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Cultural Competency for Nursing Assistants, Home Health Aides, and Medical Assistants

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This peer reviewed course is applicable for the following professions:
Certified Nursing Assistant (CNA), Home Health Aid (HHA), Licensed Nursing Assistant (LNA), Medical Assistant (MA), Medication Aide
This course will be updated or discontinued on or before Wednesday, February 26, 2025

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


≥92% of activity participants will be prepared to care for the different cultural groups.


After completing this continuing education course, the participant will be able to complete the following objectives:

  1. Identify two nontraditional cultural groups.
  2. Identify one advantage of providing culturally competent care.
  3. Define self-awareness.
  4. State the meaning behind each letter in the LGBTQ acronym.
  5. Define the term Cisgender.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Cultural Competency for Nursing Assistants, Home Health Aides, and Medical Assistants
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Berthina Coleman (MD, BSN,RN)


There are 7 billion people worldwide who speak more than 6000 languages. The world's people are moving more frequently. This movement causes differences to be less clear among traditional language, racial, and ethnic communities (Stanton, 2016).

Defining Culture and Cultural Competency

Cultural competency is the ability of healthcare workers to provide care to patients with diverse values, beliefs and behaviors, including the modifying of healthcare delivery to meet patients’ social, cultural, and linguistic needs (AHA, 2013). Culture is how groups of people understand their history, share their values, and engage in similar actions. Culture is not necessarily equal to racial and ethnic groups. It may reflect a similar social group, religion, sexual orientation, or occupation, such as the military culture. People who share a cultural belief are organized into groups. Family, gender, age, or common interests can group them. There can be multiple subcultures. For example, there are different national subgroups within the Latino cultural group, such as Cuban, Venezuelan, Mexican, etc. 

Several nontraditional groups have now been recognized as cultural groups. These groups can be teenagers, people who are deaf or hard of hearing, people experiencing homelessness, and LGBT. These groups have shared values and make similar healthcare decisions. Failure of the healthcare worker to recognize the patient's cultural group can cause poor health outcomes. Sometimes, healthcare workers may use language that they do not realize is offensive. This unawareness can cause the patient not to trust the worker. Not trusting the healthcare worker can lead to poor health outcomes and noncompliance (Stanton, 2016).

Self-awareness is the first step toward culturally competent care. This step starts with knowing your personal values and beliefs as well as healthcare values and beliefs. Think about how these factors can influence caregiving to patients. This self-awareness helps understand the cultural beliefs of patients. Being aware of your own biases and attitudes allows you to become more appreciative and sensitive to patients' needs. This awareness means that healthcare workers must think about their own attitudes toward different ethnic backgrounds and how those beliefs may cause problems when working with different cultures. Self-awareness is only one component, however. Healthcare workers must be able to develop skills in delivering culturally competent care.

Knowledge is another step in gaining cultural competence. Healthcare workers need to know cultural differences and traditions to provide the best care. Knowledge is not just learning about different cultures. There is a need to understand the patient's worldview as it pertains to their culture. Worldview is how the individual sees the world based on their values and beliefs, which are part of their culture. Understanding the patient's worldview will help the healthcare worker understand behaviors and beliefs that will directly impact care. Knowledge also entails learning about biological characteristics, variations, and cultural practices. This knowledge will also aid in communication.  

Education and training in cultural differences and skills should be included in initial training and continuing education. Healthcare workers need to identify the impact of policies and procedures on patient care and advocate for patients' cultural needs.

Healthcare organizations should provide cultural resources to meet the needs of a diverse population. The organization must focus recruitment and retention on gaining a multicultural workforce. The workforce should be similar to the cultures of people who live in the community where the organization is located.

Communication is of vital importance in cultural competence. Communication within a culture is socially based and often complicated. It includes a variation of the culture, which can often be misunderstood. Misunderstandings can lead to incorrect assumptions, stereotyping, prejudice, and issues with cultural boundaries.  When communicating with patients from different cultures, it is important to remember the culture's normal actions. The differences that exist when two cultures communicate can confuse meanings in the messages that are sent and how the messages are understood. The communication between two different cultures is called cross-cultural communication.

Cross-cultural communication includes: 

  • Respect and appreciation for another language
  • Ability to observe and communicate without judgment
  • Recognize cultural barriers
  • Encourage expression
  • Speak slowly and clearly without slang, 
  • Show empathy and the 
  •  Ability to correct misunderstandings

Good communication skills include: 

  • Actively listening
  • Pay attention to non-verbal cues
  • Pay attention to perceptions of time, space, touch, expressions, and silence
  • Understand how the patient perceives the situation and health treatments 

If an interpreter is needed, the healthcare worker should understand that cultural values cause misunderstanding when communicating with the interpreter. Family members should not be used as an interpreter as this can interfere with privacy and lead to bias. Once communication barriers are understood and overcome, the conversation about care is clear. Using the patient's own language and terms shows respect and caring.

Examples of Typical Cultural Actions

For Muslims, it is important to understand fasting during the holy month of Ramadan. Children of certain ages may be allowed to participate in fasting. In some Muslim subcultures, it may be inappropriate to touch any female patients. 

Native Americans believe in "passive forbearance," which proposes the idea that individuals should be able to choose their path free of intervention from other family members (Stanton, 2016).

The Latino culture values "personalismo," defined as politeness in the face of conflict or stress. Machismo refers to strong masculine pride and dictates mutual actions with certain male Latino subgroups. 

Sometimes, patients make decisions based on sensationalized media reports and wrong information. 

Culture Competency

Different cultures have different ideas about the role of healthcare. Some cultures view the healthcare worker as a trusted confidant. They expect the worker to provide valuable advice as needed. Other cultures may view workers as an intrusion. So, healthcare workers should adjust their actions based on the patient's background and expectations. 

The culture of healthcare has changed. Patients are making their own care decisions. Workers are encouraged to provide services that meet the patient's values. 

Being sensitive is a big part of providing culturally competent healthcare. Sensitivity helps workers to appreciate, perceive, and respond to a patient's verbal and nonverbal cues. 

Communication and Language Assistance

Healthcare workers' nonverbal communication has the most impact on patient satisfaction. If healthcare workers were attentive to the patient's needs, appeared interested, and made eye contact during care, a healthcare worker's race did not matter in the patients' evaluations (Hegazi & Pakianathan, 2018).

Health organizations that receive federal funding are required to meet standards that improve communication. Some of the standards are:

  • Care should be correct for different cultural health beliefs, actions, preferred languages, health knowledge, and other communication needs.
  • Leaders and the workforce should have the correct culture and language for the people in the service area.
  • Educate the workforce in culture and language as well as correct policies and actions.
  • Offer language assistance to patients at no cost to them.
  • Inform all patients about language assistance in their preferred language, verbally and in writing.
  • Make sure individuals providing language assistance are capable. Avoid using untrained individuals or minors as interpreters.
  • Provide easy-to-understand print material and signs in the languages commonly used by the people in the service area.

LGBTQ Community

LGBTQ usually refers to lesbian, gay, bisexual, transgender, and questioning/queer people. However, it is commonly used to represent all gender or sexual minorities, such as asexual or intersexual subgroups (Hegazi & Pakianathan, 2018). The Q in the LGBTQ community can mean "queer" or "questioning," which refers to someone exploring their sexuality or gender identity (Pakianathan et al., 2018).


The LGBTQ nomenclature is in flux constantly, and healthcare providers must make it a point to keep up with the newer terms even as the field continues to evolve. The following are definitions of terms (HRC, 2021):

  • Asexual: Can be called “ace’ for short, asexual refers to a complete or partial lack of sexual attraction or lack of interest in sexual activity.  Asexual people may experience no, little, or conditional sexual attraction.
  • Bisexual: Someone who remains attracted to both genders.
  • Cisgender: This person recognizes their gender as the same gender they had assigned at birth.
  • Homosexual or Gay: Someone who is attracted to someone of the same gender.
  • Intersex: Someone who is born with variations in sex characteristics that do not fall into the typical description of a male or female body. The bottom line is that this refers to someone whose anatomy is not exclusively female or male.
  • Lesbian: This refers to a woman who is attracted to another woman.
  • Pansexual: A person who is attracted to people of any gender or sexual orientation.
  • Questioning: This refers to someone who is questioning their gender or sexual orientation.
  • Transgender: This refers to someone whose gender differs from their gender at birth. This term may refer to people who are transgender, transsexual, or gender non-conforming.
  • Transitioning: A series of processes that some transgender people may undergo in order to live more fully as their true gender. This typically includes social transition, medical transition, such as names and pronouns, medical transition, which may include hormone therapy or gender-affirming surgeries, and legal transition, which mainly includes changing legal name and sex on government identity documents.  This individual may choose to undergo some or all of these processes. 
  • Gender dysphoria: This is a relatively new medical term that attempts to name and explain the unhappy, uneasy, or dissatisfied feelings that people in this community may experience due to conflict between one’s sex assigned at birth and one’s gender identity. Often, gender dysphoria begins in childhood but can be experienced after puberty or much later (APA, nd). As patients in the transgender community transition both socially and medically, they experience a unique set of challenges that healthcare workers must remain aware of so they can provide appropriate support during their transition. 

Unequal Treatment in Healthcare in the LGBTQ Community

The cause for unequal treatment in the LGBTQ community is complicated. Healthcare workers must create a safe environment for all patients. 

People in the LGBTQ community may be afraid to disclose their sexual orientation.  They fear bullying and poor access to healthcare (Eliason & Dejosheph, 2018).   They think there is unequal healthcare treatment and homophobia. They hear bad comments about LGBT patients from healthcare workers. They see discrimination in care against patients in the LGBT community (Grant et al., 2010). They have been refused healthcare because of their gender identity.

Education of the healthcare community to learn about the care of LGBTQ patients is needed.


Cultural competency is the healthcare worker's ability to understand the language, actions, and values of specific religious, racial, ethnic, and other social groups. Cultural competency is needed to change the patient's opinion of differences in quality healthcare. Cultural competency is an important part of health care policy. It improves healthcare.

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


  • Becoming a Culturally Competent Health Care Organization. Visit Source
  • Eliason MJ, Dibble S, Dejoseph J. Nursingʼs Silence on Lesbian, Gay, Bisexual, and Transgender Issues. Advances in Nursing Science. 2010;33(3):206-218.
  • Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn. Natl. Center Transgender. National Center Transgender. 2010;(5):23.
  • Hegazi, A., & Pakianathan, M., (2018) LGBT sexual health. Medicine. 2018;46(5):300-303. doi:10.1016/j.mpmed.2018.02.004
  • Human Rights Campaign (2021) Glossary of Terms. Visit Source
  • Pakianathan, M., Daley, N., Hegazi, A. ((2016) Gay, bisexual, and other men who have sex with men: time to end the fixation with HIV. Bmj. 2016: i4739. doi:10.1136/bmj. i4739
  • Stanton, BF. (2016) Cultural Issues in Pediatric Care, Chapter 4. In: Nelson Textbook of Pediatrics. 20th ed. Elsevier, Inc.; 2016:33-37.
  • What is dysphoria? (n.d.) American Psychiatric Association. Visit Source. Accessed 9/28/2023