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Cultural competence in nursing refers to a nurse’s capacity to understand, respect, and support patients from diverse cultural backgrounds. It requires a combination of education and skills that enable nurses to provide care in a way that meets their patients’ social and cultural needs.

Explore cultural competence in nursing, its importance, examples, related careers, strategies, trends, necessary skills, and tips for implementation. Learn more about how nurses with cultural competence can contribute to improved patient outcomes, higher patient satisfaction, and the delivery of effective, respectful health care.

Social Factors Affect Health Outcomes

The social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age that affect their health outcomes. These determinants are shaped by the distribution of money, power, and resources at the global, national, and local levels, and they have a significant impact on health disparities and inequities among communities.

The World Health Organization (WHO) identifies several key social determinants of health:

• Financial and Economic Stability: This includes factors such as employment, income, expenses, debt, medical bills, and support. Economic stability affects an individual’s ability to afford necessities such as housing, food, and health care, which in turn influences their health outcomes.

• Education: Educational opportunities, literacy, early childhood education, vocational training, and higher education are all components of this determinant. Attaining higher levels of education is linked to better health outcomes due to its connection to increased health literacy and improved access to resources.

• Community Context: This includes social support networks, community engagement, discrimination, social cohesion, and exposure to violence. Strong social connections and supportive communities contribute to better mental and physical health.

• Neighborhood and Built Environment: This includes the quality of housing, access to nutritious foods, transportation options, air and water quality, and neighborhood safety. The environment in which people live can significantly influence their health behaviors and overall well-being.

Each of these determinants can affect a person’s health outcomes. By focusing on the SDOH, policymakers and health care providers can work toward reducing health disparities and improving the overall health of certain populations.

Why Cultural Competence Matters

Nurses with cultural competence can help address and reduce health disparities by ensuring that all their patients receive appropriate and effective care. When they acknowledge the SDOH and strive to provide care that considers these factors, they promote health equity.

Health Disparities

Although Americans’ health has improved overall in recent years, “disparities continue in the incidence of illness and death among African Americans, Latino/Hispanic Americans, Native Americans, Asian Americans, Alaska Natives, and Pacific Islanders, as compared with the U.S. population as a whole,” according to the Centers for Disease Control and Intervention (CDC).

In addition to racial and ethnic health disparities , as just described, there are also linguistic health disparities in the U.S. For example, the Hispanic population in the U.S. is increasing at a rate three times faster than the overall U.S. population. Approximately 14% of Americans speak Spanish at home, but only 6% of the nursing workforce is Hispanic, according to PBS.

To understand, study, and address health disparities across racial, ethnic, linguistic, social, and geographic groups, the field of nursing can develop a workforce that is trained in the social determinants of health, and raise public awareness about them.

Health care and human service organizations are increasingly acknowledging the importance of improving services for culturally and linguistically diverse groups. Delivering the appropriate health care services to these populations requires cultural competence.

Defining Cultural Competence in Nursing

 

Cultural competence in nursing refers to the ability of nurses to deliver services that are respectful of and responsive to the cultural and linguistic needs of their patients. It involves understanding the cultural factors that influence their patients’ health behaviors, beliefs, and outcomes.

The CDC defines cultural competence as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.” This definition suggests that cultural competence can occur at the individual nurse level and the macro level of a health care organization’s norms and policies.

Culture

Culture encompasses the integrated patterns of human behavior, including the language, thoughts, communication styles, actions, customs, beliefs, values, and institutions associated with racial, ethnic, religious, or social groups.

Nurses have an ethical duty to provide equitable care to all patients, regardless of their cultural background. Nurses trained in cultural competence help fulfill this responsibility by ensuring that care is inclusive and respectful. 

A patient’s culture significantly influences how they communicate and interpret health information. Being aware of cultural differences in communication styles, language preferences, and nonverbal cues helps nurses communicate more effectively, thereby reducing misunderstandings and building trust.

Competence

Competence in this context means having the ability to operate effectively both as an individual and within the health care organization in a way that is consistent with the cultural beliefs, behaviors, and needs of the people and communities being served.

It involves the integration of knowledge, skills, and attitudes that enable nurses to understand and appropriately respond to the cultural needs, practices, and differences of their patients. This competence ensures that nurses can provide care that is both effective and respectful.

Cultural Competence vs. Cultural Knowledge

Cultural competence is the ability to function effectively in various cultural settings and adapt practices to engage with different cultural groups. In contrast, cultural knowledge, cultural sensitivity, and cultural awareness involve recognizing cultural similarities and differences, without specifically focusing on taking action or making structural changes to address them.

Key Components of Cultural Competence in Nursing

Cultural competence in nursing encompasses several key components. The primary components are awareness, knowledge, and skills.

Awareness: Recognizing One’s Own Cultural Influences and Biases

Awareness is the foundational component of cultural competence. Nurses must be aware of how their cultural background influences their perceptions, attitudes, and interactions with patients. 

• Self-Reflection: Nurses should regularly reflect on their personal experiences, values, and cultural influences. This reflection can help them identify any of their unconscious biases or stereotypical views that may affect the care they provide to patients.

• Acknowledging Biases: Recognizing and acknowledging their personal biases is crucial for nurses. Biases can lead to prejudiced attitudes and behaviors, which can negatively impact their interactions with their patients and their patients’ health outcomes.

• Cultural Humility: Awareness also involves practicing cultural humility, which means recognizing the limits of one’s knowledge and being open to learning from others. It requires an ongoing commitment to self-evaluation and self-critique.

Knowledge: Understanding Different Cultural Practices and Worldviews

Knowledge is the next critical component of cultural competence. It involves learning about and understanding the diverse cultural practices, health beliefs, and worldviews of the patients nurses serve. This knowledge enables nurses to provide care that is respectful and aligned with their patients’ cultural values.

• Cultural Practices: Nurses should be familiar with the cultural practices of the people in the communities they serve, including their dietary customs, religious practices, and traditional healing methods. This understanding helps in creating care plans that respect these practices.

• Health Beliefs: People with different cultural backgrounds have different beliefs about health, illness, and healing. Understanding these beliefs can help nurses communicate more effectively with their patients and develop culturally appropriate interventions for them.

• Language Proficiency: While fluency in multiple languages is not always possible, understanding common phrases or medical terminology in patients’ languages can both enhance a nurse’s communication with these patients and the patients’ trust in the nurse.

Skills: Developing the Ability to Communicate and Interact Effectively With People From Different Cultures

Skills related to cultural competence involve the practical application of awareness and knowledge. These skills enable nurses to communicate and interact effectively with patients from diverse cultural backgrounds.

• Effective Communication: Nurses need to develop strong communication skills that include active listening, empathy, and the ability to convey information clearly and respectfully. This includes using plain language and avoiding medical jargon.

• Cultural Sensitivity: Being culturally sensitive means recognizing and respecting patients’ cultural differences and adapting the care they receive accordingly. This involves being aware of patients’ cultural norms related to personal space, eye contact, and body language.

• Adaptability: Nurses need to be adaptable and willing to modify their approach based on the cultural background of each patient. This flexibility can enhance patients’ comfort and cooperation.

Examples of Cultural Competence in Nursing

Cultural competence in nursing involves specific actions and strategies to ensure that health care services are respectful of and responsive to the cultural and linguistic needs of patients. Here are some practical examples:

Using Language Services

Providing interpretation and translation services to patients with limited English proficiency ensures they can clearly communicate their medical history and issues and that they understand all the instructions they are given. Clear communication is crucial for accurate diagnosis, treatment, and patient compliance. Language barriers can lead to misunderstandings, medical errors, and lower patient satisfaction.

Based on the Civil Rights Act of 1964 and further reinforced in the Affordable Care Act, most hospitals and clinics are required by law to provide interpretive services to patients who need them. Providing these services can also reduce health disparities.  

Hospitals and clinics can employ professional health care interpreters, offer translation services for written materials, and use technology such as multilingual telehealth platforms to bridge language gaps. Hiring, promoting, and retaining bilingual and multilingual staff can also be an effective strategy.

Community Outreach

Community outreach programs tailored to a community’s specific cultural needs bridge the gap between health care providers and the communities they serve. They help to build trust, improve access to health care, and promote preventive health measures.

Outreach activities can include health fairs, free screening events, educational workshops, and collaborations with local community organizations. To be most effective, these initiatives need to be designed with input from community members and community health nurses to ensure they meet the specific needs and preferences of the population.

Patient-Centered Care

Incorporating patients’ cultural beliefs and practices into their care plans is an effective way to demonstrate cultural competence in nursing. 

Respecting and incorporating patients’ cultural beliefs and practices into their care plans can improve their comfort, compliance, and outcomes. It demonstrates respect for patients’ values and fosters a more holistic approach to health care.

Nurses can take time to ask patients about their cultural preferences and health practices during their assessments. Care plans can be adjusted to include culturally appropriate dietary recommendations, respect for traditional healing methods, and involvement of family members as part of the support system.

Career Paths for Specializing in Cultural Competence in Nursing

Nurses can use their expertise in cultural competence in various specialized roles. These roles focus on ensuring that health care services are inclusive, equitable, and respectful of diverse cultural backgrounds. Here are some examples:

Cultural Competence Trainer

Cultural competence trainers develop and deliver training programs for health care professionals on cultural competence and the SDOH.

• Role: Cultural competence trainers educate health care staff on the importance of cultural sensitivity, effective communication, and understanding the SDOH. They design and conduct workshops, seminars, and ongoing training sessions.

• Impact: By enhancing the cultural competence of the health care workforce, these trainers help improve patient care and reduce health disparities.

• Skills Required: These professionals need in-depth knowledge of the components of cultural competence, strong teaching and communication skills, and the ability to develop engaging and informative training materials.

Community Health Nurse

Community health nurses work directly with diverse communities to address health disparities and promote health equity.

• Role: Community health nurses engage with local populations to provide education, preventive care, and health promotion activities tailored to the cultural needs of the community.

• Impact: They build trust within communities, improve access to health care services, and address specific health issues prevalent in different cultural groups.

• Skills Required: These nurses need a solid understanding of public health principles, excellent communication and interpersonal skills, and cultural sensitivity.

Patient Advocate

Patient advocates ensure that patients’ cultural needs and preferences are respected and integrated into their care.

• Role: Patient advocates work closely with patients to understand their cultural backgrounds and ensure their preferences are considered in their health care plans. They may also mediate between patients and health care providers to ensure effective communication.

• Impact: Advocates help improve patients’ satisfaction, adherence to treatment plans, and overall health outcomes by ensuring culturally competent care is provided to patients.

• Skills Required: Advocates need empathy, excellent communication skills, cultural awareness, and the ability to navigate health care systems.

Health Care Administrator

Health care administrators implement policies and programs that promote cultural competence within health care organizations.

• Role: Health care administrators develop and oversee initiatives that ensure cultural competence is embedded in organizational policies and practices. This includes hiring diverse staff, providing ongoing cultural competence training, and ensuring inclusive patient care practices are adhered to.

• Impact: Administrators play a crucial role in creating a health care environment that values diversity, equity, and inclusion, leading to better patient care and reduced health disparities.

• Skills Required: Administrators need leadership skills, strategic planning capabilities, knowledge of health care management, and a strong commitment to diversity and inclusion.

Trends in Cultural Competence

Several trends are shaping the future of cultural competence in nursing, reflecting the evolving health care landscape and the diverse needs of patient populations. These trends highlight the importance of adapting to new technologies, embracing holistic health practices, and fostering collaborative environments.

Technology and Telehealth

The rise of telehealth presents new opportunities and challenges for health care organizations committed to providing culturally competent care. Nurses need to adapt to delivering care remotely while considering patients’ cultural contexts.

On the one hand, telehealth expands access to health care services, especially for patients in remote or underserved areas. It allows for more flexible and convenient care delivery. 

On the other hand, providing culturally competent care via telehealth requires understanding and respecting cultural differences in virtual interactions. Nurses need to be adept at using technology to ensure clear communication and maintaining cultural sensitivity in a digital format.

Training programs can help nurses develop skills for culturally competent telehealth practices, such as using interpreters during virtual visits and being aware of cultural nuances in digital communication.

Integrative Medicine

Integrative medicine is the practice of combining traditional healing practices and complementary therapies, to offer a more holistic approach to patient care. Integrating these practices requires gaining knowledge of various cultural health beliefs and ensuring that they are used safely and effectively alongside conventional treatments.

Nurses can be trained in integrative health practices so that they understand the cultural significance of these methods and can communicate their benefits and limitations to patients.

Global Health

Increased globalization requires nurses to be culturally competent in a broader context, understanding global health issues and how they correlate to cultural practices.

Exposure to global health issues and diverse cultural practices enriches nurses’ understanding and prepares them to provide care in various cultural settings. To best provide this care, nurses need to stay informed about global health trends, emerging diseases, and the cultural contexts in which they occur.

Education programs that include global health curricula and opportunities for international clinical experiences can enhance nurses’ cultural competence.

These trends underscore the dynamic and evolving nature of cultural competence, highlighting the need for continuous learning and adaptation in the ever-changing health care landscape.

Address Health Disparities With a Bachelor’s in Nursing Degree

 

Cultural competence in nursing benefits everyone in health care. As the demand for skilled health care professionals rises, the need for nurse advocates is growing rapidly. You can be part of the change toward greater cultural competence in nursing today.

Are you ready to take the next step in your nursing career? The University of Tulsa’s online RN to Bachelor of Science in Nursing (RN to BSN) program is tailored for registered nurses aiming to advance their careers and move swiftly toward nursing leadership. This program provides students with the knowledge and skills they need to advocate effectively for patients and enhance health care practices and policies. Discover how The University of Tulsa’s online program can help accelerate your nursing career.

Recommended Reading:

What Is Nursing Advocacy?

Non-Bedside Nursing Jobs You Can Get With a BSN

Hospice Nurse: Job Description and Salary

Sources:

Centers for Disease Control and Intervention, “Cultural Competence in Health and Human Services”

Indeed, “Why Cultural Competence Is an Important Quality in Nursing”

KFF, “Disparities in Health and Health Care: 5 Key Questions and Answers”

PBS News, “How Nurses Overcome Challenges While Treating Patients With Limited English Proficiency”

Pew Research Center, “5 Facts About Hispanic Americans and Health Care”

World Health Organization, Social Determinants of Health