First Nations Cultural Competence in Healthcare


Cultural competence is comprised of diverse racial and ethnical beliefs of people. When managing health issues to patients, the administrators need to acknowledge the social and cultural differences of the patients to attend to them. Failure of this can greatly influence the health of the particular groups negatively. Over the years, there has been a rise in the cultural competence due to its importance in providing health care and it has been defined in the category of providers and health care delivery.


Many scholars have attempted to define the term cultural competence and cultural competence has been identified with the diverse values, behaviors or beliefs. Therefore, cultural competence can be defined as a strategy to administer health services to patients who have different values and beliefs in a bid to meet their cultural and social needs. Since cultural competence is an emerging trend, a definite framework of how it should operate has not been identified and it is still ongoing and therefore its administration has been hindered by certain factors such as poor designed systems of care to meet the diverse population of the patients, failure in defining an elaborate diverse leadership and workforce in health care and communication breakdown between the health care providers and the patients who hold different ethnicity, cultural and racial backgrounds (The Lewin Group, 2002).

Literature Review

Importance Of Cultural Competence When Collecting Client Information

The process of cultural competence is a model that entails the provider to possess cultural knowledge and awareness of a client when delivering health care services (Bacote, 2010). The model of cultural competence comprises of culture awareness, knowledge, skills, desires and encounters as its main components. Cultural competence expects one to examine his biases towards other cultures by exploring one’s background. This helps to understand the client’s cultural beliefs better when administering health care to him. Cultural competence also helps to bring to awareness the racisms and other factors that would hinder proper and adequate administration of health care.

When collecting client information or data, one requires to possess a cultural skill for cultural assessment. This helps to act as a quality indicator to measure the outcome of measuring cultural competence (Betancourt et al, 2002). According to Streltzer and Tseng (2008), cultural factors depend on different patients and the medical attention he seeks, and he gives an example of someone suffering from an acute traumatic injury. In such a scenario, the health care providers will rely heavily on the medical aspects to identify the extent of injury in preparation of a surgery and cultural factors of the patient will play a very minimal role in such a case. Other cases such as abortion and venereal diseases are psychological matters that require more reliance on cultural factors rather than medical aspects.

First Nations Culture

First Nations is an ethnicity term referring to the Aboriginal peoples in Canada who do not fall in the category of either Inuit or Metis. According to Barman and Marie Ann (1995), first Nations cultures were held to be mere superstitions and forbidden but its recognition has risen in the recent past with the government and health providers acknowledging and encouraging the knowledge of its cultural beliefs and values.

The concept of First Nations health care culture has been taken as a major priority and integrated in the context of health practice and theory. There has been a rising need to train the Aboriginal non-believers to learn the Aboriginal cultures and needs. First Nations enact their cultures based on a situation or context. According to Browne and Varcoe (2010), a study conducted in the rural Western Canadian province on First Nations women, indicated a misinterpretation of silence portrayed by the women as lack of cooperation while in the real sense, the women argued that according to their culture, silence while being given medical care is a sign of respect to the health care provider.

First Nations still possess the historic trauma transmission that has been passed from generation to generation, a culture that tampers with the administration of health care. The traumas need to be dealt with first to prevent their transmission, a good example is First Nations children who take child abuse as normal behavior and this culture is passed from generation to generation. This plays as a hindrance to providers of health care dealing with cases of physical abuses in these children. Another cultural belief is dependency on a superior being for healing purposes. They heavily put their healing reliance on God to heal them and therefore shun modern medical care being administered to them. They fear that the disease can be a punishment from God and tend to fear his wrath by allowing a human individual to interfere (Aboriginal Nurses Association, 2009).

First Nations strongly believe in the power of healing music and one of their traditions is to perform a dance song around the sick person to administer some form of healing to him. Health providers can take this to be a hindrance in administering an emergency medical care to the patient. This is a culture that needs to be learnt and understood to the core and it is a tradition that cannot be tampered with.

Cultural Competence and Safety Approach

According to Brown and Edwards (2007), cultural competence can be defined as the skills necessary to provide adequate health care to the diverse population. Its approach hugely focuses on the cultural knowledge, the attitudes and skills by the provider. The provider, to become cultural competent need to learn about the culture presenting itself and the cultural practices of that culture that can hinder the administration of health care. Most people tend to have a biased perception towards a particular culture and practice and gaining knowledge of that culture changes the attitude of the provider. He therefore learns to possess the cultural skills to handle the client’s presented problems. Cultural competence helps the provider to be able to spring into action. One needs to further possess the communication skills as a key to cultural competence. There are however certain factors that hinder cultural competence such as lack of acceptance by individuals and the reduction of culture to technical skills.

The strengths of cultural competence are that it is based on the individual level helping him to create self-awareness. Cultural competence can further be developed at both the organizational and individual stages. The limitations are that it mainly focuses on the knowledge, attitudes and skills of the provider and culture reduction to technical skills to which helps the provider develop an expertise and it also leads to the mis-understanding that identifying the cultural root of culture problem can easily lead to it being resolved.

Cultural safety approach on the other hand entails more about cultural awareness and sensitivity. It is based on understanding the different powers in health care services, their delivery and redress of these differences through education. The cultural safety helps to improve the access of health care by diverse patients, enable providers to understand difficult cultural concepts such as discrimination and understand the culture’s limitations.

Cultural safety helps to improve learning and educational outcomes for First Nations students. This plays an important role to the children who can respond positively when they feel respected and safe in their learning experience.

The Communication And Interviewing Techniques Related To People Of Diverse Culture

Communication skills are key to cultural competence to be able to effectively provide the necessary health care to an individual. When collecting client data, one needs to effectively communicate to the client to enhance an understanding and gather the correct information. Communication skill is a necessary tool when conducting an interview. According to Servellen (1997), one technique in achieving this is by hiring multicultural cultures to administer the service. Interviewing is best done by this group of people from diverse culture that has expertise in this field.

Another technique is doing sound homework especially to the language mostly used by the diverse groups and to learn the language. This technique calls for an individual passion to learn and interpenetration of some words. Simple but understandable language is essential. One should be able to learn the technique of body language observation when communicating or interviewing the clients.

Develop the ‘in flow’ technique. This is simply enjoying oneself when communication with people from diverse culture. Relaxation and confident is very essential in this technique.

Participation is also a communication technique where the provider encourages participation of the client during the interview. This creates easiness between the two parties and the client can be able to open up freely. This enables the provider to gather all the essential information vital to help him determine how to administer health care to the client.

Interpreter services can be used as a communication technique during interviews when there is a communication breakdown. Brochures and health care information materials come in handy as a communication tool. Those with pictures are mostly favoured as the client is bound to understand them more. They can be written in different languages to suit the language the client is more accustomed to.

Impact of Client Care in Cultural Competency

Care in a client can create an impact or no impact at all and the provider should be aware of this. A client may be dissatisfied with the services offered to him by the provider. To remedy this, the correct people who understand the culture should be able to give the health care to the patient. Dissatisfaction of a client can lead to distrust.

According to Allen and Dana (2008) high technology has greatly been impacted by cultural variety which has begun to assume major proportions in culture.

Client care may not have an impact if there is a communication breakdown. The person delivering the client care should be able to communicate and explain in a way that will be understood to the client.

The client should also be explained to the policies and historical government practices and the impact of such on the client. This helps build trust in the client when he is aware of any consequences out of the care.


Cultural competency needs to be encouraged for effective health administration. Several recommendations need to be considered to achieve this. The cultures that hinder the administration should be addressed and the members who hold those cultures strongly be educated. For example the culture beliefs of circumcision, women discrimination and child abuse. Education process should be conducted to achieve this goal. Cultural competence action programs should be implemented and take effect immediately. The cultural framework should also be completed to give a defined framework on the process of administering health care to diverse patients. The hindrances in cultural competencies and safety that hinder effective administration of health care should be dealt with immensely. First Nations culture’s language should be taught to those who do not understand the language to encourage further socialism to be able to administer health care services to the First Nations cultural people. Their heritage and culture should also be taught to nurses and health care providers. The government should further introduce a legislative amendment and an interactive map to include all the First Nations language groups. Curriculum programs in culture competency should be introduced in schools for students to gain knowledge on how to go about administering medical care services to people of different culture beliefs. This will help save thousands of lives.


Diversity of cultures is a common phenomenon and everybody has a culture they belong and believe in. However, one should be willing to learn other people’s cultures to develop a good working relation. Knowledge and possession of the required skills will help in enhancing the health care required to people of diverse cultures. They should not be shunned or discriminated but rather be given the accord respect treatment and their culture respected. Biasness towards certain cultures should be dealt with at all levels and this can only be achieved by doing good research and developing an understanding towards the particular culture.

Possessing the skills entails the ability to use those skills to the diverse cultural people and help them in their health care. It should be understood that some cultures like First Nations cultures are slowly diminishing by their low birthrates and diseases and if not careful will become extinct. Therefore they need to be educated on the importance of health care and this will help save them from falling to the pit. Cultural competence is therefore necessary to be introduced to all the nursing schools for them to possess the skills as required and to effectively deliver their services to the best of their knowledge to other people who do not necessarily belong to their culture. This will help to eliminate racism and discrimination among the different cultural ethnicity groups and lives will be saved. If introduced as a course, the state will show its commitment to promoting cultural competence thereby promoting peace and social culture among different people. Culture will always live within us and therefore we should not shun it and further, we should not disregard other people’s cultures too. Embracing cultural competence should therefore be every health care provider main priority.


Aboriginal Nurses Association (2009). Cultural Competency and Cultural Safety in First Nations, Inuit and Merits Nursing Education. Canadian Nurses Association. Web.

Allen, J and Dana, R (2008). Cultural Competency Training in a Global Society. Springer Publishers, New York.

Bacote, J. (2010). The Process of Cultural Competence in the Delivery of Health Care Services. Web.

Barman, J and Marie, A. (1995). First Nations Education in Canada: The Circle Unfolds. The National Library of Canada Cataloging Publishers, Canada.

Betancourt, J. et al (2002). Cultural Competence in Health care: Emerging Frameworks and Practical Approaches. The Common Wealth Fund. Web.

Browne, A and Varcoe, C (2010). Critical Culture Perspectives and Health Care Involving Aboriginal Peoples. Contemporary Nurse. Web.

Brown, T. and Edwards, P. (2007). Medical Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Publishers, Australia.

Servellen, G (1997). Communication Skills for the Health care Professional Concepts and Techniques. Aspen Publishers, Gaithersburg.

Streltzer, J and Tseng, W (2008). Cultural Competence in Health Care. Library of Congress Cataloging Publishers, New York.

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