What is a cultural competence model?

• Applied in clinical, research, education, and the workplace (CREW) settings
• Guide for educational strategy and design, implementation, and evaluation
• Framework for understanding the process of teaching and learning optimal cultural competence*
• Research supported
• Easy to use with Jeffreys's questionnaires and assessment tools

Time-sequenced appendix tracing Dr. Jeffreys’s initial questions, conceptualization, series of studies, and other scholarly work in theory development and evaluation that lead up to the present and future is available in Annual Review of Nursing Research.

*Within the CCC model, cultural competence is defined as a multidimensional learning process that integrates transcultural skills in all three dimensions (cognitive, practical, and affective) and involves transcultural-self-efficacy (TSE) as a major component. TSE is the perceived confidence for learning or performing transcultural skills needed for culturally congruent care. Culturally congruent care actions involve the use of culturally based knowledge in sensitive, responsive, and responsible ways.

Optimal cultural competence is at the core (core value or goal).

Optimal cultural competence: a) goes beyond competence (a minimum expectation) toward the pinnacle or peak performance goal; b) embraces the diversity of diversity; c) fosters multicultural harmony; d) facilitates cultural safety; e) promotes the delivery of the highest level of culturally congruent patient care for individuals, families, and communities; and f) requires ongoing active learning. Optimal cultural competence applies across all settings: clinical/community, research, education, and workplace (CREW).

The term culturally competent care refers to nursing care that is sensitive to issues regarding culture, race, gender, and sexual orientation. Cultural competence is a process in which the nurse strives to achieve the ability to effectively work within the cultural context of an individual, family, or community from a diverse cultural/ethnic background. Campinha-Bacote proposes a culturally competent model of care that includes cultural awareness, cultural knowledge, cultural skill, and cultural encounters. The components of this model are:

• Cultural awareness
• Cultural knowledge
• Cultural skill
• Cultural encounter

Cultural awareness is the process by which the nurse becomes aware of, appreciates, and becomes sensitive to the values, beliefs, life ways, practices, and problem-solving strategies of other cultures. During this process, you examine your own biases and prejudices toward other cultures as well as explore your own cultural background. Without becoming aware of the influence of one’s own cultural values, we have a tendency to impose our own beliefs, values, and patterns of behavior on other cultures. The goal of cultural awareness is to help you become aware of how your background and your patient’s background differ.

Cultural knowledge is the process by which you seek out and obtain education about various worldviews of different cultures. The goal of cultural knowledge is to become familiar with culturally/ethnically diverse groups, worldviews, beliefs, practices, lifestyles, and problem-solving strategies. Some of the ways you can acquire knowledge are by reading about different cultures, attending continuing education courses on cultural competence, and attending cultural diversity conferences. The next step, cultural skill, involves learning how to do a competent cultural assessment. Nurses who have achieved cultural skill can individually assess each patient’s unique cultural values, beliefs, and practices without depending solely on written facts about specific cultural groups. It is extremely important to remember that each patient you care for, whether born and raised in the United States or not, is a member of a specific cultural group that affects his or her health care beliefs. Therefore, cultural assessments should not be limited to specific ethnic groups, but conducted with each individual patient. Cultural encounter involves participating in cross-cultural interactions with people from culturally diverse backgrounds. Cultural encounter may include attending religious services or ceremonies and participating in important family events. However, it is important to remember that although we may have several friends of different cultural groups, we are not necessarily knowledgeable about the group as a whole. In fact, the values, beliefs, and practices of the few people we encounter on a social basis may not represent that specific cultural group which you provide nursing care for. Therefore, it’s important to have as many cultural encounters as possible to avoid cultural stereotyping. Below are some cultural professional resources for nurses.

• Transcultural Nursing Society
• Journal of Cultural Diversity

Madeleine Leininger, who has done pioneering work in the influence of culture on health care, suggests two guiding principles that nurses can use in caring for patients from many diverse cultures. The first is to maintain a broad, objective, and open attitude about each patient. The second is to avoid seeing all patients alike. By following these principles, we can open ourselves to learning about the way others view health and illness and form relationships that are therapeutic.