As multiculturalism becomes a global trend, it is abundantly easy to imagine how a nurse and a patient experience certain misunderstandings due to their use of different cultural codes. For this reason, modern nursing education makes it a point to emphasize the importance of cultural competence in clinical settings. In fact, one of the roles that a nursing leader needs to take up is being an ambassador of change who would try to eliminate barriers to intercultural communication. By adopting relevant communication strategies, a nursing leader can contribute to negligence prevention and fight racial and ethnic disparities in health care. This paper discusses the notion of cultural competence as a leadership concept in nursing and provides a self-reflection on my own personality, background, and experiences.
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It is readily imaginable how immigrants may be struggling with gaining access to healthcare and overcoming language discordance. What is more, it is not the only issue that some of them may face. According to Bridges (n.d.), people of color are disproportionately subject to unfair treatment in clinical settings. Bridges (n.d.) cites a study that took place in 400 US hospitals and revealed that patients of color were more likely to receive cheaper and more conservative treatments than their white counterparts. Taking all these facts into consideration, it becomes clear why cultural competence is a modern nursing leadership issue that needs to be addressed. Cultural leadership has the potential of transforming clinical settings to accommodate patients of different backgrounds and eliminate injustice.
Cultural competence has been gaining increasingly more traction in nursing over the past forty years. As Cai (2016) states, the countries that have been showing the most interest in exploring the topic are the United States, Canada, New Zealand, and the United Kingdom. Coincidentally, all these countries are built on the principles of democracy and large welcome numbers of immigrants. The United States has always been a so-called “melting pot” – a multicultural and multiracial country. According to the most recent statistics provided by the U.S. Census Bureau. The U.S. houses six large groups: white, African American, Native American/Alaskan Native, Pacific Islander, Asian, and Native Hawaiian. As for the ethnic origins, as stated by the same source, the U.S. population includes 21 major nationalities and tens upon tens minor ones. The U.S. also has a remarkably high immigration rate: as of 2019, 28% of the population, or 89.4 million Americans were immigrants or their immediate descendants (“United States population,” 2019).
The question arises as to what the broad concept of cultural competence entails and what can and should be translated into clinical practice by nursing leaders. According to Cai (2016), the three pillars of cultural competence are awareness, knowledge, and skill. Awareness refers to a nurse’s self-reflective faculties that allow for an in-depth exploration of his or her own cultural and professional background. Apart from that, heightened self-awareness helps to identify one’s own racial, ethnic, and cultural biases and prejudice. Having stereotypes facilitates the process of navigating the unknown; however, it is essential that a nurse rids of them for effective and humanistic clinical practice.
Knowledge refers to the accumulation of information about different cultures. They are researching cultural norms that differ from those that a nurse was ingrained with from childhood accounts for a better understanding of others’ perceived “odd” behavior. Deep knowledge about the world prevents a nurse from jumping to conclusions about a particular patient and teaches him or her to take time when trying to establish rapport. Lastly, skill encompasses a set of faculties required for collecting cultural data about a patient to make more thought-through health decisions. All three concepts of cultural competence are interconnected and require a health provider’s acknowledgment.
For all its advantages, the concept of cultural competence is not devoid of shortcomings. As Coi (2016) rightfully points out, cultural training for nurses often blurs the line between ethnicity and culture. Arguably, a person of a minor ethnicity that has lived in the U.S. for a while might have adapted to the new culture to an extent where they no longer need special assistance in a clinical setting. The second problem identified by Coi (2016) is the notion of “otherness” that cultural competence often promotes. Cultural training should focus on both differences and similarities between people of different origins.
The question arises as to how cultural competence can be applied in the workplace and what nurses roles it fits. First and foremost, a nursing leader can and should be a patient advocate. If he or she observes injustice on the grounds of race or ethnicity taking place at their facility, they need to intervene and take measures. For instance, Bridges (2016) describes a situation in which female cancer patients of color were less likely to receive desirable treatment, namely, radiation and mastectomy. In this case, a nursing leader would need to contact a patient directly and learn more about their situation and treatment preferences.
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The second role that a culturally aware nursing leader may take is that of a researcher. It is possible to run a small study on a facility’s own population to expose racial and ethnic disparities in case those are present. A study may take the form of a retrospective data analysis in which a nurse compares and contrasts health outcomes in patients of different backgrounds. Another way to go about conducting research in cultural disparities is to run a survey and interview patients. This method might as well provide deeper insights into the nature of the issue. Lastly, a nursing leader might want to organize diversity training sessions in the workplace to transfer knowledge to other employees.
Previously, I used to pay very little attention to the issues of race, ethnicity, and culture in clinical settings. However, from personal observations and anecdotes, I learned the role of cultural competence in maintaining therapeutic communication. For instance, I discovered that in some cultures, complaining about painful sensations was seen as shameful and taboo. These patients are less likely to be straightforward about their symptoms and might need a follow-up check just in case they concealed something. All in all, the more experience I gain in the nursing field, the more I realize the importance of cultural competence.
I am convinced that with the right attitude and more effort, I would make a good, culturally aware nursing leader. After a considerable amount of self-reflection, I discovered the following positive traits that I possess:
- Curiosity. I am committed to lifelong learning and passionate about expanding the scope of my expertise. The world is an incredibly diverse place, and exploring other cultures and their characteristic is a never-ending process going through which should make part of my professional growth;
- Compassion. I cannot stand still in the face of injustice. As an opinionated person with a finely attuned moral compass, I am ready to advocate for the rights of those who are unfairly treated in clinical settings;
- Friendliness. I am cultivating not only my hard skills but also my social competencies. If a culturally sensitive issue occurs in the workplace, I would like to learn the details by contacting all the parties involved directly. Gaining their trust and coming to a consensus would take refined soft skills such as openness and friendliness.
For all my positive traits, I still have a lot of growing to do. In the near future, I would like to pay more attention to my time management skills. Researching other cultures takes time, and I should start putting some aside on a regular basis to stay up to date.
As our societies are rapidly becoming multicultural due to globalization, health workers often need to interact with patients of diverse ethnic backgrounds. Therapeutic communication is an indispensable part of the treatment process, and it is essential that it remains two-way and does not face any serious impediments. To ensure seamless communication and excellent patient outcomes, nurses should develop their cultural competence. The three pillars of cultural competence are self-awareness, knowledge, and skill. When combined, they may allow a nurse to be a successful nursing researcher, patient advocate, and workplace mentor. I am convinced that my curiosity, compassion, and friendliness would make me a culturally aware nursing leader.
Bridges, K.M. (n.d.). Implicit bias and racial disparities in health care. Web.
Cai, D. Y. (2016). A concept analysis of cultural competence. International Journal of Nursing Sciences, 3(3), 268-273.
United States population. (2019). Web.