Transcultural nursing leadership, nursing practice environment, and cultural competence: A cross-sectional study with multicultural nursing teams

Background Increasing cultural diversity in healthcare organisations demands leadership that fosters cultural competence and positive nursing practice environments. Evidence on the relationships between transcultural nursing leadership, nursing practice environments, and nurses' cultural competence remains limited, particularly in Portugal. Aim To analyse the associations between transcultural nursing leadership, the nursing practice environment, and nurses' cultural competence in Portuguese multicultural healthcare units, and to explore the potential moderating role of nurse managers' cultural competence. Methods A cross-sectional quantitative study was conducted with 346 nurses from six multicultural healthcare units in Portugal. Data were collected using validated instruments. Descriptive statistics, correlation analyses, multiple regression, and moderation analyses were performed. Findings Cultural Sensitivity and Adaptation, a dimension of transcultural nursing leadership, and Organisational Support for cultural competence reported by nurse managers were positively associated with favourable nursing practice environments. Fundamentals for Nursing, Management Support, and multicultural training were significantly associated with higher levels of nurses' cultural competence. No significant association was found between transcultural nursing leadership and nurses' cultural competence. Nurse managers' cultural competence moderated the relationship between transcultural nursing leadership and the nursing practice environment, although the interaction effect was negative and small. Discussion These findings highlight the importance of combining leadership development with organisational and educational strategies to support culturally responsive nursing practice, supporting international literature that both organisational and individual dimensions are crucial in strengthening nurses' cultural competence. Conclusion Transcultural Nursing Leadership behaviours, particularly Cultural Sensitivity and Adaptation, may contribute to inclusive and supportive practice environments for multicultural nursing teams, but not to nurses' cultural competence. To improve nurses' cultural competence, institutional strategies must ensure that initiatives to assist their development are effectively embedded into everyday practice.