Medical-Surgical Nursing · Culturally Competent Care
Concepts in Culture
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In 30 seconds
Culture Shared, learned beliefs, values, customs, and practices of a group Full entry → is the set of shared beliefs, values, customs, language, and practices that a group of people learns and passes across generations. It shapes how people understand health and illness, what causes disease, how pain should be expressed, who makes health decisions, and what a "good death" looks like. Culture is learned, not inherited; it is shared, dynamic, and woven into everyday life.
Nursing care that ignores culture misses the person. Madeleine Leininger's Culture Care Theory — a foundational nursing theory — holds that care is the essence of nursing and that the meanings and practices of care differ across cultures: nurses must discover what care means to the patient and shape care that fits. Josepha Campinha-Bacote's model describes cultural competence as an ongoing process built from five constructs: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire.
Crucially, culture is not the same as Race A social classification based on physical traits, not biology Full entry →, Ethnicity Shared heritage — ancestry, language, traditions Full entry →, or nationality — and no person is a walking checklist of their group's traits. Learning to see the difference between a cultural pattern and an individual person is the first step toward respectful, person-first care.
Why this matters
- Health beliefs drive behavior: when people seek care, which treatments they accept, how they describe symptoms, and whether they follow through.
- Communication style matters: some patients expect direct questions; others expect indirect conversation; in many families, an elder or the family as a group makes decisions, not just the patient.
- End-of-life decisions, consent, and family involvement are deeply cultural — the nurse who understands this can facilitate rather than obstruct.
- A nurse who misreads a patient's culture can erode trust in minutes; one who understands it can build a partnership that lasts the whole admission.
- Exams test the vocabulary: expect questions that distinguish race from ethnicity, cultural competence from Cultural humility Lifelong self-reflection that treats the patient as expert on their own life Full entry →, and stereotyping from genuine assessment.
The college version
Core Concepts
What culture is — and what it is not
- Learned: acquired from family and community over a lifetime, not present at birth.
- Shared: held by groups — but with individual variation, and groups contain subcultures with their own distinct practices.
- Dynamic: it changes over time, especially with migration, generational change, and exposure to new settings.
- Integrated: beliefs about health connect to religion, food, family, work, and daily routines.
Culture is not race — race is a socially constructed classification based on physical traits, not a source of learned beliefs. Culture is not nationality — a passport says where someone is a citizen, nothing about their values. Culture is closest to ethnicity — shared ancestry, language, and traditions — but even ethnicity does not predict what any individual believes.
Health beliefs and explanatory models
The biomedical model — disease explained by biology and treated with standard interventions — is one way of understanding illness, not the only one. Every patient carries an Explanatory model The patient's personal story of what is wrong and why Full entry →: their own story of what the problem is, what caused it, what they fear, and what treatment they expect. Patients frequently combine biomedical care with traditional healers, herbal remedies, prayer, or dietary practices — often without telling the care team.
The nurse's job is to elicit and understand these beliefs without judgment, document them, and share relevant information with the team (for example, so the pharmacist can screen traditional remedies against prescribed medications) — while never endorsing unproven or unsafe treatments. Understanding a belief is not the same as agreeing with it.
Acculturation, assimilation, and biculturalism
- Acculturation Adopting parts of a new culture while keeping parts of the original Full entry →: adopting elements of a new culture while retaining parts of the original.
- Assimilation Losing the original culture in favor of the dominant one Full entry →: giving up the original culture in favor of the dominant one.
- Biculturalism Moving fluidly between two cultures Full entry →: moving fluidly between two cultures, adapting to whichever setting the person is in.
These processes are not linear, and they vary by individual and by generation. A grandparent, a parent, and a child in the same immigrant family may hold very different preferences — the acculturation level of the person in the bed matters more than the family's country of origin.
From cultural competence to cultural humility to cultural safety
- Cultural competence: the knowledge and skills to work effectively across cultures. Campinha-Bacote frames it as a process — awareness, knowledge, skill, encounters, desire — rather than a finish line. A common critique is that "competence" can be treated as a checklist to complete.
- Cultural humility: a lifelong practice of self-reflection, acknowledging the power imbalance between clinician and patient, and treating the patient as the expert on their own life. It pairs competence with openness.
- Cultural safety Care environments free of discrimination, shaped by the system Full entry →: moves beyond the individual. Care environments and institutions must be designed so that patients are not harmed or disrespected by discrimination; the responsibility belongs to the system, not just to whichever clinician happens to be on duty.
Common Confusions
| Do not confuse | With | Difference |
|---|---|---|
| Race | Ethnicity / culture | Race is a social classification by physical traits; ethnicity and culture concern heritage, language, and learned practices |
| Nationality | Culture | A passport says where someone is a citizen; it says nothing about their beliefs |
| Stereotyping | Cultural awareness | Stereotyping assigns a trait to everyone in a group; awareness treats a pattern as a hypothesis to check with each individual |
| Cultural competence (finished) | Cultural humility (ongoing) | Competence can be treated as an endpoint; humility is a career-long practice of reflection and learning |
| Respecting beliefs | Agreeing with beliefs | Nurses honor and work within patient beliefs without endorsing them |
Eli explains
The same idea, in plain words
Explain it like I’m 10
Culture is like a family recipe book that gets passed down. Different families cook differently — some use more spice, some cook for big groups, some have rules about what you can eat. Nobody is wrong for cooking their own way, and you cannot guess someone's recipe just by looking at them. To cook a meal they will actually enjoy, you ask them about it first.
Worked example
Mr. Ibrahim is recovering from surgery. His nurse, Elena, notices he seems hesitant about the prescribed plan. Rather than labeling him "nonadherent," she asks: "Can you tell me what you understand about why you're here, and what you think will help you heal?"
Mr. Ibrahim describes his problem in terms of balance — too much heat in his body, he explains, and he believes a cooling diet and certain foods will restore it. He has also been taking a traditional remedy his family has used for years. Elena does not argue or dismiss him. She thanks him for sharing, documents the traditional remedy so the pharmacy can screen it against his medications, and explains the biomedical plan in plain language — what the treatment is for and what to watch for. She then works with the team to shape a plan that respects his beliefs where safe to do so, and asks the dietitian to discuss foods that fit both his preferences and his recovery needs.
Elena's actions stay within nursing scope: she asked, listened, documented, and coordinated — she did not prescribe, and she did not endorse an unproven treatment. The point is that understanding the patient's story does not require agreeing with it; it is the foundation of a plan the patient can actually follow.
Key takeaways
- Culture is learned, shared, dynamic, and integrated — never assume it is fixed or uniform within a group.
- Race is a social construct, not a biological one; culture is not determined by skin color.
- Every patient has a personal explanatory model of their illness — elicit it before assuming what they understand or want.
- Cultural competence is a process, not a certificate: awareness, knowledge, skill, encounters, and desire.
- Respect ≠ agreement: the nurse does not have to share a patient's beliefs to honor them.
- Stereotyping is the enemy: a belief common in a group is still only a hypothesis about this patient until it is confirmed.
Check yourself
5 review questions from the chapter. Try each one, then open the answer.
List the four characteristics of culture described in this topic.
Show answer
Culture is learned, shared, dynamic, and integrated.
Why is race an unreliable guide to a patient's health beliefs?
Show answer
Because race is a social classification based on physical traits; it does not predict what any individual believes, values, or practices — culture, ethnicity, and personal experience do.
What is an explanatory model, and why should the nurse elicit it?
Show answer
It is the patient's personal explanation of their illness — what it is, what caused it, what they fear, and what treatment they expect. Eliciting it reveals the beliefs that shape trust, adherence, and decision-making.
How do acculturation, assimilation, and biculturalism differ?
Show answer
Acculturation keeps parts of the original culture while adopting new elements; assimilation replaces the original culture with the dominant one; biculturalism moves fluidly between two cultures.
What is the difference between cultural competence and cultural humility?
Show answer
Cultural competence is the knowledge and skills to work across cultures, best understood as an ongoing process (awareness, knowledge, skill, encounters, desire); cultural humility is a lifelong practice of self-reflection, acknowledging power imbalances, and learning from each patient as the expert on their own life.
Study tools & related lessonsKey vocabulary · Related
Key vocabulary
- Culture
- Shared, learned beliefs, values, customs, and practices of a group
- Subculture
- A group within a larger culture with its own distinct practices
- Ethnicity
- Shared heritage — ancestry, language, traditions
- Race
- A social classification based on physical traits, not biology
- Ethnocentrism
- Judging other cultures by the standards of your own
- Acculturation
- Adopting parts of a new culture while keeping parts of the original
- Assimilation
- Losing the original culture in favor of the dominant one
- Biculturalism
- Moving fluidly between two cultures
- Explanatory model
- The patient's personal story of what is wrong and why
- Cultural humility
- Lifelong self-reflection that treats the patient as expert on their own life
- Cultural safety
- Care environments free of discrimination, shaped by the system
Sources & references
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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