Improving Cultural Competence in Nursing: Tips and Resources

doctor with arabic patient

On any given day, in a variety of health organizations across the country, professionals are treating patients with diverse health needs. A nurse may be treating a patient from a different country who isn’t familiar with healthcare standards in the U.S. Miles away at a different health clinic, another nurse may be treating a patient whose personal, ideological and/or religious beliefs may otherwise block their receiving certain types of medicine or treatment.

In these examples, the nurse is displaying something known as cultural competence, where expansive healthcare knowledge and skills merge with respectful awareness of cultural backgrounds. Cultural competence is crucial in the nursing field, but many professionals don’t possess strong skills in this area. They may not understand and respect an individual’s unique personal history and beliefs when addressing their health. The following information is meant to help current and aspiring nurses as they tackle situations and challenges regarding cultural competence throughout their careers.

What is Cultural Competency in Nursing?

Cultural competency is more than just acknowledging that individuals or patients come from diverse backgrounds. It’s the active process of taking each patient’s background into account when providing treatment, as well as respecting cultural beliefs, heritage and traditions.

Cultural Competency as a General Principle

The Centers for Disease Control and Prevention (CDC) provide a robust definition of cultural competence beyond nursing, adapted from the writings of Terry Cross, an expert on the subject:

“Cultural and linguistic competence is 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. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”

By this definition, a person’s culture could include languages, religious customs or different social or peer groups of which they may be a member. It extends beyond the healthcare practitioner and can be adopted on a larger organizational level. For example, an employee may personally be respectful of a colleague’s beliefs and behavior, but their employer may not have any larger policies in place to ensure that colleague’s unique background and heritage are respected.

Cultural Competence in Nursing

Cultural competence in the nursing profession is applicable to the interpersonal format and structure of healthcare organizations. A company may practice or exhibit cultural competence by accepting the behaviors, attitudes and policies described earlier that define their employees, clients and customers. Hospitals and health organizations apply the same behaviors and attitudes toward staff and colleague interaction and the treatment of patients and individuals.

Nurses are often the healthcare professionals who spend the most time interacting with patients. It’s important they exhibit cultural competence in their duties. The CDC notes that one of the requirements of maintaining cultural competence is that professionals “have the capacity to (1) value diversity, (2) conduct self assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge and (5) adapt to diversity and the cultural contexts of the communities they serve.”

Cultural competency will become even more important as patient populations become increasingly diverse. According to a fact sheet from the health insurance organization Cigna, the percentage of Hispanic, African American and Asian members of the U.S. population is projected to increase, while the percentage of Caucasians is expected to decrease. Additionally, the fact sheet notes that individuals who are Hispanic or non-Hispanic black experience longer wait times at care clinics than individuals who are Caucasian.

Nurses must value the diversity of patients and staff members as a part of cultural competence. They must also be able to recognize their own strengths and weaknesses in their displays of cultural competence. They must understand how to address and work with patients and professionals of different backgrounds and seek to obtain more information regarding different patient cultures.

Benefits of Cultural Competence in Nursing

There are benefits of demonstrating cultural competence in nursing beyond what the healthcare organization itself may experience. In fact, these benefits can extend to patients and other individuals.

Helps Provide More Effective Treatment

In a study published in the BMC Nursing journal, researchers found that “training that increases healthcare professionals’ awareness of their own cultural features was perceived as useful and thought-provoking. Increased awareness might facilitate the communication between healthcare professionals and patients, which is a crucial component of quality healthcare.”

Nurses must have an awareness and appreciation of patients’ cultural beliefs and customs to ensure they provide the best care. It just doesn’t mean making sure non-English-speaking patients understand the type of care they are receiving, but actually taking the extra step to understand the patient’s own cultural background and that their treatment must be in accord with their own customs and beliefs.

Creates Stronger Relationships With Patients

In an article available from SAGE Open Medicine, Frank L Samson writes that “consistent with diversity and social capital research, . . . an immigration attitude predicts physician distrust. Physician distrust may not be linked just to physician–patient interactions, the structure of the health care system, or health policies, but could also be tied to declining social trust in general.”

For example, an individual or patient who comes from a different country may not trust the medical staff at a U.S. clinic and/or may distrust the larger American healthcare system in general. This can ultimately impact the quality and type of care that a patient receives, and potentially restrict them from seeking needed healthcare in the first place.

Nurses can develop strong relationships with patients who may hesitate using the U.S. healthcare system. Nurses can convey cultural competence by empathizing with the reasons for exhibiting distrust about U.S. healthcare, and understand the cultural barriers preventing patients from receiving effective treatment.

Makes Nurses and Organizations More Aware of Diverse Health Needs

Patients from foreign countries may have unique health disorders that are uncommon in the U.S. Patients with lower socio-economic means may face certain health risks not typically shared with wealthier individuals. And while a person may seem physically healthy on the outside, they may be facing mental or emotional health challenges that require a different type or method of care.

A report from the Kaiser Family Foundation notes some of the health disparities that may exist among individuals of diverse backgrounds. For example, there were higher percentages of nonelderly individuals who were of Hispanic, Black, and American Indian and Alaskan Native backgrounds who did not receive care or delayed care compared to individuals who were White.

Being cognizant of diverse customs and practices, and the unique health afflictions of nontraditional patients can enable professionals to display more cultural competence in nursing and healthcare. This can be practiced by nurses individually or through policies set forth by the larger facility.

The textbook Cultural Awareness in Nursing and Health Care: An Introductory Text notes that “giving students and practitioners a good foundation of understanding the needs and practices of different cultural groups can enable situations which could be considered discriminatory to be managed differently.”

For example, hospitals that do not have guidelines or standards to identify and address the needs of diverse patients may not be delivering the most patient-centered care. But in a facility where standards and procedures are in place — such as asking additional questions regarding a patient’s health history or performing additional research on a person who comes from a unique cultural background — these help identify the unique health needs of diverse patients.

Tips and Resources for Cultural Competence

Nurses can and should strive to achieve as much cultural competence as possible, but it’s important to remember that there is no such thing as “total” cultural competence. It’s a constant learning process, where nurses are pushing their own knowledge barriers and actively seeking to understand different cultures. These tips can help.

Patience and Listening

In an article published in Electron Physician, “in healthcare organizations, improving communication among healthcare professional[s] has a major impact on patients’ safety since one of the important causes of medical errors and unintentional harm to patients is ineffective communication.”

In a hospital, a nurse who is not culturally competent may be preparing to provide treatment to a patient who is not fluent in English. The nurse may not understand what the patient is saying and give the wrong type of care. Similarly, the spouse of an individual who needs immediate emergency care may not understand that healthcare professionals are seeking to obtain permission to perform treatment. Those professionals may rush to perform treatment that the spouse didn’t consent to. Conversely, they may not give potentially lifesaving care because the spouse didn’t understand what was being asked.

Taking the additional time and effort to listen to a patient’s concerns and actively explain needed medical services can help nurses and healthcare professionals overcome potential communication conflicts.

Understand How Cultural Identification Can Impact Treatment

A patient may enter a healthcare facility dressed in clothing that is indicative of a foreign culture. A nurse may assume this person is of a specific international culture and provide them different treatment, even though the person has actually lived in the U.S. their entire life.

In another scenario, a person may enter a hospital dressed in clothing according to modern American fashion trends. A nurse may assume this person is well accustomed to how the U.S. healthcare system operates, even though that person is actually a recent immigrant.

The textbook Cultural Awareness in Nursing and Health Care: An Introductory Text notes that “It is important to recognize that the nurse’s own culture can influence the nurse–patient relationship. The responsibility for ensuring that nurses have the knowledge and skills to do this should lie with both them and their employers.”

Maintaining Cultural Competence in an Organization

In the book Improving Cultural Competence, the following information is given:

“An organization must have an awareness of how it functions within the context of a multicultural environment, evaluating operational aspects of the agency as well as staff ability and competence in providing culturally congruent services to racially and ethnically diverse populations. Therefore, an agency should assess how well it currently provides culturally responsive treatment.”

A healthcare organization can take the initial step by making cultural competence a priority on a larger facility level, as well as on an interpersonal level between individual staff members. But another key component of achieving and maintaining cultural competence is evaluation and assessment of current procedures.

For example, a hospital may have set guidelines when working with patients who are not fluent in English, such as providing a translator. While the introduction of translation services is a strong step forward, the hospital may evaluate feedback about the service and find that patients do not find the service helpful. That feedback may also reveal that having specific signs or forms written in different languages can be more beneficial to diverse patients and the type of treatment they receive.

Maintaining Cultural Competency

As noted earlier, cultural competence in nursing is a learning process. Hospitals and nurses will have to work to ensure their standards for cultural competence are continuously evolving to meet the needs of a growing diverse population.

Nurses who are aware of the benefits of cultural competency can more successfully help ensure patients receive the best care possible, regardless of their background. While nurses themselves may not be able to fix every disparity within the modern healthcare system, they can be cognizant of the cultural and other differences of diverse patients and in so doing, become better healthcare practitioners.