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Cultural Competence and
Diversity
By: Courtney Bass, Eliza Creedon, Jordan
Helton, Roni Houston, Aurora Salter
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Agenda

Objectives:

Identify barriers to cultural competence and ways to avoid them.

Identify ways to address cultural differences in specific cultures in
the hospital setting.

Distinguish between cultural awareness and stereotyping.
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Are You Culturally Competent?
 Cultural
sensitivity can best be described as:
A. The manner in which a subculture views their
social environment.
B. The ability to understand and care for culturally
diverse groups of clients.
C. Successful conflict resolution between different
cultural systems.
D. Professional awareness of the significance of
cultural factors in the delivery of health care.
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Are You Culturally Competent?

Cultural sensitivity can best be described as:
A.
The manner in which a subculture views their
social environment.
B.
The ability to understand and care for
culturally diverse groups of clients.
C.
Successful conflict resolution between
different cultural systems.
D.
Professional awareness of the significance
of cultural factors in the delivery of health
care.
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Are You Culturally Competent?

The nurse is organizing a disease prevention
program for a specific cultural group. To
effectively meet the needs of this group the nurse
will:
A.
Involve those affected by the problem in the
planning process.
B.
Assess the immediate impact of such a program.
C.
Develop generalized goals and objectives for the
program.
D.
Assess the needs of the community in general.
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Are You Culturally Competent?

The nurse is organizing a disease prevention
program for a specific cultural group. To
effectively meet the needs of this group the nurse
will:
A.
Involve those affected by the problem in the
planning process.
B.
Assess the immediate impact of such a program.
C.
Develop generalized goals and objectives for the
program.
D.
Assess the needs of the community in general.
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Are You Culturally Competent?

A nurse who provides culturally competent
care would expect to:
A.
Involve Social Services in the plan of care.
B.
Schedule treatments around a client’s need to
pray at certain intervals.
C.
Be knowledgeable about one foreign
language.
D.
Find out where the client used to live.
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Are You Culturally Competent?

A nurse who provides culturally competent
care would expect to:
A.
Involve Social Services in the plan of care.
B.
Schedule treatments around a client’s need
to pray at certain intervals.
C.
Be knowledgeable about one foreign
language.
D.
Find out where the client used to live.
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Are You Culturally Competent?

A helpful way for the nurse to identify and
respond to an elderly client’s cultural needs is
to:
A.
Secure the services of a translator.
B.
Identify the client’s racial heritage from the
medical record.
C.
Use a heritage assessment tool with the client.
D.
Involve the family in care as quickly as
possible
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Are You Culturally Competent?

A helpful way for the nurse to identify and
respond to an elderly client’s cultural needs is
to:
A.
Secure the services of a translator.
B.
Identify the client’s racial heritage from the
medical record.
C.
Use a heritage assessment tool with the
client.
D.
Involve the family in care as quickly as
possible
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Jefferson Hospital
Philadelphia, PA
Cultural
competence training
video with patient and provider's
perspectives.
Video
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Simple Things That Matter
 Visual
pain scale in patient’s
language
 Written
materials in patient’s
language

Be a patient advocate

Locating community resources
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4
tips for communicating with
cultural awareness
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American Nurses Association
(ANA)

“The need for health care is universal, transcending all
individual differences. The nurse establishes relationships
and delivers nursing services with respect for human needs
and values, and without prejudice. An individual’s lifestyle,
values system, and religious beliefs should be considered in
planning health care with and for each patient” (ANA, 2008).
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Barriers to Cultural Competence

Provider barriers



Staff members may be intimidated
by a different culture
Lack of knowledge or resources
about specific cultures
Unwilling to alter practices to
accommodate a different culture
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Barriers continued

System barriers

Agency’s structure or policies may
not be set up to support cultural
diversity

Lack of translator services

Lack of dietary alternatives

Do not hold staff accountable if
culturally insensitive care is
provided
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Tips for Gathering Cultural Data

Determine the patient’s level of fluency in English

Arrange for interpreter as needed

Ask how the patient prefers to be addressed

Be aware of the patient’s body language

Be aware of your own body language that could be offensive or
misunderstood

Speak directly to the patient, even when using a translator

Avoid medical jargon

Use open-ended questions
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What can help?

Use of appropriate linguistic services (interpreter)

Display empathy and respect

Use of accurate health history for diagnostic and treatment
purposes

Patient-centered communication that includes participatory
decision making

More diversity among staff
members

Education programs to train
staff
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Examples when
you don’t know
what to ask…
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Practices or Rituals

What spiritual or religious practices are important to you?

How can I as a nurse help you with your spiritual practice?
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Experience of God or Transcendence

Is religion important to you?

How would you describe what you believe in?

Are you having difficulty carrying out your religious duties?

How does your
spirituality affect
your experience of
being sick?
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Sense of Meaning

What gives most meaning to your life?

What motivates you to get well?

What have been the good outcomes from having this
difficult time in your life?
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Think about it…

If your client asked you to pray with him or her
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how would you feel about that?

How would you respond?
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What resources could you utilize?
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Cultural and Spiritual
Beliefs Affecting
Nursing Care
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Asian/Pacific
Islander
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Asian/Pacific Islander

Extended family very important

Authority of older family member is unquestioned
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Oldest male is the decision maker and spokesman
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Avoid conflict and direct confrontation
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Respect authority

Do not disagree with healthcare recommendations (but may not
follow)
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Chinese
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Chinese

Will not discuss symptoms of mental illness because they
believe this reflects on family

May produce shame or guilt

Use herbalists, spiritual healers, and physicians for care
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Japanese
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Japanese
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Believe physical contact with blood, skin diseases, and corpses
will cause illness
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Improper care of the body will cause illness
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Poor diet, lack of sleep
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Use group decision making
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Disability is a source of family shame
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Pain not expressed


Considered a virtue to bear pain
Use healers, herbalists, and physicians
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Hindu and Muslim
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Hindu and Muslim

Indians and Pakistanis do not acknowledge a diagnosis of
severe emotional illness or mental retardation because it
reduces the change of other family members getting
married
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Medical beliefs blend between modern and traditional
practices
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Vietnamese
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Vietnamese

Slow to trust authority figures due to their refugee
experiences
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Accept mental health counseling and interventions after
trust has been established
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Patriarchal society

Home remedies tried first
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Compliant with Western health care once sought
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American Indian
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American Indian

Oriented to the present

Value cooperation, family, and spiritual beliefs

Strong ties to family and tribe
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State of health exists when patient is in harmony with nature

Illness is an imbalance between personal and natural or
supernatural forces
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Use medicine man
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Illness prevented through rituals and prayer
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May mistrust healthcare providers
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Who Knew?
Some doctors in Latin
American countries
will prescribe
injections rather than
pills to treat illness. A
patient accustomed to
receiving a shot may
expect one as part of
treatment.
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Who Knew?
Some Russians
will occasionally
drink vodka with
sugar to treat a
cough.
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Who Knew?
Some Native
American cultures
believe in leaving a
window open for the
soul to leave through
at the time of death.
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Who Knew?
Among Muslims,
the left hand is
considered to be
unclean, and it is
preferable that the
right hand be used
for feeding or
administering
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Stereotyping
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Stereotyping
 Stereotyping
is the process by which
people use social categories (e.g.
race, sex) in acquiring, processing,
and recalling information about
others.
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Overcoming Cultural Stereotypes
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CLAS Standards

Stands for Culturally and Linguistically Appropriate
Services in Health Care

Issued by the U.S. Department of Health and Human Services’
(HHS) Office of Minority Health (OMH)

“To ensure that all people entering the health care system
receive equitable and effective treatment in a culturally and
linguistically appropriate manner.”
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CLAS’s GOAL

Contribute to the elimination of racial and ethnic health
disparities and to improve the health of all Americans.
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3 Types of Standards

Mandates (Standards 4, 5, 6, and 7)
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Guidelines
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Recommendations (Standard 14)
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Who uses these CLAS standards?

Policymakers

Accreditation and credentialing agencies

Purchasers
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Patients
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Advocates*
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Educators*

Health care community
*That’s you, nurses!
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There are 14 standards issued

“The collective set of CLAS mandates, guidelines, and
recommendations issued by the HHS Office of Minority
Health intended to inform, guide, and facilitate required and
recommended practices related to culturally and
linguistically appropriate health services.”
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Standards

1. Health care organizations should ensure that
patients/consumers receive from all staff members
effective, understandable, and respectful care that is
provided in a manner compatible with their cultural
health beliefs and practices and preferred language.
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2. Health care organizations should implement strategies to
recruit, retain, and promote at all levels of the organization a
diverse staff and leadership that are representative of the
demographic characteristics of the service area.

3. Health care organizations should ensure that staff at all
levels and across all disciplines receive ongoing education
and training in culturally and linguistically appropriate
service delivery.
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Standards
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*4. Health care organizations must offer and provide
language assistance services, including bilingual staff
and interpreter services, at no cost to each
patient/consumer with limited English proficiency at all
points of contact, in a timely manner during all hours of
operation.

*5. Health care organizations must provide to
patients/consumers in their preferred language both
verbal offers and written notices informing them of their
right to receive language assistance services.
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*6. Health care organizations must assure the competence of
language assistance provided to limited English proficient
patients/consumers by interpreters and bilingual staff.
Family and friends should not be used to provide
interpretation services (except on request by the
patient/consumer).
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Standards
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*7. Health care organizations must make available easily
understood patient-related materials and post signage in the
languages of the commonly encountered groups and/or
groups represented in the service area.
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8. Health care organizations should develop, implement, and
promote a written strategic plan that outlines clear goals,
policies, operational plans, and management
accountability/oversight mechanisms to provide culturally
and linguistically appropriate services.
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9. Health care organizations should conduct initial and
ongoing organizational self-assessments of CLAS-related
activities and are encouraged to integrate cultural and
linguistic competence-related measures into their internal
audits, performance improvement programs, patient
satisfaction assessments, and outcomes-based evaluations.
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Standards
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10. Health care organizations should ensure that data on the
individual patient’s/consumer’s race, ethnicity, and spoken
and written language are collected in health records,
integrated into the organization’s management information
systems, and periodically updated.
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11. Health care organizations should maintain a current
demographic, cultural, and epidemiological profile of the
community as well as a needs assessment to accurately plan
for and implement services that respond to the cultural and
linguistic characteristics of the service area.
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12. Health care organizations should develop participatory,
collaborative partnerships with communities and utilize a
variety of formal and informal mechanisms to facilitate
community and patient/consumer involvement in designing
and implementing CLAS-related activities.
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Standards
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13. Health care organizations should ensure that conflict and
grievance resolution processes are culturally and
linguistically sensitive and capable of identifying, preventing,
and resolving cross-cultural conflicts or complaints by
patients/consumers.
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14. Health care organizations are encouraged to regularly
make available to the public information about their progress
and successful innovations in implementing the CLAS
standards and to provide public notice in their communities
about the availability of this information.
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SCENARIO

You are a new nurse in the ED. You are about to assess a
patient for the first time. When you go in and introduce
yourself, the patient hands you this:
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On the back it says this:
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WHAT IS THIS? WHAT DO YOU DO?
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That was an “I Speak” card…
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What to do if you are presented with this card:
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Acknowledge the patient’s language access need
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Make a notation in chart and/or other applicable locations
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Provide services in patient’s native language
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Provide a trained interpreter (hired or contracted) OR use
bilingual staff, volunteer interpreters, or telephone languagelines
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SCENARIO

You are the charge nurse on your unit. You go in to a room
with one of your fellow nurses and notice the patient speaks
Spanish. Introductions are made, and you realize a family
member is acting as an interpreter for the nurse and patient.

Should you intervene? How?
Why?
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Remember Standard 6!

“Health care organizations must assure the competence of
language assistance provided to limited English proficient
patients/consumers by interpreters and bilingual staff.
Family and friends should not be used to provide
interpretation services (except on request by the
patient/consumer).”
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Questions?
GESTURES AROUND THE WORLD
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References

Imbert, P. (2011). Cultural Competence or Stereotyping?.
ASHA Leader, 16(15), 2-38.

CultureVision © 2005-2011 Cook Ross Inc.
http://www.crculturevision.com/

Zerwekh, J., & Claborn, J. C. (2009). Nursing Today: Transition
and Trends (6th ed.) St. Louis, MO: Saunders Elsevier.