NURS1003 Lecture 11: 11. Cultural Competence
Topic 11: Cultural Competence
Cultural competence is “A set of behaviours, attitudes, policies, and structures that enables
the health care system to deliver the highest quality care to patients regardless of race,
ethnicity, culture, or language proficiency”
Cultural awareness + Cultural Safety = Cultural Competence
What does Cultural Competence mean in practice?
At what point do you define someone or an institution as competent?
How do we measure it?
What are we measuring?
How often do we measure it?
Who sets institutional priorities?
Who decides what set of skills are needed?
Is it covered in training, legislation?
Institutional approaches to cultural competence
“Cultural Competence helps health institutions:
To respond to current and projected demographic changes
oknow them, can work with change in demographics
ourban to rural
To eliminate long‐standing disparities in health status
osocial determinants
To improve services and outcomes
To meet legislative, regulatory and accreditation mandate
ocultural competence is require for nursing
To gain a competitive edge in the marketplace
To decrease the likelihood of liability/malpractice claims”
Medical Dominance: A competing culture?
Example: Biomedical model western/high income countries
control who provides services – insurance for different practitioners
fits in western legal systems suing (Hmong women case)
Medical dominance can make achieving culturally informed care difficult:
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Hierarchical
Efficiency (time, staff, resources)
Legal constraints and concerns (litigation)
View of health
Ongoing socialisation of health professionals
‘silo’ practices (disciplines working in isolation, rather than inter‐ professionally)
Changing infrastructure is expensive
The process: cultural safety
Cultural Safety: The acknowledgement by health professionals and organisations of the need
to provide services in a manner appropriate to all members of a diverse population. Cultural
safety is achieved when a client perceives their healthcare was delivered in a manner that
respected and maintained their cultural integrity.
Culture includes but is not limited to age, gender, sexual orientation, SES, ethnicity,
migrant experience, religion
Health professions should reflect on their own cultural identity
Unsafe cultural practice diminishes, demeans or disempowers the cultural identity
and wellbeing of the recipient
The goal: cultural security
Cultural Security: When health organisations and health professionals operate from a
position where appropriate responses to cultural diversity are not only acknowledged, but
actually embedded in all aspects of health care (e.g. from policy to practice)
Respect and care for all humans
Incorporates history
oe.g. colonisation
Recognises impact of power relations – including medical dominance
Recognises similarities as well as diversity
Holistic – all aspects of a person
Acknowledges and addresses the social determinants of health
Structural – embedded in social institutions
Cycle of evaluation and improvement, adaptive to changing needs
Negotiation, communication, consensus‐ building
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Document Summary
Cultural competence is a set of behaviours, attitudes, policies, and structures that enables the health care system to deliver the highest quality care to patients regardless of race, ethnicity, culture, or language proficiency . Cultural awareness + cultural safety = cultural competence. To respond to current and projected demographic changes: know them, can work with change in demographics, urban to rural. To eliminate long standing disparities in health status: social determinants. To meet legislative, regulatory and accreditation mandate: cultural competence is require for nursing. To gain a competitive edge in the marketplace. Example: biomedical model western/high income countries control who provides services insurance for different practitioners fits in western legal systems suing (hmong women case) Medical dominance can make achieving culturally informed care difficult: Silo" practices (disciplines working in isolation, rather than inter professionally) Cultural safety: the acknowledgement by health professionals and organisations of the need to provide services in a manner appropriate to all members of a diverse population.
