Standards of Practice for Culturally Competent Nursing Care

Abstract

The purpose of this document is to initiate a discussion of a set of universally applicable standards of practice for culturally competent care that nurses around the globe may use to guide clinical practice, research, education, and administration.The recipient of the nursing care described in these standards is assumed to be an individual, a family, a community, or a population.These standards are based on a framework of social justice (Rawls, 1971), that is, the belief that every individual and group is entitled to fair and equal rights and participation in social, educational, economic, and, specifically in this context, health care opportunities.Culturally competent care is informed by the principles of social justice and human rights regardless of social context.Through the application of the principles of social justice and the provision of culturally competent care, inequalities in health outcomes may be reduced.The worldwide shortage of nurses and the global migration of both nurses and populations have heightened the need to educate nurses to deliver culturally competent care for an increasingly diverse patient population, regardless of geographic location (Miller et al., 2008;Rosenkoetter & Nardi, 2007).This need served as the primary impetus for this work.Cultural standards exist within political, economic, and social systems.Many health organizations throughout the world have defined care for their specific populations from the perspective of these systems.The variation among standards and the context within which standards are practiced precludes a single set that fits all cultures.In preparing these standards, more than 50 relevant documents from nursing organizations around the world were examined, as well as related materials from other health care professions, governmental, nongovernmental, and health and human service organizations.Examples included, but were not limited to the following: the United Nations' ( 2008) Declaration of Human Rights, the International Council of Nurses' (ICN, 2006b) Nurses and Human Rights, the Nursing Council of New Zealand's (2009a) Code of Conduct for Nurses, the National Association of Social Workers' (2001) Standards for Cultural Competence in Social Work Practice, the World Health Organization's (WHO, 1979) Declaration of Alma Alta, the American Nurses Association's (ANA, n.d.) Code of Ethics, The ICN Code of Ethics for Nurses (ICN, 2006a), and the American Association of the Colleges of Nursing (AACN, 2008b) toolkits.In addition, a "Call for Comments" on the relevance, comprehensiveness, and feasibility of implementing these standards was published and distributed to seek the opinions and criticisms from as many nurses worldwide as possible.A webbased survey facilitated this process.Responses were received by 78 nurses from 16 countries.The majority of respondents were hospital-based practitioners, with university professors being the next largest group.Their educational backgrounds were almost equally distributed between baccalaureate and graduate nurse preparation.Results revealed a high degree of satisfaction with the standards, accompanied by a number of suggestions for consideration.The document was revised to incorporate these suggestions into the present version.These 12 standards (Table 1) can serve as a guide and resource for nurses in practice, administration, education, and research by emphasizing cultural competence as a priority of care for the populations they serve.The authors acknowledge that there may not be one single set of standards that reflects all of the values of the global nursing community, but they hope this work embodies a "best practices" approach that will enhance culturally competent nursing care and health care around the globe.

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