Cultural competence in nursing and why it matters

Cultural competence in nursing and why it matters

by Manish Singh

With the focus on patient outcomes, nurses have moral and ethical obligations to put the patient’s needs first, taking into account their wishes, values and beliefs. Demonstrating an awareness of the patient’s cultural traditions and habits promotes quality care and improved patient outcomes and, ultimately, improved relations between cultural groups and the healthcare facility.

Cultural competence involves an understanding of people and relationships and being able to communicate and interact with people effectively. The word “culture” refers to groups of people, their beliefs and customs, language and habits, which often originate from a specific geographical area.

Why does cultural competence matter?

Figures quoted in an article published by the University of Nebraska show that the Hispanic population rose from approximately 12.5% of the total population in the US in 1990 to over 16% in 2009. This figure is expected to grow to 25% by the year 2050. The US Census Bureau has estimated that by the year 2043, the US will be a “majority minority” country, meaning that although the non-Hispanic white population will still be the largest group in the US, a single group will no longer be the majority.

This, in turn, means that we are increasingly becoming a culturally diverse society and should be interacting accordingly. Despite the fact that technology in its various forms has created a global community and people are interacting across cultural and ethical barriers, many issues still exist around bias and inequality, and crime statistics are testament to this divide.

It’s not a healthy situation. Research has shown that people who hold racial biases have higher levels of stress hormones when dealing with people of another race. The negative effects of bias and stereotyping are not limited to the perpetrators and their victims – they create a hostile environment and affect us all.

Cultural awareness, knowledge, sensitivity, and skill

Cultural awareness is a deliberate process whereby healthcare providers become sensitive to and appreciative of the beliefs, values and practices of other cultures. A process of self-reflection about one’s own cultural beliefs and practices, as well as awareness of the patient’s culture, is key to reversing unnecessary prejudices that hold us back.

Acquiring cultural knowledge eliminates misinformation and enables us to understand and embrace other cultures, beliefs and values. Understanding people’s historical backgrounds often leads to empathy, interest and a thirst for further knowledge.

Cultural sensitivity is demonstrated by nurses through acceptance and the expression of non-judgmental interest and respect. Nurses who convey their understanding that some healthcare practices may conflict with a patient’s cultural beliefs are able to build a trusting relationship with the patient.

Cultural skills are built up by gaining knowledge of the patient’s culture and creating a healthcare plan around the patient’s reluctance for certain treatments. A nurse’s ability to communicate effectively within the cultural norms of the patient is more likely to produce effective patient outcomes.

The development of cultural awareness and knowledge, combined with sensitivity and effective cultural encounters, ensures cultural competence.

Cultural competence in a clinical environment

Historically, many cultural groups have been marginalized, and their healthcare has been neglected as a result. Health disparity refers to differences in healthcare quality across social barriers, such as economic, environmental and socially disadvantaged groups of people.

Health inequities are differences in the distribution of healthcare according to where people are born, live, work and grow old. There are astounding differences in life expectancy rates, not only in low-income countries but within cities in high-income countries, including the US.

Due to the training they receive and their work in underserved communities, advanced nurse practitioners are well positioned to advocate for better healthcare treatment as well as improvements in sanitary services and other basic rights in their communities. Online programs offered by Marymount University can help prepare registered nurses for this expanded role in their local communities.

As more people from diverse cultural groups seek healthcare, organizations should be incorporating the various healthcare traditions into their approaches.

Nurses, in particular, should understand the needs of their patients in order to produce successful patient outcomes and, above all, display a positive attitude towards people of all races, religions and cultures and a sincere enthusiasm when interacting with them.

It comes down to more than just tolerance – each patient should be seen as a unique person with the same rights as everyone else.

An understanding and appreciation of different cultures is key to delivering quality healthcare, and this includes not only different racial, ethnic and religious cultures but also gender and sexuality beliefs.

Various religious beliefs, philosophies and cultures often go against conventional medicine practices, and nurses should respect these beliefs. However, as nurses are expected to care for patients to the best of their abilities, they need to explain the medical interventions and point out possible risks if these interventions are not followed due to religious or philosophical beliefs.

By establishing cultural connections with their patients and demonstrating empathy towards their health issues, nurses are more likely to gain the patient’s trust and hopefully reach a compromise on the method of treatment.

Cultural competence begins at nursing school. By analyzing their own cultural thoughts and beliefs, nurses can begin to understand and modify their own behavior, if necessary. Nurses should:

  • Be aware of the cultural subgroup that they belong to.
  • Be aware of their own cultural biases and make a concerted effort to overcome them.
  • Determine whether they make a conscious effort to find out about other cultures.
  • Be aware of their own willingness to administer equal care to others, regardless of their differences.
  • Determine whether they notice bias, stereotyping and prejudice in everyday life.
  • Be aware that knowledge overcomes ignorance and embrace the study of cultural differences as part of developing life skills.
  • Be aware of the language used and avoid terms or phrases that may be harmful to someone else.
  • When other people use hurtful or degrading language, ask them to stop.

An understanding of cultural differences should bring about a change in attitude towards patients.

Behavioral skills such as communication and body language, when practiced every day, will lead to culturally competent behavior becoming a natural part of their conduct.

How to improve cultural competence in the workplace

The three behaviors of cultural competence that will build a welcoming environment are:

Active listening: Listening is an art – focus on what is being said and concentrate. Avoid mental distractions and consider the emotions behind what is being said. Emotions will help you identify whether the person is upset or just inquisitive. Ask more questions rather than offer advice.

Demonstrate empathy: See things from the other person’s perspective. Engage in appropriate dialog and inquiry, regardless of whether you agree with their beliefs or not.

Engagement: Effective engagement is a mutually beneficial process where you are learning from one another. Show an interest and ask open-ended questions that encourage healthy discussion. Avoid value-laden statements.

Cultural competence is a constant learning process that needs ongoing motivation and practice. It goes beyond tolerance. It’s about being appreciative and open-minded. We should treat diversity as an asset: something to be proud of and something that each of us can find both beneficial and interesting.

By learning the rules of etiquette of the different cultures, nurses will earn more respect from their patients. For example, calling people by their first names may not be acceptable in many cultures. Some conflict situations have deep roots in history, and having a background knowledge of these cultures and their histories is important for the maintenance of good relations.

Tips for nurses dealing with cultural differences in the healthcare environment:

Showing respect is key to overcoming barriers – this includes respect for the patient’s wishes and religious or cultural beliefs. With their compassionate nature and varied roles within healthcare facilities, nurses are equipped to affect subtle changes in the manner in which patients are treated, through setting examples and mentoring junior staff where they see a need.

Nurses should always be cautious and observant. Notice the manner in which patients greet and speak to you and adopt the same etiquette.

Where language may be a barrier, use simple language and terms that the patient can understand, making use of diagrams or sketches to explain health problems and solutions.

Establishing a common ground helps to break down barriers and build relationships. A discussion around ethnic foods and ingredients eaten by different cultures is always a good place to start. Many food traditions go back to early history when cleanliness was a problem, and the banning of certain ingredients was more about cleanliness than religion. It’s always an interesting discussion.

Nurses who work in an area where a particular culture is prevalent should ideally learn to speak the local ‘second’ language. Even though people often struggle with a new language, those on the receiving side generally appreciate the effort and are likely to help out. This is a great way to break down barriers.

Knowledge of healthcare terms in different languages can be invaluable when trying to explain an illness or condition. This also applies to foreign patients who can speak English but are not familiar with the medical terms.

Many educational facilities offer online courses in cultural competency.

An effort can be made to connect with various religious leaders in the area to get some insight, particularly regarding medical beliefs, fasting and prohibited foods.

Social work can be undertaken in various communities to establish a rapport and learn more about their culture and customs.

When working with war refugees, it is necessary to understand their motivation for leaving their home country and their living conditions. The stress of relocation to a new country, as well as poor living conditions, could be the reason behind the illness being treated, particularly if it has psychological or malnutrition implications.

How does an organization instill cultural competency in its staff?

Becoming a culturally competent institution has obvious and substantial benefits for the organization. Clinics and hospitals that have put in the effort to become culturally competent have experienced an increase in respect from patients of various ethnic groups, as well as improved patient outcomes.

One option is an organized systems approach: the healthcare organization can set up a program to determine cultural competence goals in the context of strategy, establish needs and measure current performance against these needs. Following the initial investigation, design a training program accordingly and implement the training and strategies. Once the program is operational, an exercise should be run from time to time to determine the program’s success.

Alternatively, establish a cultural competence task force:

  • Hold regular workshops or arrange discussion groups.
  • Analyze patient admission data and local population data to gain insights into who uses the facility.
  • Include cultural competency education into the orientation process when new staff join the company.
  • Make use of internal media and informational emails to enforce values.
  • Include cultural competency in the hospital’s vision or mission statement.
  • Produce hospital signage in multiple languages.
  • Monitor admission statistics and patient satisfaction levels.

As staff come and go, the need for evaluation is imperative to ascertain whether the strategies are still working, as is a higher-level study to determine whether the learning is transferred into practice.


Finally, the American Nurses Association’s Code of Ethics states that nurses should collaborate with fellow healthcare professionals and the public to advocate human rights, fight discriminatory practices and reduce disparity. The code also specifies that nurses should practice with cultural humility.

Wouldn’t life be so dull if we were all the same? Let us all embrace diversity, as it makes us who we are.

Related Posts