Culturally competent practices are a journey, not a destination. As outsiders to the cultural beliefs and practices of others, we face the reality that we may only learn bits and pieces of how one's culture differs to our own. I define culture broadly as an identified sense of belonging related to gender, sexual orientation, profession, family dynamic, environmental context, race, or ethnicity. Reflect on these definitions and ask yourself: to which cultures do you identify and is there a tension among them, if any?
Cultural beliefs, practices, and lifeways are predominately learned through human interactions; observing, participating, or storytelling, and this knowledge can change in response to global changes. When we consider one's culture, we must consider the levels in which the constructs of culture exist.
Purnell (2014) states that at the tertiary level, cultural constructs are visible to outsiders, i.e. food, clothing, anything outwardly observable. At the secondary level, only persons of the culture know the “rules of behavior” (p.6). Finally, the primary level holds that the most enrooted and unconsciously held beliefs, patterns, practices, and beliefs are known by and practiced by its members. “Culture is largely unconscious and has powerful influences on health and illness” (p.6).
Becoming culturally competent practitioners
As we consider the challenging task of becoming culturally competent practitioners who provide culturally congruent care, it is necessary to consider terms related to culture care practices and our levels of development. As nurses, we often hear the terms cultural awareness, cultural sensitivity, and cultural competence and they are often used interchangeably. These terms are not all the same, however. Cultural awareness is the appreciation of culture all around us - arts, music, dress, foods, etc. Cultural sensitivity concerns one's sensitivity to another's culture - being careful not to offend. Finally, cultural competence is the pièce de résistance - the healthcare provider has the knowledge, ability, and skill to provide culturally congruent care. This is care that is meaningful for the patient and in concert with their cultural beliefs and practices (Purnell, 2014).
As practitioners, we progress through four stages of cultural competence, according to Purnell (2014). We begin our journey from unconscious incompetence; not knowing we lack knowledge. As we learn and grow, we become consciously incompetent; having an awareness of our lack of knowledge. Over time and through efforts to learn and provide culturally congruent care, we become consciously competent. Finally, the unconscious competent provider acts without thinking to provide culturally congruent care for their patients. Be warned - an unconsciously competent practitioner must check and balance one's self as assumptions cannot be made from one culture to the other.
Where to start