Cultural Competence in Nursing Practice
According to studies performed by the U.S. Census Bureau, the overall diversity of the country has significantly increased since 2010. This increase has undoubtedly introduced new demographic populations made up of different ethnic backgrounds, social norms, languages, and cultures to the U.S. healthcare system. Cultural competency in nursing is vital for minimizing the ethnic and racial disparities that can be an unfortunate part of the total patient experience. Nurses are on the frontline of the patient experience. By adopting the four core components of cultural competence, nurses can help ensure all their patients are receiving the best care possible.
What is Cultural Competence?
Many patients are stressed, anxious, and agitated. These common negative experiences can be further worsened by inadequately prepared staff who are insensitive to the patient’s unique cultural needs. A healthcare organization practicing cultural competence recognizes the potential adverse impact of cultural differences, launches initiatives and modifies outdated policies to acknowledge and meet the unique needs presented by an increasingly diverse patient population, and furthers the education of its physicians, nurses, and other staff on the successful interaction with patients for the duration of their healthcare experience.
The Culturally Competent Approach in Nursing
As national demographics continue to rapidly change, nurses will encounter more patients from increasingly diverse cultures. They will be responsible for establishing a culturally competent approach to their work– understanding how differences in culture significantly influence the patient experience and perspective– and then universally integrating that approach into their interactions.
To effectively and consistently provide a high-quality of care, nurses should be capable of appreciating the nuances of different cultural backgrounds, ethnicities, sexualities, races, and genders, in addition to being aware of one’s own norms and experiences without them adversely affecting their interactions and care provided to the patient. Nurses who have a well-established sense of cultural competency can tactfully navigate relationships with patients, even when recommended nursing interventions conflict directly with the patient’s own values and belief systems. They can nonetheless satisfy the patients’ needs by explaining clinical procedures and exploring unique options through the lens of their cultural norms.
The first provision of the American Nurses Association Code of Ethics for Nurses states: “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” This intrinsic method of delivering care requires viewing every patient as an individual possessing a set of unique needs as informed by their culture. Nurses, therefore, should be aware that patients’ cultural backgrounds may affect:
- Their initial and subsequent interactions with the healthcare system
- How they describe symptoms and communicate important issues
- The decisions they make regarding their care
- The way those decisions are then executed
These factors will all play a role in determining the quality of care that patients receive.
Components of Cultural Competence in Nursing
Nurses spend a significant amount of time working directly with patients from diverse backgrounds, and must ensure that patients receive the best possible individualized care while acknowledging and respecting their cultural differences. A culturally competent approach impacts the quality of work and encourages a positive connection with patients, which improves the patients’ perceptions of, and satisfaction with, their own care.
Cultural competence in nursing is based on four core components:
- Becoming Aware. Nurses are able to view and understand the nurse-patient relationship through an unbiased lens and become aware of how they might initially react to and provide care for someone with a different culture or background. This awareness and its acknowledgment is the first step in a culturally competent healthcare approach.
- Seeking Knowledge. Nurses continue to learn about the diversity of other world cultures– especially ones emerging from within their local population, and about the socioeconomic challenges that people from those cultures often endure. This will broaden their scope of knowledge and ultimately improve their standard of patient care by treating them with this in mind.
- Changing Attitude. Using objective self-awareness and acquired cultural knowledge, nurses can then analyze their own belief systems and values to recognize any internally held biases for and against immigrant populations, and then display an appropriate, positive attitude towards patients from those demographics.
- Applying Skill. Nurses can then integrate their awareness, knowledge, and attitude into their daily behavioral interactions with patients. These can include:
- Verbal Communication. Nurses must be aware of and consider how the patient uses dialect, tone of voice, volume, and body language when speaking with members of their family versus the healthcare staff.
- Distance & Personal Space. This refers to the patient’s cultural norms regarding physical touch, personal space, and distance from others, and taking gender into consideration if applicable.
- Social Roles & Family Hierarchy. The definition of family groups and identification of heads of family differ greatly among cultures. Many are patriarchal, while others view the mother figures as the leaders of the family group. The concept of “family” may also extend outward to non-blood-related members of the population.
- Environmental Control. Certain cultures hold the concept that the physical environment, including the patient’s health and personal life experience, is partially or entirely controlled by external non-human factors (God or other deities, fate), which can greatly influence the beliefs, confidence in, or reliance on medicines, treatment options, and healthcare in general.
Examples of a Culturally Competent Nursing Approach
- Speak with patients using layperson terms
- If necessary, use a professional language translator or interpreter
- Avoid interrupting the patient, listen carefully
- Ask follow-up questions to ensure a mutual understanding of issues
- Clearly acknowledge and respect the patient’s system of values and beliefs, especially when they appear to conflict with clinical treatment options
- Display respectful curiosity about the patient’s religious background
- Recognize culturally different expressions of grief (group prayer, crying, chanting, etc.)
- Be mindful of personal space distances in accordance with the norms of the patient’s culture
Benefits of Cultural Competence in Nursing
Cultural competence provides invaluable benefits by improving relationships not only between the provider and patient, but among healthcare staff as well. It builds trust, respect, and understanding and empowers and involves patients in their own healthcare journeys. Patients become more likely to seek healthcare, reducing repeat visits and associated costs.
Healthcare organizations also report increased patient adherence to preventive care measures, resulting in better overall outcomes. Culturally competent staff share different perspectives and ideas, which leads to increased efficiencies and mutual understanding, decision-making, and cooperation within and among teams and departments.
Additional Resources for RNs
