Cultural Competence, Patient-Centred Care, and Perioperative Nursing: A Scoping Review of Global, African, and Ghanaian Evidence

Technical Summary: Cultural Competence, Patient-Centred Care, and Perioperative Nursing

Problem Statement
Cultural competence is a critical quality imperative in contemporary nursing, particularly in perioperative settings where surgical interventions intersect with patients' cultural frameworks of meaning. Despite growing global evidence regarding cultural competence in nursing, a significant gap exists in the literature concerning perioperative and surgical nursing contexts, with a specific dearth of evidence from sub-Saharan Africa. In Ghana, a country characterized by over 50 indigenous language groups and religious pluralism, perioperative nursing has received no dedicated scholarly attention regarding cultural competence. This absence limits the ability to address the unique cultural, ethical, and clinical demands of surgical care in this setting, potentially compromising the dignity and effectiveness of care for diverse patient populations.

Methodology
This study is a scoping review conducted in accordance with the methodological framework of Arksey and O'Malley (2005), refined by Levac et al. (2010), and updated by Peters et al. (2020). The review utilized the Population-Concept-Context (PCC) framework to guide the search strategy.

• Data Sources: Searches were conducted across five electronic sources: PubMed, PubMed Central, BASE (Bielefeld Academic Search Engine), DOAJ, and Google Scholar.
• Search Terms: Terms related to cultural competence (e.g., "cultural competence," "transcultural nursing"), the population (nurses, surgical nurses), and the context (perioperative, Africa, Ghana) were combined using Boolean operators.
• Inclusion Criteria: Peer-reviewed empirical studies, conceptual papers, systematic reviews, or scoping reviews published in English between January 2020 and March 2026. Studies had to focus on cultural competence within nursing or allied healthcare settings.
• Selection Process: After removing duplicates, two reviewers independently screened titles, abstracts, and full texts. Disagreements were resolved through discussion or a third reviewer.
• Synthesis: Thirty articles were retained for systematic data extraction and thematic synthesis. No formal quality or risk-of-bias appraisal was conducted, consistent with the goal of mapping the breadth and nature of evidence rather than synthesizing effect estimates.

Key Contributions and Results
The review synthesized 30 peer-reviewed articles spanning 16 countries across five continents. The analysis revealed the following:

1. Geographical Distribution: The evidence base is heavily skewed toward high-income countries. Twenty-seven studies provided global or worldwide evidence, while only one study originated from the African continent (Ethiopia) and two from Ghana. No study was conducted exclusively within a perioperative or surgical nursing context.
2. Study Designs: Cross-sectional survey designs predominated (n=18). Nurses were the primary study population in 28 of the 30 studies.
3. Levels of Cultural Competence: Globally, nurses generally reported moderate levels of cultural competence. A consistent pattern emerged where "cultural awareness" was the strongest domain, while "cultural encounters" (direct interactions with diverse patients) was consistently the weakest domain.
4. Patient Perspectives: A critical finding was the systematic exclusion of patient voices. In 28 of the 30 studies, patient perspectives were either absent or addressed only indirectly through provider-reported data. Only one study (Kara et al., 2025) included direct patient satisfaction ratings linked to nurse cultural competence, and it was not in a surgical context.
5. Ghanaian Context: The two Ghanaian studies (Abubakari et al., 2024a, b) reported high self-reported cultural competence among nurses, though this may be influenced by social desirability bias. However, like the global trend, "cultural encounters" remained the weakest domain. These studies highlighted that integration of patient-centred care is constrained by institutional barriers, including a lack of formal policies, understaffing, and limited training opportunities.
6. Barriers: Challenges identified across the literature include language barriers, ethnocentrism, lack of training, and the dominance of the biomedical model which often displaces indigenous healing systems and relational care approaches.

Significance and Claims
The paper claims that this scoping review establishes the empirical and conceptual rationale for investigating cultural competence specifically within Ghanaian perioperative nursing. The authors identify five critical, mutually reinforcing gaps in the existing literature that justify the need for new research:

1. Absence of Perioperative Evidence: No existing study focuses exclusively on perioperative or surgical nursing contexts.
2. Exclusion of Patient Voices: The literature systematically ignores the patient's lived experience of culturally responsive care.
3. Underrepresentation of Africa and Ghana: The evidence base lacks representation from sub-Saharan Africa, limiting the transferability of findings to these contexts.
4. Weakness of Cultural Encounters: The persistent weakness of the "cultural encounters" domain suggests a structural failure in translating awareness into practice, a gap not yet examined in depth.
5. Inadequate Examination of Systemic Barriers: While barriers are identified in Ghana, they have not been examined within the specific institutional and policy context of perioperative nursing units.

The authors conclude that bridging the gap between cultural awareness and culturally competent practice in surgical care requires context-specific, patient-centred, and multi-level interventions. They argue that future research must treat both nurses and surgical patients as indispensable primary participants to generate evidence that reflects the full diversity of the communities nursing serves. The review does not propose specific experimental interventions but calls for the generation of context-specific evidence to inform nursing education, clinical practice, and health policy in Ghana and across sub-Saharan Africa.