Associations between personality traits, cross-cultural competence and cultural intelligence of nurses: a national cross-sectional study in Poland

Abstract

Background

Personality development plays an essential role in shaping cross-cultural competences, with the emotional–motivational aspect being crucial.

Objective

To assess cross-cultural competences and cultural intelligence among nurses in Poland and to examine their associations with personality traits.

Design and setting

A nationwide, cross-sectional mixed-mode survey conducted between 2022 and 2024 among 606 nurses from all Polish voivodeships.

Methods

Standardized tools were used: Cross-Cultural Competence Inventory (CCCI), Cultural Intelligence Scale (CQS), and NEO-FFI Personality Inventory.

Results

Descriptively, the mean item score was 3.72 for cross-cultural competence and 3.65 for cultural intelligence. Descriptively, CCCI subscale mean item scores ranged from 2.61 for “tolerance” to 4.54 for “mission”. Extraversion, agreeableness, openness, and conscientiousness were positively associated with cross-cultural competence, whereas neuroticism was negatively associated with it. No significant link.

Conclusions

The findings describe cross-cultural competence and cultural intelligence scores among Polish nurses and show significant associations with selected personality traits.

Registration

Not registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-026-04880-w.

Background

Since 2014, when approximately 175,000 immigrants were living in Poland, accounting for only 0.3% of the population [1, 2], the country’s migration situation has undergone dynamic changes. In recent years, Poland has experienced a substantial increase in migration, including both labour migration and forced migration related to the war in Ukraine. The Russian invasion of Ukraine in 2022 triggered a major refugee crisis in Europe, and Poland became one of the main host countries for people fleeing Ukraine, particularly in the first phase of the crisis [3–5]. In the span of one year, from January to December 2022, the number of foreigners working in Poland increased by 27.3%, reaching over one million workers, which represented 6.5% of the total workforce in Poland [1]. In 2024, approximately 1.53 million foreigners were living in Poland. By the end of April 2024, foreigners from over 150 countries accounted for 6.7% of the total workforce [6]. These demographic changes have contributed to greater diversity among patients within the Polish healthcare system, highlighting the need for targeted cross-cultural competence training for nurses and nursing students.

As a result of globalization, educational systems worldwide require changes and adaptation to the evolving realities. Ensuring high-quality healthcare demands a deep understanding and active engagement in providing culturally sensitive care for patients from diverse cultural backgrounds. Equally important is the ability to effectively collaborate with students and colleagues representing varied cultural backgrounds.

Cultural competence is a broad concept referring to a set of attitudes, knowledge, behaviors, and organizational practices that enable individuals and institutions to interact effectively and respectfully with people from different cultural backgrounds [7, 8]. In healthcare, cultural competence is particularly important because it supports culturally responsive communication, assessment, decision-making, and care planning.

Cross-cultural competence is related to, but not identical with, cultural competence. It can be understood as an individual’s ability to understand, adapt to, and function effectively in interactions with people from culturally diverse backgrounds. It includes cognitive, affective, and behavioral components, such as cultural awareness, openness, tolerance of ambiguity, communication skills, and the ability to adjust one’s behavior to culturally diverse situations [9]. Similarly, Chen and Starosta conceptualize intercultural communication competence as involving intercultural awareness, intercultural sensitivity, and intercultural effectiveness [10].

Cultural intelligence is a more specific construct that refers to an individual’s capability to function effectively in culturally diverse settings. It includes metacognitive, cognitive, motivational, and behavioral dimensions and describes how individuals acquire, process, and apply cultural knowledge in cross-cultural interactions [11–14]. Thus, in the present study, cross-cultural competence and cultural, intelligence were treated as related but distinct constructs.

In a world of increasing cultural diversity among patien, ts, students, and therapeutic teams, the development of cross-cultural competencies and intelligence poses a key challenge for ensuring high-quality healthcare. Nurses with high levels of cultural competence and intercultural intelligence are more likely to establish effective collaboration with patients from diverse cultures, taking into account their norms, values, and specific behaviors [9].

The development of cross-cultural competence and cultural intelligence is an ongoing process that may be shaped by multiple factors, including education, professional experience, exposure to culturally diverse patients, organizational context, cultural sensitivity, openness to diversity, and individual psychological characteristics [15]. Among these factors, personality traits may be particularly relevant because they are related to interpersonal functioning, emotional regulation, openness to new experiences, motivation, and adaptability in complex social situations [10, 16–18].

In the present study, personality traits were considered individual-level characteristics potentially associated with nurses’ cross-cultural competence and cultural intelligence. The conceptual model underlying the study assumes that the five personality traits included in the Big Five model—extraversion, neuroticism, agreeableness, openness to experience, and conscientiousness—may be associated with two related but distinct outcomes: cross-cultural competence and cultural intelligence. These associations are understood as correlational rather than causal, given the cross-sectional design of the study. In this model, personality traits were treated as individual-level correlates of cross-cultural competence and cultural intelligence.

The study was guided by the following research questions:

1. What are the levels of cross-cultural competence and cultural intelligence among nurses working in Poland?

2. What is the distribution of personality trait levels among the studied nurses based on NEO-FFI sten scores?

3. Are personality traits associated with cross-cultural competence and its specific domains?,

4. Are personality traits associated with cultural intelligence and its dimensions?

Methods

Aims

The aim of the study was to assess the level of cross-cultural competences and cultural intelligence among nurses working in Poland and to examine the associations between these variables and personality traits.

Study design and settings

The study was designed in such a way that the results obtained would be cross-sectional and encompass the entire territory of Poland. According to the most recent data available at the time the study began, the total number of nurses working in Poland was approximately 214,500 [19]. This figure referred to nurses employed in Poland and was used as the target population for sample size calculation. The target population was defined professionally and geographically, not by nationality, and included nurses legally authorized and actively working in Poland. The minimum required sample size was calculated using an online sample size calculator [20]. The calculation was based on the following parameters: target population size of 214,500 nurses, 95% confidence level, 5% margin of error, and an assumed population proportion/response distribution of 50%. The assumed proportion of 50% was used as a conservative estimate when the expected proportion is unknown, as it produces the maximum required sample size. Based on these assumptions, the minimum required sample size was 383 nurses. This number was adopted as the minimum required sample size. Subsequently, to ensure nationwide coverage and to approximate the geographical distribution of nurses in Poland, the distribution of nurses across the 16 voivodeships was taken into account Based on these data, the percentage of nurses working in each voivodeship was calculated, and the minimum number of questionnaires to be collected in each voivodeship was determined proportionally from the minimum required sample size of 383 participants. The target population consisted of nurses working in Poland, not the Polish general population. To ensure nationwide coverage and to approximate the geographical distribution of nurses across the country, the distribution of nurses across the 16 Polish voivodeships was used as the proportional sampling criterion. Based on these data, the percentage of nurses working in each voivodeship was calculated, and the minimum number of questionnaires to be collected in each region was determined proportionally from the minimum required sample size of 383 participants. Region was selected as the proportional criterion to ensure inclusion of nurses from all parts of Poland and to reduce the risk of overrepresentation of the most accessible regions.

Age, gender, years of professional experience, education, and workplace were not used as quota criteria. This was because reliable and sufficiently detailed population distributions for these characteristics were not available at the study planning stage and because recruitment was voluntary and did not involve probability sampling. Therefore, the final sample should be interpreted as nationwide and geographically distributed, rather than fully representative of all nurses working in Poland.

Data collection was completed after the minimum planned number of questionnaires had been obtained from each voivodeship; exceeding the minimum number was allowed. Recruitment was voluntary and did not involve probability sampling.

The inclusion criteria for the study group were as follows: conscious and voluntary consent to participate in the study, possession of the right to practice the nursing profession in Poland, active employment as a nurse in a Polish healthcare institution for at least 1 year, regardless of nationality, and completion of all questionnaires included in the study with at least 95% accuracy. Questionnaires with more than 5% missing responses or completed in a way that would hinder proper interpretation (e.g., selecting multiple answers for single-choice questions) were excluded from the study. A total of 766 nurses participated in the study, and 606 correctly completed questionnaires were returned (completion rate: 79.11%)—questionnaires completed with less than 95% were not qualified for further analysis.

The study was submitted to the Bioethics Committee of the Pomeranian Medical University in Szczecin, Poland (no. KB.006.79.2022/Z-6186) and received confirmation that no consent was required due to the absence of characteristics of a medical experiment. The study protocol was prepared in accordance with the Helsinki Declaration. Each participant was informed in writing about the purpose and course of the study and provided written consent to participate. Respondents were also informed about the option to withdraw from the study at any stage without providing a reason. The study was conducted using a mixed-mode questionnaire approach, including both online and printed self-administered questionnaires. In both modes, participants completed the same set of questions. The questionnaire was accompanied by either an introductory information page in the online version or a cover letter in the printed version, explaining the purpose of the study, the voluntary and anonymous nature of participation, instructions for completing the questionnaire, and the estimated time required to complete it. Participants provided informed consent before completing the questionnaire.

Participants were recruited through professional nursing networks, contacts with healthcare institutions, regional professional environments, and online channels used by nurses. No central database of nurses’ personal contact details was used. In the online mode, information about the study and a link to the questionnaire were distributed through these professional and online channels. In the printed mode, questionnaires were distributed through cooperating healthcare institutions and professional contacts. Participation was voluntary, and the recruitment procedure did not involve probability sampling.

Research tools

Data were collected using a structured survey package consisting of an author-developed sociodemographic data form and three standardized instruments adapted to Polish conditions.

The author-developed sociodemographic data form was used only to collect basic participant characteristics, including gender, age, place of residence, nursing education, main workplace, and years of professional experience. This form was not intended as a psychometric instrument. The standardized assessment methods used in the study were the Cross-Cultural Competence Inventory (CCCI), the Cultural Intelligence Scale (CQS), and the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI). References for the original instruments and their Polish adaptations are provided below for each tool.

The CCCI questionnaire allows for the assessment of general cross-cultural competence, including cultural skills, attitudes related to cultural sensitivity, and the ability to use cultural knowledge. The tool consists of 63 items divided into seven subscales: cultural adaptation, self-presentation, tolerance for ambiguity/uncertainty, determination, willingness to engage, mission, and a lie and social approval scale. In the present study, both the total CCCI score and subscale scores were calculated. The total score was used as a descriptive summary of the overall response pattern across all CCCI items, while the subscale scores were used to describe specific domains of cross-cultural competence measured by the instrument. The inventory was developed by Thornson and Ross [21], and the Polish adaptation was carried out by Barzykowski et al. [22]. The Polish adaptation of the tool demonstrates high reliability and good validity (Cronbach’s alpha coefficient ranged from 0.83 to 0.86) [22].

The CCCI has no standardized norms allowing categorical classification of respondents’ cross-cultural competence levels. Therefore, in the present study, CCCI results were not used to assign respondents to normative competence categories. Total and subscale scores were reported descriptively. Mean item scores were calculated only to summarize the observed response patterns within the present sample and to facilitate the presentation of scales and subscales consisting of different numbers of items. These values should not be interpreted as standardized indicators of competence level or as evidence of psychometric equivalence between CCCI subscales.

The CQS was developed by Ang et al. [11, 23], and the Polish adaptation was prepared by Barzykowski et al. [24, 25]. The CQS questionnaire is used to measure the key components of cultural intelligence. It consists of 20 items covering four areas: metacognitive, cognitive, motivational, and behavioral. The CQS is considered a comprehensive and exhaustive tool, with reliability indices ranging from 0.70 to 0.86 [23]. The adaptation of the tool to Polish conditions resulted in a tool with high reliability (Cronbach’s alpha coefficient ranging from 0.94 to 0.95), as well as theoretical, criterion, and convergent validity [25]. The interpretation of the results is based on the assumption that the higher the score on a given subscale, the greater the intelligence in that aspect, although no specific norms are available.

The NEO-FFI was developed by Costa and McCrae [26], and the Polish adaptation was prepared by Zawadzki et al. [27]. The Polish adaptation of the tool was developed by Zawadzki et al., achieving satisfactory internal consistency (Cronbach’s alpha coefficient ranging from 0.75 to 0.80) [27]. The NEO-FFI inventory was developed by the creators of the “Big Five” theory, one of the most widely recognized personality models in psychology. This theory posits that human personality can be described using five main dimensions of traits, including openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism [26]. The NEO-FFI consists of 60 items. In the present study, NEO-FFI results were interpreted using sten scores based on the Polish adaptation of the instrument, with separate norms for sex and age groups. Sten scores were categorized as low (1–4), medium (5–6), or high (7–10). Therefore, NEO-FFI results are presented as n (%) across sten categories rather than as raw-score means and measures of dispersion.

Statistical analysis

Statistical analysis was performed using R software, version 4.3.2. Categorical variables were presented as numbers and percentages, while continuous variables were summarized using means and standard deviations, medians with interquartile ranges, and minimum–maximum values. Total scale and subscale scores were calculated according to the scoring instructions for each questionnaire. For the CCCI, the total score was reported as a descriptive overall summary, whereas subscale scores were reported to describe domain-specific response patterns. For the CCCI and CQS, mean item scores were additionally calculated by dividing each total scale or subscale score by the corresponding number of items.

NEO-FFI results were interpreted using sten scores based on the Polish adaptation of the instrument and categorized as low, medium, or high for descriptive purposes. These categories were used only to present the distribution of personality trait levels in Table 1 and were not used in the correlation analyses. Associations between personality traits and CCCI and CQS scores were assessed using Spearman’s rho correlation coefficient, with personality trait scores treated as numerical variables. The magnitude of Spearman’s rho coefficients was interpreted as an effect-size indicator. Correlations of approximately 0.10 were interpreted as weak, approximately 0.30 as moderate, and 0.50 or higher as strong. Because multiple correlation analyses were performed and no formal correction for multiple comparisons was applied, the correlation analyses should be interpreted as exploratory. Therefore, emphasis was placed on the magnitude and consistency of associations rather than on statistical significance alone [28].

Table 1.

Characteristics of the study group

		n	%
Gender	Woman	571	94.22%
	Man	35	5.78%
Age [years]	≤ 30	191	31.52%
	31–40	107	17.66%
	41–50	157	25.91%
	51–60	141	23.27%
	> 60	10	1.65%
Place of residence	Village	157	25.91%
	City 10-100k inhabitants	145	23.93%
	City 100-500k inhabitants	180	29.70%
	City over 500k inhabitants	124	20.46%
Education in nursing	Medical High School	41	6.77%
	Medical College	29	4.79%
	Bachelor’s Degree	293	48.35%
	Master’s Degree	225	37.13%
	PhD Degree	18	2.97%
Main workplace	Medical wards / non-surgical departments	73	12.05%
	Surgical departments	292	48.18%
	Gynecological-obstetric-neonatal departments	14	2.31%
	Pediatric departments	44	7.26%
	Emergency room	9	1.49%
	Specialist clinics	22	3.63%
	Outpatient clinics	21	3.47%
	Other	47	7.76%
	No response	84	13.86%
Work experience [years]	1–10	269	44.39%
	10.1–20	83	13.70%
	20.1–30	151	24.92%
	30.1–40	95	15.68%
	> 40	8	1.32%

Results

Characteristics of the study group

The study involved 606 nurses from various regions of Poland. The majority of respondents were women, constituting 94.22% of the sample (571 individuals). The average age of participants was 39.94 years (SD = 12.35), with an age range from 21 to 69 years, and the largest group (31.52%) was in the 21–30 age range. In terms of residence, 29.70% of respondents lived in cities with populations between 100,000 and 500,000, while 25.91% lived in rural areas. Regarding educational level, 48.35% of participants (293 individuals) held a Bachelor’s degree in nursing, while 37.13% (225 individuals) had completed Master’s studies. The most common place of employment for the nurses surveyed was surgical wards, where 48.18% of participants worked. Additionally, 12.05% (73 respondents) worked in medical wards/non-surgical departments, 7.26% (44 individuals) in pediatric wards, and 7.76% (47 individuals) reported other workplaces. The average work experience was 16.31 years (SD = 12.92), with a range from 1 to 46 years. The largest professional groups consisted of nurses with 1–10 years of professional experience (44.39%) and those with 20.1–30 years of experience (24.92%) (Table 1).

Descriptive results for cross-cultural competence, cultural intelligence, and personality traits

The mean total CCCI score was 234.54 points (SD = 24.23), corresponding to a mean item score of 3.72. Because the CCCI has no standardized norms, this value is reported descriptively and should not be interpreted as a normative category of cross-cultural competence.

In the present sample, the observed mean item scores for the CCCI subscales ranged from 2.61 for “tolerance” to 4.54 for “mission.” These values are presented to describe the response pattern within this sample only. They should not be interpreted as a normative comparison of competence levels across CCCI domains, as such interpretation would require additional analysis of raw-score distributions and further psychometric evidence. The score obtained by respondents on the “lie” and “social desirability” scale, a control element used to identify and control distortions arising from tendencies to present oneself in a favorable light, in line with social expectations, and dishonesty in responses, averaged 2.89 per item. This suggests that respondents were unlikely to resort to lying.

The average level of cultural intelligence, assessed using the CQS questionnaire, was 3.65 points per item in the studied group (with a maximum value of 7 and a minimum of 1). The overall CQS score was calculated as the mean score across all 20 CQS items. Analysis of the individual aspects of cultural intelligence revealed that the metacognitive aspect was the highest-scoring area of cultural intelligence among nurses in Poland (the average score per item was 4.01, SD = 4.63), while the cognitive aspect was the lowest-rated (average score of 2.97, SD = 6.84). In Table 2, mean and SD values are presented for total scale or subscale scores, whereas mean item scores are reported separately to support descriptive interpretation across scales and subscales with different numbers of items. Mean ± SD and Me (Q1–Q3) are presented to summarize total scale and subscale scores, while mean item scores are reported separately for descriptive purposes because the scales and subscales contain different numbers of items.

Table 2.

Descriptive statistics for the CCCI and CQS scores

Scale / subscale CCCI	Theoretical score range	Mean total/subscale score ± SD	Me (Q1–Q3)	Mean item score
General cross-cultural competence	63–378	234.54 ± 24.32	234 (219–249)	3.72
Cultural adaptation	18–108	78.12 ± 12.28	78 (71–86)	4.34
Determination	7–42	25.38 ± 4.64	26 (23–28)	3.63
Tolerance	11–66	28.67 ± 8.24	29 (22–34)	2.61
Self-presentation	4–24	12.04 ± 4.22	12 (9–15)	3.01
Mission	7–42	31.81 ± 4.81	32 (29–35)	4.54
Willingness to engage	11–66	44.07 ± 7.65	44 (39–49)	4.01
Social desirability and lying scale	5–30	14.45 ± 4.67	14 (11–17)	2.89
CQS
Metacognitive aspect	4–28	16.02 ± 4.63	16 (13–19)	4.01
Cognitive aspect	6–42	17.79 ± 6.84	18 (12–22.75)	2.97
Motivational aspect	5–35	19.35 ± 5.49	19 (16–23)	3.87
Behavioral aspect	5–35	19.79 ± 6.16	20 (15–24)	3.96

SD, standard deviation for total scale/subscale scores; Me, median; Q1–Q3, interquartile range. Mean item scores are presented for descriptive purposes only and should not be interpreted as normative categories or as direct psychometric comparisons between subscales

The analysis of the NEO-FFI questionnaire allowed for the assessment of the intensity of each of the five personality traits included in the “Big Five” model. Using sten scores, which account for gender and age of the respondents, the obtained numerical data were interpreted, and the results were assigned to groups representing low, medium, or high levels of each trait. The largest proportion of the studied group exhibited a moderate level of neuroticism (37.95%), openness to experience (38.45%), and conscientiousness (43.07%), a high level of extraversion (48.68%), and a low level of agreeableness (47.03%) (Table 3).

Table 3.

Distribution of nurses across low, medium, and high personality trait levels based on NEO-FFI sten scores, n (%)

Level	NEO-FFI
	Extraversion	Neuroticism	Agreeableness	Openness to experience	Conscientiousness
Low	65 (10.73%)	204 (33.66%)	285 (47.03%)	175 (28.88%)	204 (33.66%)
Medium	246 (40.59%)	230 (37.95%)	193 (31.85%)	233 (38.45%)	261 (43.07%)
High	295 (48.68%)	172 (28.38%)	128 (21.12%)	198 (32.67%)	141 (23.27%)

NEO-FFI results are presented as n (%) across sten score categories according to the Polish adaptation of the instrument; therefore, measures of dispersion are not reported in this table. Sten categories were used for interpretation because they account for sex- and age-specific norms

Analysis of the relationships between personality traits and the level of cross-cultural competence and cultural intelligence

The correlation analysis showed statistically significant associations between selected personality traits and CCCI and CQS scores; however, the magnitude of these associations varied. For the overall CCCI score, associations with extraversion (ρ = 0.481), conscientiousness (ρ = 0.418), openness to experience (ρ = 0.384), and agreeableness (ρ = 0.305) were moderate in magnitude. Neuroticism was negatively associated with the overall CCCI score, but the magnitude of this association was weak (ρ = -0.134).

At the CCCI subscale level, most statistically significant correlations were weak or moderate. The strongest association was observed between extraversion and cultural adaptation (ρ = 0.515), which reached the threshold commonly interpreted as strong. Associations between conscientiousness and mission (ρ = 0.483) and between extraversion and willingness to engage (ρ = 0.497) approached this threshold but remained below 0.50. For CQS dimensions, statistically significant associations with personality traits were generally weak to moderate. Neuroticism was not significantly associated with any CQS dimension.

Because multiple correlations were examined without correction for multiple testing, these results should be interpreted as exploratory and should not be overinterpreted on the basis of statistical significance alone (Table 3).

Table 4.

Spearman’s correlations between personality traits, CCCI scores, and CQS scores

CCCI scale/subscale	Extraversion	Neuroticism	Agreeableness	Openness to experience	Conscientiousness
General cross-cultural competence	0.481*	-0.134*	0.305*	0.384*	0.418*
Cultural adaptation	0.515*	-0.037	0.356*	0.361*	0.476*
Determination	0.276*	-0.362*	0.091*	0.155*	0.273*
Tolerance	-0.268*	-0.185*	-0.255*	-0.179*	-0.369*
Self-presentation	-0.047	0.358*	0.177*	0.162*	-0.001
Mission	0.464*	-0.155*	0.288*	0.271*	0.483*
Willingness to engage	0.497*	-0.112*	0.259*	0.337*	0.402*
Social desirability and lying scale	0.089*	0.013	0.037	0.176*	0.126*
CQS scale/subscale
Metacognitive aspect	0.278*	0.037	0.202*	0.240*	0.255*
Cognitive aspect	0.103*	0.074	0.087*	0.191*	0.082*
Motivational aspect	0.278*	-0.043	0.140*	0.189*	0.208*
Behavioral aspect	0.203*	0.044	0.212*	0.167*	0.181*

Values are Spearman’s rho coefficients. Personality trait scores were treated as numerical variables in correlation analyses. * Statistically significant correlation, p < 0.05. Approximate interpretation of rho coefficients: 0.10 = weak, 0.30 = moderate, 0.50 = strong association. No correction for multiple comparisons was applied; therefore, the results should be interpreted as exploratory

Discussion

The present study showed that personality traits were associated with cross-cultural competence and cultural intelligence among nurses working in Poland, although the magnitude of these associations varied. Extraversion, conscientiousness, openness to experience, and agreeableness were positively associated with the overall CCCI score, whereas neuroticism showed a weak negative association. For CQS dimensions, associations with personality traits were generally weak to moderate, and neuroticism was not significantly associated with any CQS dimension.

These findings are partly consistent with previous research showing links between personality traits and cultural intelligence. In earlier studies, openness to experience was associated with all four dimensions of cultural intelligence, while extraversion was related particularly to cognitive, motivational, and behavioral CQ. Conscientiousness has been linked to metacognitive CQ, and agreeableness and emotional stability have been associated with behavioral CQ [11, 29]. The present study adds to this literature by showing that similar personality-related patterns can be observed among nurses working in Poland, a healthcare context increasingly shaped by migration and growing cultural diversity.

Although several associations were statistically significant, their magnitude varied, and some correlations were weak. Therefore, the findings should be interpreted as indicating modest personality-related differences rather than strong predictive relationships.

One notable finding of the present study was the relatively high proportion of nurses classified as having low agreeableness based on NEO-FFI sten scores. Agreeableness is commonly related to interpersonal sensitivity, cooperation, trust, and prosocial orientation; therefore, lower levels of this trait may be relevant in the context of communication with culturally diverse patients. However, this finding should be interpreted cautiously. The present study does not allow conclusions about clinical behavior or quality of care, and low agreeableness scores should not be treated as individual deficits. Rather, this result may indicate the need for educational approaches that strengthen relational and communication competencies, including perspective-taking, empathy, and reflective responses to culturally complex situations.

Another finding requiring careful interpretation is the negative correlation between all five personality traits and the CCCI tolerance subscale. This pattern differs from the generally positive associations observed for most other CCCI domains and may reflect the specific content or scoring direction of this subscale, the complexity of tolerance for ambiguity in cross-cultural contexts, or sample-specific response tendencies. Therefore, this result should not be interpreted as evidence that higher personality trait levels reduce tolerance. Instead, it suggests that the tolerance subscale requires cautious interpretation and further investigation in future studies, preferably with additional psychometric verification and qualitative exploration of how nurses understand tolerance, ambiguity, and uncertainty in culturally diverse clinical situations.

The positive associations observed between openness to experience and both CCCI and CQS scores may be interpreted in light of the conceptual role of openness in curiosity, receptiveness to unfamiliar perspectives, and willingness to engage with cultural difference. Similarly, the positive associations of extraversion with the overall CCCI score and several CCCI domains may reflect the interpersonal and communicative aspects of cross-cultural encounters. Conscientiousness may be relevant because culturally responsive care often requires attentiveness, preparation, self-regulation, and responsibility in adapting care to patients’ needs. Agreeableness, which is related to cooperation and interpersonal sensitivity, may also support communication and relationship-building in culturally diverse clinical situations. The observed associations may be interpreted in relation to specific components of cross-cultural interactions. Openness to experience may support receptiveness to unfamiliar cultural norms and perspectives, while extraversion may facilitate communication and engagement with culturally diverse patients. Agreeableness may be relevant to cooperation, trust, and interpersonal sensitivity, and conscientiousness may support careful preparation, self-regulation, and responsible adaptation of care. In contrast, higher neuroticism may be related to greater emotional reactivity in uncertain or stressful cross-cultural encounters. These interpretations are consistent with previous conceptual and empirical work emphasizing openness, self-reflection, motivation, adaptability, and interpersonal sensitivity as relevant to intercultural functioning [10, 16–18, 30–32].

Overall, the findings suggest that personality traits may be related to cross-cultural competence and cultural intelligence, but the generally weak-to-moderate effect sizes, the exploratory nature of the analyses, and the absence of correction for multiple comparisons require cautious interpretation. Furthermore, Piwowarczyk [15, 33] emphasizes the importance of personality, pointing out that through the lens of its development, it is possible to view the entire academic education process in terms of the development of intercultural intelligence. Educational support for cultural competence and cultural intelligence may be relevant in preparing nurses for cross-cultural encounters, particularly by encouraging cultural self-awareness, reflection, communication skills, and sensitivity to patient needs in culturally diverse clinical situations. However, the present study did not assess changes in these competencies over time or evaluate the effects of educational interventions; therefore, conclusions about their development or practical consequences require longitudinal and intervention-based research [34, 35]. Insufficient awareness among nurses regarding the need for cultural competence to provide effective and high-quality care for patients from different cultural backgrounds may become a significant issue in the world of widespread globalization. Cang-Wong’s [36] research shows that there is awareness among nurses of the need for education in cultural competency – as much as 77% of respondents expressed this need.

In conclusion, the present findings support the relevance of personality traits to cross-cultural competence and cultural intelligence, while further research is needed to clarify the direction, mechanisms, and educational implications of these associations.

Recommendation

Given the observed associations between personality traits, cross-cultural competence, and cultural intelligence, healthcare education programs should consider incorporating activities that increase awareness of individual differences relevant to cross-cultural interactions. However, the present findings do not support routine personality assessment as a mandatory component of nursing education. Instead, educational interventions should focus on strengthening modifiable competencies, such as cultural self-awareness, reflective practice, empathy, openness to diversity, communication skills, and strategies for managing uncertainty in cross-cultural encounters. Particular attention should be paid to domains with relatively lower scores, including tolerance and self-presentation. Future research should use longitudinal or intervention-based designs to examine whether educational strategies tailored to personality-related differences can improve cross-cultural competence and cultural intelligence among nurses.

Limitations

The present study has several limitations. Because of the cross-sectional design, the study allows only for the assessment of associations between personality traits, cross-cultural competence, and cultural intelligence. Therefore, the findings should not be interpreted as evidence of causal effects. Longitudinal and intervention-based studies are needed to clarify the direction and mechanisms of these associations.

The study was based on self-report questionnaires, which may be affected by response bias, recall bias, and social desirability bias. Although the CCCI includes a social desirability and lying scale, the possibility that participants presented themselves in a more favorable way cannot be fully excluded. This may be particularly relevant when assessing culturally sensitive constructs such as cross-cultural competence, tolerance, and openness to diversity.

Another limitation concerns the interpretation of CCCI scores. Because the CCCI has no standardized norms, its results cannot be used to assign respondents to normative categories of cross-cultural competence. In addition, mean item scores across CCCI subscales may not be directly comparable because subscales may differ in item content, score distributions, and response patterns. Therefore, CCCI subscale results were interpreted descriptively and should be treated as indicators of response patterns in the present sample rather than as definitive comparisons of competence levels across domains.

Although the study included nurses from all 16 Polish voivodeships and the minimum number of participants from each region was planned proportionally to the distribution of nurses across Poland, recruitment was voluntary and did not involve probability sampling. The sample was not proportionally controlled for gender, age, professional experience, education, or workplace. Therefore, the sample should be interpreted as nationwide and geographically distributed rather than fully representative of all nurses working in Poland, which may limit the generalizability of the findings. In addition, the mixed-mode survey approach may have introduced mode-related differences in responses between participants completing the questionnaire online and those completing the printed version.

The analyses were primarily correlational and did not include multivariable adjustment for potential confounders, such as age, gender, education level, professional experience, workplace, previous intercultural training, or direct experience in caring for culturally diverse patients. Therefore, the observed associations should be interpreted as unadjusted relationships and may partly reflect the influence of other individual or professional factors.

Another limitation concerns the number of correlation analyses performed. No formal correction for multiple comparisons was applied; therefore, some statistically significant findings may represent chance findings. For this reason, the correlation results should be interpreted as exploratory, with greater emphasis placed on the magnitude and consistency of effect sizes than on p-values alone. Future studies should test predefined hypotheses, apply appropriate correction for multiple testing where necessary, and use multivariable models to examine whether the observed associations remain after adjustment for potential confounders.

Future studies should consider probability-based sampling strategies, proportional control for additional demographic and professional characteristics, longitudinal or intervention-based designs, and multivariable analytical approaches. Further research should also examine the role of previous cross-cultural education, professional experience with diverse patient populations, and workplace context in shaping nurses’ cross-cultural competence and cultural intelligence.

Conclusions

1. The findings provide a descriptive overview of cross-cultural competence and cultural intelligence scores among nurses working in Poland. Because standardized normative cut-offs were not available for the CCCI, these scores should not be interpreted as indicating low, moderate, or high levels of competence. Instead, they describe response patterns observed in the present sample.

2. Personality traits showed statistically significant associations with cross-cultural competence and selected dimensions of cultural intelligence; however, the magnitude of these associations varied. Most correlations were weak or moderate, and only one association reached the threshold commonly interpreted as strong. Therefore, the findings should be interpreted cautiously and with attention to effect size rather than statistical significance alone.

3. Because the study was cross-sectional and exploratory, and because no correction for multiple comparisons was applied, the results do not imply causal effects or confirm robust predictive relationships. Future longitudinal and confirmatory studies using predefined hypotheses, multivariable adjustment, and appropriate control for multiple testing are needed to clarify the role of personality-related differences in cross-cultural competence and cultural intelligence among nurses.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

KS: Conceptualization, Methodology, Software, Writing- Original draft preparation, Formal analysis. ER: Data curation, Writing- Original draft preparation. AK: Conducting, Resources. PJ: Conducting, Resources. KM: Visualization, Investigation. DS-M: Software, Validation. MSz: Supervision, Writing- Reviewing and Editing, Writing – original draft, Validation, Methodology, Investigation, Conceptualization.

Funding

This work was supported by the Pomeranian Medical University in Szczecin, Poland.

Data availability

The data that support the findings of this study are available from coresponding author but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of coresponding author.

Declarations

Ethics approval and consent to participate

The protocol complied with the Declaration of Helsinki, and the Bioethics Committee of the Pomeranian Medical University in Szczecin concluded that formal approval was not required for conducting the study due to its nature (no. KB.006.79.2022/Z-6186). All participants provided informed and voluntary consent to participate in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.