Becoming a culturally competent health care professional is a lifelong process.  All humans struggle with the pitfalls of stereotyping, cross-cultural misunderstanding, and language barriers.  However, when a commitment is made to develop cross-cultural skills, patient/clients can receive high quality health care services that are nonjudgmental and facilitate informed decision-making.

Keep the door open for a discussion of cultural differences.

Be aware that the cultural differences between you and your patient/client could be a factor in the success of the helping relationship.  Acknowledge your differences and any concerns early in the relationship so your patient/client knows it is okay to deal openly with feelings of discomfort, confusion, or even mistrust.

Use a conversational rather than interrogatory approach.

A conversation can be more effective, and less intimidating, than an interview.  For example, you might say, “Tell me about yourself and your family,” rather than asking a specific question.  Another technique is to frame inquiries in the context of another person’s experience or in relation to the patient/client’s family.  For example, you could say: “I had one patient who asked her favorite aunt to raise her baby.  Have you ever heard of that kind of arrangement?”  Or, “How do members of your family feel about unmarried women who raise babies by themselves?”  Think about some other ways to introduce topics of discussion without asking direct questions.

Ask culturally sensitive, tactful questions.

Ask open-ended questions (rather than “yes/no” questions) to elicit the patient/client’s feelings and perceptions of the situation.   For example, you might ask, “What are your feelings about the pregnancy?” or “What worries you the most about your situation?”

Avoid making assumptions.

Be careful not to evaluate your patient/client’s behavior or attitudes on the basis of the norms and values of the dominant culture.  At the same time, be careful not to attribute everything you see to culture.  Cultural competence enhances your nursing or social work skills; it does not replace these skills.

Follow protocol. 

▶  Address people as they wish to be addressed. 

▶  Defer to family members to whom deference is customarily due. 

▶  Respect the status traditionally granted to people on the basis of age or gender.

▶  Observe the unwritten rules of eye contact, touching, and physical distance. 

▶ Ask permission before delving into subjects that may be considered deeply personal.

▶  Honor your patient/client’s wishes in matters of privacy and modesty.

Cross-Cultural Skills Checklist

Use this checklist to assess how well you are applying your cultural knowledge.  If you answered “Rarely/Never” or “Sometimes,” use the “Action Plan” column to start thinking about what else you need to know or do and steps you can take to improve your cross-cultural interactions.

	Rarely or Never	Sometimes	Frequently or Always	Action Plan
I seek information from family members and other key community informants to help me respond effectively to the needs and preferences of the culturally and linguistically diverse patient/clients I serve.
Before visiting or providing services in the home setting, I seek information on acceptable behaviors, courtesies, customs, and expectations that are unique to families of specific cultural groups served in my program.
Recognizing that individuals from culturally diverse backgrounds may desire and acquire varying degrees of acculturation, I try to learn from individual patient/clients where they see themselves on the acculturation continuum.
Recognizing that “family” is defined differently by different cultures (e.g., extended family members, fictive kin, godparents), I make an effort to learn how each family defines itself.
Recognizing that male-female roles in families may vary significantly among different cultures (who makes major decisions, activities expected of male and female children, etc.), I make an effort to learn how families view male-female roles.
I understand that beliefs and concepts of emotional and physical well-being vary significantly from culture to culture.
I understand and accept that the healthcare practices and preferences of culturally diverse people may be rooted in cultural traditions.