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A website that promotes the integrating of cultural into the health field. You can look up information by clinical topic or by culture.

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We provide information about cultural beliefs, medical issues and other topics related to the health care of immigrants to the US, many of whom are refugees.

General Caveat

It is important to remember that simply because a person is identified as a member of a particular ethnic group or religion does not necessarily mean that the person or the person's family has the set of beliefs that may be associated with the ethnicity or religion. An assessment should be made of how acculturated a person and their family are, their language skills, and whether an interpreter is needed. Be aware of some of the overall cultural values of the community and then explore the pertinent themes as they relate to providing health care for individual patients. Remember there is great diversity within community. Experiences will vary greatly depending, for example, on whether people lived in rural or urban communities in their countries of origin, how long they have been in the United States, immigration process, former occupations and levels of education. Remember that patients are individuals and are not defined by their cultural group.

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Provides information for clinical providers about cultural beliefs, medical issues and topics related to the health care of refugees & immigrants to the US.

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Health Information in Multiple Languages: MedlinePlus

Two options to find information by language or by health topic

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National Institute on Minority Health and Health Disparities (nih.gov)

Populations with Health Disparities

For NIH, populations that experience health disparities include:

Racial and ethnic minority groups (see NOT-OD-15-089 and OMB Directive 15).

People with lower socioeconomic status (SES).

Underserved rural communities.

Sexual and gender minority (SGM) groups.

People with disabilities

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A discussion on cultural competence in health care

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A discussion on cultural competence in health care

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Focus of the study is on minorities with chronic health conditions

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Home &rtrif; Cultural Competence in Health Care: Is it important for people with chronic conditions?

Visit profiles to view data profiles and issue briefs from the series Challenges for the 21st Century: Chronic and Disabling Conditions as well as data profiles on young retirees and older workers.

The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.(1) A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Examples of strategies to move the health care system towards these goals include providing relevant training on cultural competence and cross-cultural issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care.

Racial and ethnic minorities are disproportionately burdened by chronic illness

Racial and ethnic minorities have higher morbidity and mortality from chronic diseases. The consequences can range from greater financial burden to higher activity limitations.

Among older adults, a higher proportion of African Americans and Latinos, compared to Whites, report that they have at least one of seven chronic conditions - asthma, cancer, heart disease, diabetes, high blood pressure, obesity, or anxiety/ depression.(2) These rank among the most costly medical conditions in America.(3)

African Americans and American Indians/Alaska Natives are more likely to be limited in an activity (e.g., work, walking, bathing, or dressing) due to chronic conditions.(4)

The population at risk for chronic conditions will become more diverse

Although chronic illnesses or disabili- ties may occur at any age, the likelihood that a person will experience any activity limitation due to a chronic condition increases with age.(5) In 2000, 35 million people - more than 12 percent of the total population - were 65 years or older.(6) By 2050, it is expected that one in five Americans - 20 percent - will be elderly. The population will also become increasingly diverse (see Figure 2). By 2050, racial and ethnic minorities will comprise 35 percent of the over 65 pop-ulation.(7) As the population at risk of chronic conditions becomes increasingly diverse, more attention to linguistic and cultural barriers to care will be necessary.

Access to health care differs by race and ethnicity

Having a regular doctor or a usual source of care facilitates the process of obtaining health care when it is needed. People who do not have a regular doctor or health care provider are less likely to obtain preventive services, or diagnosis, treatment, and management of chronic conditions. Health insurance coverage is also an important determinant of access to health care. Higher proportions of minorities compared to Whites do not have a usual source of care and do not have health insurance (see Figures 3A and 3B).

Language and communication barriers are problematic

Of the more than 37 million adults in the U.S. who speak a language other than English, some 18 million people - 48 percent - report that they speak English less than "very well."(8) Language and communication barriers can affect the amount and quality of health care received. For example, Spanish-speaking Latinos are less likely than Whites to visit a physician or mental health provider, or receive preventive care, such as a mammography exam or influenza vaccination.(9) Health service use may also be affected by the availability of interpreters. Among non-English speakers who needed an interpreter during a health care visit, less than half - 48 percent - report that they always or usually had one.(10)

Language and communication problems may also lead to patient dissatisfaction, poor comprehension and adherence, and lower quality of care. Spanish-speaking Latinos are less satisfied with the care they receive and more likely to report overall problems with health care than are English speakers.(11) The type of interpretation service provided to patients is an important factor in the level of satisfaction. In a study comparing various methods of interpretation, patients who use professional interpreters are equally as satisfied with the overall health care visit as patients who use bilingual providers. Patients who use family interpreters or non-professional interpreters, such as nurses, clerks, and technicians are less satisfied with their visit.(12)

Low literacy also affects access to health care

The 1992 National Adult Literacy Survey found that 40 to 44 million Americans do not have the necessary literacy skills for daily functioning.(13) The elderly typically have lower levels of literacy, and have had less access to formal education than younger populations.(14) Older patients with chronic diseases may need to make multiple and complex decisions about the management of their conditions. Racial and ethnic minorities are also more likely to have lower levels of literacy, often due to cultural and language barriers and differing educational opportunities.(15) Low literacy may affect patients' ability to read and understand instructions on prescription or medicine bottles, health educational materials, and insurance forms, for example. Those with low literacy skills use more health services, and the resulting costs are estimated to be $32 to $58 billion - 3 to 6 percent - in additional health care expenditures.(16)

Lack of cultural competence may lead to patient dissatisfaction

People with chronic conditions require more health services, therefore increasing their interaction with the health care system. If the providers, organizations, and systems are not working together to provide culturally competent care, patients are at higher risk of having negative health consequences, receiving poor quality care, or being dissatisfied with their care. African Americans and other ethnic minorities report less partnership with physicians, less participation in medical decisions, and lower levels of satisfaction with care.(17) The quality of patient-physician interactions is lower among non-White patients, particularly Latinos and Asian Americans. Lower quality patient-physician interactions are associated with lower overall satisfaction with health care.(18)

African Americans, Latinos, and Asian Americans, are more likely than Whites to report that they believe they would have received better care if they had been of a different race or ethnicity (see Figure 4). African Americans are more likely than other minority groups to feel that they were treated disrespectfully during a health care visit (e.g., they were spoken to rudely, talked down to, or ignored). Compared to other minority groups, Asian Americans are least likely to feel that their doctor understood their background and values and are most likely to report that their doctor looked down on them.(19)

WHAT IS CULTURAL COMPETENCE IN HEALTH CARE?

Individual values, beliefs, and behaviors about health and well-being are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation, and occupation. Cultural competence in health care is broadly defined as the ability of providers and organizations to understand and integrate these factors into the delivery and structure of the health care system. The goal of culturally competent health care services is to provide the highest quality of care to every patient, regardless of race, ethnicity, cultural background, English proficiency or literacy. Some common strategies for improving the patient-provider interaction and institutionalizing changes in the health care system include:(20)

1. Provide interpreter services

2. Recruit and retain minority staff

3. Provide training to increase cultural awareness, knowledge, and skills

4. Coordinate with traditional healers

5. Use community health workers

6. Incorporate culture-specific attitudes and values into health promotion tools

7. Include family and community members in health care decision making

8. Locate clinics in geographic areas that are easily accessible for certain populations

9. Expand hours of operation

10. Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials

Cultural competence is an ongoing learning process

In order to increase the cultural competence of the health care delivery system, health professionals must be taught how to provide services in a culturally com-petent manner. Although many different types of training courses have been developed across the country, these efforts have not been standardized or incorpo-rated into training for health profession-als in any consistent manner.(21) Training courses vary greatly in content and teaching method, and may range from three-hour seminars to semester-long academic courses. Important to note, however, is that cultural competence is a process rather than an ultimate goal, and is often developed in stages by building upon previous knowledge and experience.
TRAINING APPROACHES THAT TEACH FACTS ABOUT SPECIFIC GROUPS ARE BEST COMBINED WITH CROSS-CULTURAL SKILL-BASED APPROACHES THAT CAN BE UNIVERSALLY APPLIED
Approaches that focus on increasing knowledge about various groups, typically through a list of common health beliefs, behaviors, and key "dos" and "don'ts," provide a starting point for health pro-fessionals to learn more about the health practices of a particular group. This approach may lead to stereotyping and may ignore variation within a group, however. For example, the assumption that all Latino patients share similar health beliefs and behaviors ignores im-portant differences between and within groups. Latinos could include first-generation immigrants from Guatemala and sixth-generation Mexican Americans in Texas. Even among Mexican Americans, differences such as generation, level of acculturation, citizenship or refugee status, circumstances of immigration, and the proportion of his or her life spent in the U.S. are important to recognize.

It is almost impossible to know everything about every culture. Therefore, training approaches that focus only on facts are limited, and are best combined with approaches that provide skills that are more universal. For example, skills such as communication and medical history-taking techniques can be applied to a wide diversity of clientele. Curiosity, empathy, respect, and humility are some basic attitudes that have the potential to help the clinical relationship and to yield useful information about the patient's individual beliefs and preferences. An approach that focuses on inquiry, reflection, and analysis throughout the care process is most useful for acknowledging that culture is just one of many factors that influence an individual's health beliefs and practices.(22)
GUIDELINES FROM PROFESSIONAL ORGANIZATIONS HELP PROMOTE CULTURAL COMPETENCE
Many professional organizations representing a variety of health professionals, such as physicians, psychologists, social workers, family medicine doctors, and pediatricians have played an active role in promoting culturally competent practices through policies, research, and training efforts. For example, the American Medical Association provides information and resources on policies, publications, curriculum and training materials, and relevant activities of physician associations, medical specialty groups, and state medical societies.(23)

Several organizations have instituted cultural competence guidelines for their memberships. For example, based on ten years of work, the Society of Teachers of Family Medicine has developed guidelines for curriculum material to teach cultural sensitivity and competence to family medicine residents and other health professionals. These guidelines focus on enhancing attitudes in the following areas:(24)

Awareness of the influences that sociocultural factors have on patients, clinicians, and the clinical relationship.

Acceptance of the physician's respon-sibility to understand the cultural aspects of health and illness

Willingness to make clinical settings more accessible to patients

Recognition of personal biases against people of different cultures

Respect and tolerance for cultural differences

Acceptance of the responsibility to combat racism, classism, ageism, sexism, homophobia, and other kinds of biases and discrimination that occur in health care settings.

ACCREDITATION STANDARDS THAT ADDRESS CULTURAL COMPETENCE IN MEDICAL SCHOOLS HAVE THE POTENTIAL TO REACH MANY FUTURE PHYSICIANS
Accreditation standards are important tools that can have widespread effects on the cultural competence of medical students, health care professionals, and health care organizations. For example, the Liaison Committee on Medical Edu-cation (LCME) - the nationally recognized accreditation body for medical schools in the U.S. and Canada - recently mandated higher standards for curriculum material on cultural competence than were previously in place. As a result, medical schools must now provide students with the skills to understand how people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. Students must also be able to recognize and appropriately address racial and gender biases in themselves, in others, and in the delivery of health care.(25)

Commitment to cultural competence is growing among health care providers and systems

Health systems are beginning to adopt comprehensive strategies to respond to the needs of racial and ethnic minorities for numerous reasons. First, there are increasingly more state and federal guidelines that encourage or mandate greater responsiveness of health systems to the growing population diversity. Second, these strategies may be seen as essential to meeting the federal government's Healthy People 2010 goal of eliminating racial and ethnic health disparities. Third, many health systems are finding that developing and implementing cultural competence strategies are a good business practice to increase the interest and participation of both providers and patients in their health plans among racial and ethnic minority populations.

In addition to increasing the cultural competence of health care providers, organizational accommodations and policies that reduce administrative and linguistic barriers to health care are also important. Policies that strive to achieve cultural competence throughout the organization must address issues on all levels, from the organization's top management to clinicians to office staff to billing and administrative staff. Organizational policies that address language and literacy barriers have been among the most successful efforts.
BILINGUAL AND BICULTURAL SERVICES ARE EFFECTIVE
Traditionally, community health centers that serve the Asian American or Latino communities have the most fully developed linguistic capabilities. For example, Asian Counseling and Referral Services (ACRS) in Seattle is a community-based mental health organization that effectively addresses language needs. They try to provide bilingual and bicultural clinicians that match the client's background. When this is not possible, ACRS provides trained staff to act as co-providers with a licensed mental health professional. These trained individuals act not only as interpreters, but also help provide a cultural context for the client's beliefs and practices. Stemming from 30 years of experience in this arena, ACRS has developed a training curriculum, "Building Bridges: Mental Health Interpreter Training for Interpreters of Southeast Asian Languages." This curriculum will be used as a model for a national mental health interpreter training project to address the needs of limited-English speaking people. This national project includes training for interpreters, trainers, and health providers, as well as a mental health interpreter certification process.(26)

Within the Latino community, the use of promotoras, also known as peer edu-cators, is becoming increasingly popular. Promotoras are generally ordinary people from hard-to-reach populations who act as bridges between their community and the complicated world of health care. They learn about health care principles from doctors or non-profit groups, and share their knowledge with their com-munities. The peer education model is not only cost-effective, but also has been shown to be more effective in terms of reaching populations who find the information more credible coming from someone with a familiar background.(27)
ASSESSING LITERACY LEVELS CAN BREAK DOWN BARRIERS
Methods employed to assess literacy levels include the use of screening instruments that test for certain skills related to functional literacy or less formal tools that allow health care professionals to determine a person's comfort level with various modes of communication. For example, at the To Help Everyone (T.H.E.) Clinic in Los Angeles, nurses and health care professionals speak individually with patients when they arrive at the health clinic to determine whether the patient prefers to learn by using written materials, pictures, verbal counseling, or some other technique. This method of assessment allows the patient to identify their own learning style preference without having to take a literacy test; it also reduces feelings of fear or humiliation that may occur when singled out.(28)

FEDERAL STANDARDS AND GUIDELINES FOR PROVIDING CULTURALLY AND LINGUISTICALLY APPROPRIATE CARE

1. The Department of Health and Human Services has provided important guidance on how to ensure culturally and linguistically appropriate health care services. The Office for Civil Rights published "Title VI Prohibition Against National Origin Discrimination as it Affects Persons with Limited English Proficiency." Very few states have developed standards for linguistic access. States that have developed such standards have focused on managed care organizations, contracting agreements with providers, and specific health and mental health services in defined settings.(29)

2. In August 2000, the Health Care Financing Administration (now Centers for Medicare and Medicaid Services) issued guidance to all state Medicaid directors regarding interpreter and translation services, emphasizing that federal matching funds are available for states to provide oral interpretation and written translation services for Medicaid beneficiaries.(30)

3. In December 2000, the Office of Minority Health of the Department of Health and Human Services issued 14 national standards on culturally and linguistically appropriate services (CLAS) in health care. These standards are intended to correct current inequities in the health services system and to make these services more responsive to the individual needs of all patients. They are designed to be inclusive of all cultures, with a particular focus on the needs of racial, ethnic, and linguistic population groups that experience unequal access to the health care system. The CLAS standards provide consistent definitions of culturally and linguistically appropriate services in health care and offer a framework for the organization and implementation of services. CLAS standards can be found at http://www.omhrc.gov/CLAS/

4. In 2002, two guides were developed to assist managed care plans with cultural and linguisti-cally appropriate services: "Providing Oral Linguistic Services: A Guide for Managed Care Plans" and "Planning Culturally and Linguistically Appropriate Services: A Guide for Managed Care Plans." Both guides can be found at www.cms.gov/healthplans/quality/project03.asp

Conclusion

Cultural competence is not an isolated aspect of medical care, but an important component of overall excellence in health care delivery. Issues of health care quality and satisfaction are of particular concern for people with chronic conditions who frequently come into contact with the health care system. Efforts to improve cultural competence among health care professionals and organizations would contribute to improving the quality of health care for all consumers.

1. Betancourt, J. R., Green, A. R., & Carrillo, J. E. 2002. Cultural competence in health care: Emerging frameworks and practical approaches. New York: The Commonwealth Fund.

2. Collins, K.S., Hughes, D. L., Doty, M. M., Ives, B. L. Edwards, J. N., & Tenney, K. 2002. Diverse communities, common concerns: Assessing health care quality for minority Americans. New York: The Commonwealth Fund.

3. Druss, B.G., Marcus, S.C., Olfson, M., Pincus, H.A. 2002. The most expensive medical conditions in America. Health Affairs, 21, 105-111.

4. Fried, V. M., Prager, K., MacKay, A. P., Xia, H. 2003. Health, United States, 2003: Chartbook on trends in the health of Americans. Hyattsville, MD: National Center for Health Statistics.

5. Ibid.

6. U.S. Bureau of the Census. 2000. Table DP-1, Profile of general demographic characteristics: 2000. Washington, DC: Author. Retrieved November 13, 2003, from http://factfinder.census.gov.

7. Day, J. C. 1996. Population projections of the United States by age, sex, race, and Hispanic origin: 1995 to 2050. (U.S. Bureau of the Census, Current Population Reports, P25-1130). Washington, DC: U.S. Government Printing Office.

8. Center on an Aging Society analysis of data from the 2000 Census, QT-P17, Ability to speak English. Washington, DC: U.S. Bureau of the Census, Census Summary File 3 ? Sample Data.

9. Fiscella, K., Franks, P., Doescher, M. P., & Saver, B. G. 2002. Disparities in health care by race, ethnicity and language among the insured: Findings from a national sample. Medical Care, 40(1), 52-59.

10. Collins et al. 2002.

11. Carrasquillo, O., Orav, E. J., Brennan, T. A., Burstin, H. R. 1999. Impact of language barriers on patient satisfaction in an emergency department. Journal of General Internal Medicine, 14, 82-87.

12. Lee, L. J, Batal, H. A., Maselli, J. H. Kutner, J. S. 2002. Effect of Spanish interpretation method on patient satisfaction in an urban walk-in clinic. Journal of General Internal Medicine, 17, 641-646.

13. Kirsch, I. S., Jungeblut, A., Jenkins, L., & Kolstad, A. 2002. Adult literacy in America: A first look at the results of the National Adult Literacy Survey, Third Edition. Washington, DC: U.S. Department of Education, National Center for Education Statistics, Office of Educational Research and Improvement. Retrieved November 13, 2003, from http://nces.ed.gov/pubs93/93275.pdf.

14. Cooper, L. A., Roter, D. L. 2003. Patient-provider communication: The effect of race and ethnicity on process and outcomes of healthcare. In B. D. Smedley, A. Y. Stith & A. R. Nelson (Eds.) Unequal treatment: Confronting racial and ethnic disparities in health care (pp. 552-593). Washington, DC: The National Academies Press.

15. Wilson, J.F. 2003. The crucial link between literacy and health. Annals of Internal Medicine, 139, 875-878.

16. Center for Health Care Strategies. 2003. Impact of low health literacy skills on annual health care expenditures. Lawrenceville, NJ: Author. Retrieved November 17, 2003, from http://www.chcs.org/ resource/pdf/h13.pdf.

17. Cooper & Roter. 2003.

18. Saha, S., Arbelaez, J. J., Cooper, L. A. 2003. Patient-physician relationships and racial disparities in the quality of health care. American Journal of Public Health, 93, 1713-1719.

19. Collins et al. 2002.

20. Brach, C. & Fraser, I. 2000. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical Care Research and Review, 57 (Supplement 1), 181-217.

21. American Institutes for Research. 2002. Teaching cultural competence in health care: A review of current concepts, policies, and practices. Report prepared for the Office of Minority Health. Washington, DC: Author.

22. Bonder, B., Martin, L., Miracle, A. 2001. Achieving cultural competence: The challenge for clients and healthcare workers in a multicultural society. Generations, 25, 35-42.

23. American Medical Association. 1999. Cultural Competence Compendium. Chicago: Author.

24. American Institutes for Research. 2002.

25. Liaison Committee on Medical Education. 2001. Functions and structure of a medical school. Retrieved February 2, 2004, from http:// www.lcme.org/functions2003september.pdf.

26. Asian Counseling and Referral Service. 2003. ACRS participates in national effort to train mental health interpreters. Seattle, WA: Author. Retrieved November 25, 2003, from http://www.acrs.org/eventsNews/ newsletter.htm

27. Kolker, C. 2004, January 5. "Familiar faces bring health care to Latinos." The Washington Post, p. A03.

28. Kiefer, K. M. 2001. Health literacy: Responding to the need for help. Washington, DC: Center for Medicare Education.

29. Goode, T., Sockalingam, S., Brown, M., & Jones, W. 2001. Linguistic competence in primary health care delivery systems: Implications for policy makers. Washington, DC: National Center for Cultural Competence, Center for Child Health and Mental Health Policy, Georgetown University Child Development Center.

30. Westmoreland, T. M. 2000, August 31. Letter to State Medicaid Directors from Timothy M. Westmoreland, Director, Centers for Medicare and Medicaid Services. Retrieved November 18, 2003, from http:// cms.hhs.gov/states/letters/smd83100.asp.
ABOUT THE ISSUE BRIEFS
This is the fifth in a series of Issue Briefs on Challenges for the 21st Century: Chronic and Disabling Conditions. This series is supported by a grant from the Robert Wood Johnson Foundation. The Issue Briefs accompany the Center's ongoing series of Data Profiles in the same series. Emily Ihara wrote this Issue Brief.

The Center on an Aging Society is a non-partisan policy group located at Georgetown University's Institute for Health Care Research and Policy. The Center studies the impact of demographic changes on public and private institutions and on the financial and health security of families and people of all ages.

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Cultural Competence in Health Care: Is it important for people with chronic conditions? - Health Policy Institute

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Visit profiles to view data profiles and issue briefs from the series Challenges for the 21st Century: Chronic and Disabling Conditions as well as data profiles on young retirees and older workers. The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and [...]

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A discussion of the components of cultural competence in nursing that includes:

Awareness - nurses paying attention to their own bias.

Attitude - nurses can analyze their increased awareness and internal belief systems.

Knowledge - using knowledge as an important way to cultivate "cultural competencies"

Skills - nurses learning "effective and respective communication and body language."

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Health disparity refers to health differences linked to economic, environmental, and social disadvantages that result in groups of people experiencing greater obstacles to health. Health equity seeks to reduce and eventually eliminate health disparities by allocating resources based on need.

Cultural awareness, diversity, and inclusivity in nursing strive to combat differences in healthcare that lead to worse health outcomes for disadvantaged racial and ethnic groups.

In some American regions, for example, the average life expectancy can vary by decades from one neighborhood to another. Dr. Jamil Norman, a registered nurse and nursing instructor, has found in her research that Black mothers in the U.S. are 3-4 times more likely to die in childbirth compared to white mothers.

"These health disparities for childbearing Black women have persisted despite overall improvements in pregnancy-related outcomes," Norman says.

This guide discusses cultural competence and how it relates to health equity in the U.S., and includes insights from nursing professionals on how both nurses and their patients can benefit from culturally competent care.

What is Cultural Competence in Nursing?

The word "culture" refers to integrated patterns of human behaviors, including norms, traditions, and values that affect the thinking and behavior of members of particular groups. Cultural competence describes the ability to effectively interact with people belonging to different cultures.

The importance of cultural competence in nursing focuses on health equity through patient-centered care, which requires seeing each patient as a unique person.

As Dr. Gregory Knapik, DNP and assistant professor of nursing, explains, "Nurses must be able to understand and appreciate different cultural backgrounds in order to do their job effectively and with the highest degree of care."

Norman specifies that "cultural competence is the willingness to understand and interact with people of different cultures, race, ethnicity, gender, and sexuality."

This approach allows nurse professionals to successfully treat patients even when patients' beliefs, practices, and values directly conflict with conventional medical and nursing guidelines. Nurses can develop the ability to tailor and explain treatment plans according to patients' needs, which may be influenced by cultural practices that don't fall within the parameters of conventional medicine.

"Utilizing cultural competence appropriately will allow for deeper connections with patients," says Knapik. "You will gain the trust of the patient by being empathetic to their differences and unique needs."

Components of Culturally Competent Care

Culturally competent care consists of four components: awareness of one's cultural worldview, attitudes toward cultural differences, knowledge of different cultural practices and worldviews, and cross-cultural skills. Together, these components contribute to a high degree of cultural competency, and nurses can integrate them into the care of their patients.

Benefits of Culturally Competent Care

Research shows significant benefits resulting from culturally competent nursing care. Social benefits include fostering mutual respect, understanding, and trust; promoting inclusion and patient and family responsibilities for their health; and increasing community participation and involvement in health issues.

Health benefits include improved data collection, preventative care, cost savings, patient compliance, and patient outcomes. Cultural competence can also reduce healthcare disparities and missed medical visits. Healthcare businesses benefit from fewer barriers and costs, increased efficiency, higher legal and regulatory compliance, and access to different ideas, perspectives, and strategies in decision making.

Cultural competence in nursing can be observed through the following examples:

Using language and terms patients understand

Make sure a medical interpreter is present if the patient speaks another language, asking a family member to translate may not be enough

Respecting patients' cultural and religious beliefs that conflict with treatment plans

Recruiting health professionals from underserved, diverse, and LGBTQ+ communities

Analyzing the ethnic composition demographics of patients currently served

Identifying patients in underserved populations and communities

Forming a committee of diverse nursing staff members to promote and coordinate cultural awareness measures, such as signage and forms in different languages and community outreach

Taking Steps to Improve Cultural Competence

Beginning in the mid-1980s, health officials began developing resources and guidelines to improve culturally competent nursing care:

While nursing education curriculums do focus on health disparities prevalent in specific cultures and the importance of culturally competent care, Norman believes that further steps can be taken.

"Although I believe that the profession of nursing is doing a lot, there is still more that needs to be done," says Norman. "Until all health care disparities are eradicated, there is always more that can be done."

Tips for Nurses to Improve Cultural Competence

Cultural competence in nursing helps build trust more effectively, which leads to better patient outcomes. This guide describes how to build cultural competence in your own work and your team's.

1. Change your practitioner/patient perspective

Cultural competence in nursing means understanding differences in perspective. For example, in some Asian and Hispanic cultures, family members may not want the older adults in their family to find out how sick they are when they are diagnosed with a disease. Family members fear this knowledge will make their older family members give up.

Additionally, calling everyone by their first name immediately after meeting them is a friendly gesture in many parts of the United States. However, it may seem disrespectful to somebody from a culture where young people refer to elders as "Mr." or "Ms."

Showing respect is a fundamental part of how to build cultural competence. "Work from a place of humble partnership instead of from an imbalanced hierarchical notion of caregiver/care-recipient," says nursing faculty member Caroline Ortiz.

2. Share Something About Your Own Culture That May be Similar to Your Patient's Culture

Establishing common ground is another vital part of cultural competence in nursing. Sharing from your own experiences is often part of cultural competency training. Norman points out "This is just a great way to build rapport with your patient, and helps to break down preconceived barriers."

For example, if you are advising a patient about healthy eating, they might mention a favorite dish from their background, a dish that is not very healthy. Rather than saying not to eat it or eat less of it, share about a dish from your background that you might not want to give up, but that you now serve as a side dish rather than an entree, or you substituted ingredients to make it healthier.

3. Learn From Your Coworkers and Colleagues

"Working in a place that has people with different cultures, beliefs, genders, race, and ethnicity helps to foster an environment of belonging," Norman says. The more that an organization recognizes and treats diversity as an asset, the easier it is to learn cultural competence.

If people feel encouraged to bring their whole selves to work, staff can develop cultural competence during all their interactions. Informal learning and employee-led initiatives can augment formal cultural competency training. "Inquire about a cultural competency department or task force," Dr. Gregory Knapik, DNP and assistant professor of nursing, recommends.

Be sure that, as a supervisor, you respect the time and effort to learn or to teach. Avoid making people feel as though they have to be spokespeople for an entire group. For example, ask for "a Hindu perspective" from a Hindu staff member rather than "the Hindu perspective."

Sometimes, you need to respect that your staff member is not up for being a spokesperson at all, that they currently cannot undertake the emotional effort of educating. And that's okay.

4. Learn a New Language

Learning a new language can help to address many of the language gaps in healthcare. Language barriers have a negative impact on healthcare outcomes and on the satisfaction of both patients and providers.

While only qualified medical interpreters should provide interpretation for patients with limited English proficiency, learning medical vocabulary or common expressions creates a welcoming atmosphere and increases trust.

Knowing medical and healthcare vocabulary in another language also helps you understand patients or family members who might speak conversational English fluently, but be less familiar with healthcare terms.

Being multilingual is an asset for any healthcare job, especially if you speak a language widely spoken in the community, but less common among healthcare workers.

5. Complete Continuing Nursing Education Courses

Many organizations offer cultural competency training for healthcare workers. These include the following:

The Office of Minority Health's free online cultural competency training, including the Cultural Competent Nursing Care course, is designed for online learning. Once you have completed the course, you can lead in-person facilitated sessions.

Georgetown University's National Center for Cultural Competence provides online courses in how to build cultural competence with specific audiences.

The National LGTB Cancer Network offers cultural competency training for oncology professionals.

6. Reach Out to Clergy to Understand Different Faiths in Your Community

Clergy can provide valuable insights into faith communities and how different faiths perceive issues related to health. These perceptions may affect treatment plans or delivery.

For example, imams (Muslim clergy) can provide guidance on how to work with patients who wish to fast for Ramadan, but should not because of health considerations.

Similarly, understanding the Amish belief that the heart is the "soul of the body" can help healthcare workers communicate about heart health to Amish communities. Being able to speak about a faith with knowledge and respect will strengthen communication with patients.

7. Seek Out Opportunities to Work With Local Community Leaders or Organizations

Partnerships with local community leaders and organizations can help build your cultural competence in nursing and establish relationships that lead to stronger relationships. For example, your organization might invite leaders of community organizations to give a talk at your workplace about a particular group and its perceptions and needs.

This lecture series can lead to building partnerships for health education and health promotion, encouraging speakers of a language to become medical interpreters, or other ways to enhance trust and empathy.

Cultural competence in nursing builds a virtuous cycle of improved reputation and trust, leading to better health outcomes.

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Cultural Competence In Nursing | NurseJournal.org

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Cultural competency is a vital skill for delivering quality nursing care across culturally diverse groups. Our guide offers tips from nursing professionals on incorporating it into nursing culture and practice.

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Article discusses ways to improve and cultural competence including:

Improve language barriers and communication.

Seek out training in cultural competence.

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Nowadays, nurses are increasingly working with patients from different cultural backgrounds. This brings opportunities and challenges for nurses to deliver culturally competent services. Whether working at a hospital, in a nursing home, or within a school, nurses must have the ability to identify differences in others. It is expected that nurses understand patients' differences in demographics, beliefs, norms, practices, and desires for medical care and take their perspectives into account when caring for them. Cultural competence is an important component of excellence in health care delivery and can contribute to the elimination of racial and ethnic health disparities.

Here are 5 ways to help you provide culturally competent nursing care.
1. Perform a cultural competence self-assessment.
Determining your own strengths and weaknesses when it comes to working with people who come from different cultures is probably one of the most important ways to help improve your cultural competence. Several organizations offer free cultural competence self-assessment tools and you can choose one that appropriate to your work.
2. Obtain a certificate in cultural competence.
You can increase your cultural awareness, knowledge, and skills through culturally competent training, a workshop, or a seminar. Journal articles, textbooks, and the internet also offer great information that can help you improve cultural competence.
3. Improve communication and language barriers. 4. Directly engage in cross-cultural interactions with patients.
The values, beliefs, and worldview of a particular cultural group are rooted within their language use; therefore, language is the key to accessing a culture. It is best if you can speak its language or find a translator (an individual providing language assistance) to help communicate with limited English proficiency patients. You also can use pictures, gestures, or written summaries to improve communication with your patients and reduce language barriers.
5. Participate in online chats and networks.
Understanding that each patient is a unique person can help nurses effectively interact with patients. Nurses need to have the ability to explore patients' beliefs, values, and needs in order to build effective relationships with them.

Online networking and social media can have a great influence on improving nurses' perceived cultural competency and cultural awareness and keeping them up-to-date on cultural competency issues.

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5 Ways to Improve Cultural Competence in Nursing Care - Minority Nurse

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Nowadays, nurses are increasingly working with patients from different cultural backgrounds. This brings opportunities and challenges for nurses to deliver culturally competent services. Whether working at a hospital, in a nursing home, or within a school, nurses must have the ability to identify differences in others.

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Resource from the Health and Human Services website. HHS.gov

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Resource from the Health and Human Services website. HHS.gov

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Cultural Competence | Department of Mental Health and Addiction Services (ohio.gov)
The state of Ohio discusses cultural competence as it relates to healthcare.

However,
The state of Ohio does not have mandatory cultural competency training.
Ohio CLAS Activities - Think Cultural Health (hhs.gov)

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Culture Competence as it relates to public health in Michigan.
However, the state of Michigan does not have mandatory cultural competency training.
Michigan CLAS Activities - Think Cultural Health (hhs.gov)