Which of the following must the nurse do in order to be culturally competent?

Nowadays, nurses are increasingly working with patients from different cultural backgrounds. This brings opportunities and challenges for nurses to deliver culturally competent services. Whether working at a hospital, in a nursing home, or within a school, nurses must have the ability to identify differences in others. It is expected that nurses understand patients’ differences in demographics, beliefs, norms, practices, and desires for medical care and take their perspectives into account when caring for them. Cultural competence is an important component of excellence in health care delivery and can contribute to the elimination of racial and ethnic health disparities.

Here are 5 ways to help you provide culturally competent nursing care.

1. Perform a cultural competence self-assessment.

Determining your own strengths and weaknesses when it comes to working with people who come from different cultures is probably one of the most important ways to help improve your cultural competence. Several organizations offer free cultural competence self-assessment tools and you can choose one that appropriate to your work.

2. Obtain a certificate in cultural competence.

You can increase your cultural awareness, knowledge, and skills through culturally competent training, a workshop, or a seminar. Journal articles, textbooks, and the internet also offer great information that can help you improve cultural competence.

3. Improve communication and language barriers.

The values, beliefs, and worldview of a particular cultural group are rooted within their language use; therefore, language is the key to accessing a culture. It is best if you can speak its language or find a translator (an individual providing language assistance) to help communicate with limited English proficiency patients. You also can use pictures, gestures, or written summaries to improve communication with your patients and reduce language barriers.

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4. Directly engage in cross-cultural interactions with patients.

Understanding that each patient is a unique person can help nurses effectively interact with patients. Nurses need to have the ability to explore patients’ beliefs, values, and needs in order to build effective relationships with them.

5. Participate in online chats and networks.

Online networking and social media can have a great influence on improving nurses’ perceived cultural competency and cultural awareness and keeping them up-to-date on cultural competency issues.

Are you a nurse who has faced situations in your nursing practice when your patients or peers were from a different culture and held different beliefs or values than you? Did those differences create problems or barriers to communication and effective work or patient care? In cases like this, understanding and implementing cultural competence is essential. Perhaps you are wondering, “What is cultural competence in nursing?” In this article, I will explain what cultural competence means and share my thoughts on the importance of cultural competence in nursing + 10 examples of how you can implement culturally sensitive and competent behaviors in your nursing practice.

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What Is Cultural Competence In Nursing?

Cultural competence refers to the ability of a person to understand and respect the attitudes, values, and beliefs of people with different cultural backgrounds. Cultural competence in nursing is the ability of nurses to provide nursing care to patients while demonstrating cultural awareness toward the patient and their loved ones.

How Is Cultural Competence Different From Cultural Humility?

Cultural humility is a process of inquiry and reflection involving one's awareness of cultural and personal biases. It includes demonstrating sensitivity and awareness of significant cultural issues affecting others, and offering opportunities for other people to share their own experiences, feelings, values, and beliefs without fear of judgment. Practicing cultural humility means a person can admit they do not know something and be willing to learn from others about their experiences while maintaining a firm belief in their own cultural standards.

On the other hand, cultural competence emphasizes the knowledge, attitudes, and skills nurses use to support care for people from different cultural backgrounds.

5 Reasons Why Cultural Competence Is So Important In Nursing

Cultural competence in nursing is no longer an option. Instead, it is vital for all nurses to develop culturally competent attitudes and behaviors. The following are a few reasons why cultural competence is so important in nursing.

1. Deeper Patient Relationships:

Cultural competence in nursing prepares nurses to relate to patients on a deeper level, making it easier for patients to respond to nurses and vice versa. These deeper nurse-patient relationships typically result in increased patient compliance and better health and organizational outcomes.

2. Greater Patient Satisfaction:

Cultural competency is known to improve the attitudes and knowledge of nursing staff, which makes patients feel more at ease, leading to greater patient satisfaction scores.

3. Less Risk of Healthcare Disparity:

Health disparity refers to the differences in the health status of different groups of people. Lack of knowledge about and respect for race, ethnicity, immigrant status, and sexual orientation are some factors that impact health disparities. When nurses practice cultural competence, they recognize that patients should be served with the same level of high-quality, safe nursing care, regardless of cultural differences.

4. Improved Patient Outcomes:

If there is a concern about the care plan, the patient is more likely to ask questions and work with the nurse to develop a culturally appropriate plan of care and be compliant, which increases overall health outcomes.

5. Better Patient Care:

Cultural competence promotes nurses' professional growth and development, making them more effective providers of patient care.

What Are The 5 Important Elements Of Cultural Competence In Nursing?

There are several elements and principles upon which culturally competent nursing practices are built. The following are five important elements necessary to practice cultural competence in nursing.

1. Cultural Awareness:

The first element of cultural competence in nursing is cultural awareness. This element involves examining yourself, your beliefs, and your values. Practicing cultural awareness means demonstrating a willingness to set aside prejudices against other cultures and developing an attitude of acceptance toward all patients and peers.

2. Cultural Desire:

A person's motivation to learn about other cultures is referred to as cultural desire. It is an openness toward other people and the ability to accept and understand cultures and learn from them.

3. Cultural Knowledge:

This element of cultural competence in nursing refers to acquiring information about the norms, beliefs, and values of others. Cultural knowledge is the aspect of cultural competence in nursing that involves actively searching for information about patients' beliefs, cultures, and values to help you understand and interact with them better, strengthening nurse-patient relationships.

4. Cultural Skills:

As you deepen your knowledge of diverse cultures, it then becomes possible to develop cultural skills. Cultural skills refer to a person's ability to collect and process relevant cultural data as it relates to the patient's presenting problem and perform a culturally sensitive and specific assessment. Cultural skills are useful in helping nurses engage patients, families, and peers with meaningful interaction, and be supportive of cross-cultural beliefs and values.

5. Cultural Encounter:

Each of the last four elements of culturally competent nursing leads to the cultural encounter. Cultural encounter occurs when nurses step out of their comfort zones and venture into new environments to interact with people from other ethnicities, cultures, and backgrounds.

5 Skills A Nurse Must Have To Provide Culturally Competent Care

It is essential for all nurses to demonstrate cultural competence in nursing. Both new nurses and experienced nurses can learn to implement skills that promote culturally competent nursing care. The following are a few essential skills to help provide culturally competent care.

1. Self-Awareness:

Becoming aware of and understanding your own cultural values, attitudes, judgments, and beliefs is vital when interacting with people from other cultures. Self-awareness is essential because our values, beliefs, and attitudes shape our perception of others and define how we see individuals and the world around us.

2. Effective Communication:

Effective, culturally respectful, and competent communication is vital in all aspects of nursing and healthcare. Effective communication can break down barriers, improve access to healthcare services, and promote positive health outcomes for clients.

3. Willingness to Learn:

Developing cultural competency involves a lifelong process of learning. Nurses must be willing to learn about themselves (self-awareness), develop behaviors and social skills relevant to diverse cultures and populations, and develop the ability to advocate for others.

4. Ability to Demonstrate Humility:

Humility is described as having a modest view of one's own importance. It is crucial for nurses to learn how to demonstrate humility when dealing with others, especially in the case of diverse cultures. Humility in cultural competence means avoiding judgment or biases about others' beliefs and accepting those beliefs, even if they contradict

5. Be Nonjudgmental:

Being culturally competent in nursing requires setting aside personal prejudices and biases that may lead to judgmental assumptions. Even the most well-intentioned among us can be judgmental at times. Practicing the art of acceptance and setting aside judgmental attitudes is a skill that demands lifelong perfecting.

HOW TO DEMONSTRATE CULTURAL COMPETENCE IN NURSING?

It is necessary for all nurses to find ways to strengthen cultural competence in their practices. There are many ways to demonstrate culturally competent nursing. The following are ten examples of cultural competence in nursing. In some examples, you will find a mock patient situation. Please note, that the names do not represent any patient's real name and is used for demonstration of the situation only.

EXAMPLE #1: Acceptance of the Patient’s Beliefs

Situation:

Mr. Jenkins has been a Christian minister for more than forty years. His primary nurse, Nurse Anna, does not associate with any religious preference, stating she does not believe in a spiritual deity or an afterlife. Mr. Jenkins fears her lack of Christian views may hinder her ability to provide the type of care he wants.

Culturally Competent Response:

Although there are an estimated ten thousand distinct religions worldwide, sixteen percent of the world's population do not affiliate with any religion, or are atheists or agnostics. In some cases, like the example above, a difference of religious opinions is cause for concern to the patient, nurse, or both.

The culturally competent response in this situation is for the nurse to be attentive to Mr. Jenkins' wants and needs without showing prejudice or bias because of her personal beliefs. If Mr. Jenkins approaches the topic of religion or Christianity with Nurse Anna, it is appropriate for Nurse Anna to listen to Mr. Jenkins without feeling the need to agree with him. In some cases, it may be necessary to set professional boundaries, including clarifying which topics are appropriate for discussion and those that are not. Cultural competence in nursing is best demonstrated in this scenario by the nurse being attentive, asking appropriate questions, and finding out to what extent Mr. Jenkins’ religious beliefs influence his decisions about healthcare.

Outcome of the Response:

When nurses show genuine interest in a patient's thoughts, values, and beliefs, it helps reduce stress and worry. It is essential to understand that showing interest does not mean changing your own beliefs to accommodate the patient. Instead, healthy conversations and appropriate sharing of relevant information can help nurses determine the best course of action in providing care while respecting the patient's beliefs and wishes.

EXAMPLE #2: Build Trust and Rapport with Patients and Team Members

Situation:

Effective nursing care requires building trust and rapport with patients and team members, regardless of racial or ethnic background. Treating patients or working with peers from diverse cultures often requires higher levels of trust to be established and maintained.

Mrs. Wilhite is an African American patient assigned to the care of Nurse Michael, a Caucasian male nurse. Mrs. Wilhite is guarded when Nurse Michael is in the room but appears more relaxed when Nurse Tammy, who is also African American, enters her room.

Culturally Competent Response:

Whether Mrs. Wilhite's apprehension is related to personal experiences related to racial differences or prejudices or the fear of such issues arising, Nurse Michael must acknowledge her feelings and work to help her feel at ease. While it could be pretty easy to request a reassignment, that does not promote cultural competence or help resolve the issues. The culturally competent response to this situation would be for Nurse Michael to get to know Mrs. Wilhite and allow her to get to know him. Simple acts such as spending a few extra minutes in the room to make sure Mrs. Wilhite is comfortable and asking about her family or hobbies show a genuine interest in Mrs. Wilhite and help build rapport and trust.

Outcome of the Response:

When patients feel a sense of rapport with and trust in their nurses, the likelihood of positive outcomes increases. Patient anxiety is reduced, participation in care increases, and open, therapeutic communication is more likely to occur. All of these contribute to improved patient outcomes and a better work environment.

EXAMPLE #3: Show an Interest in Learning About Other Cultures

Situation:

Nurse Emille works in an assisted living facility with a culturally diverse population. The facility residents are active, participating in group activities and outings. She can talk to clients from different backgrounds each day and wants to become a source of encouragement and help to anyone who needs her.

Healthcare reaches its full potential when nurses provide holistic care, including considering the patient, their family, their cultures, and day-to-day life and traditions. In this example, Nurse Emille is uniquely positioned to learn about different cultures, traditions, and beliefs and build strong nurse-client relationships.

Culturally Competent Response:

Nurse Emille can demonstrate a culturally competent response by getting to know patients on a level that is comfortable for them. Simple gestures, such as asking about her clients' families, work background, hobbies, likes, and dislikes are great ways to show interest. Allowing the clients to share their personal beliefs and stories about their cultural background and beliefs will give the nurse some insight into each client. She should show genuine interest in what each client says and, when appropriate, ask questions to gain a better understanding.

Outcome of the Response:

Showing interest in others and learning about what makes them different or unique is an excellent way to show cultural competence as a nurse. When nurses are open to hearing about their patients, families, and customs, it gives the patient a sense of belonging and strengthens the nurse-client relationship.

EXAMPLE #4: Educate Patients About Their Plan of Care

Situation:

It is crucial for each patient, regardless of their cultural background, to understand their care plan and consent to any medical procedures. If a patient is unfamiliar with a practice, the nurse is often the one who explains the procedure, why it is necessary, and how it benefits the patient.

For instance, Mr. Messina is accustomed to eating large meals that consist of heavy carbohydrate content, such as pasta and homemade breads. Unfortunately, Mr. Messina has been diagnosed with diabetes and must take insulin to control his blood sugar levels. He is frustrated, stating, "Don't you understand I'm Italian, and it's in my nature to eat pasta? I'd eat it at every meal if I could!"

Culturally Competent Response:

For many people, dietary habits are closely related to cultural traditions. Although it may be easy for some patients to give up a certain type of food, others may find it quite difficult. A culturally competent nurse should address Mr. Messina's concerns about his dietary changes with genuine concern.

The best response is to ask Mr. Messina if there are any foods he feels would be easier to give up or to enjoy in moderation. In this situation is appropriate to offer a dietary consultation with a dietician who recognizes the importance of cultural competence and is willing to help Mr. Messina develop a meal plan that makes him happy while meeting his health needs and restrictions.

Outcome of the Response:

In many cases, the fear of change is the biggest drawback for patients. When nurses make patients, like Mr. Messina, feel like their concerns or objections are valid and offer to help find solutions, the patients are less likely to be non-compliant.

EXAMPLE #5: Demonstrate Active Listening

Situation:

Mr. Wilson is an elderly patient being cared for by Sophia, a Hispanic nurse. Mr. Wilson is hard of hearing and appears anxious, especially when he does not understand what Nurse Sophia is saying, or he feels as though she does not understand what he says.

Culturally Competent Response:

Being hard of hearing can be frustrating for anyone. It becomes especially troublesome when the person who is talking feels like they are not understood. The culturally competent response to the situation would be for Nurse Sophia to calmly tell Mr. Wilson she understands he is frustrated but that she desires to listen to him and provide the best care possible. Then, the nurse should listen attentively to what the patient has to say without interrupting.

Outcome of the Response:

Practicing active listening is an excellent way to make patients feel what they say is essential. This is especially important when there are cultural barriers to communication. When a culturally competent nurse takes the time to listen to patients and puts forth the effort to understand the message the patient hopes to convey, it creates a more relaxed environment, which makes it easier to facilitate therapeutic communication and improve patient outcomes.

EXAMPLE #6: Overcome Language Barriers

Situation:

Ms. Sanchez arrived at the emergency department via ambulance with symptoms indicating a possible CVA. She speaks very little English, and her family has not yet arrived at the hospital. When Nurse Lee tries to communicate with Ms. Sanchez, the patient becomes increasingly anxious, causing the nurse to realize the need for assistance communicating with Ms. Sanchez.

Culturally Competent Response:

There are several culturally sensitive nursing care examples related to cultural competence. It is especially important to recognize examples related to barriers to care caused by language differences.

In the case of Ms. Sanchez, the culturally competent response should include a few actions by the nurse. The nurse's first action should be to speak calmly and slowly to the patient to try and ease her anxiety. If available, Nurse Lee should access the hospital's translator service at least until the patient's family arrives. In some cases, if the family is not yet present, but a phone number is available, the nurse may phone a family member and allow them to translate over the phone. Any important decisions that can be delayed without harm until an interpreter or family arrives should wait.

Outcome of the Response:

Patients requiring medical care are often anxious and scared. When there is a language barrier, it can worsen their fear and anxiety. In situations like the one described in this example, nurses can help calm patients by taking steps to facilitate effective communication. In this situation, whether the nurse utilizes a staff member, translator service, or a family member to communicate with Ms. Sanchez, the potential for a positive outcome increases.

EXAMPLE #7: Respect the Patient’s Religious and Cultural Beliefs, even if They Conflict with the Treatment Plan

Situation:

Mr. Ferrington had abdominal surgery two days ago. Although his recovery started without incident or concern, he now has bleeding, which has resulted in significant blood loss. His physician wants to do a blood transfusion. However, Mr. Ferrington is a Jehovah's Witness and does not believe in receiving blood transfusions. He states, "If Jehovah wants me to have more blood, He will stop the bleed. I choose to decline a transfusion."

Culturally Competent Response:

It is natural for nurses to want to encourage a patient's compliance with a recommended treatment regimen, especially if it is considered a life-saving measure, including a blood transfusion. In this situation, it is crucial for the nurse to set aside their own personal feelings or beliefs and respect the patient's decision. The nurse is responsible for educating the patient about the suggested treatment plan, answering any questions, and then allowing the patient to decide.

A culturally competent response in this situation would be making a statement like the following: “Mr. Ferrington, after talking with the doctor about your healthcare options, it is my understanding that you do not wish to proceed with having a blood transfusion. Do you have any concerns or questions I can address with you, or is there anyone you would like to consult with?”

Outcome of the Response:

One of the most challenging situations nurses face is knowing what could benefit a patient and increase their chances for improved outcomes but having to face the fact that the patient has a right to accept or decline treatment. When a culturally competent nurse addresses a situation like the one in this example with a sense of understanding and acceptance, it gives the patient a sense of control and helps build trust within the nurse-patient relationship. This is important because, although Mr. Ferrington may choose not to have a blood transfusion, other treatment options may be available. If he feels he can trust his nurse to listen and respect his wishes, he is more likely to be open about his wants and needs.

EXAMPLE #8: Honor Traditions for End-of-Life Care

Situation:

Knowing how to conduct oneself in the face of a patient’s death is another example of culturally sensitive nursing care. Dying is a personal process. The values, goals, and experiences of individuals impact how that person views death and dying. It is important for nurses to be aware of any cultural or religious traditions their patients have regarding end-of-life and post-mortem care.

For example: Mr. Aronowitz is an Orthodox Jewish patient receiving care in the hospice ward of a long-term care facility. Mr. Aronowitz and his family have expressed their desire to have their Jewish beliefs honored and traditions upheld, including proper post-mortem procedures.

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