Cultural competency in nursing practice and patient care outcomes

Cultural Competence

Nursing, like any of the fields within the medical professions, requires a wide-ranging set of skills. Some of these can be seen as purely technical, such as knowing how to triage a patient coming into an emergency department or how to ensure that anti-infection and anti-contagion processes are being followed. In addition to these skills, nurses must also be able to connect to their patients on a personal level, helping to alleviate the stress and fear that so often accompany medical procedures. Part of this latter set of skills requires nurses to be culturally competent, a phrase that is relatively new to the profession although nurses have been aware of the importance of this perspective on an informal level for generations. The fact that it now has a name, however, is an indicator that cultural competence is now increasingly important to the profession.

I would like to begin this paper with a definition of cultural competence. At the most basic level, cultural competence is the ability of an individual to interact in an effective and positive manner with someone from another culture or subculture (Bridging the health care gap). This ability to be effective when interacting with someone who has different experiences and values requires a number of related skills and insights. The first of these is that an individual become aware of one's own cultural view. This seems as if it should be relatively simple, but in fact it can be quite difficult. The ability to recognize and understand one's own cultural values is analogous to being aware of the air around us. Of course, we all know that there is indeed air surrounding us because if there weren't then we would all day of suffocation. However, this does not mean that in the course of our daily lives we actually pay any attention to the quality of the air.

For example, a nurse might believe that all families believe that they should provide equal healthcare to both sons and daughters since that is the prevailing cultural belief in her culture and in the American medical establishment in general. However, this is not necessarily a value that is held by all families. Thus a nurse should be careful to investigate the attitudes of the families that she is working with to determine how healthcare resources are distributed in the family so that daughters can receive adequate care.

The next aspect of cultural competence -- which also speaks to the point made directly above -- is that a culturally competent individual must be aware of her (or his) feelings about other cultures and cultural differences. For example, a nurse may feel very strongly that girls should never be discriminated against and that it is a basic human right that all individuals should have adequate healthcare. This is certainly a legitimate position; however, if the nurse tells a family that does not share this cultural belief that they are wrong or that they are bad people for giving their sons more resources.

When people with different cultural values come together, especially when one has more social power than another (as a medical professional would), there is the potential for significant conflict. If what the nurse wishes is for to help the family's daughters, she will have to find a way to explain the importance of providing care for them in a way that is consonant with the family's cultural values. The nurse might, for example, emphasize the importance of a girl's being in good health if the family wants to find a good husband for her. This approach might not be very much at odds with the nurse's own belief system, but s/he must remember that the point is to provide good care for all of the members of the family, since without the cooperation of the parents the daughter(s) will not receive care.

The above is an example of knowing how to negotiate across cross-cultural differences. This can be very difficult indeed to do, but it is an essential set of skills for anyone who works in a multicultural environment and wishes to do so in an effective, humane way. Such is the case for nearly every nurse, who is likely to find herself/himself working with patients from a very wide range of cultures and subcultures in the course of a single day.

It is not possible for any one individual, no matter how motivated, intelligent, or talented to become fluent in all of the cultural beliefs and mores of every American subculture. Thus what is needed is the ability to recognize situations in which cross-cultural differences of opinion and styles of communication are impeding a good working relationship. What must follow this recognition is the ability to draw out patients about the relevant cultural beliefs and the ability to match the cultural beliefs and needs of the patient (and family) to what Western medicine has to offer (University of Michigan Program For Multicultural Health).

The 2004 film Something the Lord Made explores some of the most important issues about how social and cultural power so often fundamentally affect relationships within a medical situation. The movie focuses on two individuals: Dr. Alfred Blalock (played by Alan Rickman), a white man who was a research cardiologist, and Vivien Thomas (played by Mos Def), a black man who was a finish carpenter. They began working together in 1930 when Blalock recognized that Thomas could provide essential skills that the cardiologist lacked and needed to help create new medical devices.