The document reviews cultural incompetence in nursing, highlighting its impact on healthcare delivery, particularly for minority populations in the United States. It discusses the roots of cultural incompetence in nursing education, the challenges faced by nursing students and professionals, and the lack of objective tools to measure cultural competence. Finally, the document identifies gaps in existing literature and proposes the need for improved training and resources to address cultural issues in healthcare.

1. Running head: CULTURAL INCOMPETENCE IN NURSING
CULTURAL INCOMPETENCE IN NURSING12
Literature Review: Cultural Incompetence in Nursing
Bettina Vargas
Kaplan University
Literature Review: Cultural Incompetence in NursingComment
by Tracy Towne: Use citations to support yoru statements so the
reader knows it is not just your opinion
In healthcare, cultural incompetence impedes the delivery of
quality care at the global, national and healthcare organizational
level. In the United States, the minority disproportionate access
of healthcare is mainly due to cultural incompetence in nursing

2. and so are the increasing health issues they face, such as high
rates of diseases and deaths. At the practicum site, Coral Gables
Nursing and Rehabilitation, the effect of cultural incompetence
in reference to the delivering poor quality care to a culturally
diverse patient population is evident. With this in mind, the
focus of this literature review is to provide insight on the trends
of cultural incompetence, explore theories used to examine
cultural incompetence, gaps in the pre-existing literature and
solutions to cultural incompetence. This will help to contextual
cultural incompetence and find lasting solutions for eradicating
cultural incompetence and prioritizing cultural competence.
Trends
Cultural incompetence in nursing finds its roots in the nursing
education and training. According to Bednarz, Schim,
& Doorenbos (2010), as the general population records
increased diversity, so do the nursing classroom where the
minorities are enrolling in nursing education at a higher rate.
This increases the need to focus on diversity in nursing
education to nurture cultural competent nursing professionals.
However, cultural incompetence among the teaching staff in
terms of the inability to counter diversity barriers make it
difficult to teach a diverse classroom and impart students with
cultural competence. These barriers emerge from values and
common attitudes held by nursing education and culture such as
avoiding unwanted discrimination and the Golden Rule, which
is “do unto others as you would have them do unto you” (para.
9). As Hassouneh (2013) indicate, the effect of such barriers, is
“unconscious incompetence” as well intentioned faculties are
unable to recognize realities, including the fact that each
student is unique and deserves unique treatment, thus generating
more barriers towards instilling students with cultural
competence. The nursing education and training lacks
uniformity in accommodating the needs of diverse students.
Lack of efficiency in cross-cultural communication, both in
written and spoken form aggravates this. Besides, nursing
education has no profound way of bringing the different

3. cultures, jargon and professional languages that the students and
the faculty possess together to create coherence and
increasingly enable the nurses and the faculty to understand
each other. The effect is a learning environment that does not
accommodate diversity and cannot impart students with cultural
competence. Comment by Tracy Towne: Citation needed
Comment by Tracy Towne: Author/year? Comment by Tracy
Towne: Indicated – use past tense verbs Comment by Tracy
Towne: Missing supporting citations
Because of lack of cultural competence skills at the
training/educational level, the nursing field records an
increasingly growing concern of cultural incompetence at the
professional level. McClimens, Brewster and Lewis (2014)
research exploring the experience of nursing students upon their
placement in a professional environment show a high level of
incompetence among the students. The students have difficulty
meeting patients’ cultural needs in relation to gender, food and
language. As a reflection of most professional environments,
signage is in English with minimal translations of languages
commonly used in the area where the facility is located. Often,
the students, who are now practicing professional nurses
experience communication breakdown and mistranslation that
compromise patient safety. Nurses cannot balance patient’s
eating habits and their professional practice expectations. They
have difficulty coping with patients observing Ramadan who
cannot drink and eat during certain times, Gambians who cannot
use cutlery and they are unable to offer food choices for
different cultures as reflected by the patient population. When it
comes to gender, some patients prefer male and others female
nurses, but most nurses cannot cope with the rejections. The
conclusions drawn are that the nurses are cultural incompetent:
they do not know the wrong or right way of delivering care to a
diverse population.Comment by Tracy Towne: Who says?
Citation needed Comment by Tracy Towne: Missing citations –
you must support yoru statements
Trends also reveal that cultural incompetence is not a reserve

4. for “fresh” nurses during their initial professional practice
settings. It extends to well-grounded nurses who have practiced
nursing for years. Hart and Mareno (2013) research on 374
nurses show emerging themes of cultural incompetence,
including increased diversity, insufficient resources, as well as,
biases and prejudices. In the presence of scarce resources,
which are poses a key challenge in dissemination of resources;
nurses use their own biases and prejudices concerning patients
to deal with the increasing cultural and resource challenges
when delivering care. They avoid attending to patients with
cultural attitudes they perceive as stubborn, not welcoming, and
attend to patients from cultures they regard as friendly, less
stubborn. Unfortunately, most still perceive their selves to be
culturally competent. This is because as Loftin, Hartin, Branson
and Reyes (2013) research show, most nurses rely on cultural
competence measurement tools to examine their cultural
competence levels. The tools depend on a person’s perceptions
and are self-administered, thus lacking any objective measure of
how culturally competent they are based on patients’
perspectives. Most nurses often get positive results, which are
misleading. The effect is that cultural incompetence continues
to prevail because no positive and constructive feedback is
available to enable nurses to critically examine their cultural
incompetence and make changes.Comment by Tracy Towne:
Citation? Comment by Tracy Towne: Citations?
Trends reveal the capacity of cultural incompetence among
nurses to result in negative health effects in the nursing field
and the entire health system in general. The impacts felt by
minorities, who comprise of diverse cultural groups and needs
that the healthcare system does not address. Strunk, Townsend-
Rocchiccioli and Sanford (2013) research on Hispanics reflect
the implications of cultural incompetence. Statistics show that
with increased immigrations, the Hispanic population will be
8.6 by year 2030. Many Hispanic groups have distinct cultural
beliefs. Because they do not receive quality care, partially due
to cultural incompetence among nurses, they exhibit

5. disproportionate burden of death, diseases, disabilities, injuries
and death in comparison to the non-Hispanic groups. Cultural
incompetence among nurses in addressing Hispanic health
issues relates to language difficulties and differences in cultural
practices and beliefs. As a result, there are missed diagnoses;
over 50% of Hispanics having Alzheimer disease remain
undiagnosed. Nurses cannot cope with Hispanics cultural beliefs
regarding hot illness, such as diabetes, hypertension and
pregnancy, and cold illness, such as nosebleeds and pneumonia.
Nurses are more likely to treat nosebleeds using icepacks,
which is unacceptable in Hispanic culture. Hispanics believe a
cold treatment cannot treat a cold illness. The effect is that
without cultural incompetence, nurses’ work under stressed
environment where they cannot practice their professional fully
or address the needs of the Hispanic patients, thus resulting in
poor delivery of health services. Overall, the healthcare system
is stressed because increased cultural incompetence means that
the health needs of minorities are not met, thus overburdening
the healthcare system. The government directs most healthcare
costs towards addressing minority healthcare needs, which are
disproportionate to the majority such as increased rates of
cancer among others. If cultural incompetence continues to
increase and continually finds its way in the practical settings
especially among nurses who are the primary care givers, the
costs and the healthcare issues faced by the minorities will
continue to increase, thus working against the delivery of
quality care to patients.Comment by Tracy Towne: Citation?
Comment by Tracy Towne: Whose statistics? Comment by
Tracy Towne: You are using no citations to support yoru
statements
Gaps in Literature
Most of the literature covers cultural incompetence in the
context of nurses’ lack of knowledge in patients’ beliefs,
values, customs and practices. However, as Vandenberg (2010)
indicates, this results to oversimplification of cultural diversity.
Socio-economic, historical, age, physical size, and political

6. factors also account for the cultural incompetence. These
factors result in complex cultural situations that are unique for
each individual and which nurses should address in a unique
manner to ensure cultural competence. Hence, because literature
does not direct much attention to these factors, they are less
considered in the practical settings, thus adding to increased
cultural incompetence among nurses.Comment by Tracy Towne:
Citation needed
According to Singleton and Krause (2010), the Joint
Commission has already coined limited proficiency in
languages, cultural barriers and low health literacy as a “triple
threat” to cultural competence. However, there is little
integration of cultural incompetence and language. Culture
combined with language provide experiential context in which
nurses understand health information provided by patients.
Knowing patients’ language and culture helps a nurse to know
the health literacy level of the patient and patient’s
expectations, thus building nurses’ capacity to deliver culturally
competent care. Hence, by offering minimal integration between
language and culture, nurses lack information to integrate the
same in the practical settings, thus adding to their cultural
incompetence. Comment by Tracy Towne: Citation needed
Literature in nursing fails to explore objective tools for
measuring nurses’ incompetence or competence levels. Jeffreys
and Dogan (2010), as well as, Jeffreys and Dogan (2012)
researches show lack of tools that could offer objective
feedback on nurses’ cultural competence to enable them make
changes to improve on their cultural competence. The basis of
instruments for measuring cultural competence, such as Cultural
Self-Efficacy Scale, Cultural Competency Instrument (CCI) and
Nurse Cultural Competence Scale among others are individual
ratings or perceptions. The inability of literature to focus on, as
well as, highlight objective tools provides nurses with no
constructive feedback to help identify and deal with their
cultural incompetence. Comment by Tracy Towne: Citation

7. Theories
Theories discussed in most literature to explore cultural
incompetence in nursing include transcultural theory, cultural
safety theory and nursing theories of cultural (in) competence.
According to Mortensen (2010), cultural safety model is
responsible for developing cultural safety guidelines that guide
nursing practice in delivering care to linguistically and
culturally diverse populations. Cultural safety theory
acknowledges multiculturalism, emphasizes the positive
outcomes and health gains of cultural competence and the
institutional power that health systems and health professionals
posses. Non- adherence to principles guiding cultural safety
results in cultural incompetence. In contrast, transcultural
theory does not adequately focus on institutional power being
an impediment to cultural competence or advocate for the
elimination of health inequalities within populations. Rather,
the theory focuses in on dynamics of social, race and power
inequalities are integral in culture care theory and cultural
incompetence and competence. Other theories covered in the
literature central to providing insight on cultural incompetence
include cultural awareness and cultural sensitivity, which lead
to cultural incompetence if not adapted. Ideally, cultural
competence theories provide insight on cultural incompetence
when viewed in the context of what may lack in the care
delivered if cultural competence is absent. This results in
cultural incompetence, as nurses cannot adhere to practices of
cultural competence and derive the benefits of cultural
competence in terms of quality care delivery. Besides, the
theoretical interpretation of cultural incompetence is nurses’
lack of capacity to counter cultural challenges in healthcare.
Hence, the literature largely covers cultural barriers that nurses’
face and difficulties in addressing the barriers to highlight their
cultural incompetence. Comment by Tracy Towne: Citations?

8. Solution
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