5 ways nurses can improve cultural competency

By | 2021-05-07T08:38:46-04:00 April 14th, 2016|4 Comments

(Content courtesy of Chamberlain College of Nursing)

As the U.S. grows more diverse, cultural knowledge and strengthened communication skills can aid healthcare providers in improving patient comfort and satisfaction with care.

The U.S. Census Bureau projects that more than half of all Americans are expected to belong to a minority group by 2044. According to the same report, nearly one in five people in the U.S. will be foreign-born by 2060. Faculty members from Chamberlain College of Nursing recently shared five ways nurses can provide more culturally congruent care.

Be curious

The continuum of cultural competency starts with exposing yourself to different cultures, said Sheri Sawchuk, MSN, RN, an assistant professor at Chamberlain. Through the Global Health Education Program at Chamberlain, Sawchuk leads students on trips to serve communities in Haiti, Kenya and beyond. Over the course of two weeks, students care for patients, make home visits, experience the culture first-hand and gain a new perspective on their own beliefs and culture.

While this experience allows for a larger than life cultural immersion, becoming more culturally competent can happen anywhere with a little bit of effort, Sawchuk said. “The first thing is to be curious and to purposefully create cultural encounters,” she said. “Go to a cultural event in your community. If you’re in the hospital and someone is speaking a different language, go try to communicate with them.”

Do your homework

Research can provide a foundation for cultural understanding and can happen through books, movies, readings, trainings or talking with people. Learn more about cultural topics like gender relations, customs, nonverbal cues, religious beliefs, views on health issues, dietary restrictions and more.

“When I have patients from different cultures, I like to have a conversation with them and really get to know them as individuals,” said Veronica Vital, PhD, RN, assistant professor and coordinator of the BSN concentration in serving Hispanic communities at Chamberlain. “I ask questions, such as what is your culture like? What are your beliefs? I seek to understand, and then when I have a patient from the same culture in the future, I am able to provide better care for them.”

Vital said it’s also important to keep in mind that many cultures have subcultures — and to avoid generalizing a population. For instance, the beliefs and cultures of Puerto Ricans, Cubans and Mexicans vary considerably, although they are all a part of the larger Hispanic community.

Account for sociocultural aspects of health

Seek to understand the social and cultural factors that might affect an individual’s health and incorporate these factors into your care where possible. These might include how individuals think about health issues, their behaviors and habits, economic issues and more. “When a nurse understands the culture of their patient, they can implement a culturally competent care regimen,” Vital said. “For instance, incorporating the culture’s foods may make a patient more likely to comply with what is being prescribed.”

On a recent trip to Haiti, Chamberlain students spent a five-hour shift in the local hospital working alongside Haitian nurses to get a fuller picture of the sociocultural aspects of health. “We wanted students to see that in developing countries, going to the hospital isn’t often a quick fix,” Sawchuk said. “Patients might not be able to afford medications or receive the same level of care we get in the hospital. It becomes even more important to educate patients and their families on how to better care for themselves in these communities.”

Ensure understanding

When determining if a patient understands English, be sure not to jump to any conclusions, Vital said. “It’s very important for nurses to know that individuals sometimes revert to their primary language in times of stress,” she said. “They may speak English and they’re just not speaking it while their families are present. It’s important not to assume language. Always, always ask the patient and include them before making assumptions.”

A simple way to ensure a patient has comprehended is to ask them to repeat back to you, Vital said. And always keep in mind that certain terminology may not be easily translated or understood — particularly figures of speech.

Find ways to connect

Building trust with a patient is essential to a nurse’s work, but can feel more challenging when there is a language barrier. When working with a translator, it can be tempting to look at and speak directly with the interpreter, Sawchuk said. During Chamberlain’s international trips, clinic stations are set up so the nurse is looking directly at the patient and the interpreter is off to the side.

“We coach our students to look at the patient while they’re speaking, and not the translator,” she said. “Our students listen and still do all the gestures, like nodding, or a touch on the shoulder or the knee if that’s appropriate in the culture. It’s a way to let the patient know that they’re connected directly to them and that the interpreter is just saying the words.”

And regardless of culture, other ways of connecting with a patient all still apply — including listening, asking questions, seeking to understand and following through.


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About the Author:

Sallie Jimenez
Sallie Jimenez is content manager for healthcare for Nurse.com from Relias. She develops and edits content for the Nurse.com blog, which covers industry news and trends in the nursing profession and healthcare. She also develops content for the Nurse.com Digital Editions. She has more than 25 years of healthcare journalism, content marketing and editing experience.


  1. Avatar
    Edith Ouellet MSN, RN April 19, 2016 at 11:20 am - Reply

    All great suggestions to enhance cultural competence. However, cultural understanding is gained through apllying these suggestions in the lived experience.

    A huge barrier exists in the workplace today, and that is the computer. Until we remove the documenting on the computer from the nurses’ workload, we will continue to see a decline in the quality of care.

    Yes our new generation of nurses are computer natives but two things exist, they have not engaged in authentic independent patient care experiences, leaving them to task clicking for the most part. They are very comfortable with computers and prefer spending their time with the technology rather than building a face-to-face relationship with the patient and family.

    The experienced nurse who have the years of lived experiences and expert knowledge are now challenged with getting the documentation finished at the expense of nursing the way we should be.

    Doctors are exploring the use of medical scribes and dragon (voice-activated) documentation technology. Why aren’t nurses exploring the same?

    Those are just my thoughts…lets bring back some of what used to work to provide good nursing care.

    • Avatar
      Nursing Student December 18, 2017 at 8:27 pm - Reply

      Dear Edith Quellet and Delbert Owens:

      I agree that cultural understanding is gained by applying the 5 strategies in the lived experience. However, I disagree with using computers and new nurses as scapegoats for the cultural insensitivity that has existed in healthcare for decades. Institutionalized prejudice and discrimination was not less of a problem 20+ years ago or when paper documentation was used more than computers. Twenty years ago, you were the nursing students and new nurses lacking in independent patient care experiences while more experienced nurses were bullying and scapegoating you for organizational problems. Generalizing nursing students and new nurses as preferring to spend time with their technology than building relationships with the patient and family is false and reflects a dysfunctional attitude toward students and new nurses who are an important aspect of progress in the nursing profession. Regressing 20+ years and scapegoating less experienced nurses will not cultivate any improvements in the nursing profession.

      Instead, the biggest barrier to achieving cultural competency in the nursing profession is that there are still nurse educators, nurse managers, staff nurses, and students who tolerate or actively support discriminatory behavior. There needs to be zero tolerance towards institutionalized prejudice and discrimination in every nursing school and healthcare facility starting from top management down to every staff nurse and student. It only takes a handful of faculty, managers, staff nurses, or students to undermine a positive and culturally sensitive environment. Everyone needs to be held accountable.

  2. Avatar
    Delbert Owens May 11, 2016 at 1:36 am - Reply

    Dear Edith Ovellet: Your letter is a full expression of what I have been feeling for the past ten years in the nursing profession. It really bothers me when I see nursing students sitting at the nurses station learning the system on the computer in place of learning personal patient / nurse relationship and hands on patient care. My wife had surgery, and during her recovery and hospital stay of four days , my wife and I had seen briefly -one student nurse, and 3 brief nurse visits, and because I am a nurse, my initials were the ones on the flow record on the door.I was the nurse, the therapist and the record recorder. 24 plus years ago when I came out into nursing clinicals, the nurse had already had learned the skill of charting in the classroom, and when we went to the hospital to the floor for clinicals we had to stay with the patient and follow the patient and care with the patient from the beginning of the shift to the end of the shift, then we had to write a paper on the clinical presentation of the patient, the tests, the diagnosis and write about each condition on the problem list, plus write a short profile of each medication.

  3. Avatar
    Nursing Student December 18, 2017 at 5:00 pm - Reply

    Review of the Hispanic Concentration, managed by Dr. Veronica Vital:

    Students receive a course grade of 100% if they demonstrate:

    -xenophobic attitudes against Latinos.
    -prejudiced attitudes and behaviors against immigrants.
    -purposeless comments in online or class discussions.
    -incivility to silence students who question xenophobic or racist attitudes
    -behavior that deliberately undermines cultural sensitivity

    The Hispanic Concentration is a joke. It is just a money making scheme for Chamberlain. Chamberlain is defrauding students by selling the idea that the Hispanic Concentration is a distinction that potential employers will recognize. Chamberlain does not care about decreasing institutionalized prejudice and discrimination in healthcare, especially not through their Hispanic Concentration.

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