As the U.S. continues to diversify, so do patient populations. By demonstrating and increasing your cultural competence, you can enhance care quality, patient outcomes, and patient-staff relationships.

According to the U.S. Census Bureau, the 2020 Census indicated the U.S. is now more racially and ethnically diverse than in 2010. And in a 2021 Gallup poll, more individuals identified as a part of the LGBTQ+ community than in 2012.

As we strive for inclusive practices, we should consider the attributes, identities, and affiliations of patients, colleagues, and nurse leaders. Differences and similarities may involve anything from a person’s religious practices to their dietary restrictions. Cultural competence in nursing is the practice of understanding these types of differences and using them to inform how we build relationships and provide care — with awareness, empathy, and skill.

Cultural Awareness

Demonstrating cultural competence in nursing starts with awareness. With awareness, you’re identifying the diversity that exists among your patients and then using that information to provide care that is informed and free from bias.

Trish Richardson, RN

Richardson explained that awareness is considering all elements of a patient’s situation and using those elements to adapt your care, so the person feels understood and comfortable.

“For example, you may be caring for someone who is recently diagnosed with heart failure and will now need to take a daily medication and routinely monitor their weight,” explained Richardson. Is English their primary language or will you need to bring in medical translation support? How do their cultural beliefs influence whether they will be compliant with medications and discharge instructions? Do they have insurance, or would they benefit from a prescription discount card (if one is available)? Do they have a scale at home and internet access to transmit their weight logs to the doctor?”

Posing thoughtful questions like these will help you find ways to communicate with your patients so they can clearly understand you while maintaining their comfort.

2018 study showed that language barriers between patients and nurses is common. Most participants in this study used interpreters to clearly communicate with their patients, reporting improved care quality in work environments with these services.

By exemplifying awareness, you’re not only improving your nurse-patient relationship — you’re also improving the quality of your care.


Empathy is an essential part of the patient-staff relationship. By exhibiting empathy, you acknowledge an understanding of another individual’s feelings or perspectives through unbiased communication and listening.

Alisha Cornell, DNP, RN, and Senior Clinical Implementation Consultant at Relias, mentioned one example of empathy used in concert with cultural competence.

It’s vital to amplify empathy through active and unbiased listening and by asking questions geared toward understanding a patient’s needs, beliefs, and values to provide the most accurate type of care.

Many marginalized groups face health disparities, including discrimination or denial of some healthcare services. These instances can create an uncomfortable environment for the patient but also produce a lower quality of care. By ensuring your patients are being heard, you’ll reinforce the patient-staff relationship and help reduce some of the health inequities they encounter.


As a nurse, you follow organizational procedures while practicing skilled, evidence-based care. When you have patients with unfamiliar or unusual backgrounds, you can utilize your well-honed skills to understand their needs and provide care on their terms. Breaking away from your usual approach may seem difficult in some situations. However, applying cultural competence will help you adapt to each patient’s needs.

Some nurses may overthink certain patient interactions, Cornell said, mentioning patients who are Jehovah’s Witnesses and can’t accept blood products, for example.

Instead of overthinking this cultural belief and creating stress around the patient’s restriction,” she said, “the nurse can first assess if the patient is at risk of needing a blood transfusion during the hospitalization. Then they can tap into their cultural competency knowledge to better understand the healthcare practices of Jehovah’s Witnesses, as well as have a discussion with the patient or family to further understand the restriction.”

Cultural competence in nursing can help lower expectations or remove assumptions that nurses may have about how patients want to receive care or what is valuable to them, according to Cornell.

Nurses may not always have the exact answer, but as they demonstrate cultural competence in their practice, they’ll constantly learn something new with each patient. With this skill set and training resources as an aid, nurses can guide their patients to ensure they feel supported, heard, and respected.

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