Understanding Cultural Competence in Nursing Care

Deborah Flowers, a critical care nurse, recalls how an elderly Native American man received a full court press when he presented with symptoms of a myocardial infarction. This despite the family's wishes to let the man die the "old way" by making peace with God and being surrounded by family members. He spent the next two weeks intubated and on mechanical ventilation. When he finally passed away a couple of weeks later, the family could not afford another trip to the healthcare facility and he died alone except for his wife.

This example shows that even for providers who have only the best intentions, medical care without cultural competence can lead to a disregard for cultural values and religious preferences for patients.

According to the National Institutes of Health, with ever changing patient demographics, an important feature of high-quality healthcare is cultural sensitivity, respect, and responsiveness to patients from disparate communities. The need for cultural competence is perhaps most evident in nursing professionals in critical care units.

What is cultural competence in nursing care?

Cultural sensitivity consists of a healthcare professional not allowing their own thoughts, ideas, and beliefs to unduly influence the care of patients from diverse backgrounds. Cultural competence is a demonstration of knowledge and understanding of cultures other than one's own and respecting the differences in beliefs, customs, language, and perspective. Adapting medical care to best meet the needs of a diverse patient population is an important aspect of cultural competence in nursing care. Advocating for the patient and recognizing every individual's unique needs are foundations of cultural sensitivity.

Why is cultural sensitivity relevant in nursing care?

Almost 40 percent - nearly half of the population - people in the United States are individuals who represent minority ethnic and racial backgrounds. It is estimated that by the year 2043, these minority groups will constitute the majority of Americans. However, this is not reflected in the healthcare workforce - for example, nursing professionals from minority backgrounds represent less than 20 percent of the total nursing workforce.

Each ethnic and racial community has its own unique cultural traits and consequently its own unique health challenges. In order to provide the best patient care for these minority groups, the development of cultural competence in nurses is of critical importance. According to Lanette Anderson, executive director of a state board for licensed practical nurses, it is not necessary to completely understand a patient's beliefs, but it is important to respect them.

How can a nurse develop cultural sensitivity?

According to the five-component model for developing cultural competence in The Case Manager authored by Campinha-Bacote and Munoz (2001), the following are the five areas of development for nurses who hope to gain better cultural competency for their patients.

Self-Awareness:

Develop an insight into one's own cultural beliefs and professional background. This in-depth self-exploration helps a nursing professional develop a keen sense of cultural awareness. Nurses can test their cultural awareness with online assessment tools.

Knowledge:

Seek information about other ethnic groups in terms of beliefs, values, and customs. Potential educational sources include the internet, journals, textbooks, workshops, and courses.

Skills:

Cultivate the ability to assess the patient's medical problem keeping in mind the relevance of his or her cultural beliefs, i.e., perform a culture-specific assessment. A framework for assessing cultural differences in patients has been developed by Giger and Davidhizar.

Interactions:

Engage in cross-cultural encounters with patients from diverse ethnic backgrounds. This direct interaction can help nurses develop cultural competence which is an ongoing process.

Desire:

Remain motivated to seek cultural awareness through interactions with an open mind and willingness to learn and accept cultural diversity.

What are some tips to develop cultural competence in nursing care?

• Explain medical jargon in simple language.
• Do not assume understanding. Studies have shown that patients with English as a second language are often uncomfortable or shy to say they do not understand certain statements.
• Inquire about herbal remedies (which can potentially interact or interfere with western medicine).
• Remember gender roles vary in different communities and the oldest male may often be deferred to for important decisions.
• Develop a respect for other people's beliefs to gain trust.
• Use both verbal and non-verbal cues to develop a nurse-patient relationship.
• There is much anecdotal evidence that having your name and title embroidered on your nursing scrubs is extremely beneficial for those patients and family members to differentiate the roles of different individuals on a medical team

Are there any courses to help develop cultural competence in nursing?

In addition to a bachelor's degree in nursing, which most U.S. hospitals require, there are online programs designed to help nurses improve patient outcomes and better address each individual's needs, including patients from culturally diverse backgrounds. These online courses offer a chance to conveniently learn at a pace that accommodates the nursing professional's work and home schedule. Some universities offer specific courses that provide an opportunity for nurses to become culturally engaged.