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Cultural Competence in the Nursing Process

The issue of cultural competence in health care is a rather new topic, one that has appeared as a response to persisting inequality in the health status of people from various ethnic minority groups, which are often disadvantaged and even marginalized when it concerns cultural sensitivity and tolerance. The education of students in the field of cultural competence in health care, which is designed to develop their intercultural awareness and thereby increase the quality of nursing in multinational societies, is just about to give its first significant results (Calvillo, Clark, Ballantyne, Pacquiao, Purnell & Villarruel, 2009).

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Although it was not until quite recently that the issue of transcultural nursing started to be extensively discussed, it should be viewed against the background of a whole number of long-standing demographic, ethnic, racial, and economic problems that exist in countries with very diverse populations. However, despite the fact that nurses are involved in a continuous process of cultural integration, cultural competence development, and self-education in order to be able to render efficient and comprehensive services, there are no specific guidelines or generally accepted models for them to rely on (Kim‐Godwin, Clarke & Barton, 2001).

Since the medical world is now facing a considerable shortage of nurses, the growing migration rates necessitate the development of universal standards that would allow nurses to provide high-quality and culturally competent care, regardless of their patients’ social or ethnic backgrounds. Thus, the aim of this paper is to find out what exactly cultural competence implies and what factors should be taken into consideration for nurses to develop an individualized, culturally responsive approach to their patients.

The primary method of this research is a literature review, on the basis of which a comparative analysis of standards for culturally sensitive nursing processes will be performed. Also, several models of health care delivery will be examined in terms of their capacity to meet the challenges of providing competent nursing for representatives of diverse ethnic groups.

Before moving on to a detailed analysis of the existing approaches to this issue, it is necessary to define cultural competence in the context of health care delivery in general terms. Culturally responsive nursing is a process, the essence of which rests upon the idea that every person, regardless of his or her nationality and current social status, possesses a unique cultural worldview, which cannot be neglected in the course of treatment. In other words, health care specialists should be aware of the fact that people belonging to the same ethnic group will behave rather similarly, demonstrating relative predictability in their reactions. However, at the same time, it’s necessary to bear in mind that cultural background always overlaps with a patient’s individual worldview, values, and beliefs, all of which must also be taken into account (Giger, 2016). Thus, it is crucial for multinational societies to understand that nursing is a culturally-bound profession whose representatives need relevant specific knowledge, skills, and guidelines in order to be able to meet the requirements of high-quality medical care, which would necessarily be free from gender, religious, racial, or other kinds of prejudice.

Since this issue has become so urgent and popular in recent years, there have appeared a lot of different assessment models of cultural competence. According to Campinha-Bacote’s model (The Process of Cultural Competence in the Delivery of Healthcare Services), the main components of culturally responsive nursing are:

  • Cultural awareness, which is the ability of a professional to analyze and estimate his or her own background, to discern existing prejudice, and to accept the fact that all patients are different, so it is wrong to impose one’s own patterns of behavior on representatives of other cultures;
  • Cultural knowledge, which should be gained in educational institutions, includes information about cultural attitudes in general and health-related beliefs in particular, and helps nurses understand how a patient perceives his or her disease and how this perception predetermines his or her response to treatment;
  • Cultural skill, which is the ability to obtain necessary cultural information about a patient and to perform an accurate physical assessment on its basis;
  • Cultural encounters, which presuppose direct interaction with a patient belonging to a different group and whose aim is to eliminate possible biases; and
  • Cultural desire, which implies that a professional involved in health care delivery should show the initiative to learn and comprehend the basics of intercultural communication and should never perform his or her duties under constraint (Campinha-Bacote, 2002).

Another assessment model of cultural competence created by Larry Purnell puts forward the following demands for quality care:

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  • All of the professionals involved in the process of treatment should possess the same information about their patient’s background;
  • Professionals must accept that one culture is not in any way better than another, though it is certainly different, and they must treat each person with due respect for his or her uniqueness;
  • The outcome of the treatment can be improved if the patient is granted the right to be an active participant in the process;
  • Doctors and nurses should not forget that a patient’s cultural worldview can exert a powerful influence on the patient’s perception of the treatment;
  • No cultural data can be considered minor or insignificant; and
  • Direct cultural encounters are the best way to improve one’s cultural competence, so nurses and doctors should be involved in continuous interactions with their patients (Purnell, 2002).

Another important approach to nursing competence is the set of criteria suggested by Jana Lauderdale and June Miller. They single out twelve basic standards of culturally competent nursing:

  • Social justice, which should be used as the primary principle in nurses’ actions;
  • Critical reflection, which is synonymous with cultural awareness;
  • Transcultural nursing knowledge, which implies nurses’ understanding of all the constituents of culture;
  • Cross-cultural practice, which presupposes the application of knowledge;
  • Health care systems and organizations that provide all the necessary resources for professionals to meet patients’ cultural demands;
  • Patient advocacy and empowerment, which implies that nurses should advocate for the inclusion of cultural worldview in the nursing process;
  • A multicultural workforce;
  • Nurses’ education and training;
  • Cross-cultural interaction with patients;
  • Cross-cultural leadership, which deals with nurses’ personal responsibility for patients;
  • Policy development, which includes nurses’ ability to establish contacts with different organizations responsible for cultural competence in treatment; and
  • Evidence-based practice and research, which nurses should rely upon in any kind of medical intervention (Lauderdale & Miller, 2009).

As demonstrated by these approaches, there are many different points of view on the issue of cultural competence in health care. However, the following implications for competent nursing practice can be suggested as a summary of the key points:

  1. Nurses should assess their own attitudes to different cultures and eliminate anything that negatively affects the treatment.
  2. Nurses should collect all relevant information about patients.
  3. Nurses should prompt patients to give their own ideas about health, disease, treatment, and the nursing process.
  4. Nurses should apply different communicative strategies according to the situation.
  5. Nurses should be able to use non-verbal communication in case their patient speaks another language.
  6. Nurses should be flexible and tolerant, thereby helping the patient to bridge the existing cultural gap.
  7. Nurses should always ensure feedback in order to establish cultural contact.

These guidelines may seem rather simple, but by using them as a guiding principle, nurses can make the process of treatment productive and pleasurable for both parties.

Having analyzed several assessment models in nursing, it is clear that cultural competence in health care delivery is indeed a process of paramount importance. Nurses need to apply a set of universal techniques that ensure their capability to accept the cultural context of the patient and provide him or her with high-quality care, regardless of which cultural group he or she happens to belong to.


Calvillo, E., Clark, L., Ballantyne, J. E., Pacquiao, D., Purnell, L. D., & Villarruel, A. M. (2009). Cultural competency in baccalaureate nursing education. Journal of Transcultural Nursing, 20 (2), 137-145.

Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of transcultural nursing, 13(3), 181-184.

Giger, J. N. (2016). Transcultural nursing: Assessment and intervention. Elsevier Health Sciences.

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Kim‐Godwin, Y. S., Clarke, P. N., & Barton, L. (2001). A model for the delivery of culturally competent community care. Journal of advanced nursing, 35(6), 918-925.

Lauderdale, J., & Miller, J. (2009). Standards of practice for culturally competent nursing care: A request for comments. Transcultural, 20(3), 257-269.

Purnell, L. (2002). The Purnell model for cultural competence. Journal of transcultural nursing, 13(3), 193-196.

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