Delivering Cultural Competent Care Psychological Effects


The ever changing multicultural world in terms of demographics and social economic perspectives combined with the disparities that exist in the health sector has pushed the nursing practitioners to rethink the role of culturally competent health care. The disparities in delivery of culturally competent care is worsened by the widening gaps in health seeking behavior evident among the people with regard to their diversity in ethnicity and culture (Flowers, 2004, p.48-49). The level of English proficiency has also impacted negatively on the immigrant populations due to the limitation it confers on the access and delivery of physician and consultancy services in healthcare. More importantly, several psychological effects have been associated with the lack in cultural competent care particularly in the black and minority populations in the United States (Derose & Baker, 2000, p. 76).

Culturally competent care is defined as the ability of health care systems to adequately provide quality care to people who have diverse values and behaviors while ensuring that their needs are respected in terms of culture and language. This concept is believed to serve as an avenue that enhances the accessibility to quality health care to the population while encouraging enrolment of more patients thereby improving the market share of the institutions (Betancourt, Green & Carrillo, 2003, p.3). The tendency of providing competent health care has become a norm for critical care nurses especially those working with high stress work environments and sensitive health cases. Of particular importance, is the demand for the nurses to develop mechanisms that will ensure that they effectively formulate rapport with patients through delivery of accurately programmed nursing interventions (Flowers, 2004, p.48-49). In line with this, the nurses are bound to listen and consider preferences brought forward by the patient or by their next of kin. Although the preference may be contrary to the conventional practices in healthcare, the nurses are required to incorporate the cultural perspective in the procedures.

The language congruence between the care providers and seekers is pivotal in the achievement of positive health outcomes and psychological effects (Warda, 2000, p.202). However, due to the inadequacies in the health care particularly in the limitation in language proficiency, has negatively affected the utilization of health care services (Derose & Baker, 2000, p. 76). The utilization of interpreters has helped alleviate this problem, albeit to a small extent. The non English speaking patients have a rather not satisfied with health care services since they consider the providers as either being unconcerned or disrespectful. This paper aims to investigate the psychological effects that are brought about by the application of culturally competent health care in the nursing practice.


The nursing practitioners are faced with the challenge of delivering quality health care to patients from diverse cultural backgrounds due to the ever changing social environment. The dynamic nature of the demographics buoyed by socioeconomic factors means that non-English speaking populations are rising and their health needs must be addressed.

Purpose of the study

The main purpose of this study is to outline the various psychological effects that the patients and the health care providers face and their implications in the nursing practice. The study is informed by the changes in the demographics and the impact it has on the accessibility and availability of health care services.


There are positive and negative psychological effects associated with the delivery of culturally competent care to patients with limited English ability.

Literature review

The changing demographics have been recorded in almost all countries in the world. For instance, Sweden had only a handful of ethnic groups in its society a few decades ago in relation to the more than 100 groups recorded in their last census. On the other hand, the United States has witnessed the largest change in the composition of its population buoyed by the high level of immigration brought about by globalization. The immigrants are largely from Africa, Latin America and lately from the Asian countries. Statistics indicate that the Hispanic and the African Americans have recorded a marginal increase of 30.8 and 141.7 % respectively during the period between 1980 and 2000. According to population experts, the marked changes in the population trends of the Hispanic and African Americans might result in whites becoming the minority in the year 2080. Healthcare professionals have initiated programs to address the specific needs of the ethnic groups by integrating cultural competence in the delivery of health care services particularly in Sweden (Betancourt et al, 2003, p.3). In light of this, the authorities in Sweden have invested heavily in research and training programs aimed at incorporation of cultural competence in all healthcare services(Flowers, 2004, p.48-52).

Proficiency in English language in the medical practitioners and patients has a great impact on the overall health outcome in the patient due to effect conferred by the interaction during the health seeking behaviour. Research has indicated that the effectiveness in all aspects of communication during the delivery of healthcare is instrumental in improving health outcomes and lowering the chances of negative psychological effects in patients. Aspects such as information gathering, interactive conversation and affective verbal and non verbal exchanges are believed to confer excellent health outcomes (Perez-Stable, Napoles-Springer & Miramontes, 1997, p.1212). The large number of Latino speaking population in the United States has necessitated the application of culturally competent care which encompasses the language proficiency of the patients.

Despite the existence of cultural diversity in the United States for many centuries, little evidence is available on health care institutions that have adequately provided services for the non English speaking populations. Many practitioners and policy makers have therefore advised that the initiation of specific processes that will ensure the integration of all forms of learning in training. The training must be all inclusive so that the cultural diversity in the society is reflected at the end of the training (Perez-Stable et al, 1997, p.1212). At the individual level, the competency in the cultural aspect is required in order to enhance the appreciation and valuation of the cultural differences of the diverse ethnic groups (Andrews & Boyle, 2002, p. 179). Despite the looming language barrier in patient-provider communication, the practitioners are trained on empathy skills that will play a pivotal role in delivering positive health outcomes (Bhui et al, 2007, p.123-124).

Baker and Derose (2000, p. 79), noted that proficiency in English impacted negatively on the health seeking behaviour of the Latino populations. Their study indicated that Latinos who had fair or poor proficiency in English recorded 22% lower visits to physicians compared to the native Latinos in the United States. This association was observed to bring about stress in life since most of those with limited English proficiency also lacked adequate health insurance. Stress also resulted from lack of effective cultural competence care between the patient and the physicians thereby dissuading them from making regular visits to healthcare institutions (Baker and Derose, 2000, p. 79; Fernandez et al, 2004, p.167; Sarver & Baker, 2007, p. 256).

A study carried out by Fernandez et al on the physician and patient dynamics found that there was a considerable effect on the interpersonal process in the Spanish speaking patients (2004, p.168). the study found that Spanish speaking patients had a higher tendency of reporting satisfactory interpersonal processes particularly when the physicians has a superb language ability coupled with better cultural competence. High levels of dissatisfaction were recorded in the encounters with physicians with lowly rated language ability (Dicicco-Bloom & Cohen, 2003, p. 25). The fact that patients were uncomfortable with non Spanish speaking physicians also meant that they experienced negative psychological effects. Anxiety and stress was common because the patients doubted the efficacy of the treatment received owing to the limitations in the communication. In end of this, Fernandez et al asserted that language that is complemented with cultural competence skills is imperative in improving health outcomes while lowering levels of negative psychological effects (2004, p. 173).

Theoretical framework

The cultural competence model relies mainly on five components. The cultural awareness and knowledge combined with the skills helps the nurse to assess the situations (Flowers, 2004, p.50). These components are complemented by the cultural encounter and desire. Cultural competence theoretical framework will be utilized in the alleviation of this problem. In this regard, it is imperative to understand the role played by the limited language proficiency in the delivery of healthcare (Betancourt et al, 2003, p.293). More importantly, the aspects of the healthcare delivery that will be affected should be noted. In this case, the patients, physicians, institutional and organizational aspects will be duly involved. The framework will involve interventions at three levels; organizational, structural and to a larger extent the clinical interventions (Suh, 2004; Braithwaite, 2003). The organizational level will ensure a fair representation of leadership and workforce with the aim of reflecting the diversity in the population of the patients. On the other hand, structural interventions will embark on initiatives that are aimed at ensuring that solid structural processes are put in place to enhance the access and availability of healthcare of the highest quality (Dicicco-Bloom & Cohen, 2003, p. 25). The utilization of interpreters and linguistically considerate services are therefore important. Clinical interventions to enhance the knowledge of the provider especially in terms of socio cultural factors and their impact on health outcomes will be integrated in the framework (Betancourt et al, 2003, p.293).

Implication to nursing

The culturally competence care is continually offering the nurses new challenges during the delivery of nursing services to the patients. The situation is worsened by the ever increasing diversity in the multicultural demographics due to high level of immigration in the United States. In end of this, there is need for each nurse to actively involve in training that will enhance the acquisition of vital knowledge and skills that will ensure the achievement of cultural competency. Their ability to offer quality is therefore improved thereby allowing the initiation and development of the necessary remedial measures to all patients irrespective of their diversity in culture or ethnic background. The language barrier also means that the nurses must embark on learning basics of several languages to improve patient-provider communication thereby lowering the psychological effects on patients and themselves (Flowers, 2004, p.52).


The ever changing demographics have necessitated the development of culturally competent care in nursing practice. This is imperative in ensuring that patients receive quality care that takes into account their linguistic backgrounds. Although non-English speaking populations are disadvantaged in accessing healthcare, several measures are in place to improve this situation. The application of cultural competence framework is pivotal in lowering the anxiety and stress associated with the language barrier.

Reference list

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Betancourt, J., Green, A., Carrillo, J., Ananeh-Firempong, O.(2003). Defining cultural Competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-302.

Bhui, K., Warfa, N., Edonya, P., McKenzie, K. & Bhugra, D. (2007). Cultural Competence in mental health care: a review of model evaluations. BMC Health Services Research. 7(15)

Braithwaite, A. (2003). Selection of a Conceptual Model/Framework for Guiding Research Interventions. The Internet Journal of Advanced Nursing Practice, 6(1)

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Derose, K. & Baker, D. (2000). Limited English proficiency and Latinos’ use of physician Services. Medical Care Research Review, 57(1), 76-91.

Dicicco-Bloom, B. & Cohen, D. (2003) Home care nurses: a study of the occurrence of culturally competent care. Journal of Transcultural Nursing, 14(1), 25-31.

Fernandez, A., Schillinger, D., Grumbach, K., Rosenthal, A., Stewart, A., Wang, F., & Pérez-Stable, E. (2004). Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. Journal of General Internal Medicine, 19(2), 167-74.

Flowers, D. (2004). Culturally Competent Nursing Care: A Challenge for the 21st Century. Critical Care Nurse, 24(4), 48-52.

Perez-Stable, E., Napoles-Springer, A. & Miramontes, J. (1997). The Effects of Ethnicity and Language on Medical Outcomes of Patients with Hypertension or Diabetes, Medical Care, 35(12), 1212-1219.

Sarver, J. & Baker, D. (2007). Effect of language barriers on follow-up appointments after an emergency department visit. Journal of General Internal Medicine, 15(4), 256-264.

Suh, E. (2004). The model of cultural competence through an evolutionary concept Analysis. Journal of Transcultural Nursing, 15(2), 93-102.

Warda, M. (2000). Mexican Americans’ Perceptions of Culturally Competent Care. Western Journal of Nursing Research, 22(2), 203-224