As the U.S. continues to diversify, so do patient populations. By demonstrating and increasing your cultural competence, you can enhance care quality, patient outcomes, and patient-staff relationships.
According to the U.S. Census Bureau, the 2020 Census indicated the U.S. is now more racially and ethnically diverse than in 2010. And in a 2021 Gallup poll, more individuals identified as a part of the LGBTQ+ community than in 2012.
As we strive for inclusive practices, we should consider the attributes, identities, and affiliations of patients, colleagues, and nurse leaders. Differences and similarities may involve anything from a person’s religious practices to their dietary restrictions. Cultural competence in nursing is the practice of understanding these types of differences and using them to inform how we build relationships and provide care — with awareness, empathy, and skill.
“The act of cultural competence in nursing represents a genuine understanding of another [person’s] cultural and religious beliefs, race, ethnicity, values, and more. Taking this approach supports a comprehensive individualized plan of care using your patient’s perspective as your guide,” said Trish Richardson, MSN, BSBA, RN, NE-BC, CMSRN, and Director of Post-Acute Care Solutions at Relias.
Demonstrating cultural competence in nursing starts with awareness. With awareness, you’re identifying the diversity that exists among your patients and then using that information to provide care that is informed and free from bias.
Richardson explained that awareness is considering all elements of a patient’s situation and using those elements to adapt your care, so the person feels understood and comfortable.
“For example, you may be caring for someone who is recently diagnosed with heart failure and will now need to take a daily medication and routinely monitor their weight,” explained Richardson. Is English their primary language or will you need to bring in medical translation support? How do their cultural beliefs influence whether they will be compliant with medications and discharge instructions? Do they have insurance, or would they benefit from a prescription discount card (if one is available)? Do they have a scale at home and internet access to transmit their weight logs to the doctor?”
Posing thoughtful questions like these will help you find ways to communicate with your patients so they can clearly understand you while maintaining their comfort.
A 2018 study showed that language barriers between patients and nurses is common. Most participants in this study used interpreters to clearly communicate with their patients, reporting improved care quality in work environments with these services.
By exemplifying awareness, you’re not only improving your nurse-patient relationship — you’re also improving the quality of your care.
Empathy is an essential part of the patient-staff relationship. By exhibiting empathy, you acknowledge an understanding of another individual’s feelings or perspectives through unbiased communication and listening.
Alisha Cornell, DNP, RN, and Senior Clinical Implementation Consultant at Relias, mentioned one example of empathy used in concert with cultural competence.
“If a patient’s culture doesn’t allow care provided by the opposite sex, make sure the nurse covering the patient during the shift is appropriate for the patient’s culture. Communicate this information with the nurse and ensure that any additional cultural norms are acknowledged and respected,” she said.
It’s vital to amplify empathy through active and unbiased listening and by asking questions geared toward understanding a patient’s needs, beliefs, and values to provide the most accurate type of care.
Many marginalized groups face health disparities, including discrimination or denial of some healthcare services. These instances can create an uncomfortable environment for the patient but also produce a lower quality of care. By ensuring your patients are being heard, you’ll reinforce the patient-staff relationship and help reduce some of the health inequities they encounter.
As a nurse, you follow organizational procedures while practicing skilled, evidence-based care. When you have patients with unfamiliar or unusual backgrounds, you can utilize your well-honed skills to understand their needs and provide care on their terms. Breaking away from your usual approach may seem difficult in some situations. However, applying cultural competence will help you adapt to each patient’s needs.
Some nurses may overthink certain patient interactions, Cornell said, mentioning patients who are Jehovah’s Witnesses and can’t accept blood products, for example.
“Instead of overthinking this cultural belief and creating stress around the patient’s restriction,” she said, “the nurse can first assess if the patient is at risk of needing a blood transfusion during the hospitalization. Then they can tap into their cultural competency knowledge to better understand the healthcare practices of Jehovah’s Witnesses, as well as have a discussion with the patient or family to further understand the restriction.”
Cultural competence in nursing can help lower expectations or remove assumptions that nurses may have about how patients want to receive care or what is valuable to them, according to Cornell.
Nurses may not always have the exact answer, but as they demonstrate cultural competence in their practice, they’ll constantly learn something new with each patient. With this skill set and training resources as an aid, nurses can guide their patients to ensure they feel supported, heard, and respected.
Cultural Competence Doesn’t End With Patients
Cultural competence is equally as important with your nurse colleagues. A 2020 study in the Health Care Management Review highlighted a link between organizational cultural competence and how it impacts teamwork. The study reported that healthcare staff with a positive perception of their organization’s cultural competence felt they had a stronger overall team dynamic.
An example of this could be if a colleague has food that needs to be prepared a certain way or is unable to eat certain products, explained Cornell. Being mindful and asking for the colleague’s preferences for team meals or finding an alternative way to enjoy team-building time that allows the colleague to be comfortable with the food being served is a way to exhibit cultural competence.
Understanding the cultural backgrounds of your colleagues can create a more open work environment, allow you to learn from your peers, enhance your self-awareness, and aid in the function of your team. This awareness of and respect for your teammates can then translate into your practice.
Improving Cultural Competence
Diversity, equity, and inclusion (DEI) skills are a huge asset in healthcare, and inclusive approaches are being integrated into the policies, procedures, and trainings of many organizations. These elements offer a welcoming and comfortable environment for both patients and staff and play a major role in the development of cultural competence.
To improve your cultural competence, you can start with education and training. Cornell elaborated on the most beneficial types of DEI education.
“The best training for cultural competency is simulation or virtual simulation training. Being able to use knowledge and judgment in a simulated environment helps to understand the emotions, the concepts, and to receive true and realistic feedback to improve cultural competency knowledge,” she said.
This type of training may start during a nurse’s academic career, but more often this education is implemented by the healthcare facility or organization where they work.
“An organization’s DEI strategy can help nurses fine-tune their understanding of cultural differences through programs, online courses, and ongoing education and training,” said Cornell.
Richardson added, “When I was at the bedside, I used this approach: If I were the one in the bed, how would I want to be treated? This helped me to gain an appreciation of my patients’ current situation.”
With this approach accepted and integrated within the work culture, nurses and patients alike feel the positive impacts.
Also, nurses can take steps on their own to increase their self-awareness and improve their level of cultural competence. This may involve learning a new language, participating in continuing education, learning more about different aspects of your community through volunteer opportunities or local faith groups, or having conversations with colleagues and patients.
Nurses work on the front lines and see individuals from all backgrounds and cultures. By improving cultural competence in nursing, you can support positive patient outcomes, intervene in reducing health disparities, and promote an inclusive and culturally sensitive environment.
Learn more about cultural competence through these courses:
Steps to Cultural Competence
(0.50 contact hour)
Healthcare professionals must develop cultural competence to be able to provide quality care and effective outcomes for all patients. This course discusses the principles of cultural competence, barriers to cultural competence, and steps clinicians can take to improve their cultural competency.
Cultural Differences Impact Interpersonal Communication
(1 contact hour)
Working cross-culturally requires you to appreciate the impact cultural differences have on interpersonal communication. When you communicate and collaborate productively with your colleagues, you are much more likely to deliver culturally relevant care to your patients and improve the overall patient experience.
Effective Communication With Patients
(1 contact hour)
Effective communication with all patients is crucial to providing safe care. The healthcare team should aspire to meet the unique communication, cultural, and familial needs of all patients.