Culturally competent care in practice
- Safe practice
The nurse asks about each person's beliefs and customs and adapts care to them, as long as safety and treatment are not harmed.
What it is
Culture shapes how people speak, behave, understand illness and decide about care, often without saying so. Cultural competence is a lifelong process of giving evidence-based care that fits the patient's values, beliefs and practices. Campinha-Bacote's model describes the culturally competent nurse through cultural awareness (reflecting on one's own values and biases), cultural knowledge, cultural skill (doing a cultural assessment) and cultural encounters. In practice the nurse creates a safe space, asks rather than assumes, uses a trained interpreter when the language differs, and negotiates care: the patient's cultural needs are accommodated whenever they do not significantly harm the treatment. In Colombia this includes indigenous, Afro-Colombian, rural and migrant communities.
What it requires
- Self-reflection on one's own values, prejudices and ethnocentric views.
- A cultural assessment for every patient, not only for «foreign» ones.
- An environment where the patient can express beliefs and identity without judgement.
- Access to an interpreter (in person or by phone).
- Willingness to negotiate times, food, modesty and rituals.
Components
- Quick assessment of the patient's view of the illness: what they think the problem is, its cause, how they are coping and how worried they are.
- Fuller assessment when needed: language, religion, diet, home remedies, who decides in the family, beliefs about transfusion, organ donation and death rituals.
- Accommodation and negotiation of the care plan.
- Evaluation with the patient of whether the plan respects their values.
How it is applied (and why)
- Reflect before the encounter on your own assumptions about this patient: unexamined bias leaks into care.
- Ask the preferred language and arrange a trained interpreter if needed: misunderstanding is a safety risk.
- Ask how the patient explains the illness and its cause: it shows what treatment will make sense to them.
- Ask about diet, religious practices, modesty, preferred gender of caregiver and who takes part in decisions.
- Ask before entering personal space or touching, and explain why: touch and distance carry cultural meaning.
- Negotiate the plan, for example the time of a medicine or keeping a head covering under a surgical cap.
- Record the patient's preferences in the chart and share them at handoff: this keeps care consistent.
- If a practice conflicts with safety, explain the reason and seek an alternative with the patient and the team.
In nursing practice
- Some families make decisions as a group; ask the patient how they want decisions to be made.
- Eye contact means different things in different cultures; notice cues and mirror the patient when possible.
- Home remedies are asked about without judgement, so the team can check for interactions.
- Leininger's transcultural theory gives the nursing framework for this practice.
Common mistakes
- Using relatives, especially children, as interpreters for clinical information.
- Assuming beliefs from appearance, surname or region.
- Labelling a patient «uncooperative» when the plan clashes with their values.
- Forgetting to record preferences so the next shift repeats the conflict.
Test yourself
Think of the answer, then tap the question to see it.
What are the four components of cultural competence in Campinha-Bacote's model as described here?
Cultural awareness, cultural knowledge, cultural skill and cultural encounters.
What is cultural negotiation?
Nurse and patient agree an approach that balances the prescribed care with the patient's cultural needs, accommodating them whenever treatment is not significantly harmed.
What does the nurse do when the patient's language differs from the team's?
Arranges a trained medical interpreter, in person or by phone, and provides written material in the patient's language when possible.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Nursing Fundamentals, 3.4: Cultural competence (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2021); Nursing Fundamentals, 3.7: Cultural assessment (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2021); Nursing Fundamentals, 3.8: Culturally responsive care (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2021); Nursing Fundamentals, 2.2: Basic communication concepts (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2021).
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Representative model, for educational purposes only.