The importance of cultural competence

The United States is the most diverse country in the world. Its citizens are of all backgrounds, cultures, languages, races, ethnicities, and beliefs. This diversity presents a challenge to the health care professional. How can we ensure that we deliver the most effective care to each patient, regardless of his or her heritage?

As a nation, we’ve made great strides to incorporate cultural sensitivity and competency training and practice in health care. More and more medical schools require classes in cultural competency and doctor/patient communication, now understood to be a crucial aspect of patient care. The ability to communicate effectively across barriers of language and culture directly affects the patient’s treatment and outcome.

ASSESSING YOUR CULTURAL COMPETENCY

Measuring your own cultural competency can shed light on the depth of your knowledge about cultures different from your own. It can also reveal what more you should learn about a specific population’s beliefs and values. Georgetown University has developed the Cultural Competence Health Practitioner Assessment (CCHPA) for this purpose. Nurses can download an assessment from the university’s Center for Child and Human Development Web site. The public health section of the American Medical Association’s Web site provides information on eliminating health disparities, and the Oncology Nursing Society’s Multicultural Toolkit is another informative resource on cultural competency.

But knowledge of the broad differences between various cultures is not, by itself, enough. Reliance solely on research and data risks generalizations and stereotyping. Even two patients of the same ethnicity with the same medical condition can have very different experiences and expectations for their medical care—based on their individual socioeconomic status, education level, cultural traditions, religious or spiritual beliefs, and personal histories—that affect their outcome. For this reason, true cultural competency requires sensitivity to intercultural differences.

Language barriers are a chief obstacle in delivering effective health care. Many states have laws that require treatment centers to have in-house translators on staff; yet cultural differences between speakers of the same language can also impede clear communication and have a negative impact on a non-English speaking patient’s treatment. Nurses should ensure that these patients have a family member or other caregiver who understands English better accompany them to their appointments. Translation companies such as Language Line Services and Interpreters Unlimited provide over-the-telephone translation in more than 130 different languages. The Health Care Language Services Implementation Guide, from the US Department of Health and Human Services Office of Minority Health, was created to address and remedy language disparities in health care. Visit its Web site to learn more about meeting the needs of patients with limited English proficiency.

Understanding cultural differences not only improves the effectiveness of the treatment the patient receives, it can also help safeguard against potential liability and malpractice claims. Miscommunication between provider and patient is one of the most common reasons for lawsuits of this kind; therefore, it is crucial that treatment centers evaluate their linguistic competence, address any gaps, and thoroughly vet both in-house translators and any enlisted translation services.

Most important is to maintain a curiosity about each patient no matter how much you may know about that person’s culture. Learn more about the patient’s individual story and his or her feelings about the situation. Remain open to your patient’s questions about you, too. An open dialogue between you and your patients that transcends cultural barriers makes for the best medicine and will facilitate the best care. ONA

Acknowledgment: CancerCare oncology social workers Vilmarie Rodriguez, LMSW, and Jennifer LaPietra, LMSW, contributed their expertise and research to this article.

Helen Miller is CEO of CancerCare.