The CDC (2014, p. 2) states that cultural competencies are "a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables effective work in cross-cultural situations."
Having these behaviors, attitudes, and policies regarding diverse cultures allow the community health nurse to provide the best care across various populations. Models such as the Campinha-Bacote Model of Cultural Competence assist nurses in identifying and developing skills that allow them to care for populations of distinct cultures (Maurer & Smith, 2013).
Another aspect of cultural competence involves three actions: cultural preservation, cultural accommodation, and cultural repatterning (GCU, 2015). Including these actions along with cultural brokering gives the community health nurse the ability to provide care with the populations culture in consideration.
Cultural preservation is the process of including the clients culture into the care. An example of this would be allowing a priest to present during the dying process of an Irish Catholic family. The importance of having the last rites performed on the patient provides strength among the family members to during the grieving process. This process also provides the patient with a form forgiveness and peace before death. A barrier to this example would be if the priest is not available or the dying process happens quicker than anticipated.
Cultural accommodation is the process of including aspects of folk practices within the care being provided. An example of this would be a shaman in the Native American Indian population.
Allowing this "medicine man" practices to continue while being cared for by modern medicine allows the community health nurse to be cultural accommodating. A barrier to this example would be in the "medicine man" practice is harmful to the patient or is contraindicated with Western medicine.
Cultural repatterning is the process of changing the patients' harmful cultural health practices while still respecting their traditions. An example of this would be the African American population and their diets high in salt and fried food with trans-fat.
Instructing them to reduce the salt and to bake instead of frying the food or using different oils to reduce the trans-fat is cultural repatterning. A barrier to this example would be a lack of knowledge regarding different cooking technique or a lack of wiliness of the patient and family members to change.
Cultural brokering is the process of the nurse intervening for the patient to ensure that they receive culturally appropriate care within the Western health care system.
An example of this would be in the Muslim culture with regards to women giving birth. In this culture they do not allow male doctors to deliver their babies.
So, if they come in to deliver their babies on an off hour it is the nurses responsibility to advocate for this patients' cultural needs and request a female doctor deliver if possible. A barrier to this example would be the inability to provide the patient with a female doctor.
Reference
Centers for Disease Control and Prevention (CDC). (2014). Practical strategies for culturally competent evaluation. [PDF documents].
Grand Canyon University (GCU). (2015). NRS 427V lecture 3: Tools for community health nursing practice.
Maurer, F.A. & Smith, C.M. (2013). Community/public health nursing practice (5th ed.). St. Louis, MO: Elsevier Saunders.