Quality health care is unevenly distributed in the U.S. A 2019 study, published in JAMA Network Open, noted that data collected from more than 5.4 million people showed a lack of progress in eliminating health inequities across the country. According to the study, “measures of health equity and health justice declined over time, and income disparities worsened.”
Achieving health care equality requires that nurses and other health care workers understand and appreciate their patients’ cultural backgrounds, a skill they can learn in an online BSN to Doctor of Nursing Practice (DNP) program. As society becomes more diverse and multicultural, health care professionals need an education focused on understanding why cultural competence is important in health care.
Nursing leaders such as nurse practitioners respond to inequalities in the provision of health care services by redoubling their efforts to build healthy communities for everyone, regardless of cultural background or economic status. They strive to instill culturally competent health care as a way to make services more accessible to underserved communities and improve health outcomes for all their patients.
Defining Cultural Competence
The American Hospital Association (AHA) defines a culturally competent health care system as one that “acknowledges the importance of culture, incorporates the assessment of cross-cultural relations, recognizes the potential impact of cultural differences, expands cultural knowledge, and adapts services to meet culturally unique needs.” But why is cultural competence important in health care? The goal of cultural competence in health care settings is to reduce racial, economic, ethnic, and social disparities when meeting a community’s health care needs.
Developing a culturally competent health care environment starts with awareness of one’s own cultural background and experiences and the need to limit their influence when interacting with people from other cultures and with different life experiences. Beyond this starting point, cultural competence requires an understanding of and respect for other cultures. It also requires responding to patients in ways that are consistent with their cultural practices.
Focusing on Patients’ Social, Cultural, and Linguistic Needs
The American Nurses Association (ANA) Code of Ethics states that nurses must “practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” The only way to treat all patients with compassion and dignity is by understanding their cultures and responding appropriately to their wishes and desires. Unfortunately, this often does not happen in practice. The following three examples demonstrate how a lack of cultural understanding adds to a patient’s stress:
● A Native American man tells emergency room staff he is following the “old ways” of dying and asks that his family be around him. Instead, he is transferred to an intensive care unit (ICU) hundreds of miles away for the extensive treatment he did not want, and his family cannot join him. He dies two weeks later, after being resuscitated twice, and his wife is the only family member with him.
● A Chinese patient admitted to the ICU after heart surgery asks the medical staff to allow his wife to cook a therapeutic meal for him that contains special herbs and that only his wife knew how to make. His nurses did not understand his initial request, after which he stopped asking because he was afraid of how they might view him.
● A newborn is too ill to be discharged with his Vietnamese mother, and the nursing staff becomes concerned that the mother appears not to be bonding with her new baby. A specialist in transcultural nursing care explains to the staff that in rural Vietnam, many people believe spirits are attracted to and may harm newborns, so they try not to draw attention to babies. What had seemed to the staff as uncaring was in fact a reflection of the mother’s love for her child.
Why Nurses Need to Consider Culture and Ethnicity
Public health efforts have expanded beyond clean air, clean water, and safe foods to include the community itself: housing, employment, health care access, availability of healthy foods, sanitation, and safety. The U.S. Department of Health and Human Services has identified “social determinants” as primary contributors to the unequal distribution of quality health care services. As leaders in the field of public health, nurses need to consider the cultural and social background of their patients to ensure that they are providing them with optimal care.
Cultural Competence Beyond Patients
Advanced practice nurses are key to integrating cultural competence in health care settings. As nurse leaders, advanced practice nurses have a commitment to putting cultural competence principles into practice, and that sets the tone for others in various nursing departments. The leadership extends beyond the health care environment to the community through public health outreach activities to improve health care access for vulnerable cultural groups.
Applying Cultural Competence in Health Care Administration
Cultural competence is important in health care for a variety of reasons. Implementing cultural competence in an organization can take place through the following steps:
● Use microtargeting surveys of the community to collect demographic information, and analyze the results to identify the cultural, social, and linguistic needs of the hospital’s patients.
● Tell the community about the survey results and use the results to set priorities for educating staff members.
● Respond to feedback about the survey from the community and educate nursing staff about the cultural needs of their patients.
Successful staff education programs share four characteristics:
● They assess the staff’s knowledge about cultural competence and the ways they currently interact with people from diverse cultures in their work.
● They review case studies, observe interactions with patients, and use online resources to learn about specific cultures and vulnerable populations.
● They schedule regular education sessions and assess their progress and effectiveness frequently, adjusting the education program as needed.
● They survey patients to determine their satisfaction with the services they received and analyze data to spot disparities in the quality of care provided to various segments of the patient population.
How Hospitals Can Promote Healthy Practices in Diverse Communities
Providing culturally competent health care requires frequent and consistent outreach to the community. The U.S. Centers for Disease Control and Prevention (CDC) provides a guide to help hospitals establish partnerships with individuals, groups, and organizations to promote healthy lifestyles. The outreach helps identify ways the hospital can meet the community’s health care needs.
To ensure that all vulnerable populations in the community are included in the outreach, it is important to identify nontraditional partners in government, educational institutions, businesses, nonprofit organizations, religions, and funding agencies. The CDC recommends first defining the hospital’s community, its characteristics, and the social and cultural ties that link people and groups.
Benefits of Promoting Cultural Competence in Health Care
Those who wonder, why is cultural competence important in health care, and why does it matter? are typically individuals who have not experienced the negative impacts of health inequality. Those who have interacted with the health care field and have not experienced health justice or health equity know firsthand how a lack of medical care can negatively affect a person’s quality of life. One of the benefits of promoting cultural competence in health care is that when more people are aware of problems in the system, positive changes can be made.
The AHA discusses how collecting data about the races, ethnicities, and language preferences of patients allows organizations to improve their cultural competence and provide more efficient patient care. By doing this, organizations can make diversity a priority in their facilities. They can properly train their nurses and staff to interact with patients, and they can get the community involved. Another benefit of incorporating cultural competence in health care is that organizations can focus on providing new disease management and prevention programs based on the patients they serve.
Development of Leadership Skills in Cultural Competence
Advanced practice nurses need to have strong leadership skills to promote and encourage culturally competent health care. They also need acumen in other core competencies, such as communication and problem-solving. Regis College’s BSN to DNP program teaches advanced practice nurses how to sharpen their ability to integrate cultural competence into their everyday work and demonstrate by example the importance of promoting equality in the provision of quality health care.
To fully demonstrate that they understand the importance of cultural competence in health care, nurses should develop certain leadership skills. Nurse leaders can study the five-component model for delivering culturally competent care developed by Joseph Campinha-Bacote and Cora Munoz in 2001.
- Cultural awareness refers to the process of self-examination that allows health care leaders to understand their own cultural backgrounds and address any biases they may have toward individuals from other cultures.
- Cultural knowledge involves the ongoing process of health care professionals seeking to better understand the languages, cultures, and belief systems of their patients.
- Cultural skills consist of doctors and nurses being able to examine patients according to a culturally based assessment and collect culturally relevant data.
- Cultural encounter is the process of a health care professional interacting with a patient from a culturally diverse background.
- Cultural desire revolves around the willingness of health care professionals to engage in cultural encounters with cultural awareness.
Regis College’s BSN to DNP program prepares students to become leaders in health care via a curriculum that includes the following courses: Concepts in Nursing Leadership; Health Promotion – Disease Prevention; Regulatory Issues: Nurse Leadership; and Health Policy, Politics, and Perspectives. Students choose one of six concentrations: Pediatrics, Women’s Health, Family, Psychiatric Mental Health, Adult Gerontology., or Adult Gerontology – Acute Care.
The Importance of Communication and Problem-Solving Skills
The importance of nursing leaders communicating their commitment to creating a culturally competent health care environment cannot be emphasized enough. The importance of communication extends to successful mediation when problems related to cultural misunderstandings arise. Researchers have found that role-modeling helps nursing leaders promote cultural competence. However, the context of exchanges between nurses and patients, as well as individual characteristics of nurses, demonstrates the importance of communication and relationship building.
Nurses’ problem-solving skills are enhanced when they understand the social, economic, and cultural backgrounds of their patients because many problems in health care settings can be traced back to miscommunication or misunderstandings between patients and nursing staff. They should be able to demonstrate firsthand knowledge regarding how and why cultural competence is important in health care.
How Advanced Practice Nurses Can Gain Essential Cultural Skills
Addressing the health care needs of underserved communities requires that nurses recognize and adapt to the social, ethnic, and linguistic needs of the people in these communities. The ANA specifies that RNs at all education levels should demonstrate certain competencies. For example, all RNs should have the following competencies:
● “Participates in lifelong learning to understand the cultural preferences, worldview, choices, and decision-making processes of diverse consumers.”
● “Communicates with appropriate language and behaviors, including the use of medical interpreters and translators in accordance with consumer preferences.”
● “Educates nurse colleagues and other professionals about cultural similarities and differences of health care consumers, families, groups, communities, and populations.”
Promoting Cultural Competence in Health Care
Advanced practice nurses with strong leadership and communication skills are needed to successfully implement cultural competence in health care settings. Nursing professionals interested in taking a lead role in the drive to bring health care equality to vulnerable communities will find Regis College’s BSN to DNP program teaches the skills required to plan, implement, and maintain culturally competent health care programs.
Learn more about how the online BSN to DNP degree program lays the foundation for health care leaders working to help others understand why cultural competence is important in health care settings.
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American Hospital Association, Becoming a Culturally Competent Health Care Organization
American Nurses Association, Code of Ethics for Nurses with Interpretive Statements
The Case Manager, “A Guiding Framework for Delivering Culturally Competent Services in Case Management”
DiversityNursing.com, “A Guide to Culturally Competent Nursing Care”
JAMA Network Open, “Trends in Health Equity in the United States by Race/Ethnicity, Sex, and Income”
The Balance, “Health Care Inequality in America”
U.S. Centers for Disease Control and Prevention, Conversations in Equity
U.S. Centers for Disease Control and Prevention, Health Disparities
U.S. Department of Health and Human Services, Cultural and Linguistic Competency
U.S. Department of Health and Human Services, What Is Culturally Competent Nursing Care: A Cornerstone of Caring?”
U.S. News & World Report, “America Has a Health Equity Problem”