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Cultural competence for the diverse population


Cultural competence for the diverse population

Help your nurses ask the right questions at the bedside

After reading this article, you will be able to:

  • Identify techniques to train staff members on cultural competency
  • Recall three questions staff members can ask whendoing a cultural assessment

The rapidly changing U.S. population is exemplified within your hospital’s walls.

With patients and staff members from different cultural, linguistic, and religious backgrounds, training nurses to be culturally competent and stressing the importance of this growing matter is crucial to providing safe, equitable patient care. “We see healthcare disparities,” says Josepha Campinha-Bacote, PhD, MAR, APRN, BC, CTN, CNS, FAAN, president of Transcultural CARE Assoc-iates in Cincinnati. “Nurses must be aware of theirpersonal biases and prejudices.”

According to the U.S. Department of Health and Human Services, “African-American women are less likely to receive healthcare; when they do receive care, they are more likely to receive it late. For example, African-American mothers were twice as likely to have late or no prenatal care compared to white mothers in 2004.”

The Joint Commission (formerly JCAHO) is stepping in and is developing standards for culturally competent, patient-centered care.

The regulatory initiative will explore the ways in which culture, diversity, and language can be drafted into new requirements (to take effect in 2011) so that cultural sensitivity can “improve the safety and quality of care for all patients,” The Joint Commission stated.

Recent studies have also emphasized that cultural competency is an issue that will only grow in importance.

Research published in Critical Care Nurse states:

If current population trends continue, it is projected that by the year 2080, the white population will become a minority group, constituting 48.9% of the United States … The increasinglymulticultural profile of the U.S. population requires that nurses provide culturally competent nursing care.

“We’re not going to be effective if we’re not responsive to different cultural groups,” says Rosemarie Taylor, EdD, RN, BSN, MA, director of education and development at Jackson Health System in Miami. “There are different values, beliefs, and assumptions, and the benefit of incorporating these values and beliefs is more effective patient care.”

Training techniques for competent care

Educating your nurses on diverse patient care might seem intimidating, but Campinha-Bacote and Taylor say there are straightforward, effective strategies that can be used to train staff members on cultural competence. Campinha-Bacote says nurses should ask themselves, “Have I asked the right questions?” and focus on the following:

Awareness. “It’s about being aware of racism and making sure others are aware of it,” Campinha-Bacote says. “Several studies prove that racism is alive and well in healthcare.”

“You have to heighten their awareness of underlying issues of cultural differences,” Taylor says. “It often functions below our conscious level.”

Skills. Give your nurses the skills to perform a cultural assessment in a way that doesn’t make the patient feel that he or she is a barrier to care, Campinha-Bacote says. Have nurses ask questions such as:

  • “What kind of treatments do you do at home?”
  • “Tell me a little bit about how your mother would treat a cold.”
  • “Are there people in your family whom you’d go to for help with your sickness?”

Knowledge. Educate your nurses not only about a culture’s belief system, but also on pharmacological differences and variations on assessment. For example, you must assess an Asian patient with jaundice differently than a white patient, because Asian patients with jaundice display a yellow color on their palms and on the soles of their feet, Campinha-Bacote says. “It’s about sharing knowledge of pharmacological differences in the body,” she adds.

Encounters. Nurses must have many encounters to validate their textbook learning, Campinha-Bacote says. “Just because you know one Cape Verdean doesn’t mean you know the group. Sometimes, cultures vary more within than across.”

Expose your nurses to several members of a cultural group so they can accurately grasp the members’ healthcare needs and wishes.

Desire. “Sometimes, something’s missing after all this. You can know all the clinically correct things to say, but you have to talk from the heart to your patients,” Campinha-Bacote says. “Cultural desire is a pivotal and spiritual component of this training model.”

Developing culturally competent staff members is not always a smooth road for a nurse manager, but being aware of the possible hurdles will better prepare you for overcoming them.

The possibility of uninterested staff members can best be fought be integrating humor into the learning process, Campinha-Bacote says.

“Make it exciting and motivating,” she says. “If you as the presenter make things applicable to the [nurses] so they can use it not only with patients but with everyone, you are likely to reach them.”


Campinha-Bacote, J. (2007). “The process of cultural competence in the delivery of healthcare service: The journey continues.” Cincinnati: Transcultural CARE Associates.

Flowers, D (2004). “Culturally competent nursing care: A challenge for the 21st century.” Critical Care Nurse 24 (4): 48–51.

The Joint Commission (2008). “Developing culturally competent patient-centered care standards.” Retrieved from

U.S. Department of Health and Human Services (2008). “Minority women’s health: African Americans.” Retrieved from


The Staff Educator, October 2008, HCPro, Inc.