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DiversityNursing Blog

Understanding Racial Concordance In The Nursing Field

Posted by Ryanna Brown

Mon, Mar 04, 2024 @ 12:37 PM

Racial concordance signifies the connection between the racial or ethnic backgrounds of patients and their healthcare providers, showcasing its profound impact on patient care, communication, trust, and overall health outcomes.

While racial concordance in Nursing offers various benefits, it's important to recognize it's not always feasible or practical to match every patient with a Nurse of the same racial or ethnic background. Emphasizing racial concordance should not overshadow the importance of Diversity, Equity, and Inclusion (DEI) within the Nursing workforce. 

Improved Communication 

This shared background fosters a sense of understanding and connection that goes beyond mere words - it's a deep-rooted familiarity with traditions, beliefs, and values that allows for seamless communication and empathy. Patients feel validated and heard when they can freely express their concerns and health needs in a language that resonates with their cultural identity. This bond of shared ethnicity or race creates a safe space for open dialogue and mutual respect, paving the way for a more holistic and personalized approach to healthcare.

Enhanced Trust 

Trust is a crucial component of the patient-provider relationship. Racial concordance can contribute to building trust between patients and Nurses, as patients may feel that their Nurse understands their unique experiences, challenges, and perspectives. This trust can lead to greater adherence to treatment plans and better health outcomes.

Cultural Competence

Nurses who share the same racial or ethnic background as their patients may possess a deeper understanding of cultural beliefs, practices, and health-seeking behaviors. This cultural competence enables Nurses to provide more personalized and culturally sensitive care, which can positively impact patient satisfaction and outcomes. Nurses of all backgrounds should receive training in cultural competence and communication skills to effectively care for patients from all backgrounds.

Reduced Health Disparities 

Racial and ethnic minorities often face disparities in healthcare access, quality, and outcomes. Racial concordance in Nursing can help mitigate these disparities by improving communication, trust, and cultural competence. Patients from marginalized communities may feel more empowered to seek care and engage in preventive health measures when they have Nurses who understand their unique needs and experiences.

Opportunity For Learning

Having a diverse workforce not only provides Nurses with the opportunity to learn from each other's unique life experiences and cultures but also fosters a rich environment for collaboration and growth. Nurses from different racial and ethnic backgrounds bring a wealth of knowledge and perspectives to the table, allowing for a dynamic exchange of ideas and practices. This diversity enriches the overall care provided to patients, as Nurses can draw upon a wide range of insights and approaches to address the needs of individuals from various backgrounds. Embracing diversity within the Nursing profession not only enhances the quality of care but also promotes a culture of inclusion and understanding that benefits both healthcare providers and patients alike.

Racial concordance in Nursing can play a significant role in improving patient care, communication, trust, and health outcomes, particularly for racial and ethnic minority populations. However, it's essential to address the broader issues of Diversity, Equity, and Inclusion within the healthcare workforce to ensure all patients receive high-quality, culturally sensitive care, regardless of the racial or ethnic background of their providers.

Topics: cultural competence, Diversity and Inclusion, culturally competent care, racial health disparities, DEI, Diversity in Health Care, racial concordance

Health Care Cultural Considerations

Posted by Erica Bettencourt

Sat, Aug 29, 2020 @ 01:22 PM

diverseheadsIn our growing diverse society, health care workers need to understand that applying only traditional westernized medical practices isn't appropriate for many patients and families. Health professionals must have an awareness of different cultural practices and spiritual beliefs in order to reduce racial and ethnic disparities in health care.

According to the American Hospital Association, cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients' social, cultural and linguistic needs.

There can be language barriers so make sure you know your patient’s preferred method of communication and arrange an interpreter. Non-verbal communication may differ across cultures. Don’t make any assumptions without knowing the person's customs.

Many cultures have special dietary considerations. Hospital staff should be educated about food culture, which is a term used to describe the non‐nutritive, yet nonetheless significant, aspects of food, such as when food is eaten and how it is served.

For example, Jewish patients do not eat pork or shellfish. Muslim patients also do not consume pork. Muslims will eat only permitted food (halal) and will not eat or drink anything that is considered forbidden (haram). Halal food requires that Allah's name is invoked at the time the animal is killed. Lamb, beef, goat and chicken, for example, are halal as long as a Muslim kills them and offers a prayer. Fish and eggs are also halal. Buddhist are mostly vegetarian, though Buddhists may eat meat if it has not been killed for them specifically.

Health care workers should use effective communication to increase their understanding about the patient's spiritual beliefs and practices. Your workplace should offer spiritual counselors like a chaplain or a rabbi. It is a good idea to have a non-denominational prayer and meditation room which can serve as an inclusive sacred space for staff and patients of all religious backgrounds.

Management should take an active role in promoting culturally competent workplace training courses and resources.

Our calendar of cultural dates is a great tool to assist staff with respectful scheduling and diversity celebrations.

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Topics: cultural competence, culturally competent care, racial health disparities, cultural considerations, ethnic disparities in health care

The Importance of Cultural Competence for Family Nurse Practitioners

Posted by Holly Rinehart, RN, BSN

Thu, Jun 20, 2019 @ 10:27 AM

culturalcompetenceThe U.S. population is growing increasingly diverse. By 2020, the U.S. Census Bureau projects less than 50% of the children in the U.S. will be non-Hispanic and Caucasian. With demographics shifting, health care professionals trained in cultural competence will meet the needs of community health more effectively.  Nurse practitioners earning their Master of Science in Nursing can gain exposure to cultural competency in nursing practice. Trained NPs can help reduce disparities minorities experience, such as lower quality care, through improved awareness.

Culture’s Influence on Health Beliefs and Perception

Culture includes the knowledge, beliefs, and behavior of different groups of people. Elements of culture influence health knowledge and beliefs, as well as behaviors and measures that are taken to promote health. Understanding and respecting different cultures is a critical aspect of providing holistic, effective care.

Nurse practitioners must be culturally competent to be able to effectively listen to their patients’ health concerns, treat their health conditions in ways that are acceptable to the patient, and communicate in ways that are responsive and respectful of the patient’s culture. Here are a few ways that culture and ethnicity influence the care patients receive:

Body Language

Cultural norms highly influence body language. One example is the degree of eye contact with which individuals are comfortable varies. Some cultures express respect by not making eye contact, which can lead health care providers to view the patient as withdrawn, and suspect depression or anxiety if not informed of this difference. Eye contact may also be viewed in some cultures as flirtatious, or even disrespectful.

Experience of Pain and Illness

Different cultures have different ways of coping with illness and pain. These differences influence how, when, and whether individuals seek care. Cultures with an acceptance of pain as part of life may not report their pain to health care providers, and may not consider it a health problem.

Emotional responses to pain are also influenced by culture. Cultures that value stoicism may warrant less outward expression of pain, leading uninformed providers to believe that the individual isn’t suffering. Other cultures expect individuals in pain to react emotionally. Nurse practitioners must be mindful of differences in how cultures view, express and accept pain.


Decision-making regarding health is also approached differently among ethnic groups. Some cultures value making health decisions as a family, or the individual receiving care will make the decision themselves, or the patient may appoint another family member to make decisions regarding their care. Nurse practitioners must be mindful that the patient may want to discuss options with their loved ones before accepting or declining a health care treatment plan.

Linguistic Barriers

Identifying linguistic barriers is another important aspect of cultural competence. Individuals may be able to communicate basic health needs to the provider, but have difficulty understanding the terminology used in the practitioner's response. NPs must be mindful of this, and also that some patients are not comfortable indicating that they don’t understand. Linguistic barriers can lead to the provider either missing or misinterpreting some of the nuances of the patient’s symptoms.

One way to help identify a linguistic or learning style barrier is through using the teach-back method. After explaining a health condition or treatment to the patient, the nurse practitioner then asks the patient to return the teaching. If they’re unable to do so or demonstrate some difficulty, interpretation services or a different teaching style, such as the use of audio or visual aids, may be necessary. Interpretation services should always be made available to those who speak English as a second language. Interpreters can also help providers better understand cultural differences.

Treatment Tailored to the Patient

Receptivity to cultural differences also influences treatment accepted by the patient. If a provider is not sensitive to or respectful of cultural differences, patients from diverse backgrounds may experience confusion or frustration. This may lead to them initially accepting treatment, but once home they may not follow through because they don’t trust the provider, don’t understand the purpose of the prescribed treatment, or the care plan conflicts with cultural values.

Taking Initiative as a Nurse Practitioner

Improved awareness helps eliminates assumptions made during care and gives voice to patients, so they can adequately express their concerns. Understanding cultural diversity in nursing also helps close the gap in health equity, reducing health disparities affecting minority populations such as higher morbidity rates and lower quality care.

Nurse practitioners are responsible for improving their own cultural competency to ensure that all patients receive effective care. The Agency for Healthcare Research and Quality offers many ideas to improve cultural awareness-one way is by respectfully asking patients about their beliefs in the context of health and treatment.

Nurse practitioners can also benefit from attending courses on cultural diversity in practice, participate in community organizations, and research the norms of different cultural and ethnic groups. Broadening one’s own understanding of culture and how people interact improves the professional ability to make meaningful connections with patients.


Agency for Healthcare Research and Quality. (2015). Consider culture, customs, and beliefs: Tool #10.

National Institute of Health. (N.d.). NIH fact sheets - Health disparities.

Peacock, S., Patel, S. (2008). Cultural influences on pain. Reviews in Pain: British Pain Society, 1(2), 6-9.

United States Census Bureau. (2018). Older people projected to outnumber children for first time in U.S. history.

Holly Rinehart, RN, BSN, is a registered nurse and writer for the Carson-Newman University blog. She specializes in emergency and perioperative nursing and cherishes the opportunity as a nurse to help serve and comfort those in vulnerable positions. In her free time, she enjoys traveling and telling nurse stories to anyone who will listen.

Topics: family nurse practitioner, cultural competence, cultural competency, NPs

Diversity Impact 2017- Moving Forward: Uniting Through Diversity

Posted by Frontier Nursing University

Tue, Jun 06, 2017 @ 02:20 PM


First article written by Frontier Nursing University
Second article Written by Marissa Silver

Frontier Nursing University believes in increasing awareness of the importance of cultural competency and decreasing health disparities. This article is about their 7th annual Diversity Impact Event. FNU states “Diversity Impact is designed to open the door for nurses to foster and strengthen collaborative discussions to address health disparities to improve minority health among underrepresented and marginalized groups.” Enjoy this informative article.

In a rapidly-changing, sometimes divided world, Frontier Nursing University (FNU) emphasizes the value of respecting and honoring diversity.

In the United States, there is a wide gap in health outcomes. Several populations face greater obstacles in obtaining good health based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, sexual orientation, physical or mental disability, or geographic location. These disparities may exist because of social and economic inequality, inadequate health care providers or systems, and bias on the part of health care providers or patients.

The gap forming in the health of women before and during pregnancies is also a source of concern. Determinants of a mother’s health may include social factors, ethnic or racial group, or her previous health statufnu1.jpegs. An infant child is also impacted by factors such as nutrition, family income, and the geographic location of their homes and neighborhoods.

Additionally, consider this: women living in rural areas have less access to health care than women living in urban areas. Where 22.8% of women live in what is defined as a “rural” area in the U.S.¹, there is a significant disparity between the health care they receive and the health care received by the “urban” population of women.

Although health care needs around the nation are diverse, health care providers do not reflect the population. In 2008, only 16.8% of Registered Nurses residing in the United States represented diverse racial and ethnic backgrounds². Additionally, underrepresented groups make up less than 10% of nursing school faculty³. The nursing profession faces the challenge of recruiting and retaining a culturally diverse workforce that mirrors the nation's demographics.

With these challenges in mind, it is important that our education system equips nurse practitioners, nurse-midwives and other healthcare professionals with the resources they need to eliminate these disparities, and ultimately achieve health equity.FNU would like to see the Frontier community impact health equity and move forward by uniting through diversity.

On June 1- 4, 2017, Frontier Nursing University held the 7th annual Diversity Impact Student Conference. Diversity Impact is designed to open the door for nurses to foster and strengthen collaborative discussions to address health disparities to improve minority health among underrepresented and marginalized groups. Students will engage in cross-cultural and intercultural workshop activities, along with leadership strategies on current diversity healthcare trends as it relates to patient-provider care.

This year’s Diversity Impact theme is Moving Forward: Uniting Through Diversity. Students will attend sessions hosted by nationally recognized nursing leaders; participate in teambuilding activities, cultural competency awareness training, and open dialogues; network with available FNU students, community leaders, faculty and staff; and learn more about the world with FNU’s International Food Menu.

fnu3.jpegFrontier Nursing University conference discusses healthcare diversity

Factors such as someone's age, race, gender and ethnicity can all play a role in their healthcare.

This weekend, Frontier Nursing University students attended a conference, to learn how those factors and other differences between populations may impact a patient's health and treatment. One factor, which may impact patients in Eastern Kentucky is living in rural communities.

"It's like a totally different population than what you see in urban areas," Vaishu Jawahar who attended the conference said. "Even though we think that sometimes urban populations have it bad, the sheer lack of resources that's out here makes being in a rural area that much harder."

Another topic discussed during the conference was caring for those in the Lesbian, Gay, Bisexual and Transgender (LGBT) community.

"As healthcare providers, no matter what your political views are you have to be able to take care of everyone or at least make them feel comfortable enough to seek out your care," said Jawahar.

As part of the discussion on serving the LGBT community, two Frontier Nursing University students talked about their experience treating patients during last year's mass shooting, at Pulse, a Gay nightclub in Orlando, Florida.

Overall, those who attended the conference said taking the time to get to know the patient and their background can make a difference.

"It's so easy for us to get caught up in our way of life, we forget there's very different realities for everyone," Wilvena Bernard, Diversity Pride Program Coordinator, Frontier Nursing University said.

More than 50 students and faculty attended the conference from across the country.

Last month, University officials announced they are moving student activities from the Hyden campus to Versailles by Fall of 2018.

Interested in learning more about Frontier Nursing University? Check out their Employer Profile! Just Click Here.

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Topics: diversity, cultural competence, Diversity and Inclusion, cultural competency, minority health, health disparities, health care providers

Cultural Competency: Bridging the Language Barrier

Posted by Pat Magrath

Tue, Mar 28, 2017 @ 02:08 PM

nurse-and-patient.jpgDepending upon your physical location of employment, whether it’s in the city, suburbs or rural area, you may encounter language barriers with your patients every day or maybe only once or twice a year. Whatever the frequency is for you, it’s important that the information you have to deliver is conveyed as clearly as possible. Some medical terms we use here in the US may not have clear translations in your patient’s native language.
What are you to do? This article will help guide you in these situations. Perhaps you’ve encountered a language barrier predicament that you’re willing to share with our Nursing community that would be helpful?

Let’s face it, it is often hard for a patient whose first language is English to navigate the technical medical vocabulary that we use in our healthcare system. Patients who don’t speak English well—or at all—are considered to have low health literacy. This is not necessarily a reflection of their intelligence, but rather of how hard it can be to educate them about their medical status, treatment plans, etc.

A language barrier can also make it hard for nurses to honor patient preferences, answer questions, and establish a trusting relationship—particularly when cultural differences exist regarding the patient’s concepts of wellness and illness. Perhaps most troubling is the fact that informed consent becomes a sticky issue, both legally and ethically, when a patient cannot understand his condition or ask questions about treatment options.

In regions with large Hispanic or Asian populations, many healthcare facilities have staff nurses who are bilingual. But what happens when you are caring for a patient that you can’t communicate easily with?

The ideal situation would be to use a professional translator who has training in medical vocabularies. These professionals are often available through a staffing service or a 24-hour telephone translation line. If you have access to these services, be sure to take advantage of them. And if you frequently encounter situations in which you feel a translator is required but none is available, you can encourage your hospital to contract with a translation service.

Often, friends or family members of the patient can step up to bridge the language gap. It’s advisable to use these ad hoc interpreters only as a last resort, because these non-professionals are more likely to make mistakes that can affect clinical outcomes. Friends or family members may have low health literacy themselves, may not fully understand a medical term that has no direct translation, or may inject their own personal views into the dialogue to the patient as an attempt to be helpful. The more complicated the medical case, the higher the likelihood of translation errors.

If you are communicating through a translator of any sort, there are a few things to keep in mind:

  • Begin by briefly advising the translator what you need from him/her: to translate the words of both parties as literally as possible, without adding or leaving out anything.
  • Ask the translator if he/she knows of any general cultural beliefs that might come into play during medical treatment—such as a cultural preference for avoiding conflict, avoiding interactions with a person of the opposite gender, or avoiding anything that might seem like questioning the authority of a clinician.
  • If the translator contracts with your employer, there is probably already a signed HIPAA agreement in place. If a family member or friend is translating, advise that person that the information being translated is considered confidential.
  • Document the name of the person translating in the patient chart.
  • Use the “teach back” method to convey medical information. You’ll be doing it through a translator, but the process can still help you assess how well the patient has understood the information being provided.

Census statistics indicate that nearly 47 million U.S. residents speak a foreign language at home, with a quarter of them reporting limited proficiency in English. These numbers practically ensure that you will encounter a language barrier at some point. Despite the difficulty in communicating, remember that you, as a nurse, are still responsible for providing a quality experience for the patient, including protecting his dignity, ensuring comfort, and advocating on his behalf. You also have to be diligent about assuring the data you document is as accurate. 

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Topics: cultural competence, language barrier

Cultural Competency: Matters of Modesty

Posted by Pat Magrath

Wed, Mar 22, 2017 @ 03:41 PM

nurse-and-patient-at-home-web.jpgGrowing up, we were taught to be modest. As we became adults and more comfortable with who we are as a person, modesty may have become more important in our lives, or perhaps, less important. It depends on our personal circumstances and beliefs.

Whatever our personal feelings are, as a Nurse, you must always be vigilant and respect your patient’s privacy. You already know this, but are you aware in some cultures, modesty truly is a virtue? For others, there could be a personal trauma, physical disfigurement, or psychological reason that produces tremendous anxiety when disrobing or showing any part of their body.

This article stresses the importance of being sensitive to each patient’s needs in delivering culturally competent care.

Many cultures and religions place a high value on modesty, particularly for women, associating it with honor and virtue. Often modesty is linked to styles of dress and circumstances under which an individual might feel comfortable being uncovered or touched. Yet, there are personal reasons for modesty too, so you’re likely to come across patients, both male and female, who have firm boundaries of privacy—including survivors of sexual assault and transgender patients.

Modesty can be so important to some patients that medical visits cause them a great deal of stress and anxiety. Some will shop around for a clinician of a particular gender or one who makes them feel comfortable—or even forego care completely. As a nurse, your ethical commitment to patient advocacy and patient dignity requires you to demonstrate cultural sensitivity to patients who value modesty. Making accommodations for a patient who values modesty is a form of holistic care, because it recognizes the individual’s emotional well-being.

In general, nurses should always preserve patient privacy, by providing gowns and cover-ups, pulling drapes closed, knocking before entering an exam room, etc. Whenever possible, go the extra mile, by providing scrub pants if a gown doesn’t close in the back or double-gowning a patient who will be leaving his room. Patients may know intellectually that healthcare providers “have seen it all,” but that doesn’t stem their embarrassment. You can also urge your employer to build an environment where patients feel safe, by speaking up about gowns that don’t close all the way or other modesty issues.

Cross-cultural patient encounters can often be challenging in terms of modesty. Muslim women are likely to request female providers only, and these requests might be hard to honor in small facilities or rural areas. They may also prefer to have their husband present during an exam or procedure, and may resist disrobing entirely—or uncovering their hair—for an exam. Women from certain Asian cultures also have a strong preference for female obstetrics staff. Ideally, nurses should be able to anticipate cultural requirements for modesty and make accommodations before patients become anxious or uncomfortable.

While the majority of nurses are female, many mistakenly believe that male patients really don’t care about modesty, but that often is not true. Many hospitals don’t have nearly enough male nurses or technicians on staff, but you should try your best to honor requests for same-gender providers for baths, catheterizations, or other intimate procedures. Always try to be sensitive to modesty concerns—even when it creates an extra step for you or takes more time.

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Topics: cultural competence, modesty

A More Diverse America Needs Health Care Adjustments

Posted by Erica Bettencourt

Wed, Feb 15, 2017 @ 04:02 PM

0209-tiled-flag-of-american-diversity.jpgHow can you properly care for a patient if you don’t understand their personal needs? Communication is key. Making a patient comfortable goes far beyond providing warm blankets. It is about the patient trusting you and knowing you have things in common that show them you understand how they feel and what they need. 

Many healthcare providers are seeing how important diversity and inclusion is to delivering quality patient care. Hospitals are providing language services by hiring a diverse staff, many of whom are bilingual or multilingual. Culturally appropriate care strategies are also key. Religious views may alter the way staff would normally provide care. That means you might assist a patient who needs to move in order to pray or work out special blood testing times to allow the patient to fast. The population is rapidly changing and by 2050, the white population will no longer be the majority.

On any given day at the Salud Clinic, Lucrecia Maas might see 22 patients. They come to the community health center tucked away in an office park here needing cavities filled, prescriptions renewed and babies vaccinated. When they start to speak, it’s rarely in English. Sometimes it’s Hindi. Or Dari. Or Hmong. Or Russian.

Maas is fluent in English and Spanish, but that gets her only so far. She often has to hop on the phone with a medical interpreter, who relays her questions to the patient and then translates the patient’s answers. “It just takes a little more time,” the nurse practitioner said. 

The future of American health care looks a lot more like the Salud clinic than Norman Rockwell’s iconic small-town doctor’s office. The country is on course to lose its white majority around 2050. That future is already visible in Sacramento County and neighboring Yolo County, where West Sacramento is located: by 2013 the combined population of Hispanic, black, Asian and other nonwhite residents had edged out whites. In West Sacramento, a historically working-class county across the river from the state capital, more than 2 out of 5 public schoolchildren already speak a language other than English at home.

Sacramento-area hospitals, community health centers and doctor’s offices have had to adapt. They’ve hired more multilingual, bicultural staff. They’ve contracted with interpretation services. The medical school at the University of California, Davis, is trying to figure out how to recruit more Latino students to a profession that remains largely white and Asian. And doctors are being trained to deliver culturally appropriate care to patients of many backgrounds. 

When a diabetic pregnant Afghan woman wanted to fast during Ramadan, the Salud Clinic’s nutritionist recalculated the best time of day to measure her blood sugar. If Mexican mothers say they’re rubbing gentian violet on their baby’s umbilical cord area to keep it clean — a harmless natural remedy — doctors encourage them to keep doing so.

Similar stories are playing out across California, which became majority minority in 2000. Health systems are using new data tools to get a better handle on just who they’re serving — and where the trend lines are pointing. County health departments, nonprofits and clinics have invested in recruiting and training bilingual community health workers.

Insurance doesn’t always pay for the extra costs of services like translation. Patient visits take extra time, straining schedules for doctors and nurses. “You can’t really help somebody if you don’t understand how they value health, and how they understand health and the health care system,” says Robin Affrime, CEO of CommuniCare Health Centers, the nonprofit that operates the Salud Clinic.


Immigrants Drive Change

Most of the nation’s population growth since the 1960s has come from the immigration of nearly 59 million people from foreign countries who settled in the U.S. in that time, mostly from Latin America and Asia, according to the Pew Research Center. (The Pew Charitable Trusts funds the Pew Research Center and Stateline.)   

Hispanic, black, Asian and multiracial babies in the United States already outnumber white babies. In three years’ time, a majority of U.S. children and teenagers will be some race other than non-Hispanic white. And in about 30 years, whites will cease to be the national majority, demographers say.

A more diverse patient population may mean a different mix of health conditions, because some are linked to country of origin. People who were born in Asia are particularly prone to hepatitis B, for instance. African-Americans are more likely to have sickle cell anemia, an inherited blood disorder more common in Africa, the Middle East, India, and parts of southern Europe and Latin America. 

Asians and Hispanics — the groups likely to drive population increase going forward — have longer life expectancies than whites. Hispanics are less likely to suffer from many chronic conditions than whites even though they’re typically poorer and less educated.

Yet second- and third-generation Hispanic-Americans are often less healthy than their immigrant parents. One theory is that with assimilation, younger generations pick up bad American habits such as eating fast food and not getting enough exercise. And health continues to vary by subgroup. For instance, Californians with roots in Mexico are much more likely to be obese than Californians with roots in Puerto Rico, survey data show.


Health Challenges

One of the challenges facing health care providers is obvious: many new immigrants can’t speak English. About 60 million Americans speak a language other than English at home and about 25 million can’t speak English very well, according to the U.S. Census Bureau.

Salud doesn’t typically bring in in-person interpreters, because they’re more expensive. But it does contract with a phone interpretation service, a business that’s growing rapidly across the county. The service provides real-time translation between English and at least 12 other languages. Interpretation of some of the less common languages, like Hmong, needs to be scheduled in advance. And there have been instances in which the interpreter speaks the wrong dialect of a language like Dari, spoken in several countries in Central Asia.

Often a staff member can help. The health center has doctors and nurses who speak Hindi, Urdu, Punjabi, Tagalog and Spanish, and has hired administrative staff and medical assistants who speak Hmong and Mien, a language spoken by some Indochinese refugees who fled to the United States during the Vietnam War.

But Mien has no written language. And some cultures and languages have concepts that defy easy translation. “There are some words where we really cannot use the translator,” said Rubina Saini, a Salud physician who speaks several South Asian languages.

Other clinics don’t do as well as Salud. Under federal civil rights law, hospitals, nursing homes and other providers that receive federal funding must take reasonable steps to accommodate patients who can’t speak English well. But the legal requirement isn’t well-enforced and services can be spotty. “Where people need language services isn’t necessarily where they’re being offered,” says Melody Schiaffino, an assistant professor at San Diego State University’s Graduate School of Public Health.  

In a recent study, Schiaffino found that about 30 percent of all hospitals nationwide don’t offer translation services. The share is even larger for public safety-net and for-profit hospitals, even in diverse cities. That’s because the government hospitals can’t afford to do so, she said, and for-profit hospitals tend to serve well-insured patients who speak English.

State policy helps determine who gets interpretation and translation help. Only 15 states directly pay for interpreters needed by Medicaid patients. California isn’t one of them, although a 2009 task force created by the state Department of Health Services recommended the change. (California does require private health insurers to provide — although not necessarily pay for — language services. The state also requires health plans in its state Medicaid program, Medi-Cal, to translate certain written materials into common languages.)

Most Salud Clinic patients have a Medi-Cal insurance plan that will cover the cost of interpretation, Donna Paul, the clinic manager, says. If a patient doesn’t have coverage, CommuniCare Health Centers absorbs the cost.

Then there’s the need to navigate cultural differences. The front-office staff knows that Southeast Asians may be uncomfortable making direct eye contact, and that Russians may speak loud and fast, Paul said. They’ve learned not to take such things personally.

Ethnic Disparities     

Treating a more diverse population also means confronting gaps in care that go beyond socioeconomic status. African-Americans, and in some cases Hispanics, tend to receive lower-quality care than whites even after controlling for income, age and symptoms, according to an often cited 2003 report by the Institute of Medicine (now the National Academy of Medicine). Black patients are less likely to be prescribed pain medication than white patients, for instance, and less likely to receive antiretroviral drugs if they’re HIV positive.

There’s no simple reason for the gap in quality, which still persists, although researchers say unconscious bias or stereotyping by physicians, cultural and language gaps, and even geography play a role. “Race and ethnicity matter, whether you like it or not,” says David Acosta, associate vice chancellor for diversity and inclusion at the University of California, Davis, health system.

To erase the gap, medical schools are adopting strategies to better prepare the next generation of doctors. One of these is to recruit and train more minority students. The second is to train all students to examine their own biases and be more sensitive to cultural differences.

In California, where almost 40 percent of residents are Latino, 4 percent of physicians are. Nearly 20 percent of all physicians in the state speak Spanish, but Acosta says bilingualism isn’t enough. As a Latino physician, he says he’s bilingual and bicultural, familiar with his Hispanic patients’ approach to health, such as the folk remedies they might try. That kind of cultural match improves trust between doctors and patients.

Black and Hispanic physicians are also underrepresented in the physician workforcenationwide. Increasing their numbers could also help ease the shortage of primary care physicians, Acosta said, because black and Hispanic physicians are more likely than white and Asian physicians to provide primary care to low-income minority communities desperately short on doctors.

UC Davis launched an effort to recruit more Latino students to health careers last summer, funded by the Permanente Medical Group, a physician group that works with Kaiser Permanente.

The UC Davis program, called Prep Médico, is aimed at undergraduates from northern and central California and starts with a summer session at the UC Davis medical school. Participants get ongoing support from mentors, access to research opportunities, and help studying for the medical school admissions exam.

Once students reach medical school, they need to be trained to treat patients of a different race, ethnicity, culture, sexual orientation or socioeconomic status than their own. Twenty-one states, including California, have adopted health equity standardsthat help guide physician training.

But there’s a debate over how best to teach so-called cultural competency. The concept is often presented to students like another task to master or acronym to memorize, said Jann Murray-García, an assistant adjunct professor at UC Davis’ school of nursing. But it’s not something you can memorize with flashcards. “There’s just no way to master the complexities of other people’s lives and personhoods,” she says. And recognizing one’s own racial biases and stereotypes, and learning how to deliver good care despite them, can be a lifelong process, she says.

Crunching Data

Kaiser Permanente has turned to data, to make sure these new populations are getting the care they need.

For more than a decade, the organization has broken down its quality of care data by race, gender and ethnicity and used it as a guide to drive health care priorities, with a goal of narrowing health care disparities.

For example, African-Americans are more likely than whites to have very high blood pressure and — partly as a result — to suffer from strokes, heart disease and end-stage kidney disease. First, Kaiser’s analysts figured out what the gap looked like for their own patients. Then they created a new set of instructions for care teams, informed partly by patient focus groups.

Among other changes, physicians were asked to prescribe African-Americans medications proven to be more effective for them. Physicians, nurses and other health workers took additional care to listen to patients, follow up, and nudge them to stay on top of their treatment plan. The effort has paid off: Since 2013, Kaiser has cut the high blood pressure control gap between its African-American and white patients in half.

Health systems can use data to improve their language services, too, says Glenn Flores, a physician and chair of health policy research at Medica Research Institute, a nonprofit research group. All it takes is asking new patients a few questions to check their English fluency, and noting what other languages they speak. That way clinics and hospital systems can arrange for in-person interpreters ahead of time for patients who need them and figure out which languages are essential when they are hiring staff or contracting for medical translation services. “Very few hospitals around the country do this,” he says. 

Nationally, health data need to more accurately capture racial and ethnic subgroups, says Kathy Ko Chin, president and CEO of the Asian & Pacific Islander American Health Forum. The “Asian and Pacific Islander” category used by the U.S. Census Bureau, for instance, encompasses everyone from third-generation Chinese-Americans to Pakistani engineers to Cambodian refugees. People with origins in the Middle East have no U.S. Census designation of their own, and can self-identify as white, Asian, African or “other.” Without more specific data, it’s hard to know what problems local communities have and what services they need, Ko Chin says.

California policymakers have unusually detailed data at their fingertips thanks to the California Health Interview Survey, conducted by the University of California, Los Angeles. Researchers have been able to tease out findings that can inform better care, such as the fact that Korean women are much less likely to receive mammograms than Japanese women in the state.

Use our free checklist to scale your diversity and inclusion efforts.

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Topics: hiring, cultural competence, Diversity and Inclusion

A Guide to Culturally Competent Nursing Care

Posted by Brian Neese

Thu, Feb 02, 2017 @ 01:05 PM

thumbnail_Culturally-Competent-Nursing-Header.jpgCultural respect is vital to reduce health disparities and improve access to high-quality healthcare that is responsive to patients’ needs, according to the National Institutes of Health (NIH). Nurses must respond to changing patient demographics to provide culturally sensitive care. This need is strikingly evident in critical care units.

“As an emergency room nurse in a small rural hospital, I was present when an elderly Native American man was brought to the emergency room by his wife, sons, and daughters,” Deborah Flowers says in Critical Care Nurse. “He had a history of 2 previous myocardial infarctions, and his current clinical findings suggested he was having another. During the patient’s assessment, he calmly informed the emergency room staff and physician that, other than coming to the hospital, he was following the ‘old ways’ of dying. He had ‘made peace with God and was ready to die’ and ‘wanted his family with him.’”

“The emergency room physician ordered intravenous fluids, a dopamine infusion, a Foley catheter, and transfer to the intensive care unit of a regional hospital 3 hours away. The patient died 2 weeks and 2 code blues later, and was intubated and receiving mechanical ventilation for most of that time. No family members were present when he died except for his wife. The rest of his family members were unable to afford the cost of traveling to a healthcare facility that far from home. This man’s cultural values and preferences in relation to dying were disregarded.”

In contrast, promoting culturally competent nursing care helps nurses function effectively with other professionals and understand the needs of groups accessing health information and healthcare.

Examining Culturally Competent Nursing Care


Cultural competence can be defined as “developing an awareness of one’s own existence, sensations, thoughts, and environment without letting it have an undue influence on those from other backgrounds; demonstrating knowledge and understanding of the client’s culture; accepting and respecting cultural differences; adapting care to be congruent with the client’s culture,” according to Larry Purnell in his book Transcultural Health Care: A Culturally Competent Approach (1998).

Another definition states that cultural competence “describes how to best meet the needs of an increasingly diverse patient population and how to effectively advocate for them,” says Barbara L. Nichols, former CEO of the Commission on Graduates of Foreign Nursing Schools, in NSNA Imprint.

Explanations of culturally competent nursing care focus on recognizing a patient’s individual needs, including language, customs, beliefs and perspectives. Cultural sensitivity is foundational to all nurses. “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person,” states the American Nurses Association’s Code of Ethics for Nurses.



More than one-third (37 percent) of the U.S. population consists of individuals from ethnic and racial minority groups, and by 2043, minority groups will become the majority, according to research from the American Association of Colleges of Nursing. However, nurses from minority backgrounds represent 19 percent of the registered nursing (RN) workforce. Men account for 9.6 percent of the RN workforce.

There is a “challenge presented by the health care needs of a growing number of diverse racial and ethnic communities and linguistic groups, each with its own cultural traits and health challenges,” the NIH says. Nurses and other healthcare providers must account for these differences through cultural respect to support positive health outcomes and provide accuracy in medical research.

“The development of cultural competence in the nursing practice first requires us to have an awareness of the fact that many belief systems exist,” says Lanette Anderson, executive director of the West Virginia State Board of Examiners for Licensed Practical Nurses. “The beliefs that others have about medical care in this country, and sometimes their aversion to it, may be difficult for us to understand. We must remember that we don’t need to understand these beliefs completely, but we do need to respect them.”

Developing Cultural Competence

Framework for Delivering Culturally Competent Services

Campinha-Bacote and Munoz (2001) proposed a five-component model for developing cultural competence in The Case Manager.

  1. Cultural awareness involves self-examination of in-depth exploration of one’s cultural and professional background. This component begins with insight into one’s cultural healthcare beliefs and values. A cultural awareness assessment tool can be used to assess a person’s level of cultural awareness.
  2. Cultural knowledge involves seeking and obtaining an information base on different cultural and ethnic groups. This component is expanded by accessing information offered through sources such as journal articles, seminars, textbooks, internet resources, workshop presentations and university courses.
  3. Cultural skill involves the nurse’s ability to collect relevant cultural data regarding the patient’s presenting problem and accurately perform a culturally specific assessment. The Giger and Davidhizar model offers a framework for assessing cultural, racial and ethnic differences in patients.
  4. Cultural encounter is defined as the process that encourages nurses to directly engage in cross-cultural interactions with patients from culturally diverse backgrounds. Nurses increase cultural competence by directly interacting with patients from different cultural backgrounds. This is an ongoing process; developing cultural competence cannot be mastered.
  5. Cultural desire refers to the motivation to become culturally aware and to seek cultural encounters. This component involves the willingness to be open to others, to accept and respect cultural differences and to be willing to learn from others.


Nurses should explain healthcare jargon to patients whose native language is not English, according to Monster contributing writer Megan Malugani. A breast cancer awareness program for U.S. immigrants demonstrated that women were too shy to say they didn’t understood certain terms. Some assumed that Medicare and Medicaid were forms of cancer.

Many people from other cultures seek herbal remedies from traditional healers — and they can be harmful or interact poorly with Western medicine. Nurses should ask patients about any alternative approaches to healing they are using. Another example of cultural sensitivity involves nurses understanding the roles of men and women in the patient’s society. “In some cultures, the oldest male is the decision-maker for the rest of the family, even with regards to treatment decisions,” Anderson says.

The most important way for nurses to achieve cultural competency and promote respect, according to Anderson, is to gain the patient’s trust for a stronger nurse-patient relationship. This requires sensitivity and effective verbal and non-verbal communication.


Nurses should never make assumptions or judgments about other individuals or their beliefs. Instead, nurses can ask questions about cultural practices in a professional and thoughtful manner.

Common pitfalls to avoid involve stereotyping and labeling patients, according to Flowers.

  • Nurses should avoid unintentionally stereotyping a patient into a specific cultural or ethnic group based on characteristics like outward appearance, race, country of origin or stated religious preference. Stereotyping refers to an “oversimplified conception, opinion, or belief about some aspect of an individual or group of people,” she says. Additionally, many subcultures and variations can exist within a cultural or ethnic group. For instance, the term Asian-American includes cultures such as Chinese, Japanese, Taiwanese, Filipino, Korean and Vietnamese, and within these cultures, there are variations in geographic region, religion, language, family structure and more.
  • Nurses should be careful about labeling patients. For instance, citizens in the United States may refer to themselves as Americans, but that term can also apply to individuals from Central and South America. Flowers recommends referring to a person from the United States as a U.S. citizen.

Responding to Higher Standards in Nursing

More hospitals across the United States now require that nurses have a bachelor’s degree. Rising educational standards are emphasized to increase the quality of care that patients receive. Alvernia University’s online RN to BSN Completion Program is designed to improve patient outcomes and help nurses meet each patient’s needs, including those unique to the patient’s cultural background. The degree program takes place in a convenient online learning environment that accommodates students’ work and personal schedules.

The RN to BSN Completion Program includes a class — NUR 318 Developing Cultural Competency & Global Awareness — which offers students “an opportunity to begin their lifelong journey to becoming culturally engaged.” This course has existed at Alvernia University for more than a decade, and demonstrates how Alvernia is leading the way in preparing culturally competent nurses.

Topics: cultural competence

Cultural Competence

Posted by Alycia Sullivan

Fri, Mar 01, 2013 @ 01:52 PM

To be culturally competent the nurse needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge. Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes.

Adapting to different cultural beliefs and practices requires flexibility and a respect for others view points. Cultural competence means to really listen to the patient, to find out and learn about the patient's beliefs of health and illness. To provide culturally appropriate care we need to know and  to understand culturally influenced health behaviors.

In our society, nurses don't have to travel to faraway places to encounter all sorts of cultural differences, such as ethnic customs, traditions and taboos. The United States provides plenty of opportunities for challenges stemming from cultural diversity. To be culturally competent the nurse needs to learn how to mix a little cultural understanding with the nursing care they offer. In some parts of the United States culturally varied patient populations have long been the norm . But now, even in the homogeneous state of Maine where we reside, we are seeing a dramatic increase in immigrants from all over the world.  These cultural differences are affecting even the most remote settings.

Since the perception of illness and disease and their causes varies by culture, these individual preferences affect the approaches to health care. Culture also influences how people seek health care and how they behave toward health care providers. How we care for patients and how patients respond to this care is greatly influenced by culture. Health care providers must possess the ability and knowledge to communicate and  to understand health behaviors influenced by culture. Having this ability and knowledge can eliminate barriers to the delivery of  health care.  These issues show the need for health care organizations to develop policies, practices and procedures to deliver culturally competent care.

Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989)  list five essential elements that contribute to an institution’s or agency’s ability to become more culturally competent. These include: 

1. valuing diversity; 
2. having the capacity for cultural self-assessment; 
3. being conscious of the dynamics inherent when cultures interact; 
4. having institutionalized cultural knowledge; and 
5. having developed adaptations of service delivery reflecting an understanding of cultural diversity. 

These five elements should be manifested at every level of an organization, including policy making, administration, and practice. Further, these elements should be reflected in the attitudes, structures, policies, and services of the organization.

Developing culturally competent programs is an ongoing  process, There seems to be no one recipe for cultural competency. It's an ongoing evaluation, as we continually adapt and reevaluate the way things are done. For nurses, cultural diversity  tests our ability to truly care for patients, to demonstrate that we are not only clinically proficient but also culturally competent, that we CARE..

Meyer CR.(1996) describes four major challenges for providers and cultural competency in healthcare. The first is the straightforward challenge of recognizing clinical differences among people of different ethnic and racial groups (eg, higher risk of hypertension in African Americans and of diabetes in certain Native American groups). The second, and far more complicated, challenge is communication. This deals with everything from the need for interpreters to nuances of words in various languages. Many patients, even in Western cultures, are reluctant to talk about personal matters such as sexual activity or chemical use. How do we overcome this challenge among more restricted cultures (as compared to ours)? Some patients may not have or are reluctant to use telephones. We need to plan for these types of obstacles. The third challenge is ethics. While Western medicine is among the best in the world, we do not have all the answers. Respect for the belief systems of others and the effects of those beliefs on well-being are critically important to competent care. The final challenge involves trust. For some patients, authority figures are immediately mistrusted, sometimes for good reason. Having seen or been victims of atrocities at the hands of authorities in their homelands, many people are as wary of caregivers themselves as they are of the care.

As individuals, nurses and health care providers, we need to learn to ask questions sensitively and  to show respect for different cultural beliefs.  Most important, we must listen to our patients carefully. The main source of problems in caring for patients from diverse cultural backgrounds is the lack of understanding and tolerance. Very often, neither the nurse nor the patient understands the other's perspective. 


Topics: nursing, cultural competence, transcultural, transcultural nursing

Diversity in Nursing

Posted by Alycia Sullivan

Fri, Mar 01, 2013 @ 01:49 PM

By: Mark E. Dixon

The nursing shortage isn't going away, but a federal commission had discovered one positive side effect - the shortage has helped make nursing one of the most ethnically diverse of the healthcare professions.

That's relatively speaking, of course.

Nurses are 50 percent more likely than physicians to be minorities, according to the final report of the Sullivan Commission on Diversity in the Healthcare Workforce.

Even so, Blacks, Hispanics and American Indians together total only 9 percent of nurses, despite representing about 25 percent of the U.S. population. By comparison, only 6 percent of physicians are minorities.

Minorities make up about 10 percent of nursing baccalaureate faculties and 4.2 percent of medical school professors. Nurse educators are more than twice as likely to be members of a minority group as are medical school professors. 

The problem with a disproportionately white healthcare workforce is that it cannot adequately serve a population that is increasingly non-white, according to the commission report.

"Diversity in the health workforce will strengthen cultural competence throughout the health system," the commission said. "Cultural competence profoundly influences how health professionals deliver healthcare."

According to the commission, language barriers in particular are a critical issue; 20 percent of Americans speak a language other than English at home.

Minority groups receive poorer quality healthcare and experience higher mortality rates from heart disease, HIV/AIDS, diabetes, mental health and other illnesses. Minority children are more likely to die from leukemia than white children. 

An increase of more than 20,000 minority nurses is needed to increase their proportion of the nursing workforce by 1 percent.

By the middle of this century, the U.S. population could be more than 50 percent nonwhite, according to the commission's report.

Recommended Strategies

Established in 2003, the Sullivan Commission was formed to recommend strategies to improve access to care and dismantle barriers to health professions' education.

Chaired by former U.S. Secretary of Health and Human Services Louis W. Sullivan, the 15-member commission consists of experts from the health, higher education, business and legal arenas.

The Sullivan Commission's findings were endorsed by the American Association of Colleges of Nursing, whose president, Jean E. Bartels, PhD, RN, called on legislators, nursing practice leaders and nurse educators to implement the commission's recommendations.

Bartels said: "National nursing organizations, the federal Division of Nursing, hospital associations, nursing philanthropies, and other stakeholders within the healthcare community agree that recruiting under-represented groups into nursing is a priority for the profession and an important step toward addressing the nursing shortage."

Commission recommendations included:

· Health profession schools should hire diversity program managers and develop plans to ensure institutional diversity.

· Colleges and universities should provide an array of support services to minority students, including mentoring, test-taking skills and application counseling. 

· Schools granting baccalaureate nursing degrees should provide "bridging programs" that help graduates of 2-year programs transition to 4-year institutions.  Associate nursing graduates should be encouraged to enroll in baccalaureate programs.

· Professional organizations should work with schools to promote enhanced admissions policies, cultural competence training and minority student recruitment.

· To remove financial barriers to nursing education, funding organizations should provide scholarships, loan forgiveness and tuition reimbursement programs.

· Congress should substantially increase funding for diversity programs within the National Health Service Corps and Titles VII and VIII of the Public Health Service Act.

Diversity Friendly

Meanwhile, nursing seems to be friendly to workers who are minorities.  

A study by Vanderbilt University nursing researcher Peter Buerhaus, PhD, RN, FAAN, showed that part of the 9 percent increase in the nursing workforce from 2001 to 2002 was due to nurses over 50 returning to the hospital.  

Hospitals are making work environments more supportive for older workers. For example, some offer scheduling flexibility and reduced physical requirements.

In addition, the acute nursing shortage and innovations such as talking thermometers have enabled nursing programs and employers to hire people with vision and hearing loss or impaired mobility.

A 2003 Bureau of Labor Statistics survey showed that Hispanics - 13.7 percent of the U.S. population - comprise just 4.4 percent of all medical records and health information technicians, 2.8 percent of pharmacists and 1.3 percent of emergency medical technicians and paramedics. Blacks (12.8 percent) comprise 2.6 percent of physical therapists, 1.3 percent of opticians and less than 1 percent of dental hygienists.

Asians, who make up 4.2 percent of the U.S. population, are represented at that rate or higher in most healthcare segments - particularly physicians and surgeons (16.1 percent), and clinical laboratory technologists and technicians (12.3 percent). However, they are underrepresented as licensed practical and vocational nurses (3.6 percent), dental hygienists (1.4 percent) and dispensing opticians (1.3 percent).

Source: Advance for Nurses

Topics: diversity in nursing, minorities, diversity, cultural competence

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