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, and 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, 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, 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 unawareness can cause the patient not to trust the worker. Not trusting the healthcare worker can lead to poor health outcomes and noncompliance.1
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 is helpful to 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 the 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 worldview of the patient 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 and variations as well as 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 policy, procedure 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 keep in mind 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
- 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.