Are You (Culturally) Competent? A Guide for Nursing Students

Maria Prymchenko is 38 weeks pregnant, and something is wrong. She stumbles into the hospital doubled over in pain. Doctors rush her back for testing and determine that Maria’s placenta has separated from her uterine wall. She needs a C-section, and fast. But as the doctors explain the procedure to Maria and her husband, it’s clear the couple doesn’t understand — English is their second language and their skills are limited.

Within 20 minutes, Maria’s doctor has a Slavic interpreter in the exam room. Although his Ukrainian is rusty, he’s able to describe the procedure, outline the risks, and, most importantly, learn that Maria is anemic. Pregnant women with anemia are twice as likely to need a blood transfusion after C-section delivery. This information allows the medical staff to fully prepare for the operation and take potentially lifesaving measures.

A language barrier like this not only makes it more difficult to provide care in real-time, but it can also lead to major health consequences down the road. According to federal survey data, Spanish-only speakers in the U.S. seek healthcare services far less than Hispanic adults who are proficient in English. A similar trend occurs when patients feel a medical facility may not respect or accommodate their religious practices or dietary needs. This means fewer preventative check-ups, fewer necessary medications, and more dismissing of symptoms that could lead to something serious.

The following guide looks at the importance and impact of cultural competence in healthcare. If you’re a nursing or allied health student, you can learn how to become culturally competent, read examples of competence in action, and find expert insight from a nursing professional.

How Cultural Competence Improves Outcomes

At the outset, it’s important to remember that we’re all a complex mixture of our cultures, values, and lived experiences. So it stands to reason that healthcare providers who consider these complex backgrounds and beliefs develop better relationships and treatment plans for their patients — leading to better outcomes. But studies show that racial and ethnic minorities report less partnership with physicians and lower levels of satisfaction with care.

If you’re interested in being a better partner in patient care, we invite you to explore how cultural competence bridges misunderstandings and improves outcomes — just like how Maria’s access to a Slavic interpreter potentially saved her life. Let’s dive deeper into the practical benefits of cultural competence.

It Builds Trust with Patients

Reflecting cultural competence is key to developing trusting relationships with others who may look, act, or speak differently from you. While trust can be built over time, it only takes one negative interaction to destroy that trust. There are some practices that lend themselves to the development of a trusting relationship, each aiming to minimize misunderstandings and increase the likelihood of patients seeking preventive care. Here are a few:

• Clear Communication: Speaking clearly and professionally can enhance the communication between you and the patient. Avoid using slang or medically dense jargon to help minimize confusion.
  
• Active Dialogues: When patients and providers are both afforded the opportunity to speak and answer questions, it allows for misunderstandings to be reduced and corrected in a timely manner, fostering trust.
  
• Matching Providers to Like Patients: Research shows that patients are more likely to keep regular appointments and seek out medical care if they know they will see a provider who shares their culture.

It Encourages Holistic Care

Caring for your patients is about more than simply treating what’s medically wrong — the goal of healthcare is to treat the whole patient, meaning you must consider “indirect” care as well. For example, some women of Korean descent eat seaweed soup after childbirth to help heal their mind and soul — as well as their bodies. This cultural practice reflects the Korean holistic approach to wellness and may be part of a post-birthing plan for a hospitalized patient. Cultural competence takes into account the whole person and their deeply held beliefs, which will require conversations about non-medical components of care as well.

How to Practice Cultural Competence: The 5 Building Blocks

Developing cultural competence takes time but can begin with some core principles for a strong foundation. Applying these principles now will allow you time to hone your skills while learning more about various cultures. The more you can learn now, the better prepared you will be to interact appropriately and be sensitive to the needs of others. Consider the following five building blocks of cultural competence, which also include practical ways you can take action today to improve how you deliver patient care.

Awareness

As a healthcare professional, you will be required to provide care to patients from diverse backgrounds. Your ability to communicate and share information with people from cultures other than your own is known as intercultural communication. Cultural awareness includes customs and beliefs, which can be either medical or non-medical in nature. Awareness also means recognizing that each person is entitled to their own unique perspective.

TAKE ACTION: To improve awareness, take a moment to perform an inner reflection about your own worldview and beliefs. Then, select a culture that has a different belief system from your own and identify what makes it different from yours. Consider how these differing worldviews each contribute to culture and are of equal value.

Knowledge

In order to better develop your own cultural competence, it is helpful to recognize different behaviors. Learning about another culture includes learning about its history, language, common customs, and typical way of life — which all contribute to a person’s sense of cultural identity. This will help you understand what is typical versus atypical in a particular situation based on culturally acceptable behaviors. Cultural knowledge takes time to develop, but it increases understanding and demonstrates acceptance.

TAKE ACTION: You’ll likely encounter many different cultures in your professional life, but make an attempt to learn the language of those you see regularly. This can be as simple as creating a list of the important words that will help you communicate better with your patients, becoming conversant with those key terms first.

Skills

Typically, language is the most well-known skill of intercultural communication. The more that you know and can learn about different cultures, the better you will be able to interact with diverse groups of people. Your skills will continue to develop the more you practice and the more interactions you have with others. In order to develop cultural skills, take time to ask more detailed questions about the healthcare beliefs and practices surrounding a different culture. Valuable cultural skills to have include adaptability, active listening skills, trust, and identifying areas of conflict or concern.

TAKE ACTION: Familiarize yourself with the Giger-Davidhizar Transcultural Model (GDTAM), which includes six cultural phenomena: communication, time, space, social organization, environmental control, and biological variations. These are designed to provide a framework for patient assessment and implementation of culturally sensitive care.

Encounter

Cultural conventions such as family expectations, the role of women and children, personal space, and social greetings all contribute to how we interact with one another in our environment. These encounters combine to build relationships, which must be founded on trust for long-term success. Every encounter with another person provides an opportunity to practice cultural competency skills and learn from it. The more you learn, the stronger your communication skills will become. While each person must be seen and treated as the unique individual they are, understanding components of their culture can make the encounter go as smoothly as possible. Positive encounters lend themselves to better outcomes because there is mutual understanding and trust.

TAKE ACTION: To increase encounters with different cultures, consider volunteering at a local clinic aimed at treating minorities and underserved populations in the local community. Also consider following organizations like UNICEF and World Relief, which sometimes have local chapters that provide aid and placement of refugees in communities and need volunteers.

Desire

A strong motivation to independently learn more about other cultures is known as desire. It is a willingness to be open to beliefs and worldviews that are different from your own. Accepting someone for who they are and being able to meet them at least halfway is required regularly of you as a healthcare provider. This allows you to better help your patients understand the care they are entitled to receive. Likewise, cultural respect benefits consumers, stakeholders, and communities to increase positive health outcomes.

TAKE ACTION: To implement desire as a building block, seek out learning opportunities on your own. This can include taking an online continuing education course or researching your preferred degree program to include cultural competency courses as part of the curriculum offerings. Recognize another culture that has a strong presence in your community and attend a restaurant, event, or business within that community to learn more about it.

Examples & Scenarios: Are You Culturally Competent?

While knowledge about cultural competence is power, practice is even more fundamentally powerful. Are you ready to provide whole-person care to people of different ethnicities and cultures than your own? Let’s apply what we’ve learned by reading examples of cultural competence in practice, followed by real-world scenarios that challenge you to demonstrate empathy and choose partnership-building paths for your patients.

Example #1: Sarah

A nurse on a busy postoperative medical-surgical floor is caring for a 48-year-old Jewish woman named Sarah. The nurse enters the room to give Sarah her daily morning medications, which she had refused to take the previous morning. Sarah’s medications are a mix of gelatin capsules and tablets. After handing the medication cup to Sarah, the nurse notices her pick through them and only take the pills that are in tablet form, leaving all the gelatin capsules in the cup she sets aside. Frustrated, the nurse explains the medical benefits the medications provide and asks Sarah why she’s refusing some of them. Sarah says her religious views prohibit her from ingesting possible pork-containing products. The nurse was not aware of this restriction and consults the pharmacy to see if there is an alternative option that could meet Sarah’s needs. After confirming vegetarian capsules are available, the nurse can then provide all of her medication in a form that remains compliant with kosher restrictions. Sarah is appreciative of the effort and gladly takes them all.

Example #2: Hai

Hai is a 2-year-old Vietnamese boy brought into a pediatric clinic for a routine exam by his mother, who has limited English proficiency. During her assessment, the nurse notices Hai has a runny nose and an occasional cough. She lifts Hai’s shirt to listen to lung sounds and notices multiple circular red and purple marks on the toddler’s back. The marks are rather large, and the nurse believes they are evidence of abuse. The nurse’s disposition becomes matter of fact towards the mother, who becomes anxious and tries to explain in Vietnamese. The language barrier adds to the confusion, and tensions escalate. The pediatrician, Dr. Luong, enters the room and is able to speak Vietnamese. After talking with the mother, he is able to explain to the nurse that the toddler had received a cultural ritual known as cupping to help restore balance during a recent illness. The nurse is relieved and apologizes to Hai’s mother about the misunderstanding.

Scenario #1: Amira

Amira is a young Muslim woman who needs to be admitted to the hospital to receive intravenous fluids and antibiotics. She is hesitant to stay overnight for care. The nurse tells Amira that she can leave, but that it would mean leaving against medical advice. Amira appears conflicted but says nothing more. What would you do next?

Answer: This is an opportunity to begin a conversation, trying to dig down to discover what makes Amira uncomfortable about the prospect of staying overnight. When you ask open-ended questions of Amira, she may reveal that Muslims have specific daily rituals, like they are required to pray five times per day facing east, wash before and after prayer and maintain modest coverage. This may inspire you to call the charge nurse of the receiving floor to secure a room with an eastern-facing window. The result: After you tell her that her room will have a window that faces east, easy access to running water, and a modesty gown, a relieved Amira agrees to stay.

Scenario #2: Robert

Robert is an 84-year-old patient who belongs to the Jehovah’s Witness religious community. He has been admitted into the emergency room via ambulance after he used the restroom at home and noticed a large amount of dark blood in the toilet. Since then, he has continued to pass multiple bloody stools and is becoming increasingly symptomatic. Lab work was performed and showed his blood counts are low. Doctors are advising Robert and his family members that he needs a blood transfusion and a procedure to stop the bleeding, but he has refused both. What do you do next as his healthcare provider?

Answer: Communication is again key in this scenario, as a conversation with Robert will reveal that members of Jehovah’s Witness congregations do not accept blood products. In this scenario, you should listen to his explanation, then follow up with a thorough but empathetic discussion of the risks and benefits — and then allow Robert and his family time to discuss. In the end, you and anyone who is part of his healthcare team must respect Robert’s decision and belief system, even if you do not personally agree with it.

Cultural Competence Quick Start

Developing the skills necessary to understand other cultures is an evolving, lifelong learning process. It will gradually become easier as you encounter more and more people, especially if you seek out these interactions and go into them with an open mind. Becoming an expert in cultural competence takes education and experience, but if you’re just starting to learn about the concept and what it takes, here’s how you can take a few solid first steps.

• Communicate Without Jargon – Clear and concise communication is the preferred way to communicate with patients, preferably without the burden of hard-to-understand concepts that you’re educated to know — but the layperson doesn’t understand. If your patient seems perplexed after talking with you, offer to explain again, this time focused on omitting medical jargon.
• Listen – One of the best ways to connect with someone new is by performing active listening. With active listening, you are both active participants in a conversation that easily passes back and forth. Listening to others makes them feel heard and enables trust, which will make them more likely to open up and speak truthfully about any medical concerns they may have. Offering reassurance and asking clarifying questions will reduce miscommunication mishaps and demonstrate that you genuinely care about the other person.
• Be Patient – No doubt healthcare is a fast-paced, sometimes chaotic environment. This fact alone provides challenges to providers’ ability to deliver culturally competent care because they may not feel they have the time necessary to bridge a language barrier or ask the right questions. Mistakes are far more likely to occur when someone is in a rush. Taking time to be patient and fully understand the individual in front of you will help you deliver higher quality care and also maintain a safe environment for your patient.
• Reflect – Do a quick inner reflection on your knowledge of other cultures. When interacting with others, reflect on what went well or what could have been better. Reflection helps you look inward to learn and develop awareness that will help prevent these kinds of misunderstandings from happening again. It also helps you to identify potential biases you may have and how they might influence how you provide care to others.
• Educate Yourself – Interactions with patients can often be an educational opportunity, but as a nurse or allied health professional, you also should spend time actively learning about and researching your patients’ beliefs. This new knowledge you acquire can also be passed along to a colleague when they encounter someone from the same culture, which could improve their patients’ health outcomes as well.
• Show Respect – While you do not have to agree with your patients’ beliefs and worldviews, you must be able to respect their decisions and recognize that they are entitled to their own opinions. Cultural respect improves patient outcomes by allowing each person to be who they are, affording everyone the freedom to make their own choices about their care.

Cultural Competence Resources for Students & Professionals

Throughout this guide, we’ve illustrated how demonstrating cultural competence can have marked benefits on your ability to provide quality care to patients from diverse backgrounds. Eager to do a deeper dive? Consider some of the following resources to help further develop your own cultural competence and meet your educational goals.

• National Institutes of Health (NIH) Cultural Respect: This website promotes cultural respect while also providing additional resources like language access and health literacy.
• Minority Students & Healthcare Education: Visit this site for resources and tips on supporting minorities seeking a career in healthcare. When more minorities are represented in the healthcare profession, more diverse cultural backgrounds can be more readily understood.
• Diversity in Healthcare: This resource demonstrates how supporting culturally and linguistically appropriate services (CLAS) leads to safer, healthier, and stronger communities.
• The Language of Cultural Responsiveness: This first-person account presented by the Center for Health Progress shows how access to healthcare improves with communication.
• Becoming a Culturally Competent Healthcare Organization: Read about what the American Hospital Association is doing to improve care and diversity in hospitals across the country.
• Cultural Competence in Health and Human Services: The Centers for Disease Control and Prevention addresses healthcare disparities and the importance of expanding services to underserved populations.
• Cultural Competence in Healthcare is a Worthy Discipline: This Forbes article discusses why healthcare changes and cultural education require effort but are well worth it.
• Cultural Humility vs. Cultural Competence — and Why Providers Need Both: This article from the Boston Medical Center Health System explains the difference between cultural competence and humility.
• Why is Cultural Competence Important in Mental Healthcare: Read about considerations and information specific to providing culturally competent mental healthcare, provided by national mental health nonprofit Fountain House.
• Culturally and Linguistically Appropriate Services (CLAS): The importance and implementation of CLAS in the United States is addressed here by the U.S. Department of Health and Human Services.

Inside Cultural Competence with Colleen Kienbaum

Colleen has worked in several nursing specialties including emergency medicine, cardiac care and perioperative services before becoming a full-time nurse writer. Currently, she holds CPAN and CAPA certifications and enjoys the dynamic role nurses play in today’s healthcare. Colleen is also a military spouse and mother who enjoys traveling and exploring new places with her family.

Are there services aimed at supporting diverse patient populations seeking healthcare?

Most healthcare organizations are equipped to handle diverse patient populations by offering interpreter services, translated written materials, and religious support through a chaplain. It is strongly suggested by medical experts that family members and friends are not used as interpreters. Any healthcare organization that receives federal funding or reimbursement from a federal entity, such as Medicare, is required to provide interpreter services to those with limited English proficiency. If translated written materials are not available, medical interpreters can translate them to the patient in person or over the phone. Chaplains are also employed by many healthcare organizations and can offer spiritual support to patients in need.

What kind of influence can the nurse provide in supporting a patient’s cultural preferences?

Nurses are first and foremost patient advocates. This can look different depending on the patient and their unique circumstances. Nurses will often be required to coordinate and oversee culturally competent care by coordinating services the patient needs to be successful. This can include activities such as advocating for social services, calling an interpreter, or assisting with special dietary requirements. Nurses are trained to provide holistic care and to take into consideration the emotional and spiritual needs of a patient in addition to providing for their medical needs.

What does diversity look like across the nursing profession right now?

Nursing is a diverse profession. There are so many different specialties that you can get into depending on your interests. Diversity within the profession is expanding as well, but there is still more that can be done. According to a study conducted in 2020 by the National Council of State Boards of Nursing, 40% of the population identify as a member of a minority group, but only 19% of nurses identify that way.

How can we increase diversity amongst healthcare professionals?

Minority students often face barriers to higher education, but there are resources available to help — such as diversity recruitment programs — that aim to recruit exceptional talent for healthcare from underrepresented groups. Encouraging more persons of color and other minorities to seek a professional career in healthcare includes finding ways to support their academic and personal needs. This will help ensure a brighter, more diverse future for healthcare.

What should students consider regarding cultural competence when thinking about choosing a college?

Choosing a nursing program or other allied health degree option that meets your personal and academic needs is important. Most universities offer a diverse array of options to help students broaden their knowledge and introduce them to new concepts and ideas. When reviewing programs, look for those that offer cultural diversity courses as part of their course curriculum. In person practicum and clinical hours will offer opportunities to meet and interact with patients from different backgrounds. Also consider the program’s application process and whether they require and promote volunteer hours, as this is an excellent opportunity to help the local community and get to know the needs of the people that live there.