Being a nurse, your main focus is to provide skilled patient care to the best of your ability. As the cultural landscape of our world continues to diversify, practicing cultural competence in nursing practice has become more relevant than ever before.
What is cultural competence in nursing?
According to Georgetown University:
Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.
Why is cultural competency important in nursing?
Cultural competency in nursing practice is the cornerstone of providing superior care for people of all cultures. It is relevant in our everyday lives, but even more so for nurses who regularly care for patients in their most vulnerable state.
When a patient enters medical care, they may be highly stressed because of pain, nerves, fear, and worry. If they are accompanied by family members, the stress is intensified as these emotions are compounded.
Comforting patients during this time is crucial.
It’s easy to understand the importance of cultural competence in nursing as it allows you to comfort those with different beliefs and gives you an opportunity to provide care at the highest level.
BONUS:
Respecting the different cultures of patients is an important and necessary skill. Above and beyond inclusion and respect, the effects of cultural competence in nursing practice extend to the actual medical care provided to patients.
Keep in mind: distinct cultural practices may influence the care plan and even how a patient perceives his or her illness. This is another reason why effective nursing and cultural competence go hand in hand.
Increasing Cultural Competence in Nursing Practice
Through years of research and education, many medical scholars have shared knowledge and techniques that nurses can employ to practice cultural competence.
Cultural competencies for nurses these techniques are built upon three pillars:
- knowledge
- attitude
- skills
1. Knowledge
Learning about the culture base of those in your area is the first step to strengthening your cultural competence.
Depending on your location, the number of cultures you encounter will vary. Seek out information on topics such as shared traditions and values of each cultural group.
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In larger cities, you may be able to accomplish this by:
- researching your city website for demographic information
- visiting the local library or university
- doing specific research within cultural groups around town
Maintaining a level of awareness of the cultures around a service area enables a nurse to quickly assess the medical needs of a patient.
In the event a patient cannot confirm his or her culture, having a thorough understanding of genetic elements shared by people of the same ancestry ensures proper diagnosis and treatment.
For example, culture is incredibly important in the mental health field. Nursing and culture cannot be separated. According to the National Center for Biotechnology Information, “culture bears on whether people even seek help in the first place, what types of help they seek, what types of coping styles and social supports they have, and how much stigma they attach to mental illness.”
Part of enhancing your culturally competent care nursing knowledge includes the ability to conduct a cultural assessment. In the following section, you will learn the importance and techniques used to master this skill.
Patient-Centered Care and Cultural Competence In Nursing Practice: Cultural Assessment
Conducting a Cultural Assessment is an essential step in delivering patient-centered care. Madeleine Leininger defines cultural assessment as a “systematic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values, and practices to determine explicit needs and intervention practices within the context of the people being served”.
The goal of a cultural assessment is for a nurse to formulate an acceptable treatment plan for each patient based on the information provided by that patient regarding their beliefs.
Berlin and Fowkes designed the mnemonic, LEARN, in conducting a cultural assessment. This mnemonic stands for 5 steps outlined below:
Listen
Listen to the patient’s perception of the presenting problem.
Explain
Explain your perception of the patient’s problem. Is it physiological, psychological, spiritual, and/or cultural? It can and often will be more than one.
Acknowledge
Acknowledge the similarities and differences between the patient’s perception and your perceptions. In certain cases, it may be easier to focus on the similarities while working towards bridging the gap between the differences.
Recommend
Recommendations are built upon the knowledge gained from the first three steps. It is inevitable that culture will affect the recommendations, and the patient must be involved in this process.
Negotiate
In some instances, the patient may require negotiating a treatment plan. It is imperative that nurses are sensitive to the cultural practices of each patient while still providing the best care possible.
Cultural competency in nursing is an ongoing practice. If working in an unfamiliar community, consider volunteering some free time as a community health worker to learn more about the community in the field. Having the ability to execute an analysis ensures you can handle each unique situation as it arises.
2. Attitude
Attitude plays a large role in the ability to become and serve as a culturally competent caregiver. In this case, “attitude” refers to a level of awareness in yourself and your patients in regards to stereotypes, rules of interaction and communication customs.
It’s a fact that culture influences a person’s behavior and decision-making.
Become aware of your cultural attitude. Being sensitive to those of other cultures allows you to plan the best care for your patients.
Seek to understand the basics of all cultures with which you will engage, such as spirituality, customs, and family hierarchy. Having this general knowledge will help you understand the attitudes of your incoming patients and their families.
A caregiver will likely identify most with the culture in which they were raised. With that comes a need to identify and debunk stereotypes from other cultures. There are situations in which we may portray a lack of sensitivity without knowing how our actions may affect others. Reflect on your own cultural attitude, so that even the most subtle of stereotypical tendencies do not affect the level of care provided to your patients.
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Taking an active role in encouraging diversity and cultural inclusion is an excellent way to become (and stay) aware of the many similarities and differences among your community of co-workers, peers, and patients. According to MinorityNurse.com, The Pacific region has the highest percentage of minority nurses, with 30.5% of nurses identifying themselves as belonging to a minority.
3. Skills
Developing a skill set based on increasing your cultural competency can be accomplished by focusing on skills like communication and conflict-resolution.
Communication is a key component of skilled nursing.
Clear communication between different cultures when medical treatment is taking place is critical.
An example of cultural competence through communication is making an effort to use layman’s terms with patients and patient families who do not speak your native language. Medical terminology can be difficult to understand in your own language, let alone a foreign language.
It also involves learning to adapt to new and different situations in a flexible way. Remember that the hospital environment may not be familiar ground for your patients. Especially when it’s outside the realm of their cultural identity.
As stated earlier in the article, culturally-driven medical attitudes can create issues in patient care plans. This inevitably gives rise to the need for effective conflict-resolution skills.
Author and scholar Josepha Campinha-Bacote, PhD, MAR, PMHCNS-BC, CTN-A, FAAN points out that, “Ironically, conflict can provide nurses with an excellent opportunity for developing compassion, the emotional task of sharing in one’s suffering. When cross-cultural conflict arises, the goal is to respond with compassion.”
Her article provides a detailed example of how cultural beliefs play a large role in medical decision-making. The overwhelming evidence concludes that a “nurse can deliver patient-centered care when the patient’s health beliefs, practices, and values are in direct conflict with medical and nursing guidelines”.
Practicing the techniques in this article and its cited sources can help you enhance nurse cultural competence.
Tools and Resources to Strengthen Your Cultural Competence in Nursing Practice
For further detailed information about cultural competence, visit the U.S. Department of Health and Human Services Office of Minority Health.
This website provides a wealth of knowledge on a variety of topics. It includes a library of over 50,000 documents, books, journal articles, and media related to the health status of racial and ethnic minority populations.
Additionally, the website includes a vast amount of data and issue briefs that may prove interesting to nurses who are seeking to learn about new cultures.
Another excellent list is provided by The National Association of School Nurses; this comprehensive resource guide includes a variety of articles and websites dedicated to cultural competency.
Conclusion
Cultural competence in nursing practice focuses on knowledge, attitude, and skill. Consistently working towards being culturally competent is an exercise in compassion and respect.
Employ these techniques on a regular basis to grow your level of competency:
- Ask questions and take time to learn about what the answers mean in different cultures.
- Use clear, descriptive communication that aligns with the communication practices of your patient’s culture.
- Keep an open mind and employ the skills you practice when the occasional conflict arises.
- Acknowledge and be aware of any situations in which you may portray a lack of sensitivity, and work to keep from doing so.
- Actively seek out colleagues and peers of different cultures to learn more about interacting and respecting your differences.
➡ Do you have a story about cultural competence in nursing and how it has helped you?
Share with us in the comments below!
