5 Ways to Improve Cultural Competence in Nursing

Providing culturally competent care can be challenging. It takes intention on your part to seek out the needed education and resources. Learn these five strategies to help you become a more culturally competent care provider.

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  • Workforce Development Columnist
    Specializes in Workforce Development, Education, Advancement. Has 25 years experience.
5 Ways to Improve Cultural Competence in Nursing

You receive shift report only to find out that one of your patients speaks very little English. In addition, the family member who usually translates is ill and won't be in for a few days. The facility has language services, but after spending almost 30 minutes on hold, you decide to just "wing it" and hope for the best.

However, the patient's condition changes just after shift change, and you must explain options to them quickly. So, as you try to talk to them, you use the one language you think they'll understand - touch. However, as you reach for their hand, they pull it away and yell a resounding, "No!”.

Sometimes providing culturally competent care is operationally challenging, like in the scenario above. Other times, it's difficult because you don't know what you don't know. The good news is that there are always ways to improve your care to meet the cultural and spiritual needs of the patient. 

Ways to Provide Culturally Competent Care

Acknowledging that culture is vital to delivering nursing care is critical no matter where you work. Learning about other cultures and thinking about what you say and how you provide care shows your patients you respect them as unique individuals, not just a diagnosis. 

You might wonder what strategies you can use when delivering culturally competent care. Let's review some practical tools you can put in your cultural diversity toolbox to use during your next shift. 

1- Acknowledge Your Biases

Everyone has biases. And as much as you might like to think that you don't act on them at work, biases can be challenging to overcome. Therefore, when striving to provide culturally competent care, you must consider your biases and explore why you feel the way you do.

Once you acknowledge how you feel, it's easier to begin challenging yourself to change how you respond. For example, you can find a trusted friend or colleague who can help you with any biases you might have. Or, you might even be able to have an open discussion with someone from another culture or ethnic background who can help educate you on the culture. Just be kind when asking questions, keep an open mind, and listen to understand, not only to respond. 

2- Learn About Other Cultures

If you care for a specific population of people, learn about this culture first. Research everything from their traditions to how they feel about health and healthcare. You can find someone locally to train you and others on your unit about the culture. Ask them to present the information and then give everyone a test so you can see how much you learned.

You can also take classes about a specific culture or complete continuing education courses that cover several cultures. Set a goal of implementing one or two things you learn into your daily nursing practice, and be sure to self-evaluate how well you're doing. 

3- Use Interpreters and Apps

If you're caring for someone who speaks a different language than you do, ask your supervisor to set up an in-person or virtual interpreter. Never rely on family interpreters so they can just be family members and provide traditional types of support to the patient. You can also download apps on your smartphone to help translate words and sentences to make communication easier. 

4- Respect Your Patients' Wishes

An essential element of cultural competence is knowing when to respect your patient's wishes. This can be difficult if you disagree with the decisions they make about their health. One example of a time you might need to respect your patient's decision includes when a person decides not to accept blood or blood products because of their religious beliefs, even though they need it. Another example includes when a patient refuses to talk about mental health struggles you know they are having because it's a taboo topic in their culture.

You should continue to educate and offer support when disagreeing with the patient's decisions. Telling the patient you think their decision is wrong is never acceptable. Instead, find comfort in knowing you provided all the information needed to make an informed decision. 

5- Support Hiring a Culturally Diverse Nursing Workforce

The nursing workforce should reflect that of the patient population. Therefore, urge your leaders to be intentional about building a workforce of nurses with varied ethnicities and backgrounds. This hiring strategy allows each nurse to bring unique skills, talents, and experiences to patient care to deliver culturally competent care. 

Be Proud of the Care You Provide

Every person is uniquely created with experiences and beliefs. Therefore, it is necessary to learn to accept them for who they are and deliver care that honors their culture and ethnicity.

What other strategies do you use to provide culturally competent nursing care?


Becoming a Culturally Competent Health Care Organization

How to Improve Cultural Competence in Health Care

Workforce Development Columnist

Melissa Mills, BSN is a registered nurse with over 23 years of experience. She is a nurse leader and freelance writer who loves challenging the status quo.

158 Articles   323 Posts

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#1: Talk with your patient. While using care to be personable and respectful, ask them if you are not sure how their beliefs may or may not figure into the situation.

Just before Thanksgiving I was caring a patient who is an immigrant and whose culture I was not completely familiar with. Patient mentioned the holiday so I asked if they would be celebrating and when they said they would I asked what kinds of traditions they liked to do.

They said, "Cook a turkey....mashed potatoes, gravy" and laugggghed like crazy, as if to say, "duh." They were very good natured about it.

Showing a genuine interest in others is almost never wrong and if you are sincere it can really bridge a gap.

Workforce Development Columnist

Melissa Mills, BSN

158 Articles; 323 Posts

Specializes in Workforce Development, Education, Advancement. Has 25 years experience.

 @JKL33 I love this! So simple yet powerful. I think we often worry that we'll offend someone by asking them questions. It's almost like we punish ourselves for not knowing rather than engaging in honest communication. Most people are fine with us not knowing the ins and outs of their culture. They want us to genuinely show care and interest by simply asking questions.

Erin Lee, BSN, RN

20 Articles; 33 Posts

Specializes in Critical Care, Procedural, Care Coordination, LNC. Has 11 years experience.

Great article, thank you for sharing!

My favorite is learning from my patients or their family directly, even if I already have a good understanding. I have learned through experience that by asking it makes them aware that I am considering their individual and personal needs, it opens up conversations, and I learn a lot. Often peoples wishes or cultures are disregarded, so if we don't bring it to their attention they may assume we have no idea. 

I had a Jehovas Witness patient that needed a blood transfusion, without it things really didn't look good. The MD came to discuss his code status, he didn't get to involved in the conversation just put the option on the table and the patient chose full code. After the MD left I sat with the patient, we discussed his beliefs and he explained to me why his people believe what they do. I expressed my respect and understanding. During that conversation I was able to explain why the MD came down, that we were scared for him, that we respected his wishes. I painted the picture of a car needing fuel, what happens when the car doesn't have the fuel, the engine can't run, and how our body is the same with blood. If our heart doesn't have enough blood to pump through our body, a code would truly be ineffective, and could potentially cause more pain. I explained that we would proceed with full code if that is what he truly wished, but after our beautiful conversation and finding understanding in each other, he decided to proceed with AND/DNR status.

The best part of the story, he never coded, he recovered, 5 days later I got to visit him in the step down unit. His body was able to make and replace the lost blood while we supported him with IVF's and electrolytes. It was super amazing and a lesson for those of us involved in his care. 

Workforce Development Columnist

Melissa Mills, BSN

158 Articles; 323 Posts

Specializes in Workforce Development, Education, Advancement. Has 25 years experience.

@Erin Lee OMG! What a touching story. And an excellent reminder that taking the time to genuinely connect with a patient helps everyone understand. It takes an open mind and a huge heart to have these hard conversations, and it sounds like you have both! Thanks so much for sharing. Happy holidays!

Erin Lee, BSN, RN

20 Articles; 33 Posts

Specializes in Critical Care, Procedural, Care Coordination, LNC. Has 11 years experience.

Thank you @Melissa Mills. Happy Holidays to you as well!