Cultural sensitivity begins with a recognition that there are differences between cultures. These differences are reflected in the ways that different groups communicate and relate to one another, and they carry over into interactions with health care providers. Cultural sensitivity does not mean, however, that a person need only be aware of the differences to interact effectively with people from other cultures. If health care providers and their patients are to interact effectively, they must move beyond both cultural sensitivity and cultural biases that create barriers. Developing this kind of culturally competent attitude is an ongoing process.
A culturally competent clinician views all patients as unique individuals and realizes that their experiences, beliefs, values, and language affect their perceptions of clinical service delivery, acceptance of a diagnosis, and compliance.
Cultural competence is an important component of nursing care. This is especially true given America's increasingly diverse patient population and the disparities in the health status of people from different racial, ethnic,
Recognizing differences among cultures is important, but the clinician should also be aware that differences also exist within cultures. The assumption that a common culture is shared by all members of a racial, linguistic, or religious group is erroneous. The larger group may share common historic and geographic experiences, but individuals within the group may share nothing beyond that.
Culture greatly influences how people view their health and the health care services they receive. Clinicians should be aware of these differences, respect them, and work within the parameters set by the patient's values. Clinicians must also recognize their own cultural values and draw parallels where possible; they should also identify any prejudices and stereotypes that prevent them from communicating effectively with patients from different cultures.
The language barrier
Language differences between the clinician and the patient are a further barrier to optimum health care. Where possible, hospital or local school translators should be used, since it's not always in the client's best interest to have a family member act as an interpreter. The client may feel uncomfortable discussing personal matters in front of a relative. In addition the interpreter may lack a medical vocabulary, or may reinterpret what the patient says in an effort to "help." Role conflicts may further hinder translation. For example, a child or a person of the opposite sex may be embarrassed by the information or feel it improper to convey the message intended.
When using an interpreter the clinician should:
- Try to find an unrelated interpreter of the same sex as the patient, who is able to translate medical information clearly.
- Schedule more time for the appointment, if possible. Discuss the focus of the session with the interpreter before the patient arrives; be clear about what the interpreter should convey to the patient.
- Have the interpreter meet with the patient before the session to assess his or her educational level. This will determine how complex the discussion can become. If the patient has already met the clinician, the interpreter should be presented as a member of the healthcare team.
- Speak in short sentences or phrases, to make translating easier for the interpreter. Make sure the patient under- stands what he or she has been told by asking for him/her to repeat the message in his/her own words.
- Remember who the patient is—keep the focus on the patient, not the interpreter.
- Be sensitive to cultural differences when using nonverbal communication. For example, a touch has many cultural meanings. Clinicians must be aware that personal space has different boundaries in different cultures.
One of the biggest debates about cultural competence is whether the health care provider should be of the same culture or speak the same language as the patient. Many clinicians from racial, ethnic, or cultural minorities believe very strongly that providers should be of the same culture as the patient. Others believe this is unnecessary and wrongly maligns people who aren't members of that specific group.
Another area of disagreement is whether training programs, such as diversity workshops, affect cultural competence. The argument against them is that cognitive information does not necessarily change attitudes or behavior.
In order to be culturally competent clinicians need not possess full knowledge of every cultural practice and belief. Instead they should be sensitive to others' preferences and values, and should not assume that one person's preferences and values apply to everyone in that same group. Patients are often willing to share their customs with those who seek to understand them. Genuine concern about what is important to the client is the best way to insure that culturally competent care will be provided.
Chrisman, Noel J., and Phyllis Arn Zimmer. "Cultural Competence in Primary Care." In Adult Primary Care. Edited by P. V. Meredith and N. M. Horan. Philadelphia:W. B. Saunders, 2000.
Chrisman, Noel J., and Phyllis Arn Zimmer. "Transforming Health Care through Cultural Competence Training." In Cultural Diversity in Nursing: Issues, Strategies and Outcomes. Washington, DC: American Academy of Nursing, 1997.
Uffen, Ellen. "Becoming a Culturally Competent Clinician." American Speech-Language Hearing Association Leader (April 2001).
Blue, Amy V. "Provision of Culturally Competent Health Care." Medical University of South Carolina, Deans' Rural Primary Care Clerkship. <http://www.musc.edu/deansclerkship/rccultur.html>.
Chrisman, Noel J., Ph.D., M.P.H. Professor, Community Health Nursing, School of Nursing, University of Washington. Interview by author.
Cohen, Elena, and Tawara D.,Goode. "Why Is There a Compelling Need for Cultural Competence?" National Center for Cultural Competence. <http://gucdc.georgetown.edu/nccc/nccc6.html>.
"How Does Cultural Competency Differ from Cultural Sensitivity?" Center for Effective Collaboration and Practice. <http://cecp.air.org/cultural/Q_howdifferent.htm>.
King, Mark A., Anthony Sims, and David Osher. "How Is Cultural Competence Intergrated into Education?" Center for Effective Collaboration and Practice. <http://cecp.air.org/cultural/Q_integrated.htm#def>.
Palinkas, Lawrence A., Ph.D. Professor, Department of Family and Preventive Medicine, University of California, San Diego. Interview by author.
"Why Is Cultural Competence Important for Health Professionals?" Diversity Rx. <http://www.diversityrx.org/HTML/MOCPT1.htm>.