Cultural competence in the era of evidence-based practice.

Cultural competence has become an important concern for contemporary health care delivery, with ethical and legal implications. Numerous educational approaches have been developed to orient clinicians, and standards and position statements promoting cultural competence have been published by both the American Medical Association and the American Nurses Association. Although a number of health care regulatory agencies have developed standards or recommendations, clinical application to patient care has been challenging. These challenges include the abstract nature of the concept, essentializing culture to race or ethnicity, and the attempts to associate culture with health disparities. To make cultural competence relevant to clinical practice, we linked a cultural competency continuum that identifies the levels of cultural competency (cultural destructiveness, cultural incapacity, cultural blindness, cultural precompetence, and cultural proficiency) to well-established values in health care. This situates cultural competence and proficiency in alignment with patient-centered care. A model integrating the cultural competency continuum with the components of evidence-based care (i.e., best research practice, clinical expertise, and patient's values and circumstances) is presented.