Role & Growth
Culture and language influence how a patient perceives and interprets health and illness. Health disparities and subsequent poor health outcomes constitute a national crisis. Evidence shows that race, socioeconomic status and perceived biases adversely affect access to healthcare, views of disease and wellness, and ability to understand and adhere to treatment recommendations.1
In 2003, the Institute of Medicine called for the examination of attitudes, behaviors and corporate culture practices that contribute to health disparities.2 To correct cultural and ethnic inequities, healthcare organizations have incorporated elements of cultural competence.
What is Cultural Competence?
Cultural competence results in an ability to function effectively in cross-cultural situations.3 The first step toward cultural competence involves self-examination of personal values, biases and philosophies that may skew perception, response and interpretation of subjective data collected during healthcare encounters. Cultural competence is an ongoing process to build the skills necessary to remedy cultural, ethnic and racial inequalities.4
In 2001, the U.S. Department of Health and Human Services Office of Minority Health introduced a framework for integration of best practices for culturally and linguistically appropriate services (CLAS).3 The National Standards for Culturally and Linguistically Appropriate Services in Health Care have become the cornerstone for providing culturally appropriate care in all healthcare settings.1 The CLAS standards apply to all organizations that receive federal funds.3,5
Culturally Competent Care
Culturally competent care standards address general provider and staff competencies that help ensure quality patient-centered care. 1-3 Patients should receive understandable and respectful care in their preferred language, and that care should be compatible with their cultural health beliefs and practices.3 NPs and PAs can incorporate these standards by integrating patients' health beliefs and traditional practices (see table). In addition, NPs and PAs should recruit, retain and promote diverse staff and leadership who represent the demographic characteristics of the service area. All staff members should receive ongoing training in culturally and linguistically appropriate care.
Language Access Services
Language access services (LAS) standards require that federally funded service providers ensure adequate language access to patients with limited English proficiency.3 NPs and PAs meet LAS standards by offering and providing written and verbal notices informing patients of their right to receive bilingual services, interpreter services and language assistive services in their preferred language.
Organizational supports for cultural competence standards foster the ability to facilitate and enhance cultural competence.3 These standards emphasize the importance of participatory collaborative partnerships to facilitate community and patient involvement in designing and implementing CLAS-related activities. NPs and PAs should use these principles to guide strategic planning, program design and outcomes-based evaluations.
NPs and PAs can affect positive change by integrating cultural competence into their practice settings.
A free interactive CME-accredited curriculum is available to help integrate culturally competent practices. Access it at https://cccm.thinkculturalhealth.hhs.gov/.4
1. Putsch R, et al. (2003). Reflections on the CLAS standards: Best Practices, Innovations and Horizons. http://www.xculture.org/files/CLAS.Standards.Report.pdf. Accessed Jan. 4, 2012.
2. Smedley BD, et al, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, D.C.: The National Academies Press; 2003.
3. U.S. Department of Health and Human Services. Office of Minority Health. What is cultural competency? http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=11. Accessed Jan. 4, 2012.
4. U.S. Department of Health and Human Services. Office of Minority Health. A physician's practical guide to culturally competent care. Why culturally competent care? https://cccm.thinkculturalhealth.hhs.gov/. Accessed Jan. 4, 2012.
5. U.S. Department of Health and Human Services. Office of Minority Health. National Standards on Culturally and Linguistically Appropriate Services. http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15. Accessed Jan. 4, 2012.
Candace C. Harrington is an adult and gerontologic nurse practitioner who works for Evercare in Greensboro, N.C. She is a member of the adjunct faculty for Vanderbilt University School of Nursing in Nashville.
Culturally Competent Questions for Patients
• What do you call this illness?
• What do you think caused this problem?
• What does your sickness do to you? How does it work?
• How severe is your sickness?
• What problems has your sickness caused you?
• What kind of treatment do you think you should get?
• What are the most important results you hope to get?