Culturally Competent Care
Key concepts
Culturally competent care is patient-centered and aims to make patients feel supported and safe by recognizing and respecting cultural differences.
Cultural competence is a lifelong process of applying evidence-based nursing while respecting patients' cultural values, beliefs, worldviews, and practices to improve outcomes.
Transcultural nursing is the core field that integrates culture into health care to help people maintain/regain health or face death in a meaningful way.
Core theories and models:
Cultural care theory (also linked to transcultural nursing): health care must consider a person’s cultural background to be effective; culture shapes health and health care concepts.
Transcultural Assessment Model (Geiger and David Heiser): six cultural phenomena guide assessment of culturally diverse individuals.
The four C’s of cultural assessment: a quick tool to identify patient perspectives on problems and care.
The aim of culturally competent care is to improve care quality and health outcomes for culturally diverse patients through awareness, curiosity, and sensitivity.
Theoretical foundations
Madeline Leininger (nurse and anthropologist) and the concept of transcultural nursing
Transcultural nursing incorporates patients' cultural beliefs and practices to help maintain/regain health or face death in a meaningful way.
Cultural Care Theory (Dr. Langenhaer in the transcript) asserts that health care cannot be effectively provided without considering a person’s cultural background.
Culture is a fundamental component of human life and influences health perceptions, illness experiences, and health care expectations.
Therefore, health care providers must approach each person with cultural sensitivity and tailor care to their cultural needs.
These theories form the basis for culturally competent care and health equity across diverse populations.
The Transcultural Assessment Model
Developed by Geiger and David Heiser
Purpose: guide nurses to assess and provide care for culturally diverse people by acknowledging each person as unique.
The six cultural phenomena to assess:
Communication – language, tone, and nonverbal cues used by patient and provider; cultural variations affect interaction effectiveness.
Personal space – different cultures have different comfort zones; four zones define interpersonal distance:
Intimate: within 1.5 ft
Personal: within 4 ft
Social: within 10 ft
Public: more than 10 ft
Nurses should respect cultural norms around space and observe cues; enter personal space only with permission.
Social organization – family, community roles, and decision-making patterns; family involvement in care varies by culture.
Time orientation – cultural beliefs about punctuality and whether time is linear or cyclical.
Environmental control – beliefs about causes of illness and use of traditional healing practices; control over environment as a cultural factor.
Biological variations – beliefs about biology, illness causation, and use of alternative therapies; pain management and medication views vary.
Cultural context and personal space
Personal space is culturally influenced; entering someone’s space can cause distress.
If a nurse must enter personal space, obtaining permission and explaining the reason is important.
Modesty and exposure concerns vary; respect patient cues and preferences.
Touch is also culturally sensitive; gender norms may affect who provides care in certain situations.
Cultural beliefs about nutrition and health practices
Cultural traditions influence nutrition, postpartum care, and dietary practices:
Indonesia: pregnancy and breastfeeding may include taboos; some fruits, meats, fish, soda, coconut water, and cold beverages may be avoided;
Rural Zula communities: some fruits taboo; consumption of sweets, ice, and alcohol may be prohibited; postpartum recovery foods favored include soft porridge, fruits, vegetables, beetroot, and tea;
Asia (postpartum): rice commonly eaten; meat may be taboo for a period (e.g., two months postpartum) depending on locale; easy-to-digest, high-protein, warm, cooked, brothy foods (soups/stews) are nourishing;
Food insecurity contexts may alter taboo restrictions after birth;
Menopause in South Asia: predominantly plant-based diets linked to fewer hot flashes and night sweats due to estrogen changes;
Spanish women: Mediterranean diet (olive oil, fruits, fish, white meats, modest alcohol) associated with less menstrual pain and shorter cycles;
Malaysia: belief that during menstruation only certain staple foods like rice and cassava should be consumed due to concerns about health or luck;
India: some regions restrict sour foods (curd, tamarins, pickles) during menstruation due to beliefs about menstrual disruption.
These beliefs influence food choices, health management, and attitudes toward illness and recovery.
Cultural nursing assessment process
Culturally competent care requires:
Introducing yourself by name and role when entering a room; acknowledging family members; Addressing the patient with their title and last name; asking how they wish to be addressed and their pronouns; documenting preferences;
Stand at least an arms length from patient.
Observe how the person and family members communicate non-verbally, such as by on contact, spacing, touch and other behaviors, to determine the level of nonverbal communication to follow
Documenting the patient’s preferred language and whether an interpreter is needed; using interpreters when necessary to prevent misunderstandings;
Asking respectful questions about culture and beliefs to avoid miscommunication; inquiring about limits on who can provide care (e.g., same-gender provider preferences in some cultures);
Ask if any limitations exist on who can care for a patient. For example, many patients who are Muslim will prefer a same gender care provider.
Show respect for the patient’s cultural beliefs and values. Integrate the cultural beliefs in nursing care as much as possible.
Reassuring patients that culturally competent care is a priority for all health care workers;
After establishing a culturally sensitive environment, incorporating a cultural assessment into care using various assessment guides; the Four C’s model is an example of a quick tool.
The four C's of cultural assessment
What do you think is wrong? What is worrying you?
Purpose: discover the patient Considers to be the problem and what they call it.
What do you think Caused this problem? How did this happen?
What are you doing to Cope with this problem? How are you taking care of yourself?
How serious are the problems for you? How Concerned are you?
The four questions help reveal the patient’s perspective, beliefs about causation, coping strategies, and perceived seriousness.
Ethical and clinical practice implications
Respect patient autonomy and preferences while balancing safety, nutrition, and medical needs.
Avoid cultural stereotyping by using structured assessment (the four Cs) and individualizing care.
Ensure language access through interpreters to prevent miscommunication and to support informed decision-making.
Recognize the emotional impact of cultural transition (moving to a new country, loss of a spouse) on health perception and care needs.
Consider gender-sensitive care preferences (e.g., same-gender providers) when requested by patients.
Summary takeaways
Culturally competent care requires ongoing learning, humility, and explicit integration of cultural beliefs into care plans.
The transcultural nursing framework emphasizes culture as a central determinant of health and care delivery.
The Transcultural Assessment Model provides a practical structure to evaluate cultural variables affecting care.
The four Cs offer a concise, structured way to elicit the patient’s own understanding of their health problem, its causes, coping strategies, and perceived seriousness.
Real-world application (e.g., the Miss Wang scenario) demonstrates how to implement culturally sensitive assessment and care planning in a clinical setting while accommodating language needs, personal space, dietary preferences, and family involvement.