Should Cultural Competence Be Replaced? by Anita Noble DNSc, CNM, CTN-A, IBCLC

written by Anita Noble DNSc, CNM, CTN-A, IBCLC,  Senior Lecturer- Clinical,  Henrietta Szold/Hadassah-Hebrew University School of Nursing, Faculty of Medicine

Healthcare students and professionals are taught the importance of caring for patients and their families in accordance with their culture and language. Different countries have mandated that culturally appropriate care be provided (Australian Government & Australian Institute of Health and Welfare, 2021; Care Quality Commission, 2021; U.S. Department of Health and Human Services, Office of Minority Health, 2016). Many healthcare organizations have a framework to provide culturally competent care (McCalman et al, 2017).

After all these years, is cultural competence passe’? It’s relevance has been put into question. The literature contains articles about whether another concept should replace cultural competence. For example, structural competence has been proposed as an overarching concept whereby cultural competence is seen as a component of structural competence (Metzel & Hansen, 2014). In a JAMA Psychiatry article, Hansen and colleagues (2018) recommend moving from cultural to structural competence as a way to address social determinants while Harvey & colleagues (2020) advocate structural competence for global health. Tervalon & Murray-Garcia’s (1998) concept of cultural humility has gained acceptance as another concept to be used in healthcare. Campinha-Bacote’s (2020a) model added cultural humility as a sixth construct. This concept was previously used with her Biblically based model of cultural competence in reference to the healthcare professional’s commitment to personal sacrifice in serving others (Campinha-Bacote, 2020b). Cultural safety is another concept introduced as a replacement for cultural competence (Curtis, et al, 2019). In New Zealand, the concept of cultural safety was developed as a response to colonization effects on the Māori people (Ramsden, 2005). As a result, cultural safety is included in New Zealand’s nursing and midwifery education.

With new concepts introduced, should we put cultural competence on the backshelf or replace it? As mentioned above, some have proposed that newer (and some not-as-new) concepts take a more front and center place. Should we say that the concept of cultural competence had a long run and that it’s time to go?

Cultural competence provides the over-arching definition for providing care that is culturally and linguistically appropriate. Cultural competence is not only a concept, but also a framework that incorporates a dynamic approach towards providing optimal healthcare. Since Cross and colleagues (1989) defined cultural competence, others have modified and expanded its definition such as Betancourt et al, (2002), the National Center for Cultural Competence (1998) and Spector (2017). By expanding the definition, cultural competence remains relevant, even today, on the legislative, institutional and clinical levels. The question, therefore, is not whether it should be replaced. Healthcare professionals do not have to take an either-or approach – rather the individual concepts can be incorporated into the umbrella of cultural competence to provide care that is holistic, dynamic and respectful.