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Clinical Trials Office

Culturally Competent Care

  1. What is Culture?
  2. Cultural Competence
  3. Levels of Cultural Competence
  4. Cultural Quotient
  5. Cultural Competency in Nursing
  6. Examples
  7. Conclusions

Contents of Class

What is Culture?

  • Culture is typically described as the totality of learned behaviors of a people that emerges from their interpersonal interactions.
  • Culture includes the ideals, values, and assumptions about life that are widely shared and that guide specific behaviors.
  • Objective culture
    • Visible: artifacts, food, clothing
  • Subjective culture
    • Invisible: values, attitudes, norms


    • Provides us with our identity, beliefs, values, and behavior.
    • Is learned as a part of the natural process of growing up in a family and community and from participating in societal institutions.
    • Is the conscious and unconscious content that a group learns, shares, and transmits from generation to generation that organizes life and helps interpret existence.

    Culture Cont.

    • Gives context and meaning in life.
    • Is a filter through which people process their experiences and events of their lives.
    • Influences people’s values, actions, and expectations of themselves.
    • Impacts people’s perceptions and expectations of others.

    Culture = Context

    • People form a community and interact with each other. This can be formed around specific identities, geographies, beliefs, and daily practices.
    • Culture can involve ethnicity, race, and sexual orientation.
    • Dominant groups set the parameters; have the greatest influence.
    • Subordinate groups must learn the parameters; have less influence.

    Culture & Cultural Groups

    • The meaning and nature of culture is derived out of the lived experiences of different social groups.
    • From this comes a complex combination of dominant and subordinate cultures that serve the function of society.
    • Culture social power

    Dominant & Subordinate Cultures

    • Language
    • Sanctions (penalties/rewards)
    • Norms (appropriate/inappropriate behavior)
    • Values (collective conceptions of what is desirable)

    Cultural Dynamics Include:

    Cultural Competence

    • The awareness, knowledge, and skills needed to work with others who are culturally different from self in meaningful, relevant, and productive ways.
    • The ability to work effectively across cultures in a way that acknowledges and respects the culture of the person or organization being served.

    What is Cultural Competence?

    • One can gain a broadening of perspective that acknowledges the simultaneous existence of different cultures requiring neither comparison nor judgment.
    • One can be aware of likely areas of potential cross‐cultural miscommunication, misinterpretation, and misjudgment; anticipate their occurrence (knowing what can go wrong); and have the skills to set them right.

    Cultural Competence

    • Self-awareness
    • Cultural understanding
    • Multiple perspectives
    • Intercultural communication
    • Relationship building
    • Flexibility/adaptability
    • Intercultural facilitation/conflict resolution skills
    • Multicultural organizational development skills

    Cultural Competence Includes:

    Cultural awareness: First and foremost, perform a self-examination to gain insight into beliefs and values. Cultural knowledge: Seek out information to expand knowledge base of different ethnic groups Cultural skill: Collect relevant cultural information. It is insensitive to assume a person’s cultural preferences based on appearance, country of origin or religion. Instead, ask questions and seek information in a professional manner. Cultural Encounter: This is the process of engaging with people from culturally diverse backgrounds, as this exposure increases cultural competence. Cultural Desire: Individuals must find the motivation to become culturally aware by remaining open-minded to learning and being accepting of others.

    How to Develop Cultural Competence:

    Levels of Cultural Competence

    • The dehumanization of specific cultures or individuals signifying an underlying bias toward the superiority of the dominant or majority group.
    • There is an intention to ignore issues affecting minorities and promote policies and standards that have an adverse impact on them.

    Cultural Destructiveness

    • The inability to work with diverse populations.
    • There is not an intention to ignore issues or promote policies and standards that have an adverse impact on minorities; instead, their practices are based on a lack of understanding and ignorance.

    Cultural Incapacity

    • Approaches used by and for the majority are perceived as relevant for all others.
    • Practices are adopted for "the greater good”, which is generally the majority perspective.
    • This level is characterized by inability to examine or even recognize existing biases in approaches to practices, education, and research that perpetuates the continued existence and development of models that support stereotypes of diverse populations and thus further promotes prejudice.

    Cultural Blindness

    • Recognition of potential weaknesses and biases within practices and a decision to take action to address the problem.
    • Although this phase is a positive movement, false "comfort" may set in after making only minimal efforts to be responsive to diverse populations. The efforts may only be peripheral and not sufficient to truly address cultural issues.

    Cultural Pre-Competence

    • A demonstrated commitment to diverse populations in all aspects of the structure and functions of the organization.
    • The commitment is characterized by a sustained, systematic integration and evaluation at all levels of significant collaboration from diverse populations into the infrastructure of the organization.

    Cultural Competence

    • Demonstrated by the organization's commitment to diversity and by its external expertise, leadership, and proactive advocacy in promoting appropriate care for diverse populations.

    Cultural Proficiency

    • Progress requires a continual assessment of an one’s ability to address diversity, celebrate successes, learn from mistakes, and identify opportunities for rediscovery.
    • An important point to remember is that actions taken at one point in time may not be sufficient to address diversity issues at another point in time.
    • Today's changing environment demands that efforts to move toward cultural proficiency are more than the "right" and "good" thing to do - they are the essential component of effective service/care.

    The Cultural Competency Continuum

    Cultural Quotient

    • It is one’s ability to function effectively in a variety of cultural contexts.
    • In addition to understanding different cultures, it focuses on problem solving and effective adaptations for various cultural settings.
    • It is an overall capability you can take with you anywhere.

    Defining Cultural Quotient

    • The extent to which you understand the role of culture in how people think and behave and your level of familiarity with how cultures are similar and different.

    Cultural Quotient Knowledge

    • There is widespread globalization― People of different cultures today live together everywhere in the world.
    • There are more opportunities to interact with people from different cultures in many aspects (e.g., domestically, business, and work).
    • One needs to know the customs of other cultures, especially the taboos or risk offending people.
    • People with higher CQ are able to interact with people from other cultures easily and more effectively.

    Why CQ Matters

    Cultural Competency in Nursing

    • As the bridge between practitioners and patients, nurses are in a unique position to respond to the growing demand of a diverse population. If nurses can propel the healthcare industry toward cultural competency, they can significantly reduce health disparity and ensure quality healthcare for all populations.
    • More than one-third (37 percent) of the U.S. population consists of individuals from ethnic and racial minority groups, and by 2043, minority groups will become the majority, according to research from the American Association of Colleges of Nursing.
    • However, nurses from minority backgrounds represent only 19 percent of the registered nursing (RN) workforce.
    • Men account for only 9.6 percent of the RN workforce.

    Relevance of Cultural Competence in Nursing

    • Patients from other parts of the world may experience entirely different medical issues than US patients.
    • Gihan ElGindy, RN, MSN, executive director of the TransCultural Educational Center in McLean, Virginia, learned this firsthand when she developed a breast-cancer awareness program for recent immigrants from areas in Africa, the Middle East and Asia that are virtually cancer-free.
    • While many of the 500 women in the program had never heard of breast cancer, their risk level increases the longer they live in the US.
    • "Our American literature says these groups of women are ignorant or don't comply," ElGindy says. "But why [would] they have to know about cancer if it doesn't exist in their countries?"

    Don't Make Assumptions

    • Healthcare jargon is especially difficult for people whose native language is not English.
    • The women in the breast-cancer program, for instance, had "no clue about the American terminology we use but were too shy to say they didn't understand," ElGindy relates.
    • For example, when one of the questions on ElGindy's initial survey asked, "Do you have Medicare or Medicaid?" some respondents assumed that Medicaid and Medicare were forms of cancer.

    Explain Every Detail

    This Photo by Unknown Author is licensed under CC BY-SA-NC

    • Whatever the patient's cultural background, the health provider and patient both want the patient to return to the best state of health possible.
    • Sometimes a nurse can help patients preserve their beliefs and values within the American medical model; other times, the nurse can teach patients why new techniques or technologies that are antithetical to their beliefs are required for their recovery.
    • In nonemergency situations, health care providers should look for alternatives to treatments that contradict patients' beliefs. Making these small accommodations can have big payoffs for patients' emotional well-being.

    Accommodate and Educate

    • When in doubt, the best way to provide sensitive care to patients of diverse cultures is to ask questions.
    • When you initiate care during your initial assessment, ask if there are any cultural or religious practices or beliefs that you need to know about in order to respect and support their needs.
    • If a patient is unsure or unaware of their unique needs in the healthcare setting, encourage them to communicate those needs to you as they happen to arise.

    Ask Questions

    • How can patients love and accept themselves in ways that promote healing if we, as nurses, are not willing to offer them acceptance in their myriad of problems and complexities?
    • Through the simple act of acceptance, nurses can become an agent of healing, whether or not they are aware of it.
    • Acceptance becomes a powerful tool that demands solidarity between nurse and patient



    • An elderly Irish woman, was hospitalized and then scheduled for surgery. The woman complained of pain to her family but said nothing to her physician.
    • Hiding pain is a general characteristic of Irish women.
    • Unaware of this cultural tendency, the physician denied the family’s request to move up the surgery date.
    • The woman’s condition worsened, and she died during surgery.
    • If a culturally competent nurse had intervened, the Irish woman may have had an entirely different outcome.
    • Another example is in Chinese culture, where a Chinese patient may be showing respect to a physician by avoiding eye contact.
    • In American culture, a lack of eye contact can be considered rude or an indicator of depression.
    • In both Muslim and Navajo cultures, eye contact has other distinct meanings.
    • Understanding the nuances between cultures and how language has different meanings for different people is crucial when treating patients of backgrounds different from one's own.
    • Providing effective, sensitive healthcare for patients of other cultures requires empathy, flexibility and a commitment to continuous learning.


    • To deliver truly culturally competent care, we must look at where our patients are coming from and what their ideas of wellness and illness are.
    • Sensitive cultural care is not just a phenomenon that takes place when occasionally encountering foreigners in the hospital or providing care to someone of a different religion.
    • It is the result of the awareness that everyone belongs to a unique subculture based on beliefs and practices and the mindful consideration and space given to every patient.
    • The conscientious nurse can affirm, respect, and nurture all patients through deliberate awareness, acceptance, and asking.


    Cerveny, M., Kratochvilova, I, Hellerova, V. & Tothova, V. (2022). Methods of increasing cultural competence in nurses working in clinical practice: A scoping review of literature 2011-2021, Frontiers in Psychology, 13. Obtained October 10th, 2023 from PubMed database. Deering, M. (2022). Cultural Competence in Nursing, Nurse Journal.org. (Obtained October 17th, 2023). Nair, L., Adetayo, O.A. (2019). Cultural competence and ethnic diversity in healthcare, Plast Reconstr Surg Glob Open, 7(5), e2219. U.S. Department of Health & Human Services. Culturally competent nursing care: A cornerstone of caring. (Obtained October 17th, 2023, https://ccnm,thinkculturalhealth.hhs.gov).