The United States is becoming more ethnically and racially diverse, yet there is evidence that disparities and other challenges still exist. One way to address these gaps is the promotion of cultural competence on a system-wide scale. Because nurses are patient advocates, they are in a pivotal position to effectively provide culturally competent care to improve patient outcomes.
The U.S. Population Is Becoming More Diverse
According to United States Census Bureau projections, the nation will become markedly more diverse by 2060. Then-acting director Thomas L. Mesenbourg said, “The next half century marks key points in continuing trends — the U.S. will become a plurality nation, where the non-Hispanic white population remains the largest single group, but no group is in the majority.” The U.S. Census Bureau estimates that racial and ethnic minorities, who now make up about 37 percent of the U.S. population, will comprise 57 percent in 2060.
In brief, the census bureau expects the Asian and Hispanic populations to more than double, American Indian and Alaska native populations to increase by more than half, and Native Hawaiian and other Pacific Islander populations to nearly double. Groups who identify as bi-racial or multi-racial are projected to triple. The black population will rise slightly, and the white population, expected to peak in 2024, will slowly decrease thereafter. According to the Pew Research Center, by 2065, one in three Americans will be an immigrant or have immigrant parents, compared with one in four today.
Despite the growing diversity in the population, disparities in the healthcare system remain. The Institute of Medicine (which changed its name to National Academy of Medicine [NAM] in 2015) report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care is the result of a committee that reviewed over 100 studies of healthcare assessments for various racial and ethnic minority groups. Their findings show that the vast majority of minorities are less likely than whites to receive needed services — even when other variables, such as insurance status, age and income are similar.
Why Cultural Competence is Important
One recommendation for closing the gap on these disparities from the Unequal Treatment report, is to promote cultural competence. The National Institutes of Health (NIH) identifies cultural respect as an essential factor in reducing healthcare disparities and improving access to high-quality healthcare for a diverse groups of patients.
According to a report by the Commonwealth Fund called Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches, there is a common thread in the assorted definitions of cultural competence: Nearly all refer to the need for healthcare providers to be aware of, and responsive to, differences in patients’ cultures. Experts view cultural competence as a way to increase access to quality care for all patient populations. It would replace the current one-size-fits-all model with a system that is more responsive to diverse populations.
Failure to be culturally competent can lead to patient dissatisfaction. According to Cultural Competence in Health Care: Is it important for people with chronic conditions?, by Georgetown University’s Health Policy Institute, one source of dissatisfaction relates to language. The report says lack of effective communication can lead to patient dissatisfaction and a lower quality of care. For instance, Spanish-speaking patients report being less satisfied with their care and more likely to report problems with healthcare than their English-speaking cohorts. When patients used professional interpreters, however, they were as satisfied with their healthcare visit as those who used bilingual providers.
Another barrier to achieving cultural competence is a lack of understanding of diverse cultures and beliefs. Per the report, Asian Americans are the group least likely to feel that their healthcare providers understand their backgrounds and values.
Why Cultural Competence is Necessary in Nursing
According to an article in Critical Care Nurse, cultural competence can help nurses establish better rapport with their patients. Improved levels of communication can be a critical factor in assessing patient needs and developing appropriate treatments and interventions. The authors say that “culturally competent care cannot be offered to all patients unless nurses have a clear understanding of diverse cultural backgrounds.”
For instance, the author references a case in which a Vietnamese mother appeared unable to bond with her newborn infant who was too ill to be discharged. She fed him and changed his diapers but would not show any outward signs of maternal bonding, nor would either parent visit the baby while he was hospitalized. The nurses were justifiably concerned, but after consulting with a nurse specializing in trans-cultural care, they learned that the parents behaved like this because of cultural beliefs. Like many rural Vietnamese, the parents believe spirits are attracted to newborns and are likely to cause them harm. By avoiding the baby, they believe they are deflecting attention from the infant. This seeming lack of concern was in fact a reflection of their intense love for the infant.
The online RN to BSN program at Arkansas State University can help prepare nurses to provide culturally competent care. One of the program’s core courses, Cultural Competence in the Health Professional, teaches self-assessment through awareness, knowledge, sensitivity and acceptance of the role cultural issues play in a diverse healthcare system. In an increasingly racially and ethnically diverse nation, reducing disparities in the healthcare system has become a priority. Cultural competence — understanding cultural beliefs and differences within diverse patient populations — is a useful approach that can improve patient outcomes.
Learn more about the A-State online RN to BSN program.
U.S. Census Bureau Projections Show a Slower Growing, Older, More Diverse Nation a Half Century from Now. (2012, December 12). http://www.census.gov/newsroom/releases/archives/population/cb12-243.html
Cohn, D’Vera. (2015, October 5). Future immigration will change the face of America by 2065. http://www.pewresearch.org/fact-tank/2015/10/05/future-immigration-will-change-the-face-of-america-by-2065/
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. (2002, March 20). http://www.nationalacademies.org/hmd/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx
Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches. (2002, October). https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2002_oct_cultural_competence_in_health_care__emerging_frameworks_and_practical_approaches_betancourt_culturalcompetence_576_pdf.pdf
Cultural Competence in Health Care: Is It Important for People With Chronic Conditions? (2004, February). https://hpi.georgetown.edu/agingsociety/pubhtml/cultural/cultural.html