Cultural Competence in Healthcare for Better Care

After nearly two decades in the nursing industry, my default answer to the question of what constitutes culturally competent care is the use of an interpreter. Culturally competent care has been a repeated topic in hospital orientations and annual trainings, and the inclusion of cultural and linguistic competence in continuing medical education is required by many state legislations. Yet, despite repeated exposure, my understanding of what comprises cultural competence is limited to the low-hanging fruit of the basic accommodation of language interpretive services. But there must be more to it than that; otherwise, why is there so much focus on providing culturally competent care?

Why Culturally Competent Care Matters in Healthcare Settings

Let’s take a glimpse into why culturally competent care is important. Beyond the catch phrase, the definition of cultural competence is the ability to collaborate effectively with individuals from different cultures, particularly with respect to factors that can affect health and healthcare, such as language, communication styles, attitudes, beliefs, and behaviors. Such competence can enhance healthcare experiences and outcomes for these patients. Taking measures to improve cultural competence will help alleviate healthcare disparities and improve healthcare outcomes in diverse populations. An individual who does not feel understood will feel as though they are being treated differently and are less likely to seek medical treatment or engage with the healthcare system. Delay in treatment, avoidance of primary prevention, and unforthcoming communication can all lead to poor outcomes.

Cultural Competence Goes Beyond Race and Ethnicity

Cultural competence is often seen as encompassing only racial and ethnic differences, but should include sexual orientation, age, gender, disability status, and other demographic characteristics.

From Cultural Competence to Cultural Humility: A Paradigm Shift in Healthcare

While cultural competence is a commendable aspiration, training providers in becoming competent in various cultures presents the risk of stereotyping, stigmatizing, and fostering implicit racist attitudes and behaviors. To address this risk, there is a proposed paradigm shift towards cultural humility, as opposed to cultural competence. Cultural humility is an orientation to care that is based on self-reflexivity, an appreciation of patients’ lay expertise, openness to sharing power with patients, and a commitment to continuing to learn from one’s patients. The thinking that underlies cultural competence training requires the provider to be familiar with cultures other than their own, which can enhance their communication skills and ability to form efficacious relationships with their patients. However, in perceiving culture as stagnant, a reproduction of social stereotypes and an imbalance of power between patients and providers can be perpetuated. Thus, there is movement towards the pursuit of cultural humility, where providers admit that they do not know but are willing to learn from patients about their experiences, while being aware of their cultural embeddedness.

What Cultural Humility Looks Like in Clinical Practice

A culturally competent provider needs to have an evolving knowledge and awareness of health-related beliefs, practices, and cultural values of diverse populations, as well as illness and diagnostic incidence and prevalence among culturally and ethnically diverse populations. Additionally, the provider should be cognizant of treatment efficacy data of culturally and ethnically diverse populations. For a provider to show cultural humility, they must listen with curiosity and interest, maintaining an awareness of their own potential biases and adopting a non-judgmental stance. The provider must further recognize their inherent status of privilege as a provider and be willing to understand and learn from their patients.

Evolving Cultural Competence: A Call for Continuous Learning and Humility

As with most aspects of healthcare, the concept of cultural competence is a fluid process, encompassing more demographic characteristics and considerations of efficacy than previously conceptualized. Cultural competence cannot be stagnant if it is to be effective in alleviating healthcare disparities and improving healthcare outcomes in diverse populations. To serve the needs of a diverse population, it is imperative that the healthcare system take measures to improve cultural competence. A shift towards cultural humility to reduce the reproduction of social stereotypes and imbalance of power between patients and providers could be just what the doctor ordered.

Author: Krista Reynolds, RN, CCM

Continue Your Learning Journey in Cultural Competence and Beyond

If you’re a nurse, case manager, social worker, or allied health professional looking to deepen your understanding of cultural humility, equity, and person-centered care, CareerSmart Learning has you covered.

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Cultural Diversity and Cultural Competence in Healthcare (3.0 CE)

Cultural Sensitivity in Older Adult Care (4.0 CE)

Addressing Implicit Bias in Healthcare (2.0 CE)

Geriatric Nutrition & Cultural Considerations (2.0 CE)

Trauma-Informed Care in Skilled Nursing (1.5 CE)