Cultural Competence in Nursing

Cultural competency is a vital skill for delivering quality nursing care across culturally diverse groups. Our guide offers tips from nursing professionals on incorporating it into nursing culture and practice.

Health disparity refers to health differences linked to economic, environmental, and social disadvantages that result in groups of people experiencing greater obstacles to health. A patient’s culture — including ethnicity and race, gender, age, class, education, religion, sexual orientation and identification, and physical abilities — have also been linked to disparities. 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. 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. The U.S. Centers for Disease Control and Prevention has released similar findings, estimating that Black women die of maternal causes at 2.6 times the rate of non-Hispanic white women.

“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.

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 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.”

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.

Nurses can pay close attention to their own implicit biases and how they react to people whose backgrounds and cultural experiences differ from their own. For example, a person who becomes conscious that they think of immigrants as illegal aliens achieves cultural awareness of that particular bias.

Once nurses tap into awareness, they can actively analyze their increased awareness and internal belief systems. Using the above example, the person can examine their own background, beliefs, and values to better understand how they interact with others, and how those interactions might be improved to build better connections and deliver better care.

Providers should continually improve their knowledge to better understand the values, beliefs, and practices associated with the health and well-being of various cultural groups. This could include a clear understanding of local and traditional healthcare networks and systems, as well as the unique needs of the communities they serve.

Nurses put their awareness, attitude, and knowledge into practice by repeating culturally competent behaviors until they become integrated into their daily interactions. These behaviors include effective and respectful communication and body language. Among various cultures, nonverbal communication methods, such as gestures, can mean very different things.

These skills empower nurses to communicate in a cross-cultural context, negotiate healthcare and other service delivery, and mediate and manage conflict, among other important capabilities.

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, cost savings, patient adherence to care recommendations, and patient health outcomes. Cultural competence can also reduce healthcare disparities and things like unfilled prescriptions or missed medical visits. This also benefits the healthcare delivery system and care providers by improving satisfaction of healthcare services received and improving the experiences of both providers and patients.

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

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

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.”

Cultural competence in nursing helps build a more therapeutic nurse-patient relationship, which leads to better patient outcomes because patients are more likely to follow care plans that take their culture and beliefs into consideration. This guide describes how to build cultural competence in your own work and your team’s.