Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence.

At the core of both patient centeredness and cultural competence is the importance of seeing the patient as a unique person. For the purpose of this article, cultural competence is viewed as an expansion of patient-centered care. More specifically, cultural competence can be seen as a necessary set of skills for nurses to attain in order to render effective patient-centered care. However, a vexing question remains, "How does the nurse deliver patient-centered care when the patient's health beliefs, practices, and values are in direct conflict with medical and nursing guidelines?" The purpose of this article is to provide nurses with a set of culturally competent skills that will enhance the delivery of patient-centered care in the midst of a cultural conflict. I will begin by offering a conceptual framework for cultural competence and a description of the cultural skill needed to formulate a mutually acceptable and culturally relevant treatment plan for each patient. Next I will describe effective approaches for cultural encounters. Finally I will present a vignette that illustrates how the nurse can deliver patient-centered care when the patient's health beliefs, practices, and values are in direct conflict with medical and nursing guidelines.