Cultural Competence in Nursing

Health disparity refers to health differences linked to economic, environmental, and social disadvantages that result in groups of people experiencing greater obstacles to health. Health equity seeks to reduce and eventually eliminate health disparities by allocating resources based on need.

Cultural awareness, diversity, and inclusivity in nursing strive to combat differences in healthcare that lead to worse health outcomes for disadvantaged racial and ethnic groups.

In some American regions, for example, the average life expectancy can vary by decades from one neighborhood to another. Dr. Jamil Norman, a registered nurse and nursing instructor, has found in her research that Black mothers in the U.S. are 3-4 times more likely to die in childbirth compared to white mothers.

"These health disparities for childbearing Black women have persisted despite overall improvements in pregnancy-related outcomes," Norman says.

This guide discusses cultural competence and how it relates to health equity in the U.S., and includes insights from nursing professionals on how both nurses and their patients can benefit from culturally competent care.

What is Cultural Competence in Nursing?

The word "culture" refers to integrated patterns of human behaviors, including norms, traditions, and values that affect the thinking and behavior of members of particular groups. Cultural competence describes the ability to effectively interact with people belonging to different cultures.

The importance of cultural competence in nursing focuses on health equity through patient-centered care, which requires seeing each patient as a unique person.

As Dr. Gregory Knapik, DNP and assistant professor of nursing, explains, "Nurses must be able to understand and appreciate different cultural backgrounds in order to do their job effectively and with the highest degree of care."

Norman specifies that "cultural competence is the willingness to understand and interact with people of different cultures, race, ethnicity, gender, and sexuality."

This approach allows nurse professionals to successfully treat patients even when patients' beliefs, practices, and values directly conflict with conventional medical and nursing guidelines. Nurses can develop the ability to tailor and explain treatment plans according to patients' needs, which may be influenced by cultural practices that don't fall within the parameters of conventional medicine.

"Utilizing cultural competence appropriately will allow for deeper connections with patients," says Knapik. "You will gain the trust of the patient by being empathetic to their differences and unique needs.”

Components of Culturally Competent Care

Culturally competent care consists of four components: awareness of one's cultural worldview, attitudes toward cultural differences, knowledge of different cultural practices and worldviews, and cross-cultural skills. Together, these components contribute to a high degree of cultural competency, and nurses can integrate them into the care of their patients.

Benefits of Culturally Competent Care

Research shows significant benefits resulting from culturally competent nursing care. Social benefits include fostering mutual respect, understanding, and trust; promoting inclusion and patient and family responsibilities for their health; and increasing community participation and involvement in health issues.

Health benefits include improved data collection, preventative care, and cost savings, along with reduced care disparities and missed medical visits. Healthcare businesses benefit from fewer barriers and costs, increased efficiency, higher legal and regulatory compliance, and access to different ideas, perspectives, and strategies in decision making.

Cultural competence in nursing can be observed through the following examples:

• Using language and terms patients understand
• Respecting patients' cultural and religious beliefs that conflict with treatment plans
• Recruiting health professionals from underserved, diverse, and LGBTQ+ communities
• Analyzing the ethnic composition demographics of patients currently served
• Identifying patients in underserved populations and communities
• Forming a committee of diverse nursing staff members to promote and coordinate cultural awareness measures, such as signage and forms in different languages and community outreach

Taking Steps to Improve Cultural Competence

Beginning in the mid-1980s, health officials began developing resources and guidelines to improve culturally competent nursing care:

• The Heckler Report, also called the Report on Black and Minority Health, was released in 1985 to mobilize elimination of health disparities.
• The federal Office of Minority Health was established in 1986 to implement the Heckler Report.
• The Healthy People 2010 agenda, which includes the goal of eliminating health disparities, released in 2000 with an update in 2010.
• National CLAS Standards, a 2000 federal report outlining culturally and linguistically appropriate services (CLAS) in health care, was updated in 2013.
• LEP Guidance, issued in 2000 and in 2003, addresses working with people with limited English proficiency (LEP).
• Think Cultural Health launched in 2004 as a clearinghouse of resources where healthcare professionals can find culturally and linguistically appropriate services.
• The National Partnership for Action to End Health Disparities is a community-driven approach to achieving health equity.
• MedlinePlus offers health information in multiple languages.

While nursing education curriculums do focus on health disparities prevalent in specific cultures and the importance of culturally competent care, Norman believes that further steps can be taken.

"Although I believe that the profession of nursing is doing a lot, there is still more that needs to be done," says Norman. "Until all health care disparities are eradicated, there is always more that can be done."

Tips for Nurses to Improve Cultural Competence

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