Impact of Cultural and Linguistic Competence

This report explores the effects of cultural and linguistic competence in nursing practice and delivery of health care services. It analyzes interventions to eliminate cultural and linguistic incompetence and improve communication.

Running head: IMPACT OF CULTURAL AND LINGUISTIC COPETENCE 1
Cultural and Linguistic Competence
Name of Student
Institution Affiliation

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 2
Table of Contents.
Abstract.................................................................................................................................. 3
Introduction........................................................................................................................... 4
The National CLAS............................................................................................................... 5
Cultural Competence............................................................................................................ 9
Linguistics Competence...................................................................................................... 10
Effective Communication................................................................................................... 11
Conclusion........................................................................................................................... 13
References………………………………………………………………………………… 16

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 3
Abstract
The principle intent of this report is to explore the effects of cultural and linguistic
competence in nursing practice and delivery of health care services. Nursing has been an
evolving occupation for over the past few years, and their role has increasingly been defined.
Some of the essential qualities that are crucial for nurses today are cultural and linguistic
competence and effective communication. Moreover, the study will analyze the several
interventions that will be used in eliminating cultural and linguistic incompetence and the
issue of miscommunication.

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 4
Introduction
Nursing is a very diverse, rewarding, interactive and demanding career. In healthcare,
nurses are trained to be competent in giving care to all persons regardless of skin complexion,
age, language, and cultural belief. Subsequently, in the health profession nurses face
differences when communicating with diverse patients since they have to speak to patients in
a way, they won’t feel offended (Haverinen, 2017). When people or groups from various
cultures communicate, this is known as intercultural communication. The transaction process
of listening and reacting to people from different cultural backgrounds can be complicated.
The rise in ethnicity in health care, ensures service providers are looked upon to focus
on the diversity in their work and learn and adapt to the appropriate practices. Similarly, the
goal of nurses is to give culturally competent care. Reducing barriers to communication is
essential. Cultural and language distinctions and health literacy are some of the factors that
may hinder the delivery of service and may be barriers to how doctors offer treatment to
consumers of health care services. According to Brabers, Rademakers, Groenewegen, van
Dijk & de Jong, (2017) health literacy is the act of obtaining, communicating and
understanding simple health information and services that will enhance appropriate health
decision making
The National Standards for Culturally and Linguistically Appropriate Services in
Health and Health Care (known as the National CLAS Standards), is a policy that is used to
guide in the elimination of health disparities (Barksdale et al., 2016). According to the Office
of Minority Health, U.S. Dept. of Health and Human Services (2016) the standards provide a
blueprint for health care organization that help to deliver effective and respectful services to
patients. These policies have a broader meaning of recipients and how patients receive
services in a health center. Moreover, it explains that we no longer refer people as patients,

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 5
but we call them individuals since matters affect them at a personal level. Conclusively, it is
not about consumer satisfaction rather than how one delivers assistance to attain contentment.
The National Standards for Culturally and Linguistically Services (National CLAS)
Safe practice in the health sector is an essential part of promoting health and social
respect for patients in care, empowerment, and decision - making. The standards aim to
protect people in the workplace, patients and the general public. Moreover, it guides all
aspects of health and social providers at hospitals on how they should treat and behave in the
presence of the service users so that they can fill empowered, respected and appreciated.
Subsequently, the regulations help to improve understanding of how people’s
differences can affect their experiences, health outcomes and quality of care given. Several
factors such as; genetic inheritance, personal behaviors, access to health care services, and the
external environment determine health. Health equality should be a priority for all health
facilities. In this case, health equity is the achievement of the highest level of patient welfare
for all people in a given population.
The standard provides a basis for health and hospitals, that ensure all patients receive
equal and effective treatment in a cultural and linguistic competent manner, which will help
eliminate health disparities. Moreover, the regulations help in the creation of guidelines,
policies, and rules for hospitals that will ensure they provide culturally competent services to
diverse consumers.
The National CLAS 2013 are services that consider and respect the health of an
individual. It defines health as being free from diseases. Moreover, it describes culture as a
series of learning beliefs, social behavior, customs, and language. CLAS ensures that services
are suitably and sensitively, in a way that it respects people's cultural standpoint. The office
of monitoring health developed 15 standards that hospitals use in guiding the implementation
of culturally and linguistically appropriate services. Principal, Governance, leadership and

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 6
workforce, communication and language assistance, and engagement, continuous
improvement are the categories used in grouping the standards (Thompson, 2016).
The principle is the sole purpose of the standards which is to provide effective,
equality, understandable and responsible quality services that meet health literacy, language
difference, cultural diversity, and effective communication. Moreover, policies, leadership,
and employees outline the general planning and control level of a health care facility.
Subsequently, it considers the correct way of recruiting staff, which is hiring a diverse
workforce. Moreover, it explains the effective of teamwork in health care facilities. Health
practitioners should be willing to work together to provide effective and efficient medical
treatment.
On the other hand, communication and language assistance are principles that
emphasize on educating nurses and doctors how to communicate information to clients.
Additionally, it outlines hospitals responsibility in providing non-verbal experts that will help
in service delivery between the nurse and patient. Patients with disabilities such as blindness
and being should be given equal treatment. Moreover, they should be allowed to express
themselves in their methods. Effective communication between the staff is also necessary.
The flow of information from nurses to doctors and the pharmacist is crucial in providing the
right treatment to clients.
Lastly, engagement and continuous improvement are principles that promote the
efficient performance of health care organizations. Every doctor, nurse, and staff working in a
hospital should be accountable for his or her actions (Ogbolu, Scrandis, & Fitzpatrick, 2018).
The principles help in the evaluation of performance for the different employees including
top management. More so, the laws encourage senior management to involve its staff in the
decision-making process. Nurses and doctors can be an asset in formulating decision because

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 7
they are well aware of the challenges facing the facilities. Additionally, they are involved in
the daily activities of the hospitals and often communicate with clients.
The standards clearly emphasize that top management of any organization are
responsible for the implementation of the CLAS standards. Managers should be able to
provide performance feedback of every staff in the organization. It is essential because it
helps to outline the shortcomings of an individual and the appropriate training method that
each should receive. When implementing the CLAS standards, it is advice able to use the
toolkit. It mainly helps healthcare agencies such as hospitals, clinics, and local health
departments in Health Care Delivery.
The standards also provide strategies for implementation of the measures and a
list of resources for additional guidance. The enhancement of the old rules was triggered
by the rapid growth in the demographic trends occurring in the United States. Moreover, the
rapid growth of future treatments and different ways to reduce gaps promoted change. The
principles also address the issue of health literacy, patient satisfaction and safety, and the
advancement of technology.
The use of the new standards helps to promote cultural competence which has
emerged as a solution to inequalities (Narayan, 2017). To achieve cultural competence in an
organization, training of cross-cultural issues is very important. Creating policies is also
crucial in reducing administrative and linguistic barriers to patient’s care. Social-cultural
barriers, language, attitudes towards health care and beliefs are the significant barriers to
culture and linguistics. Concerning the cultural obstacles in healthcare, nurses should be
willing to facilitate interconnection between the culture of the patient, health literacy, and
language to improve the outcomes for culturally diverse health service users. Moreover,
establishing policies and procedures that will help assess the competency of staff is essential.

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 8
Furthermore, the National CLAS standards inspire health and care corporations to go
beyond the minimum requirement of the legal duties for equality and health inequalities. The
laws will create health and care services that are true, legal, fair and diverse for everyone.
National CLAS standards aim at addressing disparities and disparities in health care
(Barksdale et al., 2016). In spite of the effort of trying to implement them in hospitals, they
should be reign forced when a student enrolls in a nursing school. Before practitioners can
understand other cultures, they should realize personal and organizational values and beliefs.
This will enable them to listen to the patient’s understanding of health, being respectful, and
negotiating treatment options.
Medical centers like clinics, which support communication by the use of CLAS
standards, have been able to achieve high-quality health care services. Preliminary health
research shows that when individuals can express themselves without difficulties excellent
patient outcome is achieved. In most cases, lack of cultural competence is associated with the
continued tolerance of health disparities, which is a result of misperception between the
patient’s culture, language, and opinion with that of the nurse.
Standards for Culture and Linguistics promotes responsiveness to diversity in
healthcare organizations. In other words, they help place specific policies and cultural
practices that act as a guide when offering services (Seeleman, Essink-Bot, Stronks, &
Ingleby, 2015). Communication, language assistance, engagement, continuous improvement,
and accountability are the essential standards in the healthcare organization. They affect the
outcome of how a health practitioner perform. Although leadership
and principal standards are crucial, they lack a direct impact on how the service is
delivered. However, the enhanced National CLAS Standards encourages a united adoption of
all Standards since it is the most effective and efficient approach to achieve quality health
care services for all individuals.

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 9
Lastly, hospitals should achieve social safety and meet the expectation of the service
users. Subsequently, social safety is when a health provider recognizes and honor the
cultural identities of their patients and adequately meet their needs and expectations (Mairs-
Levy, 2017). In other words, a hospital may be culturally unsafe if their practices diminish
and disempower the well-being of their patients.
Cultural competence
Culture refers to thought, beliefs, values, customs, and religious difference and social
behaviors that specifically characterize a given community or society. The increase of
culturally diverse population requires nurses to be willing to accommodate patients and
acquire skills attitudes that permit active working environment. According to Purnell (2018),
cultural competence is having the knowledge, skills, and understanding of the client’s culture.
Accepting and respecting cultural differences is crucial in promoting cultural diversity and
reducing health disparities. More so, analyzing standards that help improve culture and
language in a healthcare organization is essential.
The act of being culturally competent for nurses is understanding one’s views on
culture, as well as the opinions of their patients. This means being able to recognize
similarities and differences within and between different cultural groups. Subsequently, the
development of systems approaches, and interventions of eliminating culture incompetence
are crucial in health care (McCalman, Jongen & Bainbridge, 2017).
Lack of cultural diversity awareness and language are the barriers of implementing the
standards (Ogbolu, Scrandis, & Fitzpatrick, 2018). Inadequate resources such as time and
lack of cultural competence training also act as barriers (Ogbolu & Scrandis, 2017). An
organization that has culturally competent nurses can easily attain a patient-provider
relationship. However, racism has been a significant problem in service delivery. Most white
people are considered to be a privilege since they have an advantage over Africans due to

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 10
their complexion. The power of whiteness is triggered by cultural and structural forces and
practices in a particular country. Privilege occurs when a group of people can access
something of value that is denied to others just because of their skin color (Hobbs, 2018).
There are various interventions that healthcare facilities can use to solve cultural
competence. The main reason why hospitals face the challenge in cultural diversity it’s
because they lack nurses and doctors that are knowledgeable on the different languages,
beliefs, and personality difference. However, having a diverse workforce will also promote
quality service which will enhance patient satisfaction at all times (Jongen, McCalman &
Bainbridge, 2018).
Leadership and workforce standards help in recruiting and hiring qualified individuals
that will be able to adjust to a diverse population. Secondly, the National CLAS standards
emphasize the importance of continuing education and training of nurses and doctors.
Moreover, it outlines the importance of employing a culturally diverse staff member into
administrative and managerial positions. Such diversity helps them in planning, making
policies and decision making in regards to health care issues. Lastly, providing mentoring
opportunities to support personal growth will also help improve the effectiveness of an
organization.
Linguistic Competence
Language is the process by which communication is both conveyed and accepted. In
the nursing profession, language is used to promote quality care, inform patients about their
health and educate them on the various treatment. It is therefore crucial that what is conveyed
is commonly interpreted by both the patient and the nurse. Nurses should also use common
knowledge and language while communicating with their patients. Communication using
medical term may create fear, confusion and lack of satisfaction by patients.

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 11
Linguistic competence refers to the capability of an individual or health organization
to effectively communicate to a diverse population (Andrews & Boyle, 2019). Health care
providers and health care facilities should be able to understand and respond effectively to the
linguistic needs of patients. For an organization to be linguistically competent, it needs to
value diversity, assess themselves, manage language diversity and acquire cultural
knowledge.
The Office of Minority Health developed the Center for Linguistic and Cultural
Competency in Health Care (CLCCHC) that helps to address health needs to individuals that
are unable to speak English fluently. The mission for the regulation is to enhance
collaboration with federal agencies, public and private healthcare to improve effective
delivery appropriate linguistic and culturally competent healthcare.
Moreover, health organizations, linguistics competence requires interpretation and
translation services. The translation of written material will help to provide alternative
information based on the needs of the population being served, employing individuals that
can translate both verbal and non-verbal communication is necessary. It will enhance the
accommodation of all individuals that need treatment. Individuals should be informed of the
availability of language assistance programs. Though it might seem to be time-consuming, it
will help the organization have an added advantage in the market.
Effective communication
Effective communication between service providers and service users is crucial in
ensuring the delivery of efficient and quality services (Almutairi, 2015). Good
communication helps consumers feel in control; therefore, nurses should demonstrate
sincerity, kindness, and humility (Brooks, Manias & Bloomer, 2018). Effective
communication requires an understanding of the patient’s culture and language. Moreover,

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 12
good communication enhances the nurse-patient relationship that is necessary for providing
high-quality nursing care (Norouzinia, Aghabarari, Shiri, Karimi & Samami, 2015).
At times the difference in languages might cause miscommunication and
misunderstanding between the service provider and the patient (Crawford, Candlin & Roger,
2017). It also requires excellent communication skills that will help the consumer trust and
feel valued by health practitioners. Moreover, how information is conveyed to female may
differ from how a nurse will communicate with a male. Females tend to be emotion and
require clear information, one that will not promote fear and confusion. It is therefore vital
for the nurse to be aware of the right way to communicate with different patients.
Verbal and non-verbal communication understanding should be the main priority of
an organization. Verbal communication refers to the use of spoken words to transmit
information between the service user and the nurse (Sibiya, 2018). Verbal communication is
sufficient since the nurse can understand what illness the patient is suffering. Similarly, it is
easy for the nurse to raise questions with the aim to achieve clarity of the patient's sign and
symptoms. However, non-verbal is not reliant on words; instead, it uses body language to
communicate. Similarly, non-verbal communication between nurses and patients may affect
the service delivery especially in cases where the service provider does not understand
(Junaid, Shaban & Khan, 2019).
Hurried communication should not be encouraged. Taking time to know a consumer
is essential to create a friendly environment. Physical factors such as hearing and seeing can
also hinder communication. For nurses to achieve cultural and linguistic competency, they
need to be willing to accommodate all kinds of patients. At times, pain can be a significant
hindrance of communicating. However, lighting, temperature, furniture placement, and
comfortability of the patient are some of the environmental factors that may hinder
communication (Stans, Dalemans, de Witte, Smeets & Beursk, 2016).

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 13
Ensuring that their is implementation of communication interventions to health
inequalities is crucial in achieving satisfaction. Nurses should make an effort to assuring the
patient that he or she has support from the hospital. In other words, a nurse can give
painkillers that will help reduce pain which will allow the patient to explain himself. Another
way that nurses can use is the use is explaining health-related jargons this will help to prevent
the patient from fearing.
Thirdly, the use of interpreters in the interpretation of non-verbal communication will
also enhance clear communication. Persons with a deaf disability should not be
discriminated; rather the hospital should be able to serve them as the rest of the patients
equally. Additionally, providing a peaceful environment will also help in providing quality
services. Noisy environments tend to be distractive and may hinder one from listening. It is,
therefore, crucial to ensure that the hospital is peaceful
Conclusively, quality care services mean that the nurse should not make assumptions
about the patient’s treatment or disorder; instead, they should assess the needs and
expectations of service users. Therefore, it is essential for nurses to ensure the existence of a
trustful environment where the patients can freely express their problems and solutions are
adequately offered. Subsequently, good communication between patient-service provider
helps service users communicate their worries, and thus get emotional relief which promotes
excellent patient outcomes.
Conclusion
In conclusion, establishing tools to promote culturally competent, compassionate, and
intercultural communication in health facilities is also necessary for promoting quality
services (Papadopoulos, Shea, Taylor, Pezzella & Foley, 2016). Although culture and
linguistic are independent health inequalities, they have a critical relationship. The National
CLAS standards are essential in ensuring the provision of safe and quality care.

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 14
The different grouping of the standards helping to emphasize on how organizations
should formulate, develop and implement their policies about the rules. Subsequently, the
regulations contribute to active recruiting of staff members that can be able to meet the
cultural, linguistic and communication needs. However, the standards are strict on how
service providers offer treatment.
Implementation of health promotion programs will also improve the skills of the staffs
in an organization. Furthermore, it is essential to develop measures to assess the effectiveness
of the programs being implemented to improve the areas that have less impact. Evaluation of
the program is crucial since it helps to improve the quality of services and healthcare
outcomes.
Communicating mission, policies and procedures is also crucial in promoting
excellent performance by nurses. Every facility should ensure that their policies and
regulations match the National CLAS requirements. An assumption can be the worst decision
made by managers. Regular supervision and individual career development plans should be
done to ensure that every employee is fit to do a particular task and that everyone employed
has the right and required skills. Moreover, effective communication between service
providers is crucial since information on patient welfare has to be communicated in the
different departments to achieve the best health care (PAmudha, Hamidah, Annamma &
Ananth, 2018)
Cultural competence training intervention for health care providers and students is
essential for quality health services. It helps to focus on the patient-provider relationship and
helps to promote changes in the clinical environment. Establishing individual responsibility
will also help increase the performance of an individual. Lastly, employee empowerment is
very crucial in an organization since they will feel appreciated and respected. Allowing them
to be part of the decision making process will motivate them to give quality services, which

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 15
increases the overall performance of the health care facility. For nurses to achieve cultural
and linguistic competency, they need to be willing to accommodate all kinds of patients.

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 16
References
Almutairi, K. (2015). Culture and language differences as a barrier to provision of quality
care by the health workforce in Saudi Arabia. Saudi Medical Journal, 36(4), 425-431.
doi: 10.15537/smj.2015.4.10133
Andrews, M., & Boyle, J. (2019). Transcultural Concepts in Nursing Care. Journal Of
Health Disparities, 4(4), 632-647
Barksdale, C., Rodick, W., Hopson, R., Kenyon, J., Green, K., & Jacobs, C. (2016).
Literature Review of the National CLAS Standards: Policy and Practical Implications
in Reducing Health Disparities. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/27444488
Barksdale, C., Rodick, W., Hopson, R., Kenyon, J., Green, K., & Jacobs, C. (2016).
Literature Review of the National CLAS Standards: Policy and Practical Implications
in Reducing Health Disparities. Journal Of Racial And Ethnic Health Disparities,
4(4), 632-647. doi: 10.1007/s40615-016-0267-3
Brabers, A., Rademakers, J., Groenewegen, P., van Dijk, L., & de Jong, J. (2017). What role
does health literacy play in patients' involvement in medical decision-making?. Plos
One, 12(3), e0173316. doi: 10.1371/journal.pone.0173316
Brooks, L., Manias, E., & Bloomer, M. (2018). Culturally sensitive communication in
healthcare: A concept analysis. Collegian. doi: 10.1016/j.colegn.2018.09.007

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 17
Crawford, T., Candlin, S., & Roger, P. (2017). New perspectives on understanding cultural
diversity in nurse–patient communication. Collegian, 24(1), 63-69. doi:
10.1016/j.colegn.2015.09.001
Haverinen, E. (2017). Paediatric Intensive Care Nurses' Intercultural Communication
Competences. Retrieved from https://www.theseus.fi/handle/10024/121894
Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency
interventions: a systematic scoping review. BMC Health Services Research, 18(1).
doi: 10.1186/s12913-018-3001-5
Junaid, A., Shaban, M., & Khan, N. (2019). Perceptions of Patients on Doctors’ and Nurses’
Non-verbal Communication in lahore, pakistan: A Phenomenological Stud. Retrieved
from https://www.pafmj.org/index.php/PAFMJ/article/view/2604
Hobbs, J. (2018). White Privilege in Health Care: Following Recognition with Action. The
Annals Of Family Medicine, 16(3), 197-198. doi: 10.1370/afm.2243
Mairs-Levy, J. (2017). Towards A More Culturally Competent Health Care Delivery System.
MOJ Public Health, 5(6). doi: 10.15406/mojph.2017.05.00148
McCalman, J., Jongen, C., & Bainbridge, R. (2017). Organisational systems’ approaches to
improving cultural competence in healthcare: a systematic scoping review of the
literature. International Journal For Equity In Health, 16(1). doi: 10.1186/s12939-
017-0571-5
Narayan, M. (2017). Strategies for Implementing the National Standards for Culturally and
Linguistically Appropriate Services in Home Health Care. Home Health Care
Management & Practice, 29(3), 168-175. doi: 10.1177/1084822317696707

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 18
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2015).
Communication Barriers Perceived by Nurses and Patients. Global Journal Of Health
Science, 8(6), 65. doi: 10.5539/gjhs.v8n6p65
Office Of Minority Health, U.S. Dept. of Health and Human Services. (2016). Learn:
National CLAS Standards fundamentals (webinar). Retrieved from
https://www.hiv.gov/blog/learn-national-clas-standards-fundamentals-webinar
Ogbolu, Y., Scrandis, D., & Fitzpatrick, G. (2017). Barriers and facilitators of care for
diverse patients: Nurse leader perspectives and nurse manager implications. Journal
Of Nursing Management, 26(1), 3-10. doi: 10.1111/jonm.12498
Ogbolu, Y., Scrandis, D., & Fitzpatrick, G. (2018). Barriers and facilitators of care for
diverse patients: Nurse leader perspectives and nurse manager implications. Journal
Of Nursing Management, 26(1), 3-10. doi: 10.1111/jonm.12498
PAmudha, P., Hamidah, H., Annamma, K., & Ananth, N. (2018). Effective Communication
between Nurses and Doctors: Barriers as Perceived by Nurses. Journal Of Nursing &
Care, 07(03). doi: 10.4172/2167-1168.1000455
Papadopoulos, I., Shea, S., Taylor, G., Pezzella, A., & Foley, L. (2016). Developing tools to
promote culturally competent compassion, courage, and intercultural communication
in healthcare. Journal Of Compassionate Health Care, 3(1). doi: 10.1186/s40639-
016-0019-6
Purnell, L. (2018). Update: The Purnell Theory and Model for Culturally Competent Health
Care. Journal Of Transcultural Nursing, 30(2), 98-105.
doi:10.1177/1043659618817587

IMPACT OF CULTURAL AND LINGUISTIC COMPETENCE 19
Seeleman, C., Essink-Bot, M., Stronks, K., & Ingleby, D. (2015, November 16). How
should health service organizations respond to diversity? A content analysis of six
approaches. Retrieved from
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-
1159-7
Sibiya, M. (2018). Effective Communication in Nursing. Retrieved from
https://www.intechopen.com/books/nursing/effective-communication-in-nursing
Stans, S., Dalemans, R., de Witte, L., Smeets, H., & Beursk, A. (2016). The role of the
physical environment in conversations between people who are communication
vulnerable and health-care professionals: a scoping review. Retrieved from
https://doi.org/10.1080/09638288.2016.1239769
Thompson, V. (2016). Enhanced Cultural and Linguistic Services Standards: Not Just
Language Anymore | Institute for Public Health | Washington University in St. Louis.
Retrieved from https://publichealth.wustl.edu/enhanced-cultural-linguistic-services-
standards-not-just-language-anymore/