Cultural Competence in Nursing: ASKED, LEARN, and Care of Diverse Patients

Cultural competence is a core nursing skill tested on the NCLEX and essential for safe, respectful patient care. This note reviews key definitions, the Campinha-Bacote ASKED model, the LEARN cultural assessment framework, considerations for common cultural groups, interpreter use, and frequent exam traps.

Key Definitions

• Culture — shared beliefs, values, customs, and behaviors of a group that influence health practices and perceptions of illness.
• Cultural competence — the ability to provide care that respects and responds to a patient's cultural beliefs; requires awareness, knowledge, and skills.
• Cultural humility — a lifelong process of self-reflection in which the nurse remains a learner.
• Ethnocentrism — the belief that one's own culture is superior; interferes with culturally competent care.
• Stereotyping — assuming all members of a cultural group share the same beliefs; leads to inaccurate assessments.
• Implicit bias — unconscious attitudes that affect understanding and actions; the nurse must recognize and address it.

Campinha-Bacote ASKED Model

Cultural competence is a process, not an endpoint. Without desire, the other components are ineffective.

• Awareness — Recognize one's own cultural biases; examine personal beliefs, values, and prejudices.
• Skill — Conduct a cultural assessment; use the LEARN model and culturally appropriate questions.
• Knowledge — Understand cultural health beliefs and common practices of patient populations.
• Encounters — Seek direct cross-cultural interactions and opportunities to care for diverse patients.
• Desire — Maintain genuine motivation to be culturally competent; stay open, curious, and willing to learn.

LEARN Model for Cultural Assessment

A framework for cross-cultural communication. The goal is to negotiate a plan that respects the patient's beliefs while meeting medical needs.

• Listen to the patient's perception of the problem — "What do you think caused your illness?"
• Explain your perspective using simple terms, without medical jargon.
• Acknowledge differences and similarities; do not dismiss the patient's beliefs.
• Recommend a plan of care that incorporates cultural practices when possible.
• Negotiate a mutually acceptable plan that respects beliefs while meeting medical needs.

Core Cultural Concepts

• Spirituality influences health decisions. Offer chaplain visits and incorporate prayer or spiritual rituals when appropriate.
• Family roles vary by culture. Identify the decision-maker, who may be the eldest male or female.
• Food practices include fasting during Ramadan, vegetarianism, halal, and kosher dietary laws. Respect these preferences.
• Health beliefs may involve traditional healers or herbal remedies. Do not dismiss folk remedies unless they are harmful.
• Communication style varies — adapt to patient preferences for eye contact, touch, and silence.
• Death rituals include specific body preparation, mourning practices, and burial customs. Respect these rituals.

Cultural Considerations by Group

Asian Patients

• May avoid direct eye contact as a sign of respect.
• Silence may indicate thoughtfulness, not lack of understanding.
• Traditional practices include acupuncture, cupping, and coining (rubbing a coin on the skin).
• Coining and cupping leave bruises that can be mistaken for abuse — document as cultural practices.

Hispanic/Latino Patients

• Family is central to health decisions; personalismo (building a personal relationship) is important.
• Traditional healers include curanderos, yerberos, and sobadores.
• Do not dismiss traditional healers; incorporate them when safe.

Muslim Patients

• Prayer five times daily requires clean water and a quiet space.
• Modesty calls for same-gender providers when possible.
• Dietary restrictions include halal food, no pork, no alcohol. Fasting during Ramadan affects medication timing.
• Do not touch a patient of the opposite gender without permission unless medically necessary.

Jewish Patients

• Kosher dietary laws prohibit pork, shellfish, and mixing meat with dairy.
• Sabbath (Friday sunset to Saturday sunset) may restrict electricity use.
• Avoid non-kosher food; check about Sabbath observance before scheduling procedures.

Using Interpreters

• Use a certified professional interpreter for patients with limited English proficiency.
• Do not use family members, especially children, who may filter or omit information.
• Speak directly to the patient, not to the interpreter. Keep sentences short and pause frequently.
• Use teach-back to confirm understanding.
• Never use family members for informed consent, bad news, or sensitive information.

Common Exam Traps

• Do not use family members as interpreters — use a certified professional.
• Do not assume all patients from a cultural group share the same beliefs — assess each patient individually.
• Do not dismiss traditional healing practices unless harmful.
• Do not mistake coining or cupping bruises for abuse — document as cultural practices.
• Do not touch a patient of the opposite gender without permission in some cultures.
• Do not ignore spiritual needs — ask about prayer or clergy visits.

Key takeaways

• The Campinha-Bacote ASKED model (Awareness, Skill, Knowledge, Encounters, Desire) frames cultural competence as an ongoing process driven by desire.
• The LEARN model (Listen, Explain, Acknowledge, Recommend, Negotiate) structures culturally sensitive assessment and care planning.
• Always use a certified professional interpreter — never family members, and never children.
• Document coining and cupping as cultural practices to prevent mistaken abuse reports.
• Respect food practices, family decision-making structures, and traditional healing when safe.
• Avoid stereotyping, ethnocentrism, and implicit bias by assessing each patient individually.