The art of cultural competence in nursing

Cultural competence is turning out to be one of the most important skills for professionals in the 21st century. The world is more diverse than ever. People move from country to country for many different reasons, and in many parts of the world, including the US, most communities are made up of individuals from different countries, cultures and races.

Today’s professionals need to develop cultural competence if they hope to do well in the workplace. For healthcare practitioners in particular, cultural competence has become an all-important skill. Nurses, doctors and other healthcare workers now serve diverse communities, and they cannot afford to be influenced by biases that arise because of differences in culture or background.

Many employers, when seeking new employees, specify that they must be culturally competent. Many nursing courses also have an emphasis on cultural competence — by the time students qualify they are aware of the importance of understanding others and not letting cultural differences get in the way of service delivery.

Cultural competence as a foundation for a successful nursing career

The best family nurse practitioner courses, for example, teach students the value of cultural competence. These courses are usually for those who would like to transition from an RN to an MSN, and they cover topics like theoretical foundations and advanced nursing, evidence-based practice for quality outcomes, health policy and healthcare delivery in advanced nursing practice and foundational concepts for family nurse practitioners.

The question, Where do family nurse practitioners work, and does it have a bearing on how culturally competent they should be, is an extremely important one. After completing an online Master of Science in Nursing — Family Nurse Practitioner program at Texas Woman’s University, for example, family nurses can expect to work in a variety of settings. The course prepares them to deliver services in inpatient and outpatient clinics and hospitals, private practice, urgent care clinics, rural health clinics and corporate clinics. Some practitioners even go on to work in non-traditional roles or settings, like travel nursing or telehealth.

As to whether where they work matters when it comes to cultural competence, the answer is yes, it does. Nurses who serve within diverse populations, such as in city clinics and hospitals, may find that they quickly need to understand a lot of different cultures compared to those who work in a rural setting where the population is composed of people from a more or less similar background.

If a student chooses to specialize in travel medicine, they can expect to visit many different countries in the course of their career, and they should be much more culturally diverse than a nurse who works in a single community throughout their career.

This is not to say that cultural competence matters more in some specialties than others — all nurses, if they hope to have successful careers, should strive to understand all patients regardless of their backgrounds.

But what is cultural competence and how does it help a practitioner who serves in a diverse community? How can one become more culturally competent, and what sorts of opportunities does it open up for nurses who want to advance the career ladder? As students prepare to join the workforce, they need to understand the issues surrounding this particular topic so they can be adequately prepared and provide nursing services without favor or bias.

What is cultural competence?

Simply defined, it is the ability to understand and interact with people from other cultures. Certain prerequisites are necessary before one can consider themselves culturally competent.

The first is that one needs to understand their own culture, because it can be difficult to understand another person’s culture if one does not know their own.

One also needs to have a willingness to learn about others and their world views, and when they encounter differences they should be open-minded and have a positive view and an appreciation for the fact that others do and view things differently.

Why is it important in nursing?

Nurses deal with all sorts of people — as the US becomes increasingly diverse they must provide services to immigrants, refugees and whoever else happens to require treatment and care. People from other cultures and backgrounds have a different view of the world. They also often have opinions about how they would rather be treated, and if nurses are not prepared to listen and understand that it can lead to misunderstandings that have serious consequences.

For example, the way men and women interact in some cultures is quite different from a typical American interaction. In some parts of the world, a male nurse cannot treat a female patient, and vice versa. If a female patient is presented with a male nurse on visiting an American hospital it can lead to difficulties, and unnecessary complications may arise.

In a culturally competent environment, if a patient has any objections to being treated and cared for by a person of the opposite sex, they are assigned a practitioner they are more comfortable with and the focus can then shift to providing care so that they can get well as soon as possible. Nurses are patient advocates, and they need to understand their patients so that they can represent them. Any barriers, be they cultural or linguistic, can impact their ability to do so.

Because communities in the US are getting more and more diverse every year, it is the responsibility of the nurse to make sure that they are open to learning about other cultures and appreciating differences rather than developing bias or negativity because someone has different beliefs or a different view of a certain issue. It is well known that culturally competent nursing care can have significant benefits for patients. These include mutual respect, understanding and trust. It makes it easier to collect data and feedback, improves preventive care, reduces costs and helps patients feel included.

The overall effect of all this is better patient outcomes. In other words, culturally competent nurses have happier patients who heal faster. The higher the number of culturally competent nurses a healthcare facility has, the better outcomes it delivers to patients.

What are the components of cultural competence?

There are four pillars of cultural competence, and when nurses integrate them into everyday practice they improve the quality of treatment and care for their patients.


Nurses should be aware of their own biases so that they can work on eliminating them. They should examine their interactions with people from different backgrounds and cultures to see whether they have preconceived notions that may be holding them back from delivering the best quality of treatment and care.

A good example of this is if a nurse becomes aware that they think of certain people as backward because they come from Africa or Asia. If they are aware of this bias, they can work on eliminating it by getting to learn about people from those parts of the world. A different view almost certainly educates the nurse and gives her a new appreciation of her patient.


Attitude is all about changing internal belief systems. Once a nurse is aware that they may be treating a patient differently because of their background, they can work on examining their beliefs to understand where they come from and whether they are justified.

A better understanding of another culture almost always brings forth facts that we were not aware of before, and they help us change our attitudes.


Knowledge is the most important element in cultural competence. The more a nurse knows about other cultures, the more open-minded they are likely to be. Knowledge comes from actively learning about others, their beliefs and the reasons why they have a different worldview.

Nurses can acquire knowledge by talking to their patients, reading books, watching documentaries, and even getting involved in community activities of groups from different countries and backgrounds.

Communication skills

Cultural competence is only useful if it is communicated properly. Nurses ought to be conscious of how they listen and respond to patients and even their body language. They should also be open to the fact that communication may differ among people from different cultures.

In the West, for example, eye contact is considered important, but in some cultures, looking an adult in the eye can be construed as impertinence. Learning little nuances like this goes a long way in helping nurses understand their patients, and the better they understand their patients, the better care they can provide.

What are examples of cultural competence in nursing?

There are many examples of nurses displaying cultural competence in their everyday interactions with patients:

  • Using language that the patient understands — patients sometimes feel frustrated because doctors and nurses speak in medical terms that do not mean much to them. Every day, nurses across the US strive to use language that patients understand when discussing their symptoms and treatment, and it is a great example of cultural competence.
  • Using translators — when there is a language barrier between a patient and a nurse a translator can help smooth things out. Sometimes an English-speaking family member is present, but it may be embarrassing or awkward for them to get involved in the conversation. A translator is a neutral party, and they can help the nurse understand the patient, and vice versa, without any awkwardness.
  • Respecting that a course of treatment or care may conflict with a patient’s beliefs — it is not always that patients agree to what a practitioner suggests for treatment, and culturally competent nurses often take the time to find alternative treatments that are more agreeable.
  • Analyzing the patient demographic — for nursing staff to provide better services, they take the time to understand who their patients are and where they come from.
  • Recruiting professionals from underserved communities — patients from minority communities tend to feel better served by people from minorities, so nurses need to hire practitioners from these communities.
  • Identifying underserved communities — this is an eye-opening exercise, and it often falls within the docket of the community nurse. After they identify communities that do not have adequate health services they can strive to understand why they are underserved and develop strategies to provide better care.
  • Having a diverse staff — it can be difficult to become culturally competent without hiring people from different backgrounds. Healthcare managers strive for diversity in hiring, making sure that different communities and backgrounds are represented.

What can nurses do to become more culturally competent?

Becoming culturally competent is not easy, especially for nurses who have not been exposed to people from other backgrounds, but it can certainly be done using the following tips:

Work on perspective

Nurses who want to become more culturally sensitive ought to work on how they see others. Just because a person has a different belief or way of doing things does not make them less deserving of care and compassion.

This means that nurses must develop a deep respect for all patients even as they strive to learn more about their cultures. Nurses should work in partnership with the patient rather than imposing their will on them.

Share a little about one’s own culture

This helps establish common ground, and it is a great way to invite others to share about their own culture. It also helps build rapport with patients and breaks down barriers.

It does not have to be anything complicated or long-winded or overly involved. It is just about looking for common ground so that the patient feels they can talk more about themselves and their illness, treatment and the way they would like to be cared for.

If, for example, the patient comes from a country where alternative treatments are commonly used, and they have used such treatments in the past, the nurse can mention a herb that they use themselves and talk about their positive experiences with it. If the patient feels that they have some things in common with their nurse they may get comfortable enough to open up.

Learn about different cultures from co-workers

If a nurse works in a diversified facility, they should take the time to learn about other cultures from fellow employees. It helps foster great working relationships, and it also gives them a better understanding of their patients. Nurses should not be afraid to ask questions (but always be polite) and take time to attend cultural events that offer a better insight into life in other parts of the world.

There are certain nuances nurses should observe when interacting with co-workers. For example, they should not make them feel like they represent all others from their community. It can make them feel uncomfortable.

A good awareness of geography is also important. You cannot refer to Asian culture — there are many different countries in Asia, and each has its own culture. The same goes for Africa. Ask about people and cultures of a specific country rather than an entire race, and do not assume that people share beliefs just because they share an ethnicity.

Take communication courses

A big part of becoming culturally sensitive is improving how one communicates with patients and others around them. Nurses can become better communicators by regularly taking courses that teach how to listen and talk to patients and colleagues.

Immerse oneself in a culture from time to time

As a hobby, people can choose a culture and immerse themselves in it for a few weeks to learn as much as they can about it. It is fun, and it opens one’s mind to perspectives that they may have otherwise missed.

Take other faiths seriously

Faith and religion are just as important as culture, and they can cause problems in nurses who are not open-minded and accepting. Many elderly people, for example, take their faith seriously, and it is not unusual for them to invite their caregivers to read the bible or say a word of prayer.

It does not help for a nurse to ridicule a patient’s faith or tell them that they believe in science. Allow them to practice their faith, and be open to the fact that it is something they deeply believe in and hold dear.

People can take the time to learn the basics of common religions like Christianity, Islam, Judaism and Hinduism. It makes it easier to have conversations with patients who are believers, and it helps engender trust, which leads to better communication.

Work with local community leaders

Community leaders are often selected to represent everyone in the community, so regularly working with them can open up a nurse’s mind to other cultures.

It may be possible to ask for an invitation to community activities where nurses can meet people of different races, and as they get to know the community better, volunteer to help in their projects or even suggest projects.

Eventually, nurses who have committed time to learning about different cultures will have a decent understanding of people from other cultures and backgrounds. When the time comes to treat and care for these patients, they will be more willing to open up to nurses who have an idea of who they are and the basics of their culture.


Cultural competence in nurses is no longer simply ‘nice to have’. As communities in the US become more and more diverse, employers are looking for nurses who are knowledgeable about different cultures. Culturally competent nurses have better interactions with patients, and they register better patient outcomes.

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