NCM 120 Transcultural Nursing GUIDELINES FOR THE PRACTICE OF

Module 2: Culturally Competent Nursing Care CULTURALLY COMPETENT NURSING CARE

2.3.1. Lesson: Culturally Competent Nursing Care GUIDELINES DESCRIPTIONS

1. Knowledge of Nurses shall gain an
CULTURALLY COMPETENT NURSING CARE Cultures understanding of the
perspectives, traditions,
values, practices, and
RATIONALE FOR CULTURALLY COMPETENT family systems of
CARE culturally diverse
individuals, families,
 Vulnerable populations- are groups that are communities, and
poorly integrated into the health care system populations they care for,
because of ethnic, cultural, economics, as well as knowledge of
geographic (rural and urban settings), or health the complex variables
characteristics (i.e. disabilities or multiple that affect the
chronic conditions) achievement of health
 Immigrants – people who move from one and well-being.
country or region to another for economics,
political, religious, social, and personal reasons 2. Education and Nurses shall be
 Health Tourism – in which patients travel to Training in Culturally educationally prepared to
other countries for medical and surgical health Competent Care provide culturally
care needs. congruent health care.
 Refugees – people who flee their country of Knowledge and skills
origin for fear of persecution based on ethnicity, necessary for assuring
race, religion, political opinion or related that nursing care is
reasons) and other casualties of civil unrest or culturally congruent shall
war in politically unstable parts of the world be included in global
 Inter-professional collaborative practice – health care agendas that
refers to multiple health providers from different mandate formal education
professional backgrounds working together with and clinical training as
patients, families, caregivers, and communities well as required ongoing,
to deliver the highest quality care (WHO,2010). continuing education for
 Culturally competent care is an extension of all practicing nurses.
inter-professional collaborative practice
involving: 3. Critical Reflection Nurses shall engage in
 Clients and their families critical reflection of their
 Credentialed and licensed Health own values, beliefs, and
professionals cultural heritage in order
 Folk or traditional healers (e.g. herbalists, to have an awareness of
religious and spiritual leaders – rabbis, how these qualities and
imams, priests, elders, monks and other issues can impact
religious representatives or clergy. culturally congruent
nursing care.

4. Cross-Cultural Nurses shall use

Communication culturally competent
verbal and nonverbal
communication skills to
identify client’s values,
beliefs, practices,
perceptions, and unique
health care needs.

1
5. Culturally Competent Nurses shall utilize cross- establish policies and
Practice cultural knowledge and guidelines for
culturally sensitive skills comprehensive
in implementing implementation and
culturally congruent evaluation of culturally
nursing care. competent care.

6. Cultural Competence Health care organizations 10. Evidence-based Nurses shall base their
in Health Care Systems should provide the Practice and Research practice on interventions
and Organizations structure and resources that have been
necessary to evaluate and systematically tested and
meet the cultural and shown to be the most
language needs of their effective for the
diverse clients. culturally diverse
populations that they
7. Patient Advocacy and Nurses shall recognize serve. In areas where
Empowerment the effect of health care there is a lack of evidence
policies, delivery of efficacy, nurse
systems, and resources on researchers shall
their patient populations investigate and test
and shall empower and interventions that may be
advocate for their patients the most effective in
as indicated. Nurses shall reducing the disparities in
advocate for the inclusion health outcomes.
of their patient's cultural
beliefs and practices in all
dimensions of their health DEFINITIONS AND CATEGORIES OF
care. CULTURAL COMPETENCE
 There is no universally accepted definition of
8. Multicultural Nurses shall actively cultural competence
Workforce engage in the effort to  Culturally competence conceptually divided into
ensure a multicultural 2 major categories:
workforce in health care  Individual cultural competence – refers to the
settings. One measure to care provided for an individual client by one or
achieve a multicultural more nurses, physicians, social workers, and/or
workforce is through other health care, education, or social services
strengthening of professionals
recruitment and retention  Organizational cultural competence – focuses
efforts in the hospitals, on the collective competence of the members of
clinics, and academic an organization and their effectiveness in
settings. meeting the diverse needs of their clients,
patients, staff and community.
9. Cross-Cultural Nurses shall have the  Cultural baggage – refers to the tendency for a
Leadership ability to influence person’s own culture to be foremost in his/her
individuals, groups, and assumptions, thoughts, words, and behavior.
systems to achieve
outcomes of culturally
competent care for
diverse populations.
Nurses shall have the
knowledge and skills to
work with public and
private organizations,
professional associations,
and communities to

2
CULTURAL SELF-ASSESSMENT CULTURAL ASSESSMENT OF CLIENTS

PURPOSE CULTURAL ASSESSMENT

 Is for nurses to critically reflect on their own  foundation for culturally competent and
culturally based attitudes, values, beliefs, and culturally congruent nursing care
practices and gain insight into and awareness of,  a term that refers to the collection of data about
the ways in which their background and lived the client’s health state.
experiences have shaped and informed the
person the nurse has become today. Two (2) Major categories of data:
 Nurse’s cultural self-assessment is a personal  Subjective data (what clients say about
and professional journey that emphasizes themselves)
strengths as well as areas for continued growth  Objective data (what Health professionals
thereby enabling nurses to set goals for observe)
overcoming barriers to the delivery of culturally  Emic or insider’s perspective – The ability to
congruent and competent nursing care see the situation from the client’s point of view
 Etic perspective – looking at the situation from
BIAS an outsider’s vantage point
 refers to the tendency, outlook, or inclination  Cross-cultural communication – ability to
that results in an unreasoned judgement, positive successfully form, foster, and sustain
or negative, about a person, place, or object. relationships with members of a culture that
differs from one’s own
ETHNOCENTRISM  Cross-cultural communication – is based on
 refers to the human tendency to view one’s own knowledge of many factors such as the other
group as the center of and superior to all other person’s values, perceptions, attitudes, manners,
groups. social structure, decision-making practices and
 Ethnocentrism may lead to Pride, Vanity, Belief an understanding of how members of groups
in the superiority of one’s own group over all communicate both verbally and non-verbally.
others, contempt for outsiders, and cultural
imposition INDIVIDUAL CULTURAL COMPETENCE
CULTURAL IMPOSITION Individual Cultural Competence
 is the tendency of a person or group to impose  is a complex integration of knowledge, attitudes,
their values, beliefs and practices onto others values, beliefs, behaviors, skills, practices, and
cross-cultural nurse-client interactions that
CULTURAL STEREOTYPE include effective communication and the
 refers to a preconceived, fixed perception or provision of safe, affordable, accessible,
impression of someone from a particular cultural research, evidence-based, and best practice,
group without meeting the person. acceptable, quality and efficacious nursing care
 The perception generally has little or no for clients from diverse background
basis in fact Diverse or Diversity
 refers to the client’s uniqueness in the
PREJUDICE dimensions of race; ethnicity; national origin;
 refers to inaccurate perceptions of others or socioeconomic background; age; gender; sexual
preconceived judgments about people based on orientation; philosophical and religious
ethnicity, race, national origin, gender, sexual ideology; lifestyle; level of education; literacy;
orientation, social class, size, disability, religion, marital status; physical, emotional, and
language, political opinion, or related personal psychological ability; political ideology; size;
characteristics. and other characteristics used to compare or
categorize people
DISCRIMINATION
 refers to the act or behavior of setting one
individual or group apart from another, thereby
treating one person or group differently from
other people or groups.

3
 CULTURE OF THE DEAF
5 STEP PROBLEM-SOLVING PROCESS FOR  More than 5% of the World’s population
DELIVERING CULTURALLY CONGRUENT AND experience disabling hearing loss.
COMPETENT NURSING CARE FOR  Disabling hearing loss – is defined as the loss of
INDIVIDUAL CLIENTS greater than 40 decibels in the better ear in
adults and the loss of greater than 30 decibels in
the better ear in children.

COMMUNICATION AND LANGUAGE

ASSISTANCE
 Language Access Services (LAS) have become
a matter of increasing national importance.
 Currently, about 20% of the US population
speaks a language other than English at home,
and 9% has limited English proficiency. By
2050, more than half the population will come
from racial or ethnic minority backgrounds.
Diversity is even greater when dimensions such
as geography, socioeconomic status, disability
status, sexual orientation, and gender identity are
considered. Attention to these trends is critical
for ensuring that health disparities narrow, rather
than widen, in the future.
ORGANIZATIONAL CULTURAL COMPETENCE
 Cultural competence requires that organizations PREVENTION OF DEAFNESS
have the following characteristics:  Immunizing children against childhood diseases,
 A defined set of values and principles and including measles, meningitis, rubella, and
demonstration of behaviors, attitudes, policies mumps
and structures that enable them to work  Immunizing adolescent girls and women of
effectively cross-culturally reproductive age against rubella before
 The capacity to (1) value diversity, (2) conduct pregnancy
self-assessments, (3) manage the dynamics of  Screening for and treating syphilis and other
difference, (4) acquire and institutionalize infections in pregnant women
cultural knowledge, and (5) adapt to diversity  Improving antenatal and perinatal care,
and the cultural contexts of the communities including promotion of safe childbirth
they serve  Avoiding the use of ototoxic drugs, unless
 Incorporation of the previously mentioned items prescribed and monitored by a qualified
in all aspects of policy making, administration, physician, nurse practitioner, or other health care
practice, and service delivery and systematic provider
involvement of consumers, key stakeholders,  Referring infants with high risk factors (such as
and communities those with a family history of deafness, those
born with low birth weight, birth asphyxia,
CLIENTS WITH SPECIAL NEEDS jaundice, or meningitis) for early assessment of
 Health Disparities – population-specific hearing, prompt diagnosis, and appropriate
differences in the presence of disease, health management, as required
outcomes, or access to health care.  Reducing exposure (both occupational and
 These differences can affect how frequently a recreational) to loud noises by creating
disease affects a group. How many people get awareness, using personal protective devices,
sick or how often the disease causes death. and developing and implementing suitable
 Populations affected by disparities legislation.
 Racial and ethnic minorities
 Residents of rural areas
 Women, children, and the elderly
 Persons with disabilities
 Other special population such as deaf
4