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

1 Contact Hour
This peer reviewed course is applicable for the following professions:
Athletic Trainer (AT/AL), Certified Nursing Assistant (CNA), Home Health Aid (HHA), Medical Assistant (MA)
This course will be updated or discontinued on or before Saturday, May 8, 2021

This course prepares healthcare workers 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 2 nontraditional cultural groups
  2. Identify one advantage of providing culturally competent care
  3. Define the meaning behind each letter in the LGBTQ acronym
  4. Define the term Cisgender
CEUFast Inc. did not endorse any product, or receive any commercial support or sponsorship for this course. The Planning Committee and Authors do not have any conflict of interest.

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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 in the world today who speak more than 6000 languages. The world’s people are moving more frequently. This causes differences to be less clear among traditional language, racial and ethnic communities.1

Defining Culture and Cultural Competency

Cultural competency is the ability of healthcare workers to provide equal care to different cultural groups.2

Culture is the way groups of people understand their history. How they share their values. How they 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. They can be grouped by family, gender, age or common interests.

There can be multiple subcultures. For example, within the Latino cultural group, there are different national subgroups such as Cuban, Venezuelan, Mexican, etc.

There are several nontraditional groups which have now been recognized as cultural groups in. This can be teenagers, deaf, homeless, 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 can cause the patient not to trust the worker. Not trusting the healthcare worker can lead to poor health outcomes and noncompliance.1

Examples of Cultural Typical Actions Which May Impact the Delivery of Healthcare

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.1

The Latino culture values “personalismo,” which is 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.

Immunizations can be viewed with distrust among certain groups. Sometimes patients make decisions based on sensationalized media reports and wrong information.

Culture Competency in Healthcare Practice

The beliefs about the role of healthcare workers differs a lot between various cultures. Some cultures view the healthcare worker as a trusted confidant, who is expected to provide valuable advice as needed. Other cultures may view any advice provided as an intrusion. So, healthcare workers should adjust their actions based on the patient’s background and expectations.

The culture of healthcare has changed, and patients are seen as active decision makers in their own care. Workers are encouraged to provide services that meet the patient’s individual values. At one time, stereotyping by healthcare workers was viewed as taboo in healthcare. As the culture in healthcare continues to improve, patients are being identified by their cultural group to improve health outcomes.

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.

Several studies have shown that healthcare worker’s nonverbal communication has the most impact on patient satisfaction. Research showed that if healthcare workers were attentive to the patient’s needs, appeared interested and made eye contact during a healthcare encounter, a healthcare worker’s race did not matter on the participant's evaluations.4

The National CLAS Standards

The office of Minority Health of the US Department of Health and Human Services along with the Agency for Healthcare Research and Quality developed the National Standards on Culturally Linguistically Appropriate Services (CLAS). Health organizations that receive federal funding are required to meet CLAS standards. The basic idea of the CLAS standards is that better communication leads to improved health status. The following are some of the CLAS standards:

  • Care should be correct for different cultural health beliefs and actions, preferred languages, health knowledge and other communication needs.
  • Leaders and 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 individuals at no cost to them.
  • Inform all individuals of the availability of language assistance services 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.

The Lesbian, Gay, Bisexual, Transgender and Questioning Community

Definitions of the Terms in the LGBTQ Community


Refers to the 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. The Q in the LGBTQ community can mean “queer” or “questioning,” and this refers to someone who is exploring their sexuality or gender identity.5


Someone who remains attracted to both genders.5


Someone who is not attracted to any gender. They typically do not identify with a specific sexual orientation.5


This is a person who recognizes their gender as the same gender they had assigned at birth.5

Homosexual or Gay

Someone who is attracted to someone of the same gender.5


Someone who is born with variations in sex characteristics that do not fall into the typical description of a male or female body. Bottom line, this refers to someone whose anatomy is not exclusively female or male.


This refers to a woman who is attracted to another woman.5


A person who is attracted to people of any gender or sexual orientation.5


This refers to someone who is questioning their gender or sexual orientation.5


This refers to someone whose gender is different from their gender at birth.5  Transgender has become a general term which refers to people who are transgender, transsexual or gender non-conforming.5 Gender dysphoria defines distress attributed to gender incongruence as it relates to the patient’s mind and body. The LGBTQ nomenclature is in flux constantly, and healthcare workers must make it a point to keep up with the newer terms even as the field continues to evolve.5

Gender Dysphoria

The unhappiness or dissatisfaction that transgender people may experience.

Disparities in Healthcare in the LGBTQ Community

Unequal treatment in healthcare in the LGBTQ community:

The cause for the higher health unequal treatment among the LGBTQ community is complex. It is important that healthcare workers create a safe environment for patients.

People in the LGBTQ community may be afraid to disclose their sexual orientation.  There are reports of bullying and poor access to healthcare.6 There are reports of unequal healthcare treatment and homophobia by the LGBTQ community. According to a 2010 study, a national survey of LGBT physicians 65% of them reported hearing derogatory comments about LGBT patients from healthcare workers. 34% of them reported witnessing discrimination in care against patients in the LGBT community.7 A 2011 survey of transgender people noted that 19% of survey responders reported being refused healthcare because of their gender identity.8

Education of the healthcare community to become competent in the care of the LGBTQ community is a way to bridge the gap in the healthcare unequal treatment. There has been a push to include competencies in healthcare education.


Cultural competency is the ability of the healthcare worker to understand the language, actions and values of a specific religious, racial, ethnic and other social groups. Cultural competency is one of the main ways to change the patient’s opinion of differences in quality healthcare. Cultural competency has become an important part of health care policy and practice where it is now seen to improve healthcare.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
Reflect on Practice ImpactDescribe how this course will impact your practice.   (No Test)


  1. L, Stanton BF. Cultural Issues in Pediatric Care, Chapter 4. In: Nelson Textbook of Pediatrics . 20th ed. Elsevier, Inc.; 2016:33-37.
  2. A Comprehensive Framework for Hospital Care Performance Evaluation. Journal For Healthcare Quality. 2003;25(6):46. doi:10.1097/01445442-200311000-00014.
  3. Center for Disease Control and Prevention. Tuskegee Study and Health Benefit Program - CDC - NCHHSTP. Centers for Disease Control and Prevention. Accessed January 28, 2019. (Visit Source)
  4. Aruguete MS. Participants' Ratings Of Male Physicians Who Vary In Race And Communication Style. Psychological Reports. 2002;91(7):793. doi:10.2466/pr0.91.7.793-806
  5. Hegazi A, Pakianathan M. LGBT sexual health. Medicine. 2018;46(5):300-303. doi:10.1016/j.mpmed.2018.02.004.
  6. Pakianathan M, Daley N, Hegazi A. 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.
  7. Eliason MJ, Dibble S, Dejoseph J. Nursing's Silence on Lesbian, Gay, Bisexual, and Transgender Issues. Advances in Nursing Science. 2010;33(3):206-218. doi:10.1097/ans.0b013e3181e63e49.
  8. 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.