Culture refers to knowledge, beliefs, behaviors, ideas, attitudes, values, habits, customs, languages, symbols, rituals, ceremonies, and practices that are unique to a particular group of people. Culture is learned from one generation to the next, shared, social in nature, and dynamic. Ethnicity is a group’s perception of themselves, or a group identity, involving a common social heritage passed from one generation to the next. Race is a grouping of people based on biological similarities, such as facial features or color. Race and ethnicity are often related because biological and cultural similarities reinforce each other.

Ethnocentrism is the belief that one’s own culture is superior to all others. Oppression follows when one group imposes cultural biases on another. Racism is discrimination directed toward those who are misperceived to be inferior due to biological differences. Stereotyping is the expectation that all members of a racial, ethnic, or cultural group act alike and share similar beliefs and attitudes.

The United States is a multicultural society; but its dominant culture is of white, middle-class, Protestant, European ancestry. Minority groups are ethnic, racial, or religious groups making up less than a majority of the population. Over the years, immigrants and refugees have entered the United States from non-European countries, contributing to the multicultural nature of society. People gain knowledge of the characteristics of the dominant group through acculturation, the process of learning norms, beliefs, and behavioral expectations of a group. They go through cultural assimilation when they become absorbed by the dominant culture.

Each culture in a society can be defined by several organizing phenomena: communication, space, orientation to time, social organization, environmental control, and biological variations. Communication is important since language barriers and body language affect mutual understanding. Likewise, the use of personal space and a person’s orientation to time vary by culture.

Social organization includes family, religious, and ethnic groups. Extended family is more important in Native American and Hispanic American cultures than in the majority culture. The definition of “family” is broadening in our society, requiring the nurse to reframe traditional notions of family groups. Alternate lifestyles are becoming more common in the United States and require cultural awareness on the part of the nurse.

Environmental control refers to the relationships between people and nature and to a person’s perceived ability to control activities of nature. An example is a culture’s determining cause of illness. For example, some cultures believe that illness is caused by supernatural forces or by disharmony between the person and the environment and may not be likely to attribute disease to lifestyle or other factors. Biological variations among cultures include enzymatic differences, susceptibility to disease, and nutritional variations. Traditional standards of childhood development do not apply to all cultures because patterns of upbringing, and perhaps biological characteristics, differ across cultures. Additionally, the biological response to various medications varies across cultures.

Transcultural nursing was initiated by nurse/anthropologist Madeleine Leininger. Transcultural nursing refers to the study and analysis of different cultures and subcultures with respect to cultural care, health beliefs, and health practices, with the goal of providing health care within the context of the client’s culture. Nurses who understand cultural factors are more open to some of the subtle reasons for client behavior and preferences. Folk remedies and healers often perplex health professionals because folk remedies may conflict with traditional medicine.

Studying culture is also important because cultural disparities negatively influence access to health care. Some populations are at greater risk for health problems, including the poor, the homeless, migrant workers, abused individuals, the elderly, pregnant adolescents, and people with acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases. These vulnerable populations have difficulty finding transportation to medical services, difficulty understanding medical instructions, and fewer financial resources to access care. The homeless, often deinstitutionalized from mental health facilities without adequate community support, are more susceptible to diabetes, AIDS, respiratory diseases, cardiovascular diseases, and parasitic infestations.

Cultural Competence and the Nursing Process

Cultural competence is the process through which the nurse provides care appropriate to the client’s cultural context. Culturally competent nurses are aware of the client’s cultural values, beliefs, and practices; seek knowledge about other cultures; have the skills to perform a culturally-specific assessment; willingly interact with clients from diverse backgrounds; and are motivated to become culturally competent or sensitive.

Nurses providing culturally competent care perform a cultural assessment, formulate nursing diagnoses, and evaluate their plans of care. A culturally competent cultural assessment requires self-reflection, facilitation of client choice, gaining cultural knowledge, and effective communication. A cultural assessment should include the client’s ethnic heritage, family roles and functions, religious practices, food preferences, native language, social networks, formal and informal educational experiences, health care beliefs, and family patterns of health care. Formulating culturally competent nursing is challenging because several nursing diagnoses are culturally biased. For example, a nurse may use the nursing diagnosis Impaired Communication simply because the client speaks a different language. Other nursing diagnoses, such as Noncompliance, Impaired Social Interaction, Deficient Knowledge, Disturbed Thought Processes, and Powerlessness, may also be used in a culturally inappropriate manner.

Culturally Competent Nursing Interventions and Evaluations

Culturally sensitive nursing intervention requires self-awareness, a nonjudgmental approach, and client education. Self-awareness necessitates introspection and study of other cultures. A nonjudgmental approach entails avoiding stereotyping and judgmental words or avoiding reacting negatively to another person’s lifestyle. Client education needs to be delivered without medical jargon and without looking down on the client. Instructions should be given with an interpreter, if necessary, and with the active involvement of both client and family. Culturally competent evaluation means involving the client in determining the client’s and nurse’s progress toward meeting expected outcomes.