Chapter 2: Cultural Competence: Cultural Care

Key Points – Print

This section discusses key points about demographics, national standards, and heritage.
• • In the United States, about one in eight people are immigrants. One in every three
residents belongs to a group other than single-race, non-Hispanic White.
• o Of this emerging majority, Hispanics are the largest population.
• o The second largest population is Asians followed by Blacks, American
Indians, Alaska natives, Native Hawaiians, and other Pacific islanders.
• o Many new immigrants have little understanding of the modern health care
system and medical and nursing practices and interventions. Many also speak and
understand little or no English.
• • The National Standards for Culturally and Linguistically Appropriate Services in
Health Care state that health care organizations should ensure that patients receive
effective, understandable, and respectful care in a manner compatible with their
cultural health beliefs and practices and their preferred language.
• o When people with limited English proficiency seek health care, services
cannot be denied to them.
• o The most common non-English languages spoken at home are Spanish,
Chinese, French, German, and Tagalog.
• • Cultural care is professional health care that is culturally sensitive, appropriate, and
competent. To develop cultural care, you must have knowledge of your personal
heritage and the heritage of the nursing profession, the health care system, and the
patient.
• • Heritage consistency is the degree to which a person’s lifestyle reflects his or her
traditional heritage. A person can possess values that are consistent with the norms of
the traditional culture or that are modern (or acculturated to the norms of the dominant
society).
• • Heritage consistency includes determination of a person’s cultural, ethnic, and
religious background and socialization experiences.
• o Culture has four characteristics. First, it is learned from birth through
language acquisition and socialization. Second, it is shared by all members of the
same cultural group. Third, it is adapted to specific conditions related to
environmental and technical factors. And fourth, it is dynamic and ever changing.
• o Ethnicity pertains to membership in a social group that claims to possess a
common geographic origin, migratory status, religion, race, language, shared
values, traditions or symbols, and food preferences. One’s cultural background is
a fundamental component of one’s ethnic background.
• o Religion is the belief in a divine or superhuman power or powers to be obeyed
and worshipped as the creator or ruler of the universe. Spirituality is borne out of
 each person’s unique life experience and his or her personal effort to find purpose
and meaning in life.
• o Socialization is the process of being raised within a culture and acquiring the
characteristics of the group. Education is a form of socialization.

This section presents critical points about heritage assessment and health-related
beliefs and practices.
• • You assess factors related to heritage to determine the depth to which you and the
patient identify with a traditional heritage, that is, the cultural beliefs and practices of the
family, extended family, and an ethnoreligious community.
• • Before you can understand the role that beliefs and values play in a person’s life, you
must understand culturally dominant values and personal values. Cultural conflicts
between nurses and patients from diverse backgrounds are related to different time and
relationship perceptions. For example, in some cultures, the past may influence health
practices. When making decisions about health, patients may rely on relationships with
others, and their behavior may depend on the opinion of others.
• • In a multicultural country, you must accept that differences exist and be open to the
importance of these practices to the patient.
• • The meaning of health and illness is determined, in part, by the way members of a
person’s culture define them. The perceived causes of illness and symptoms can be
culturally based and may be viewed as biomedical (or scientific), naturalistic (or
holistic), or magicoreligious. All cultures have their preferred lay or popular healers,
recognized symptoms of disease, acceptable sick-role behaviors, and treatments. Patients
may seek help from biomedical health professionals as well as traditional healers. You
must be aware of traditional folk practices and assess them.
• • In times of illness, religion and spirituality may be a source of comfort for patients
and their significant others. Religion and spiritual leaders may strongly influence the
perception of health, illness, and practices. Religious beliefs may influence the person’s:
• o Explanation of the cause of illness,
• o Perception of its severity,
• o And choice of healers.
• • Spirituality may be used to find meaning and purpose for illnesses.
• • Each person responds differently to the same stimuli, regardless of the primary
culture and value system. You should guard against stereotyping individuals. You
should also understand culture-bound syndromes, which may have no equivalent from a
biomedical perspective.