Cultural competence: a priority for performance improvement action

An increase in diversity that has been accompanied by a sharp decrease in white Caucasian "mainstream" culture has made cultural competence a priority in nursing performance improvement. Each culturally diverse group defines health and illness differently. Most have a long and well-established tradition of folk health beliefs and practices, which strongly impact members' reactions to American standards of care--an influence on both patient satisfaction and treatment compliance. This article describes the culture--health care relationship and lists 10 indicators for measuring cultural competency. It presents a practical, systemwide model for the improvement of nursing care quality through enhanced cultural competency and lists resources, which can be used to both support and improve cultural competency throughout an integrated health care system.