Real Cultural Competency for Nurses

Stereotypes of other cultures fail all the time.

It is fine to know that Guatemalans believe that drafts cause illness, or that Vietnamese people favor a medicinal herb made from dried mugwort. But what about hipster Guatamalans or Vietnamese suburbanites who live outside of Cleveland? There are too many cultural health beliefs to know them all. And even if you do, they may not apply to a particular person.

A better approach is to learn the ways cultures create different lenses for doing life. Given that knowledge, you can identify when culture is interfering in a therapeutic relationship and adjust accordingly. Cultural anthropologist Sherwood Lingenfelter has devised a model which alerts us to different values and helps nurses respond wisely. The model looks these crucial life attitudes:

Time and Event


Time Oriented: Westerners tend to think of “time as money.” People are expected to be punctual, use time effectively, and stick to a schedule. If a visiting nurse shows up at a patient’s home five minutes late, that may be excusable. But if the nurse is half an hour late, the patient might demand an explanation.


Event Oriented: Some cultures emphasize the value of the event regardless of the time required. In this perspective, flexibility is paramount if the present event warrants it. Such a patient might expect a long conversation over a new diagnosis regardless of the number of restless people in the waiting room.

Task and Person

TaskTask Oriented: These cultures encourage individuals to find their identity in productivity and a strong work ethic. Accomplishing goals is highly valued. The phlebotomist who, when making room to room rounds in the hospital, drew blood from a dead patient was a task oriented person.

PersonPerson Oriented: In some cultures, relationships are primary and positive interactions with others are most important. Individual accomplishment is secondary to the good and cohesiveness of the group. A person oriented patient will not be impressed with the nurse who greets him with “Where is your wound?” no matter how good the nurse’s wound care.


Status and Achievement

Achievement BWAchievement Oriented: These cultures believe that status is determined by one’s achievements. Status can change based on one’s successes and failures. This idea is what animates the question, “Why haven’t you become a doctor?”

TuxedoStatus Oriented: These cultures ascribe prestige based on a person’s place in the hierarchy. Status tends to be fixed based on credentials of birth and rank. On meeting you, these patients will want to know your title.


Crisis and Non-Crisis

Crisis BWCrisis Oriented: Some cultures (especially in resource rich contexts) emphasize the importance of avoiding any potential crisis. Such cultures anticipate problems, expend energy on plans to avoid them, stockpile resources, practice emergency response procedures, and seek expert advice. Their motto might be “Always be prepared!”

Noncrsis BWNon-Crisis Oriented: Some cultures (especially in resource poor contexts) downplay potential problems, focus on dealing with whatever is happening now, deal with problems when they come up with whatever resource are available, and rely on personal knowledge rather than expert advice. Their motto might be “Don’t worry. Be happy!”

Holistic and Dichotomistic

Holistic BWHolistically Oriented: Many cultures value the “big picture” which is more impressionistic, informed by emotion, and comfortable with grey areas. “Right brained” people strive to synthesize information, are slow to make definitive judgements, and value the sensory over the abstract. A holistic patient might be especially open to looking at diet, stress, sleep, and other factors that contribute to a disease state.

Dichotomistic BWDichotomistically Oriented: Western cultures tend to value scientific thinking which prizes logic, analysis, and precision. “Left brained” people who think this way like clear answers, are attentive to details, and strive for objectivity. Patients who think this way may seek “the right pill” rather than looking at lifestyle issues that contribute to their disease.

Vulnerability as Weakness and Vulnerability as Strength

Vul as strength bwVulnerability as Strength: In such cultures, revealing failure and error may be seen as courageous and honest. People are willing to talk about weaknesses and shortcomings when it seems needed. In a therapeutic culture, people believe that “you are as sick as your secrets.”

Vul as weakness 2 bwVulnerability as Weakness: In some cultures, error or failure is especially shameful. Care is taken to not make others look bad. In such cultures, runners in a race may glance back, not to make sure that they are winning, but to make sure they are not winning by too much and thus shaming others.


Ministering Cross Culturally 3(For a much more in-depth treatment of these cultural traits, please see Sherwood G. Lingenfelter’s excellent Ministering Cross-CulturallyThis material was used with Dr. Lingenfelter’s permission. For picture credits, please click on the picture.)


Below is a 48-item test to determine your dominant cultural perspectives.

The results will reveal your cultural values and help you identify strategies to deal with people who are different. 

1.I would not feel comfortable working for a large company because I would never see the whole picture of what I was working on.
2.I seek out friends and enjoy talking about any subject that happens to come up.
3.I avoid setting goals for fear that I might not reach them.
4.I am more concerned about what I have accomplished than I am with the position and title of my job.
5.I seldom think much about the future; I just like to get involved in things as they turn up.
6.I feel things are either right or wrong; discussion of “gray” areas makes me uncomfortable and seems to compromise the truth.
7.When making a decision, I feel that more than one of the options can be a right choice.
8.When I set a goal, I dedicate myself to reaching that goal, even if other areas of my life suffer as a result of it.
9.I am always one of the first to try something new.
10.I tend to associate only with people of the same social status.
11.I feel strongly that time is a scarce commodity, and I value it highly.
12.When my car needs tuning, I go to the dealer rather than let my neighbor who works out of his garage do the job. With professionals I know it will be done right.
13.I like performing before an audience because it pushes me to perform better.
14.My primary criteria for buying a car are low price and a record of quality and reliability; I do not let family or friends influence me to spend more for a “name brand.”
15.My desk or work area is very organized. There is a place for everything and everything is in its place.
16.I attend lectures and read books by experts to find solutions to issues of importance to me.
17.If offered a promotion that entailed moving to another city, I would not be held back by relationships with parents and friends.
18.I find it difficult to relate to people who have a significantly higher occupational or social position than mine.
19.I always refer to my watch or cell phone in order not be late for anything.
20.I feel very frustrated if someone treats me like a stereotype.
21.I tend not to worry about potential problems; I wait until a problem develops before taking action.
22.When waiting in line, I tend to start up conversations with people I do not know.
23.I hate to arrive late; sometimes I stay away rather than walk in late.
24.I get annoyed at people who want to stop a discussion and push the group to make a decision, especially when everyone has not had a chance to express his or her opinion.
25.I plan my daily and weekly activities. I am annoyed when my schedule or routine gets interrupted.
26.I do not take sides in a discussion until I have heard all the arguments.
27.Completing a task is almost an obsession with me, and I cannot be content until I am finished.
28.I enjoy breaking out of my routine and doing something totally different every now and then to keep life exciting.
29.When involved in a project, I tend to work on it until completion, even if that means being late on other things.
30.I eat in only a few select public places outside my home where I can be sure the food is the best quality and I can find specific items I enjoy.
31.Even though I know it might rain, I would attend a friend’s barbecue rather than excuse myself to repair the damage a storm has done to my roof.
32.I always submit to the authority of my boss, pastor, and teachers, even if I feel they may be wrong.
33.I feel there is a standard English grammar and that all Americans should use it.
34.To make meals more interesting, I introduce changes into the recipes I find in cookbooks.
35.I argue my point to the end, even if I know I am wrong.
36.I do not feel that anything I have done in the past matters much; I have to keep proving myself every day.
37.When starting a new job, I work especially hard to prove myself to my fellow workers.
38.When introducing important people, I usually include their occupation and title.
39.I talk with others about my problems and ask them for advice.
40.I avoid participating in games at which I’m not very good.
41.Even if in a hurry while running errands, I will stop to talk with a friend.
42.I have set specific goals for what I want to accomplish in the next year and the next five years.
43.I like to be active with many things so that at any one time I have a choice of what to do.
44.When shopping for a major item, I first get expert advice and then buy the recommended item at the most convenient place.
45.I enjoy looking at art and trying to figure out what the artist was thinking and trying to communicate.
46.I feel uncomfortable and frustrated when a discussion ends without a clear resolution of the issue; nobody wins the argument.
47.I resist a scheduled life, preferring to do things on the spur of the moment.
48.When leading a meeting, I make sure it begins and ends on time.