Cultural Competence in Nursing Practice

One of the greatest challenges in healthcare today is to provide culturally competent care in nursing practice. Nurses spend more time in direct patient care than other groups of health professionals (OMH, 2013). Increasingly diverse racial, ethnic, and sociocultural backgrounds of patients present challenges to providing care. Cultural and language differences may cause misunderstanding, a lack of compliance, or other factors that negatively influence patient health outcomes. As demographics continue to change, nurses will be expected to deliver care that encompasses such differences.

The perception of illness and disease varies by culture. Culture also influences how people seek healthcare and how they behave toward providers. To provide the highest quality of care and ensure successful patient outcomes, nurses must embrace diversity and have cultural awareness. Diversity refers to patients of different ethnic and socioeconomic backgrounds, religions, beliefs, competencies and orientations. Cultural competence is a set of behaviors, attitudes, and skills that enables nurses to work effectively in cross-cultural situations (OMH, 2013). This means obtaining accurate cultural information and then communicating that knowledge to the patient.
Cultural competence is critical, as it enables the nursing professional to be flexible, adaptive and respectful while caring for the whole person. A culturally competent nurse understands his or her own world views and is tolerant of – and sensitive to – those of the patient. According to Rebecca M. Patton, MSN, RN, CNOR, President of American Nurses Association, "Providing effective and respectful nursing care to our country’s increasingly diverse population is of paramount importance to the American Nurses Association (ANA).” 

Meyer (1996) described five major challenges for providers and cultural competency in healthcare:
  •  Awareness. Recognizing clinical differences among people of different ethnic and racial groups. 
  • Communication. Encompasses everything from the need for interpreters, to understanding language differences, and other obstacles to meaning.
  • Ethics. Realizing that while Western medicine is among the best in the world, we do not have all the answers.
  • Respect. Showing respect for the belief systems of others and the effects of those beliefs on well-being are critically important to competent care.
  • Trust. For some patients, authority figures are immediately mistrusted. Having been victims of trauma or witnesses of such in their homelands, many people are wary of both the caregivers and the care.

The main source of barriers in caring for patients from diverse cultural backgrounds is the lack of understanding and tolerance. Very often, neither the nurse nor the patient understands the other's perspective. It is a learning process that requires nurses to ask questions sensitively and listen to patients carefully. Mutual understanding is important to ensure the healthcare being delivered is meets the physical and emotional needs of the patient.

According to Jeffreys & Zoucha (2001), the real challenge is for health care professionals and organizations to go beyond the goal of achieving “competence” (a minimum standard) toward the goal of achieving “optimal cultural competence” (a standard of excellence).


Jeffreys, M.R., Zoucha R. 2001. The invisible culture of the multiracial, multiethnic individual:
a transcultural imperative. Journal of Cultural Diversity 8(3): 79-84.

Meyer, C.R. (1996). Medicine's melting pot. Minn Med 79(5): 5.

Teaching Cultural Competence in Nursing and Healthcare, 2010, Springer Publishing

U.S. Department of Health and Human Services.

U.S. Department of Health and Human Services: Health Resources and Services Administration

U.S. Department of Health & Human Services: Office of Minority Health