometence during their undergraduate education (Kardong-Edgren, 2007). There have been many studies about the scoe of nursing education rograms in terms of cultural cometence and methods and techniques utilized to teach this toic (Anderson et al., 2007; Chang et al., 2013; Von Ah & Cassara, 2013; Tezel, 2015; Bayık Temel, 2015). However, there have been few studies directed towards determining cultural cometence levels in nurse educators (Sargent et al., 2005; Kardong-Edgren, 2007). Results of these studies show that cultural cometence levels of nurse educators are affected by their knowing a foreign language, getting involved in exchange rograms and visiting a foreign country (Sargent et al., 2005). There have been studies from Turkey on cultural sensitivity in samles of students studying communication (Bekiroglu & Balcı, 2014) and rimary education (Yılmaz & Gocen, 2013), rimary school teachers (Rengi & Polat, 2014) and nursing and medical students (Meydanlıoglu et al., 2015). However, there have not been any studies to evaluate cultural sensitivity levels of nurse educators. Therefore, results of the resent study will comlete the missing art of the relevant literature. The aim of the study was to determine intercultural sensitivity levels of the nurse educators and affecting factors. Methodology This descritive study was conducted in deartments of nursing at seven universities in İzmir in the western art of Turkey. Data were collected between vember 2015 and February The study oulation comrised of 245 nurse educators working at nursing deartments of seven universities. Forty-five educators not available at the time of data collection due to giving birth, unaid work leaves or being abroad were excluded from the study. The resonse rate was 75% and the study samle included 152 nurse educators. Data were gathered by descritive characteristics form reared by the researchers in light of the relevant literature and Intercultural Sensitivity Scale (Hui-Ying et al., 2013; Von Ah & Cassara, 2013; Meydanlıoglu et al., 2015; Uzun & Sevinç, 2015). The descritive characteristics form was included of 17 questions about gender, age, title, affiliated institution, duration of work exerience, exerience of travelling abroad, willingness to articiate in exchange rograms, to work abroad and to continue academic career in a foreign country, knowing a foreign language, receiving education in a foreign country through an exchange rogram (Erasmus and Socrates etc.), receiving or offering education in a foreign country,

3 International Journal of Caring Sciences Setember-December 2017 Volume 10 Issue 3 Page 1376 willingness to attend an exchange rogram, communication in social media with eole from different cultures, following mass communication tools of other countries (newsaer, radio, television and Internet), oinions about cultural cometence in education of nursing students, cultural knowledge and skills of communication with nursing students and cultural cometence in curricula of nursing deartments. The original version of Intercultural Sensitivity Scale was develoed by Chen and Starosta (2000) to determine cultural sensitivity of students. It has been adated to German (Fritz & Mollenberg, 2002), Sanish (Vilà Baños, 2006), Chinese (Peng, 2006) and Serbian (Petrović et al., 2015). Turkish validity and reliability of the scale were tested by Bulduk et al. (2011) and its Cronbach α was reorted to be In the resent study, Cronbach α was found to be The scale included 24 items and five emotional dimensions (Chen & Starosta, 2000; Bulduk et al., 2011). There were seven items (items 1, 11, 13, 21, 22, 23 and 24) in the subscale interaction engagement, six items (items 2, 7, 8,16, 18 and 20) in the subscale resect for cultural differences, 5 items (items 3, 4, 5, 6 and 10) in the subscale interaction confidence, 3 items (items 9, 12 and 15) in the subscale interaction enjoyment and 3 items (items 14, 17 and 19) in the subscale interaction attentiveness. The scale is a five-oint Likert scale and 1 corresonds to comletely agree and 5 corresond to totally disagree. The items 2, 4, 7, 9, 12, 15, 18, 20 and 22 are scored in the reverse order. There is not a cut-off value of the scale. Higher scores obtained from the scale indicate higher levels of cultural sensitivity (Chen & Starosta, 2000; Bulduk et al., 2011). Ethical aroval was obtained from Ethical Committee of Nursing Faculty of Ege University. A written ermission was also taken from administrations of the universities where the study was erformed. All the articiants gave oral informed consent. Data were analyzed with Statistical Package for Social Sciences for Windows Kolmogorov- Smirnov test was used to show whether the data were normally distributed. The data were evaluated with descritive statistics (numbers, ercentages, mean, and standard deviation). The total score for Intercultural Sensitivity Scale (KSZ=0,786, >0.05) and the scores for interaction engagement (KSZ=1,347, >0.05), resect for cultural differences (KSZ=1.325, >0.05) and interaction confidence (KSZ=1.031, >0.05) had a normal distribution, but the scores for interaction enjoyment (KSZ=1.657, <0.05) and interaction attentiveness (KSZ=1,949, <0.05) did not have a normal distribution. The non-arametric tests Mann Whitney U test and Kruskal Wallis H tests were used to evaluate the data without a normal distribution and the arametric test Student s t test was used to evaluate the data with a normal distribution. The results were evaluated by using 95% confidence interval and the significance level of <0.05. Results The distribution of socio-demograhic characteristics of the nurse educators is shown in Table 1. Ninety-four oint one ercent of them were female and their mean age was 35.18±9.64 years (min:22; max:63). The mean duration of academic work exerience was 10.24±9.27 years (min:1; max:35) and 52.0% of the educators were research assistants. Sixty oint five ercent of the educators lived in the Aegean region of the country for most of their life and 69.1% reorted to travel abroad for various reasons. Sixty-seven oint eight ercent of the educators sometimes communicated with eole from different cultures through social media and 64.5% of the educators sometimes followed mass communication tools of other countries. Ninetytwo oint eight ercent of the articiants reorted to know a foreign language. Only 21.1% of the articiants had an exerience of receiving or offering education abroad through an exchange rogram (Erasmus and Socrates etc.). However, 88.8% of the articiants were willing to articiate in exchange rograms and 74.3% of the articiants wanted to continue their academic career in a foreign country. Sixty-seven oint eight ercent and 63.8% of the articiants reorted that they had cultural cometence in education of students and communication resectively. Fifty-two oint six ercent of the articiants found the curriculum of their deartment to be artly cometent in terms of cultural care. The articiants got the scores 27.39±2.90 for interaction engagement, 16.27±1.82 for resect of cultural differences, 17.16±2.48 for interaction confidence, 5.91±2.00 for interaction enjoyment and 11.65±1.68 for interaction attentiveness. The mean score for the scale was 78.39±4.96 (Table 2).

4 International Journal of Caring Sciences Setember-December 2017 Volume 10 Issue 3 Page 1377 Table 1. The distribution of the nurse educators according to their descritive characteristics Variables n % Gender Female Male Title Professor Associate Professor Assistant Professor Lecturer Research Assistant Region where the articiants lived for most of their life Mediterranean Region East Anatolian Region Aegean Region Southeast Anatolian Region Middle Anatolian Region Black Sea Region Marmara Region Administrative Units where the articiants lived before starting their occuation City/megacity (İstanbul, Ankara, İzmir) Town/small town/village Visiting a foreign country for various reasons (education, tourist and living in a foreign country etc.) Communicating with eole from different cultures through social media (Facebook, Twitter, Instagram) Never Sometimes Always Following mass communication tools of foreign countries (Newsaer, radio, television and Internet) Never Sometimes Always Knowing a foreign language Receiving and offering education in a foreign country (Erasmus and Socrates etc.) Willingness to benefit from exchange rograms Willingness to continue academic career in a foreign country

5 International Journal of Caring Sciences Setember-December 2017 Volume 10 Issue 3 Page 1378 Level of cultural cometence in education of nursing students Sufficient Partially sufficient Insufficient Level of cultural knowledge and skills of communication with nursing students Sufficient Partially sufficient Insufficient Cultural cometence in curricula of nursing deartments Sufficient Partially sufficient Insufficient Total Table 2. Scores of the nurse educators for intercultural sensitivity scale (n=152) Subscales Mean Score ±SD Mean Min.-Max. Score item score Interaction engagement Resect for cultural differences 16.27± Interaction confidence 17.16± Interaction enjoyment 5.91± Interaction attentiveness 11.65± Total score 78.39± The distribution of the scores for Intercultural Sensitivity Scale and its subscales according to some factors are resented in Table 3. There was not a significant difference between the scores for the subscales and frequency of communication through social media (>0.05), oinions about cometence of educational rograms in terms of cultural care (>0.05), willingness to continue academic career abroad (>0.05), knowing a foreign language (>0.05) and willingness to articiate in exchange rograms (>0.05). However, the difference between following mass communication tools and the scores for resect for cultural differences (<0.05) and the scores for interaction enjoyment (<0.05) was significant. There was also a significant difference between willingness to articiate in exchange rograms and the scores for resect for cultural differences (<0.05). There was a significant relation between cultural knowledge and skills about offering care to individuals and interaction confidence (<0.05) and interaction enjoyment (<0.05), between having an exerience of being abroad and interaction confidence (<0.05) and between cultural knowledge and skills concerning communication with nursing students and interaction confidence (<0.05) and interaction enjoyment (<0.05) (Table 3). The total score for the scale did not differ significantly deending on all the factors examined in the study (>0.05). Discussion In order that nursing students can acquire skills necessary to offer care to individuals, families and communities from different cultures, it is imortant that nurse educators should have sufficient cultural sensitivity. In the resent study, nurse educators were found to have a moderate level of cultural sensitivity. In a study by Uzun and Sevinç, Turkish nurses were reorted to have a moderate level of cultural sensitivity (Uzun & Sevinç, 2015). Conflicting with the results of these studies, Hui-Ying et al. (2013) in their study in Taiwan reorted that ublic health nurses had a low level of cultural sensitivity (Hui-Ying et al., 2013).

6 International Journal of Caring Sciences Setember-December 2017 Volume 10 Issue 3 Page 1379 Table 3. The distribution of the scores of the nurse educators for the subscales of intercultural sensitivity scale according to some factors Variables Interaction Engagement Resect for Cultural Differences Interaction Confidence Interaction Enjoyment Interaction Attentiveness Total score for the Scale Frequency of communicating through social media Frequency of using mass communication tools Receiving and offering education in a foreign country Level of cultural knowledge and skills for offering care Cultural cometence in curricula of nursing deartments Willingness to continue academic career in a foreign country Having an exerience of being abroad Knowing a foreign language Level of cultural knowledge and skills for communicating with nursing students Willingness to benefit from exchange rograms N x±sd F/t/z/ x 2 x±sd F/t/z/ x 2 x±sd F/t/z/ x 2 x±sd F/t/z/ x 2 x±sd F/t/z/ x 2 x±sd F/t/z/ x 2 Never ±2.58 F: ±1.84 F: ±2.66 F: ± ± ±5.21 x 2 :3.452 x 2 :3.093 Sometimes ±2.54 : ±1.73 : ±2.31 : ± ± ±4.55 :0.178 :0.213 Always ± ± ± ± ± ±6.04 Never ± ± ± ± ± ±6.39 F:0.086 F:4.670 F:2.726 x :0.918 :0.011 : :5.883 x 2 :0.934 Sometimes ± ± ± ± ± ±4.33 :0.050 :0.627 Always ± ± ± ± ± ± ±2.11 t: ±1.87 t: ±2.39 t: ±1.92 z: ± ±3.08 : ±1.76 : ±2.51 : ±2.01 : ±1.66 Sufficient ± ± ± ± ±1.69 Partially F:.905 F:.897 F: ±2.53 x 2 : : ±2.01 sufficient : ±2.36 : ± ±1.62 :0.004 Insufficient ± ± ± ± ±1.52 z:-.323 :0.75 x 2 :4.756 : ± ± ± ± ±5.98 Sufficient ± ± ± ± ± ±3.30 Partially F:.407 F:.920 F:1.627 x :0.666 :0.401 : x 2 :2.387 : ± ± ± ± ± ±1.65 sufficient :0.303 :0.111 Insufficient ± ± ± ± ± ±6.03 Sufficient Partially sufficient Insufficient ± ± ± ± ± ± ± ± ± ± ±2.80 t:-.438 :0.66 t:.377 :0.71 t:.676 :0.50 F:1.345 :0.264 t: : ± ± ± ± ± ± ± ± ± ± ±1.94 t:-.225 :0.82 t:-.576 :0.57 t:.348 :0.73 F:.534 :0.587 t:-.746 : ± ± ± ± ± ± ± ± ± ± ±2.52 t:1.003 :0.32 t:2.647 :0.009 t:0.731 :0.47 F:9.222 :0.000 t:1.541 : ± ± ± ± ± ± ± ± ± ± ±1.52 z:-.713 :0.48 z: :0.27 z:-.831 :0.41 x 2 :8.221 :0.016 z: : ± ± ± ± ± ± ± ± ± ± ±1.36 z:-.615 :0.54 z:-.685 :0.49 z:-.963 :0.34 x 2 :3.896 :0.143 z:-.024 : ± ± ± ± ± ± ± ± ± ± ±5.09 F:.899 :0.409 F:.691 :0.503 t: :0.168 F:2.171 :0.118 F:1.119 :0.329 t:.379 :0.71 t:1.214 :0.23 T:1.321 :0.20 F:2.298 :0.104 t:-.487 :0.63 F: Variance analysis, t: Student's t-test, z: Mann-Whitney U test, x 2 : Kruskal-Wallis test, <0.05

7 International Journal of Caring Sciences Setember-December 2017 Volume 10 Issue 3 Page 1380 It has been noted in the literature that intercultural sensitivity of individuals differs due to effects of social media and mass communication tools (Hui-Ying et al., 2013; Bekiroglu & Balcı, 2014; Meydanlıoglu et al., 2015). In the current study, frequency of communicating through social media was not found to influence cultural sensitivity whereas following mass communication tools of foreign countries was found to be effective in resect for cultural differences and interaction enjoyment. Hui-Ying et al. (2013) reorted that communicating and making friends with individuals from different cultures and reading books about different cultures had an effect on cultural sensitivities of ublic health nurses (Hui- Ying et al., 2013). Previous studies on university students reorted that communication with individuals from different cultures had an influence on cultural sensitivity levels (Bekiroglu & Balcı, 2014; Meydanlıoglu et al., 2015). In the resent study, the rate of the nurse educators articiating in exchange rograms was quite low. However, the status of articiating in these rograms was found to influence resect for cultural differences. It has been reorted that national and international exchange of nurse educators is very useful in gaining exerience through living and working in a foreign culture and acquiring cultural sensitivity (Temel, 2008). Prior studies have also shown that willingness to work abroad (Uzun & Sevinç, 2015) and having an exerience of being abroad (Sargent et al., 2005; Meydanlıoglu et al., 2015) raise intercultural sensitivity. Consistent with the literature, the current study showed that having an exerience of being abroad increased the scores for interaction confidence. Sargent et al. (2005) also reorted a ositive relation between visits to foreign countries and scores for cultural awareness. In addition to visits to foreign countries, knowing a foreign language has been reorted to have a ositive effect on cultural sensitivity in nurses (Hui-Ying et al., 2013; Uzun & Sevinç, 2015) and university students (Bekiroglu & Balcı, 2014; Meydanlıoglu et al., 2015). Conflicting with the literature, this study showed that knowing a foreign language did not affect intercultural sensitivity in the nurse educators. This difference can be attributed to the fact that almost all the nurse educators (92.8%) knew a foreign language. In fact, it is obligatory for the nurse educators in Turkey to ass foreign language tests to be able to continue their academic careers. It is of imortance that nurse educators should be equied with aroriate knowledge and skills so that an environment for cultural cometence can be created in educational institutions. Although intercultural nursing courses and intercultural nursing concets have been incororated in nursing curricula recently, very few nurse educators have taken the courses and have had intercultural nursing certificates (Montenery et al., 2013). In the resent study, more than half of the nurse educators considered nursing curricula of their deartments as artially sufficient in terms of cultural care. Cultural cometence of nursing deartments lays an imortant art in nurses offering culturally cometent care at local, national and global environments (Montenery et al., 2013). One of the most imortant goals of nursing education rograms is to rovide students with education for cultural cometence throughout all stages of nursing education (Anderson et al., 2007). In a study by Kardong- Edgren (2007), most of the nursing faculties were found to integrate the concet of culture into their curricula, but very few of them offered elective culture courses. In addition, although the nurse educators were not reared about cultural content, they were found to teach this subject (Kardong-Edgren, 2007). In a study by Von Ah & Cassara (2013), nursing students noted that they did not receive sufficient education about offering care to individuals in accordance with their culture (Von Ah & Cassara, 2013). This study has several limitations. First, it was erformed on the nurse educators in one city of Turkey and obtained data were based on selfreorted information. In addition, the results of the study can only be generalized to the samle of the study. Conclusions A samle of Turkish nurse educators in the resent study was found to have a medium level of cultural sensitivity. The total score for Intercultural Sensitivity Scale was not found to be influenced by all the factors examined in the study. However, following mass communication tools of foreign countries, articiating in exchange rograms, having an exerience of being abroad and cultural knowledge and skills about offering care were shown to influence

8 International Journal of Caring Sciences Setember-December 2017 Volume 10 Issue 3 Page 1381 some subscales of cultural sensitivity. So that nurse educators cultural sensitivity can be imroved, it could be useful to design in-service trainings and workshos, to encourage the educators to get involved in exchange rograms and to rovide them with oortunities to attend these rograms. In addition, it can be recommended that elective intercultural care courses should be integrated into undergraduate and graduate nursing education rograms. The name and the ostal address of the lace where the work was carried out: Ege University Faculty of Nursing, Deartment of Public Health Nursing, Izmir, Turkey References Anderson, N., Calvillo, E. & Fongwa, M. (2007) Community-Based Aroaches to Strengthen Cultural Cometency in Nursing Education and Practice. J of Transcultural Nursing 18(1 sul), 49S-59S. Temel, A.B. (2008) Transcultural (Multicultural) Nursing Education. Ataturk University J of School of Nursing 11(2), Bekiroglu, O., & Balcı, S. (2014) Looking for the Clues of Sensitivity of Intercultural Communication: "A Survey on the Samle of Communication Faculty Students. Selçuk University J of Turkiyat Research 35, Bulduk, S., Tosun, H., & Ardıç, E. (2011) Measurement roerties of Turkish intercultural sensitivity scale among nursing students. Turkish Clinics J of Medical Ethics 19(1), Chang, H., Yang, Y. & Kuo, Y. (2013) Cultural Sensitivity and Related Factors Among Community Health Nurses. Journal of Nursing Research 21(1), Chen, G., & Starosta, W.J. (2000) The Develoment and Validation of the Intercultural Sensitivity Scale. Human Communication 3, Eginli, A.T. (2011) The Imortance of Training Cultural Differences in the Acquisition of Cultural Cometence. Marmara University J of Social Sciences Institute 9(35), Fritz, W., & Mollenberg, A. (2002) Measuring Intercultural Sensitivity in Different Cultural Contexts. Intercultural Communication Studies 11(2), İz, F.B., & Temel, A.B. (2009) Culturel cometencies in nursing. J of Family and Public, 11(5), Kardong-Edgren, S. (2007) Cultural Cometence of Baccalaureate Nursing Faculty. J of Nursing Education, 46(8), 360. Meydanlioglu, A., Arikan, F., & Gozum, S. (2015) Cultural Sensitivity Levels of University Students Receiving Education in Health Discilines. Advances in Health Sciences Education 20(5), Montenery, S.M., Jones, A.D., Perry, N, Ross, D., & Zoucha, R. (2013) Cultural Cometence in Nursing Faculty: A Journey, t a Destination. J of Professional Nursing 29(6), Peng, S.Y. (2006). A Comarative Persective of İntercultural Sensitivity between College Students and Multinational Emloyees in China. Multicultural Persectives 8(3), Petrović, D.S., Starčević, J., Chen, G.M., & Komnenic, D. (2015) Intercultural Sensitivity Scale: Proosal for a Modified Serbian Version. Psihologija 48(3), Rengi, O., & Polat, S. (2014) Evaluating Personal Qualifications of Teacher Candidates in Terms of Intercultural Sensitivity Levels. Journal of World of Turks/Zeitschrift fur die Welt der Turken 6(3), Ruddock, H.C., & Turner, D.S. (2007) Develoing Cultural Sensitivity: Nursing Students Exeriences of a Study Abroad Programme. J of Advanced Nursing 59(4), Sargent, S.E., Sedlak, C.A., & Martsolf, D.S. (2005) Cultural Cometence among Nursing Students and Faculty. Nurse Education Today 25(3), Sevig, U., & Tanrıverdi, G. (2011) Definition of transcultural nursing,aim, remliminary, and historical develoment. İstanbul: İstanbul Medical. Soltani, A. (2014) Imact of Ethnic Background on Iranian EFL University Students' Intercultural Sensitivity Level. Procedia - Social and Behavioral Sciences 136, Temel, A.B. (2011) Effects of Multiculturalism And Transcultural Communication On Health Services Presentation (.43-75). İstanbul: Siyasal Kitabevi. Tezel, A. (2015) The Concet of Culture in Foreign Nursing Education Curriculum Examles. J Public Health Nurs-Secial Toics 1(3), Tortumluoglu, G. (2004) Transcultural Nursing and Examles of Cultural Care Models. Cumhuriyet University J of School of Nursing 8(2), Uzun, O., & Sevinç, S. (2015) The Relationshi between Cultural Sensitivity and Perceived Stress among Nurses Working with Foreign Patients. J of Clinical Nursing 24, Vila Banos, R. (2006) Intercultural Sensitivity of Teenagers: A Study of Educational Necessities in Catalonia. Intercultural Communication Studies 15(2), Von Ah, D., & Cassara, N. (2013) Percetions of Cultural Cometency of Undergraduate Nursing Students. Oen J of Nursing 3(2), Yilmaz, F., Gocen, S. (2013) Investigation of The Prosective Primary Teachers Intercultural Sensitivity Levels in Terms of Certain Variables. Adıyaman University J of Social Sciences Institute 15,