11 minute read
Cultural Competence: Seeing the World Through the Eyes of Others
BY MICHELE WOJCIECHOWSKI
Experts explain why understanding and practicing cultural competence is crucial for nurses and midwives alike.
Oftentimes, the United States is described as a “melting pot”—meaning that people living here are made up of a variety of races, religions, and cultures. Because nurses and midwives will provide care to many different people in their careers— or depending on where they practice, every single day—it’s crucial for them to know as much about other cultures so that they can provide the very best care possible.
This is where cultural competence comes into play.
Defining Cultural Competence
According to the American Hospital Association (AHA), “Cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs, and behaviors, including the tailoring of health care delivery to meet patients’ social, cultural, and linguistic needs.”
Laurie Cure, PhD, MBA, CEO for Innovative Connections, has consulted with health care organizations for more than 25 years, including in cultural competence. She takes the AHA’s definition of cultural competence one step further: “If we recognize cultural competency as a skill that supports the ability of care providers to achieve enhanced patient outcomes by not only respecting various differences in people but, perhaps more importantly, valuing those differences, then race, ethnicity, religion, sexual preference, and country of origin are all important to recognize and take into account when caring for patients,” Cure explains. “As a nurse, you are often the most trusted individual who is partnering with the patient. This requires you to value cultural differences. This valuing of others—knowing and appreciating what’s important to them— translates into everything you do in caring for the patient and their family.”
“Cultural competence, at its core, is about embracing similarities as well as recognizing differences—whether they are based on race, gender, age, education, language, socioeconomics, sexual orientation, views on marriage, approaches to raising children, or anything else,” says certified nurse midwife Nola A. Holness, PhD, NP-C, CNM, a clinical assistant professor in undergraduate nursing at Florida International University Nicole Wertheim College of Nursing & Health Sciences. “Cultural competency means a willingness to respect and embrace such differences so we, as health professionals, can continue to deliver the highest quality of care to the patient while working within the cultural context of that individual, their family, and their community.”
But cultural competence isn’t just about respect. It also can influence the care you provide. “Ultimately, cultural competency allows you to communicate more effectively, understand the decisionmaking process so you can create more effective medical treatments for your patients, and avoid medical errors that results from misunderstandings. In the end, you can create a better patient experience with improved safety and outcomes,” says Cure. “Cultural competence, at its core, is about embracing similarities as well as recognizing differences—whether they are based on race, gender, age, education, language, socioeconomics, sexual orientation, views on marriage, approaches to raising children, or anything else,” says certified nurse midwife Nola A. Holness, PhD, NP-C, CNM, a clinical assistant professor in undergraduate nursing at Florida International University Nicole Wertheim College of Nursing & Health Sciences.
Be Aware of Who You Are
Before you can learn about your patients’ cultures, you must know who you are. This means understanding that everyone has their own culture, their own experiences, and even their own biases. “Cultural competency is also a two-way street. It’s a call to action for us as nurses to be self-aware and acknowledge how our own culture, our own beliefs, and even our stereotypes of others shape our outlook and the way we care for our patients,” says Latisha Barfield, ARNP, CNM, MSN, DNP, a certified nurse midwife and clinical assistant professor in undergraduate nursing at Florida International University. “This resonates now more than ever, given what is going on in our world today where everyone wants to be right and thinks their way of
doing things is right. Having a culturally competent mindset can help us transcend that.”
Being culturally competent also means understanding that even if you’re a member of a minority group, that doesn’t mean that you automatically understand everyone in that group. “Cultural competency is rooted in the awareness of the differences among our patients, and between our patients and ourselves. As nurses, we need to examine ourselves and recognize our biases and other cultural characteristics that could possibly interfere with how we treat and develop therapeutic relationships with our patients, many of whom will not share our own background, experiences or customs,” says Holness.
In addition, don’t generalize. For example, if an Asian patient acts in a certain way, don’t assume that all Asian people will. Besides being stereotyping and pigeonholing a patient, generalizing like this doesn’t take into consideration any patient’s personal upbringing and cultural experience. “There are dominant cultures, but there are sub-cultures within. We really need to understand that. Just because patients come from the same country, does not mean they share the same dominant culture, beliefs, or experiences,” Barfield points
out. “Look at our own country and the differences from East Coast to Middle America to West Coast. The same holds true globally for other countries. We cannot generalize and should not generalize. We have ample opportunities to learn about other cultures and the variations within those cultures thanks to the internet and social media. It’s this desire to keep learning that can help us avoid the pitfalls of pigeonholing.”
Helping in Patients’ Care
Having cultural competence can be crucial when caring for some patients. “Cultural sensitivity helps to break down barriers that may hinder patients from receiving the care they need. Nurses need to understand the impact cultural competence has on a patient’s health care outcomes,” stresses Jamil Norman, PhD, MSN, academic coordinator for Walden University’s RN-to-BSN program. She also makes sure to incorporate cultural competence into all of her teaching. “Interactions between nurses and patients can have either a positive or negative impact on the patient. Nurses should always strive to have a positive impact.”
Barbara A. Anderson, DrPH, RN, CNM, FACNM, FAAN, professor emerita at Frontier Nursing University and editor of Best Practices in Midwifery: Using the Evidence to Implement Change, also works as a consultant for nursing education, public health, and nurse-midwifery. Having worked in 62 nations during her career, Anderson understands how difficult it can sometimes be to have a positive impact on a patient whose culture is quite different from your own. This can even happen while you’re treating someone in your proverbial own backyard.
For example, Anderson was treating a young Spanishspeaking patient in the United States for a severe, recurrent bladder infection. “As the teaching nurse, I was failing to convince him about the importance of handwashing to prevent infection—no matter how often I explained it in Spanish. He would take his pills, but he saw no need to wash his hands, saying the infections were caused by an evil spirit,” recalls Anderson.
She explained to him that it wasn’t evil spirits causing the infection. But he wouldn’t listen. He then told Anderson that washing his hands wasn’t “macho.” “He would not budge—putting a protective, cultural barrier around his masculinity,” says Anderson. If she couldn’t get him to wash his hands, he wouldn’t get well and stay that way.
Anderson realized that she hadn’t truly listened to her patient’s world view of what he believed caused his disease—evil spirits. “I was intrigued, trying to figure out how to convince him that these recurrent infections were connected to his poor handwashing techniques,” says Anderson. So she decided to approach the problem from his world view.
Knowing that he was religious, she asked if he was baptized. He said he was and that baptism protected him against evil spirits. Since he was adamant that evil spirits caused his infection, she went along and said that they did, and she could show them to him on a machine.
Anderson called the lab and asked them to put a culture specimen on a slide under one of the microscopes. She took the patient to the lab and showed him a “swirling mass of bacteria.” He was horrified.
“These are the evil spirits that are hurting you. They live on your hands. What do you think we should do about this? Should we baptize your hands to destroy those bad spirits?,” she asked.
“He got it and became a fiery advocate of hand washing, explaining contagion and describing what evil spirits
looked like to his macho friends and his pastor (who agreed with my approach),” says Anderson. “Some people criticized me for this approach, saying this wasn’t appropriate. But that day, the patient and I crossed a deep chasm of cultural difference. I learned that one aspect of cross-cultural competency is seeing the world through a different lens.”
While Anderson’s approach may have been controversial, she succeeded in making her patient well—and helping him to stay that way.
“Nurses should embrace being culturally competent and committed to learning as much as they can so that they are properly equipped to deliver care to people who have historically received less than optimal care due to cultural differences,” says Talonda Rogers, MSN, RN,
a nurse educator for the practical nursing program at the Chester County Intermediate Unit in Downingtown, Pennsylvania and owner of RISCQ by TALONDA Healthcare Consultants & Educators, LLC. “Lives literally depend on it. Not being culturally competent could lead to adverse health outcomes for patients. Even worse, not being culturally competent can lead to death.”
Learning Cultural Competence
In Anderson’s case, she learned how to treat her patient based directly on his personal beliefs. But it’s important to learn about cultural competency overall before learning the distinctions held by various patients.
“The best way to obtain cultural knowledge is to interact with and learn from people of different cultures,” says Norman. “Reading books about different cultures can help nurses understand various perspectives. Continuing education that focuses on cultural competence in patient care should be required for all nurses.”
“Nurses can join nursing organizations and take part in conferences, webinars, and trainings that will help them become culturally competent,” adds Rogers.
If you want the organization you work for to begin offering classes or workshops in cultural competence, Cure suggests that you “determine which populations are most prevalent in your community or hospital. It’s difficult to understand all cultural dynamics, so prioritize those closest to you as a starting place.” She also says that “Reading books, watching movies, or seeking out information about various cultures can be an important step as well.”
Most importantly, ask your patients. “Asking questions such as ‘Are there any special requests you have based on your identified culture? What culture do you identify with? How can we make sure your stay here honors your cultural needs, traditions, and values?’” recommends Denise L. Caleb, EdD, PHR, SHRM-CP, executive vice president of partnerships and chief transformation officer of Talent Plus, Inc. “There are so many questions that lead to understanding and allow for superior service to be delivered. If I do not ask, then I make assumptions, which could be misaligned and run the risk of not creating service excellence.”
Rogers says that nurses “should ask if there are any religious or cultural beliefs or rituals the nurse should be aware of in order to make their stay better.”
“I recommend keeping questions broad to avoid assumptions,” says Cure. “Showing respect is of utmost importance, but also remember that nurses must balance culture with patient needs as well as legal and policy considerations.”
“Don’t be afraid to share cultural similarities and differences so your patient learns about you, and you learn about them,” says Holness. “As nurse midwives, we tend to do that.”
Making Mistakes
Cure says that if you’re being culturally competent, you will get something wrong sometimes. If you do make some kind of mistake, apologize.
“In most situations, an authentic, specific apology is the best advice,” Cure says. “Since many cultures are hierarchical, don’t be surprised if feedback does not come directly to you, but instead goes to your supervisor. Be open to your mistakes and work to adjust your behavior in a culturally competent way.”
“Say ‘I’m sorry,’ then explain your intention, listen to how they were made to feel, provide concern, and show care for the offense. Then say, ‘My apologies,’ hit the clear button, and move forward,” says Caleb.
Know too that you will never stop learning how to be culturally competent. “As our society continues to change, so does our cultural competency levels. Culture, diversity, and inclusion work is a journey and that journey does not have a destination,” explains Caleb. Remember just to try. “If we never try, we fail automatically out of the gate.”
Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about the nursing field but comes close to fainting when she actually sees blood. She’s also author of the humor book, Next Time I Move, They’ll Carry Me Out in a Box.
