The parents of a critically ill newborn avoided visiting their child in the hospital. Their worried medical team consulted a nurse who knew the family’s culture and found out why. Because their Vietnamese cultural traditions had instilled in them the belief that their presence would attract evil spirits, the parents stayed away to protect their newborn from harm — an act of love, not indifference.
Cultural competence in nursing bridges misunderstandings like this one. Cultural backgrounds influence patient healthcare experiences. Every day, nurses encounter the challenge of serving patients from cultural backgrounds of all kinds. Cultural competence is key to making those connections positive.
Why Is Cultural Competence in Nursing Important?
What is culture? In simplest terms, a group’s culture is its shared beliefs, language, social customs, and other behaviors. Cultural competence in nursing tailors healthcare to fit a patient’s unique cultural background.
Cultural competence in nursing is essential because a patient’s culture can affect how they:
- Describe their symptoms
- Approach care options
- Implement treatment plans
Culturally influenced choices such as these affect the quality of care patients receive.
Cultural Competence in Nursing: Diversity and Patient Outcomes
The United States is increasingly diverse, but diversity among the nation’s physicians hasn’t kept pace. For example, Hispanic individuals make up about 18% of the U.S. population but only 6% of U.S. physicians. In the same vein, Black individuals constitute more than 13% of the U.S. population but less than 5% of the nation’s physicians.
Diversity and Patient Outcomes
For better health outcomes, caregivers and patients need to be equally diverse. One reason is people are more likely to seek regular medical care — and avoid waiting until they’re seriously ill — if they know they’ll see physicians and nurses who share their culture.
Another reason diversity improves patient care outcomes is that the presence of nurses who are culturally competent caregivers from diverse backgrounds increases the likelihood of accurate, empathic communication between patient and caregiver, lowering barriers to understanding and comfort level that can cause misunderstandings.
Social Inequities and Patient Outcomes
Many factors contribute to our nation’s health inequities — systemic racism, provider bias, and the underrepresentation of people of color in medical studies, to name a few — and result in an imbalance of quality care in favor of the white majority. When it comes to culturally competent nursing, social inequities between diverse patient groups affect patient outcomes — now more than ever. According to the Centers for Disease Control and Prevention, “Long-standing systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19.”
Across the board, cultural inequities continue to negatively affect healthcare outcomes for diverse cultures. For instance, Black patients with breast cancer are 67% more likely than white patients to die from this disease, according to a discussion of diversity and inclusion in the Los Angeles Business Journal.
According to the same source, Black and Hispanic young people are more likely to die from diabetes than their white counterparts.
These negative outcomes are likely because such underrepresented groups have a history of experiencing social inequities that result in unequal quality of care.
Ramping up diversity among healthcare professionals can certainly begin to heal cultural inequities in healthcare. Right now and into the future, however, culturally competent nurses can reach across the cultural divide.
Advice for Culturally Competent Nursing
In a larger sense, practicing culturally competent nursing means more than understanding and acknowledging specific cultural differences. It also calls for seeing patients through a lens of cultural understanding, always striving to recognize and respond to each patient’s differing language, customs, and beliefs.
To prepare to practice with cultural competence, a nurse can become familiar with the elements of culturally competent healthcare and strive to apply them with compassion and respect to every patient they encounter.
Know the Elements of Culturally Competent Nursing
Learning to deliver culturally competent nursing care takes effort, but the reward of bridging the cultural divide to give better care is well worth it. The following are five components to know and practice.
1. Cultural Awareness
Culturally competent nursing begins with awareness — an in-depth reflection on a nurse’s own cultural beliefs and practices related to healthcare. Consider questions such as these:
- Does your culture postpone doctor appointments in favor of trying home remedies?
- Does your culture practice dietary restrictions or customs related to meals and nutrition?
- Does your culture talk about illness? Who makes the decisions about care?
- Does your culture have important birthing or end-of-life customs?
Quizzing yourself about your own cultural background and how it affects your healthcare choices is a key first step in understanding others’ views. Various cultural assessment tools can also help you explore your awareness of your cultural attitudes toward healthcare.
2. Cultural Knowledge
Learning as much as possible about other cultures is an important step in understanding people and providing them with culturally competent care. Explore websites, journal articles, books, college courses, and workshops for in-depth discussions of the cultures of groups you may serve, as well as other groups.
3. Cultural Skill
According to Diversity Nursing, cultural skill is a measure of a nurse’s ability to “collect relevant cultural data regarding the patient’s presenting problem and accurately perform a culturally specific assessment.” Nurses who develop cultural skill can better gauge and respond to their patients’ health issues. They can customize their approach to caregiving based on what they know about each patient’s culture.
Specific models for best practices that support developing cultural skill include the Giger and Davidhizar Model of Transcultural Assessment. This model—designed to help student nurses tailor and deliver culturally competent care—assesses cultural differences in six areas: communication, time, space, social organization, environment, and biological variations.
4. Cultural Encounter
Developing cultural competence in nursing is an ongoing process. The way to continually grow as a culturally competent nurse is simple: Interact often with patients from all cultures. Cross-cultural interactions deepen understanding.
5. Cultural Desire
A motivated culturally competent nurse wants to engage with other cultures and learn from them. Willingness to be open to other cultures generates the understanding and respect that result in culturally competent nursing — to the benefit of patients and caregivers alike.
Overcome Common Communication Barriers
Often, people of different cultures speak different languages, which can cause confusion for patients and caregivers who don’t speak the same language. Miscommunication in healthcare can have serious repercussions. For example, communication barriers can affect patients’ willingness to accept treatment and their ability to understand explanations about their own health needs.
At minimum, culturally competent nurses should:
- Listen carefully to patients
- Avoid interrupting
- Ask follow-up questions
- Be sensitive to nonverbal cues
Nurses should also think about word choice when speaking with patients. Avoid phrases that might offend. For example, don’t label a patient’s culture by using terms they don’t use to refer to themself, such as categorizing a Spanish-language speaker from the Dominican Republic as “Spanish.” Referring to U.S. citizens as “American” can be off-putting as well, because Central and South Americans, for instance, are also American.
When nurses and caregivers don’t share a common language, using translators and interpreters is critical. A colleague might serve in this role, or the patient might bring a family member who can assist. Either way, be sure to allow enough time for full communication to take place.
Examples of Culturally Influenced Miscommunications
Culture affects communication in unexpected ways. For instance, non-English-speaking patients getting mammograms or other technical procedures might hesitate to say they don’t understand the technician’s medical jargon. In another situation, a patient might misinterpret the term “Medicaid” as the name of an illness.
Furthermore, in some cultures, only designated family members, often the eldest man, make important decisions about a person’s healthcare. This can cause communication breakdowns in the examining room. For instance, a female patient who seems reluctant to accept treatment might be deferring the decision to a husband or son who isn’t present, a circumstance a nurse might misunderstand.
Finally, good communicators don’t stereotype. Avoid assuming that an individual’s way of expressing themself, or the opinions they share, reflect a cultural stereotype (“all members of this group are this way”). In addition to respecting cultural differences, culturally competent nurses respect each patient’s uniqueness.