The document discusses the importance of cultural competence for nurses. It begins by outlining how culturally competent nurses can positively impact patient care, health outcomes, and quality of life. The author then describes their experience taking a cultural competence course which led them to critically examine their own cultural beliefs and biases. Through introspection, the author realized they held unconscious sexist beliefs that had negatively influenced their nursing practice, especially regarding pediatrics and obstetrics. The course taught the author that developing cultural competence is an ongoing process that requires regular self-evaluation to confront changing personal biases. The document concludes that mastering cultural competence is essential for nurses to provide optimal, non-harming patient care.

1. RUNNING HEAD: CULTURAL COMPETENCE: INTROSPECTION, INFLUENCE & IMPACT 1
Cultural Competence: Introspection, Influence and Impact
Anthony Grissett, RN, MBA
Caring for a Multicultural Society
NSG 3016
Colleen Darrow, Professor
June 22, 2015

2. Cultural Competence: Introspection, Influence and Impact 2
Abstract
Culturally competent registered nurses can hugely impact patient care, health outcomes and
quality of life measures. Possessing an effective skill set requires a commitment to evaluating personal
beliefs and biases, passion to consistently seek new learning experiences and opportunities as well as the
willingness to advocate for patients who have been historically marginalized. The scope of impact
includes increased access to care for minority populations, improved communication between staff,
patients and families, enhanced educational opportunities and broader research on efficacy of established
evidence based practices on diverse ethnic and cultural populations.
Influence on Nursing Care

3. Cultural Competence: Introspection, Influence and Impact 3
The concepts learned in Caring for a Multicultural Society can be readily implemented
and immediately begin improving the quality of care delivered by student RNs; in turn greatly
improving patient outcomes and facility quality measures. A culturally competent nurse begins
with self-evaluation; recognizing and addressing closely held personal beliefs and cultural biases
is the first step in delivering quality care. A workforce committed to continually doing the work
required to meet the needs of all patients should be the goal of all healthcare facilities and is just
one of the influences cultural diversity brings to the medical field. Additional areas of influence
include:
o Improved communication between medical staff, patients and families.
o Better educated and medically compliant patients.
o Reduced barriers to accessing healthcare delivery systems by traditionally
marginalized populations, and
o Enhanced focus on cultural/racial differentiations in established evidence based
practices (EBP).
Instantaneously a culturally sensitive nurse’s communication skills are enhanced; by
recognizing that each patient brings unique cultural, ethnic and sociodemographic beliefs and
practices. Homogenous assumptions based on outward appearance are expelled when one is
dedicated to meeting the unique needs of each patient. Conversations ensue to gauge how family
traditions, social stressors and personal health practices influence the patient’s beliefs on healing
and recovery. Intimate exchanges work to build common ground which fosters a mutually
beneficial relations, as opposed to an imbalance of power which is commonly expressed by
minority and marginalized patients.

4. Cultural Competence: Introspection, Influence and Impact 4
Improved communication, respect for differences and recognition of individual agency
has the additional benefit of enhancing patient education and/or training. Recognizing cultural
nuances that will influence compliance with recommended medical interventions is essential to
promoting optimal patient outcomes. Muslim dietary practices, Jehovah’s Witness belief on
blood products and the traditional diet of Southern African Americans are all factors one must
consider when educating a Type 2 Diabetic on daily nutritional intake. A culturally sensitive
nurse will recognize cultural beliefs, but through conversation and intimate interaction, will also
identify subtle patient specific nuances that need be addressed to encourage the needed dietary
adjustments. Compliance with prescribed medications, frequency of follow up visits and
referrals to specialists must all be moderated by patient specific practices and beliefs.
When patients recognize that historical practices of racism, discrimination and biased
care delivery are being challenged, overhauled and supplanted by a uniform commitment to
health equity for all; many of the barriers to accessing healthcare services by the systemically
disenfranchised will be eliminated. This progression will be more daunting and fractious than
the aforementioned spheres of influence. However, overcoming deeply held distrust, resentment
and maltreatment will require a more concerted effort; but is no less achievable.
Essential to this aim is reinvestigating currently accepted evidence based practices.
Recent literature and reports are inundated with calls for culturally competent evidence based
practices; which have historically had limited participation from minority populations. This lack
of diversity calls into question whether or not established EBPs are truly impactful. In order to
assuage doubts universities, pharmaceutical companies and healthcare facilities will need to
validate whether or not currently utilized EBPs are truly universal; or are there modifications that
must be employed to meet the needs of varying ethnicities and cultures?

5. Cultural Competence: Introspection, Influence and Impact 5
Introspection: Critically Interrogating Personal Beliefs
Over the past five weeks my understanding of personal cultural adeptness has changed
drastically. At the beginning of this course I considered myself “highly proficient” regarding
cultural competence. For the past 15 years I have worked diligently to address health disparities
in underinsured and disenfranchised populations. My commitment to health equity is
unquestionable. I have written grants, created programs and advocated endlessly for improved
access to care for minorities in Northeast Florida. I have conducted trainings, presented at
conventions and published articles on the importance culturally competent care; so when I
initially completed the Culturally Competent Assessment, I was surprised by how much I didn’t
know.
Honestly, the focus of my work has been improving health outcomes for African
Americans and Hispanics; more specifically black and Hispanic males. While, extremely versed
on all aspects of injustices, oversights and needed changes for this group; I did not critically
interrogate my personal beliefs regarding other ethnic cultural groups. The initial assessment
also highlighted that I lacked proficiency regarding specific aspects of the population on which I
purported to be an authority. When it came to child birth and rearing, my skills were sorely
deficient. Pediatrics was the one area of nursing that I had no interest in at all. I begrudgingly
stumbled through that semester; giving the minimal attention to the coursework and clinical.
After I completed the initial assessment, I realized that I had never critically interrogated my
personal beliefs regarding this area of nursing care. Why was I so adverse to pediatrics? What
was it about children, child birthing and rearing that I found so repugnant.
Truthful introspection brought forth the truth; while I am comfortable being a “male
nurse”, I find caring for children and child bearing mothers to be “women’s work”. Yes, I the

6. Cultural Competence: Introspection, Influence and Impact 6
male feminist, the advocate for true equality of the sexes is indeed “sexist”! I can be a great
nurse; maintaining my masculinity, as long as I don’t care for children or pregnant women. This
would be beneath me, would show weakness, would be an embarrassment worthy of all the
baseless slurs and slights that staunch believers in patriarchy hurl at men who don’t live up to
masculine stereotypes. “I am afraid of what people will say about me if I was to pursue
Pediatrics or Obstetrics as my area of specialty” this is something I never contemplated or
verbalized, but there it was. A shameful reality that negated my ability to be effective in my
chosen profession. I began to think about the missed opportunities for self-actualization during
my clinical rotation and while work as a professional nurse. The many times I dismissed patient
concerns, sped through interactions and skipped over suggested interventions because I felt
uncomfortable in my role. If I as a paid Cultural Competence Trainer and self-professed
“Specialist” could be so misguided; how much so are nurses who have not had the education,
training and resources I have been privy to?
Impact to Personal Nursing Role & Practice
The subject matter covered in this course, from cultural competence assessment to
weekly postings and culminating with this assignment have all culminated in improving my
nursing skill set. When reading Paulo Freire’s “Pedagogy of the Oppressed”, I was most struck
by the explanation of “education” which stems from the Latin “educe” which means “to bring or
lead out”. Hence, education is the process of “bringing or leading out” what is innate; which is
what the materials covered, assignments completed and experiences borne of this coursework
have accomplished. The overarching lesson I take from this experience is the recognition that
the work of cultural competence is ever changing, requires a commitment to life-long practice

7. Cultural Competence: Introspection, Influence and Impact 7
and demands regular assessment of personal beliefs and biases; which change as societies
become more diverse and fluid.
Conclusion
Campinha-Bacote and Munoz created a model for developing cultural competence. The
five cultural components are awareness, knowledge, skill, encounter, and desire (Campinha-
Bacote, 2011). While, I had the desire, awareness and encounters my knowledge and skills were
lacking. In all honesty, I focused my training and energy on populations in which I had a vested
interest and ignored doing the work that would make me truly impactful. In the study, Culturally
Competent Nursing Care; A Challenge for the 21st
Century, the author found unintentional
stereotyping, eschewing subcultures and subjective categorizations as pitfalls to be avoided.
Assuming myself to be a “Cultural Competence Specialist” was puerile. While I had
extensive training and mastery of the language; I was self-centered and narrow focused in
practice which is the antithesis of cultural competence. Regular self-evaluation of cultural
competence knowledge, beliefs and practices is essential to being an effective purveyor of this
skill set. The easily identifiable benefits to patient outcomes and overall quality of life makes the
necessity of mastering this skill obvious. As registered nurses we are charged with “doing no
harm”; and ensuring that we are diligently working to provide optimal care is the cornerstone of
this mandate. Not doing the work required is inexcusable.

8. Cultural Competence: Introspection, Influence and Impact 8
References
Campinha-Bacote, J. (2011). Delivering patient-centered care in the midst of a cultural conflict:
the role of cultural competence. The Online Journal of Issues in Nursing., 16(2).
Flowers, D. L. (2004). Culturally competent nursing care: a challenge for the 21st century.
Critical Care Nursing, 48-54.