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One of the most important ways community health nurses can provide care that is culturally competent is through education and finding ways to stay up-to-date so that the patient’s culture and values are thoroughly understood.  Establishing rapport is the fundamental first step with any patient to help in understanding what a patient believes about health and how they value their own health.  Due to the vast amount of cultures and subcultures, it is difficult to know everything about each practice.  But, according to Maurer & Smith (2013), nurses can master the knowledge and skills associated with cultural assessment and learn about some of the cultural dimensions of care for clients representing the groups most frequently encountered.  Communication that is effective is key and the nurse will need to assess both verbal and nonverbal components. It is ideal if the nurse speaks the same language or has interpreter services to develop the plan of care.  In addition, the nurse must be aware of their own beliefs, biases, and assumptions while being sensitive to the patient’s differences.  When the nurse uses the following strategies, the patient is getting care that is integrated with cultural competence. 

Cultural preservation is about promoting the patients’ culture and healthy practices.  An example would be in the Vietnamese culture and a mother who is on labor & delivery unit.  The father may not be present, as men do not always attend deliveries. Also, the mother may be reluctant to feed the colostrum, believing it to be bad for the baby.  A barrier could be language as many in this culture read and write well in English but may not speak it fluently.  The nurse needs to assess the patients understanding thoroughly while being patient and encouraging the mother.  If there is uncertainty, an interpreter should be used. 

Cultural accommodation refers to patients using folk practices within the Western health care if it does not have adverse effects on their health.  This method is a supplement to their medical treatment plan.  An example is the use of a shaman or “medicine man” which some cultures such as Native Americans use often and can assist in healing through communication with spirits.  A potential barrier would be the use of equipment such as rattles and drums for a patient who was in contact isolation.  Also, fasting and cleansing rituals may not be appropriate for a patient hospitalized with a diagnosis such as small bowel obstruction. 

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Cultural repatterning promotes patients to change harmful health practices while being respectful to their cultural traditions.  This can be challenging as a patient may not have been educated in the past and is part of their “normal” life.  An example would be traditional foods in some cultures are very high in salt when prepared.  If a patient has a chronic condition such as heart failure, the patient must know about the harmful effects of salt and can potentially cause an exacerbation.  A barrier could be the patient does not know how to prepare their traditional meals to lower salt intake and this is where the nurse can teach label reading or refer the patient to a nutritionist to help achieve the best health outcome. 

Cultural brokering is when the nurse who fully understands the patient’s culture and values, will advocate for that patient to safeguard their care in the Western health care system.  An example is a patient who is Jehovah Witness and has an order for a blood transfusion.  The nurse has already had a conversation with the patient who has made wishes known for no blood products and does not eat the blood of animals.  A barrier is that the patient may have weakness or anemia symptoms without some form of treatment.  The nurse can then contact the physician to discuss alternative treatments to help the patient while respecting their wishes of no blood products. 

Maurer, F.A. & Smith, C.M.  (2013). Community/public health nursing practice (5th ed.). St. Louis, MO: Elsevier Saunders.