Cultural Competence: A Detailed Concept Analysis for Nursing Students

This essay provides a comprehensive concept analysis of cultural competence in nursing, drawing from Madeleine Leininger's Cultural Care Diversity Theory. It examines the purpose of cultural competence in reducing healthcare disparities, particularly among underserved populations. The analysis includes a literature review, exploration of the uses of cultural competence, defining attributes (awareness, attitude, and behavior), model cases, borderline and contrary cases illustrating intolerance, and barriers to diversity such as language and stereotyping. The essay emphasizes the importance of understanding and respecting diverse cultural values and beliefs to promote effective and equitable healthcare practices. Desklib is a valuable resource for students seeking similar solved assignments and study materials.

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Running Head: Cultural Competence
Culture Competence: Concept Analysis
[Student ID]
[Student Name]
November 22, 2016

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Cultural Competence: Concept Analysis
According to McEwen and Willis (2010), “Concept analysis, concept development,
concept synthesis, and other terms refer to the rigorous process of bringing clarity to the
definition of the concepts used in science” (p54). The purpose of analyzing concept is to clarify,
organize its application in nursing practice (McEwen and Willis, 2010). This paper examines the
concept of cultural competence which is from Madeleine Leininger theory of Cultural Care
Diversity Theory (CCN, 2015). “The purpose of Leininger’s theory is to enhance knowledge
related to the uniqueness of nursing care of each patient as well as to value cultural heritage of
human care” (CCN, 2015).
Concept and theory analysis are the tools that assist in showing the value of nursing profession.
Steps of conducting analysis are: (CCN, 2015)
1. Select a concept
2. Determine the purpose of the analysis
3. Identify all the use of the concept
4. Define Attributes
5. Identify model case of the concept
6. Identify alternate cases: Borderline, related, contrary, invented, illegitimate
7. Identify antecedents and consequences of the concept
8. Define empirical references of the concept
The Purpose of Cultural Competence Concept
The aim of the cultural competence concept is to increase nurse awareness of the
importance of culture in reducing health care disparities (Like, 2011). According to Like (2011),
“Providing culturally competent services has been proposed as one of several key strategies for

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helping to reduce racial and ethnic disparities in health and health care” (p197). Some of causes
of health disparities in America are “…poverty, lack of health insurance, limited social capital,
and unsafe environment” (Like, 2011, p271). According to Diaz, Clarke, Gatua (2015)
“Underserved segment of the population, including racial and ethnic minorities, persons in rural
and geographically isolated areas, and those in lower socioeducational and socioeconomic group
continue to experience poor health outcome” (p23).
Literature Review
The method of concept analysis require eight-step approach. According to McEwenand
Willis (2010) concept analysis is conducted when concept theory or practice require clarification.
Dudas (2011) in the study of competence described the relationship of cultural competence in
nursing with the growth of minority faculty which has failed to keep up with the changing nurse
workforce. Faculty members can be role models to minority student. However the author failed
to explained the effect of slow in growth of minority faculty as related o cultural competence. If
cultural competence is trained in nursing school, student should be able to identify with it. Many
new nursing graduates are always not competent enough until they gain the experience (Moore
and Walker, 2011). However, the author described the defining concepts which has stated clearly
their relationship with the concept (Long, 2012).
In the study of tolerance (Moore and Walker, 2011) explained their analysis of tolerance in
relation to cultural competence. There is a good analysis on health care professional being
cultural congruent by understanding the concept of tolerance in cultural diversity.
Diaz, Clarke and Gatua (2015) in the study cultural competence in rural nursing education has
failed to include in-depth the study of culture in their education. However, disparities as
described in isolated geographical areas might not have been due to cultural value. The author

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failed to give a review of why graduate nurses fail to take position in this areas. The author
explained in depth how understanding rural culture can help in eliminating health disparities. In
this case there is still room for more research on cultural competence in rural nursing education.
Uses of Cultural Competence
Understanding cultural competence is important because it helps promote diversity
among nursing students, health workers and their patients. It involves the ability to identify,
understand and respect the values and beliefs of others (Bentley and Ellison, 2007). To reduce
health and health care disparities one has to be able to understand their culture to be able to
understand others. This prepares the nurses psychological on how to deal with patient from
different background (Diaz, Clarke and Gatua, 2015)
Defining Attributes
Dudas (2012) “Defined attributes of cultural competence as a process that can be
categorized into three dimensions: Awareness, Attitudes, and behaviors” (p318).
Awareness: To be able to understand culture one has to first consider their own thoughts, ideas
and biases. Some characteristics of biases are stereotyping, racism and generalization which can
hinder the progress of cultural competence (Dudas, 2012).
Attitude: When dealing with patient nurses have to learn to be sensitive to their belief, value, and
culture. Nurses have to be conscious of the way they act or talk towards their patient. Body
language can sometimes be seen as meaning a different thing and therefore, when giving cultural
care nurses need to be mindful of their body posture. This helps in not being judgmental to a
different group of people or culture (Dudas, 2012).

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Behavior: Webster dictionary defines behavior as the way we conduct ourselves or our response
to a certain group of people or person. According to Dudas (2012) Behavior represents the
actions the nurse demonstrate when adapting care to be culturally congruent” (p319)”
Model Case 1 – Cultural Competence
As a result of my experience in Jordan, I feel that I am much more sensitive and aware of
differences. After not being able to speak the language and being a minority. I am much
more aware of the need to feel understood. I also understand better how to incorporate
beliefs and practice into care (Dudas, 2012, p320).
In the case all the three defining attributes of cultural competence have been used in the quote to
understand how all three work define how to be culturally competence.
Model Case 2
After working in a neurological floor for two years, I am more aware and sensitive to
peoples feeling in regard to their diagnosis. I have learned to listen to myself and
understand my value to be able to behave in a respectful way when caring for this patient
(Invented).
In the two cases all the three defining attributes have been included to show how the three work
together to be understand cultural competence.
Borderline Case - Intolerance
“A young and skillful White nurse works with culturally diverse staff on a cardiac step-
down unit. The young nurse, who vies herself as tolerant, is reading Kathryn Stockett’s
The Help, a story about indignities suffered by black women who worked for prominent
White families in Jackson, Mississippi during the 1960s. Upon observing the young nurse
reading Stockett’s novel and asking her about it, a middle-aged African American ward

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secretary exclaims, “Aw hell, honey, I don’t have to read that sh-- to know what it’s
about. I live it every day.” The young nurse bristles and walks off. Later the young nurse
seeks the counsel of a trusted and experienced African American nurse, who helps her to
understand the history of race relations in the South and the fact that prejudice, if more
subtle, still persists in their workplace and beyond. With new understanding and sincerity
the young nurse initiates a conversation with the ward secretary, apologizes for her
abrupt behavior, and invites the ward secretary to lunch”(Moore and Walker, 2011,
p51).
When searching for cultural competence tolerance was one of the case studies that appeared
during search. Using this borderline case of tolerance still shows two of the defining attributes of
cultural competence of understand (being aware of the race history), and behavior.
Contrary Case– Intolerance: Is to give a case on what the concept is not
Sri Lanka-trained obstetrician. R, who was hired by a rural health clinic, is concluding
the 12th week of her six-month probationary period during which time, according to her
contract, she may be terminated without cause. A divorced, single mother of teenaged
twin sons, Dr. R formerly worked at public hospitals in Madras, India and two large U.S.
cities where she gained colleagues’ respect for her professionalism and client-centered
practices. But she is now the recipient of derision and scorn. Her supervising physician
remarks that she is a “poor fit” for the rural practice group, which includes several
women, among them an Ethiopian internist and an Iranian urologist, both educated in
the U.S. Dr. R braids her long hair, but loose strands fall over her ears and forehead.
She wears a sari under her lab jacket and sports a diamond stud in her nose, which was
custom in her hometown of Jaffna. Several coworkers complain vigorously about Dr. R’s

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dress and demeanor, but her patient satisfaction scores meet or exceed the clinic
average. Twice when Dr. R was “on call”, her timely and precise response to obstetric
emergencies resulted in good outcomes for moms and their babies. Nonetheless, she
receives a termination notice signed by the clinic’s Board of Directors” (Moore and
Walker, 2011, p51).
Using the contrary case of Intolerance show lack of culture value on the side of Dr. R. Besides
doing her work she would like people around her to be culturally aware of her beliefs and to be
able to change their behavior and attitude towards her.
Barriers in diversity:
1. Language barrier:
Good communication is a necessity in high-quality care and positive health outcomes in any
patient-physician interaction. Unfortunately; however, there are many barriers currently blocking
the communication between a physician and his or, her patient. Factors that are, or can be
potential barriers in healthcare communication include one’s nationality, lifestyle, health, and
educational status.
One’s nationality can play a big role in one’s communication status with his or, her
physician (Fritz, 2016). Communication between a physician and his or, her patients can be
particularly challenging when patients of different nationalities are unable to speak the local
language. Language barriers between patients of different nationalities and their physicians can
cause a patient to be dissatisfied with his or, her care or can cause miscommunication issues
between both the physician and his or, her patient (Sargent, Sedlak and Martsolf, 2005).
One’s lifestyle can also be a factor in communication barriers between one’s physician
and his or, her patient. Barriers contributed to one’s lifestyle can stem from the cultural aspect of

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one’s life to their ability to receive health coverage (McEwen and Wills, 2014). Individuals of
different cultural backgrounds may at times have different beliefs regarding healthcare than their
physician’s do. This in turn can cause the patient to have a fear in health-care systems or even
distrust in their prescribed therapies, causing a communication barrier to exist.
One’s health issues may also become a factor in communication barriers between a
physician and his or, her patient. If a patient is deaf or even blind, communicating with one’s
physician can become a huge problem if proper techniques are not used. Along with health issues
educational issues are also a disadvantage in proper communication between one’s physician and
his or, her patients (Like, 2011). If a patient is lacking basic educational skills, like the reading or
speaking of English then it is hard for a physician properly to relay health information to their
patients by the means of speaking, health packets, and even prescriptions.
2. Stereotyping:
The first thing of attention is the amount of negative stereotypes placed in the media about
health care and nurses. Examples include “the physician handmaiden, the naughty nurse, the
angel, the physician gold digger, etc.” These are thoughts and images that people believe to be
true by listening to an unreliable source (Dreher and MacNaughton, 2002). These stereotypes
make it hard for nurses because people expect nurses to act in such a way that is not professional
or true based on the stereotypes.
Another important concept to think about is how the media influences culture. If the media
places negative stereotypes on the health care profession, it will be more difficult for health care
to strive. Nurses need the help of the community and the culture to spread good, reliable and
quality information around so that health care can receive benefits to better care for the patients
(Holland, 2007).

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Lastly, it is important to understand that not everything in the media is reliable or true. For
example television shows such as Grey’s Anatomy, House, and ER. Being a nursing student, I
have watched these shows and picked out things that these characters do completely wrong. But,
watching this I know that it is just a television show that is made to capture an audience and
receive publicity to make money (Dudas, 2012). I know that this is not really how health care is
ran, but as this chapter states, people who have no or little college education start to fall into the
stereotypes of these television shows.
Overall, we must be careful when making decisions in the health care setting, because people
are continuously watching and judging the profession. Nurses must always use critical thinking
skills and perform professionally to direct consumers toward a more positive outlook on the
health care profession.
Identify and discuss at least two issues for each of the five points above.
1. Value diversity-
Regardless of the type of business, business size or job position, in today’s ever changing
and expanding business world, diversity is present. The value of diversity in teams is not
understood by many. Many may believe that too much diversity within a team or workgroup may
cause conflict, but the truth is, with a bit of research; diversity in teams enriches and improves
decision making and the other overall performance of a team. I will be discussing the value of
diversity in teams and workgroups, identifying the reasons why diversity works and the
invaluable benefits and advantages it provides when applied within a team or workgroup.
Turning a group into a team is not an easy task for any manager or leader, and with the
challenge of diversity in the workplace, many managers cringe at the idea of forming teams. It is
a difficult task, but understanding how diversity doesn’t make the job harder- but easier, helps

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tremendously. Research efforts have shown how differences among team members can impact
both team process and outcomes (Diaz, Clarke and Gatua, 2015). Variety, creativity, and
enriched discussions are just some of the few advantages that a well formed, diversified team
will experience. A team with one personality type may cause more harm than good.
A team must have balance. Balance in the membership of the team gives the group or
company the different perspectives. Variety of opinion makes for more complete discussions of
the issues, and eventually, better decision making overall. Although many may argue that a
better team would be people who share the same opinions and viewpoints (for the sake of getting
alone), the reality is that a well balance team can be achieved by mixing team member
personality types Another way to achieve a balanced team is by teaming up members of the
opposite sex, and mixing employee ethnicities. This way you assure that the team will have
creative discussions. This is also a way of making sure that there are many different ideas, and
creative thinking amongst team members.
If there is a team comprised of identical personality types, same gender, same
background and expertise- you cannot expect anything much different, than what you are putting
together. The more differences in a group- the higher the chance that the group’s final outcome
will incorporate several different types of thinking, organizing, creativeness and that the final
result will be a melting pot of cultures, professional and personal backgrounds. Each member of
the team brings something new to the table, and when it comes down to meeting important
deadlines and business goals- creativity and new “fresh” thinking is always a positive.
Personality types are taken into consideration. Balancing a team may be difficult but once
the team has been developed and organized, the mix of different ideas, culture, balance and
experience will help the teams end result, hence helping the business. It can seem a bit tricky, but

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evaluating personality types can be useful in establishing this balance. Diversified teams also aid
in the interpersonal and communication skills of members of the team.The value of diversity
within a team is important to understand, not only when building or forming a team, but as a
team member yourself. It may be a balancing act to form the team, but once the team has been
organized, and communication is open- the range of information shared and discussed within that
team is invaluable to the success of the overall product.
2. Institutionalization of Cultural Knowledge-
Components of cultural diversity must be integrated into schools, programs, and agencies.
All school staff must be trained to work with students of different cultures. The integration of
cultural knowledge must be present in school policies, programs, and publications. For example,
school staff may have to meet cultural competencies to ensure they are serving all the students.
This would improve the collaboration with families and agencies to better meet the needs of
students. Cultural knowledge within a school can enhance the schools ability to serve diverse
populations.
Antecedent and Consequences
Antecedents are consequences that come before the concept and consequences are the
result after the study of the concept. One of the antecedent of cultural competence is cultural
diversity which includes race, color, ethnicity, class, ability/disability, social and economic
status, religious orientation and many that are related to cultural diversity (Dudas, 2012).
Consequences as mentioned by Dudas (2012) are patient outcome, communication an
organizational benefits.
Patient Outcome: Health disparity is a marker for patient outcome. To achieve patient
outcome, health disparity need to be eliminated. Working towards eliminating health care

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disparities, nurse need to provide care according to the patient beliefs and tradition (Dudas,
2012).
Empirical Referent
According to Dudas (2011) cultural competence incorporates the concepts of cultural
awareness, cultural desire, cultural knowledge, cultural skills, and cultural encounters. There is
no measurement that uses Purnell’s 12 domain of cultural competence. There are no studies
addressing cultural competence in nursing. There is room for more research to be conducted on
cultural competence. There are very little study to measure the culture of competence.
Conclusion
Cultural competence is a very important topic to quality care of patient. Health care
disparities are still a challenge but with cultural competence we can realize health promotion and
disease prevention. In a nurse daily work they all experience patient from different cultures.
Nursing should encourage continuous education on cultural competence. The author used the
eight steps of analyzing concept.

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References
Books and journals
Bentley, R. and Ellison, K.J., 2007. Increasing cultural competence in nursing through
international service-learning experiences. Nurse educator. 32(5). pp.207-211.
Diaz, C., Clarke, P. N. and Gatua, M. W., 2015. Cultural Competence in Rural Nursing
Education: Are We There Yet? Nursing Education Perspectives. 36(1). pp. 22-26
Dreher, M. and MacNaughton, N., 2002. Cultural competence in nursing: foundation or
fallacy? Nursing outlook. 50(5). pp.181-186.
Dudas, K. I., 2012. Cultural Competence: An Evolutionary Concept Analysis. Nursing
Education Perspectives. 33(5). pp. 317-321.
Like, R. C., 2011. Educating clinicians about cultural competence and disparities in health and
health care. The Journal of Continuing Education in the Health Professions. 31(3). pp.
196-206.
Long, T.B., 2012. Overview of teaching strategies for cultural competence in nursing
students. Journal of cultural diversity. 19(3). pp.102.
McEwen, M. and Wills, E., 2014. Theoretical basis for nursing. 4th ed. Philadelphia, PA:
Lippincott, Williams, and Wilkins.
Moore, H. K. and Walker, C. A., 2011. Tolerance: A Concept Analysis. Journal of Theory
Construction and Testing. 15(2). pp. 48-52.
Sargent, S.E., Sedlak, C.A. and Martsolf, D.S., 2005. Cultural competence among nursing
students and faculty. Nurse education today. 25(3). pp.214-221.
Online
Fritz, R., 2016. Diversity for Groups and Teams in the Workplace. [Online]. Available through:
< http://smallbusiness.chron.com/diversity-groups-teams-workplace-10998.html>.
[Accessed on 25th November 2016].
Holland, K., 2007. How Diversity Makes a Team Click. [Online]. Available through: <
http://www.nytimes.com/2007/04/22/business/yourmoney/22mgmt.html>. [Accessed on
25th November 2016].