Chapter Summary

Individuals and groups pass culture from one generation to the next in a dynamic process that influences a person’s actions and helps to shape their identities, roles, and lifeways. Cultural identity is the unique combination of beliefs, values, attitudes, behaviors, customs, practices, experiences, and language that make up an individual’s sense of belonging to a particular group. To provide culturally and linguistically responsive nursing care, nurses must develop cultural humility and awareness and prioritize client self-determination.

Culturally responsive care fully considers the needs of individuals and groups in relation to their cultural backgrounds, values, and preferences and is one potential outcome of the dynamic process of cultural competence. A nurse’s ability to provide effective, culturally responsive care involves ongoing reflection about their own attitudes, beliefs, and values, as well as an understanding of health inequities and the social determinants of health.

Personal factors that affect a nurse’s ability to provide culturally responsive care include value system, beliefs, customs, cultural identity, and knowledge and attitudes about other cultures. Implicit and explicit biases, stereotypes, othering, and ethnocentrism play a role in nurses’ interactions with clients. Barriers to providing culturally responsive nursing care include systemic and organizational barriers within the health care system and structural inequities in the broader health care environment.

Culturally responsive attitudes include a positive approach to diversity, respect and equal treatment for cultural differences, and cultural humility. Models of cultural competence offer ways to best provide culturally responsive care and include Campinha-Bacote’s process of cultural competence, Giger and Davidhizar’s transcultural model, and the Purnell model of cultural competence. Tools for self-assessment of cultural competence include the IAPCC-R and the TSET.

Cultural and linguistic competence is the ability to understand and respond effectively to the culturally diverse needs that clients bring to health care encounters. Different communication styles affect how individuals interpret messages and may involve tone, volume, and speed of speech; eye contact; facial expressions; emotional expressiveness; and high- and low-context communication. Promoting health literacy—the ability to access, understand, and use health information or services to make informed decisions—can reduce health disparities.

Strategies to provide clients with culturally and linguistically competent care include translation, interpretation via certified medical interpreters, observation of nonverbal communication, use of jargon-free language, the “teach-back” method, and culturally tailored materials. Such strategies address the specific content, language, and delivery needs of different clients and can improve their engagement and outcomes.