What Role does Cultural Diversity play in Patient Safety?

Submitted by Elizabeth Shiferaw

Tags: culture diversity patient safety

What Role does Cultural Diversity play in Patient Safety?

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Cultural Diversity plays a very important role and will continue to play an even greater role as we move into a more diversified world. We live in an era of constant change and transformation, which in return paves the way for cultural transparency. The U.S. population consists of members from different racial and ethnic groups and depending on their geographical location, they can either be more or less concentrated. In many cases, Ardoin & Wilson (2010) claim that barriers of communication exist between patients and nurses because of the complexity of various cultures within the U.S. Therefore, as a means to break down these barriers, they advocate for culturally competent nurses to better ensure patient safety. Narayanasamy & White (2005) take it a step further and justify the need for the practice of Transcultural Nursing and how it is going to be helpful in the future. In this paper, I am going to discuss the importance and exigency of cultural diversity amongst the nursing profession. I will also show how its importance along with cultural competency amongst nurses can play a role in patient safety.

Current Practice

Transcultural nursing care has been both developed as a specialty and established as a formal area of practice as the result of theory development by Dr. Madeline M. Leininger, a nurse-anthropologist. Her Theory of Cultural Care Diversity and Universality (1991) provides the foundation for providing culturally competent care for patients of all ages, as well as to families, groups, and communities (Ackley, 2011). A nurse who is culturally competent has the knowledge and skills to adapt nursing care to cultural similarities and differences. Hospitals today are advised to follow these ideologies and in combination with NANDA approved diagnosis such as, Impaired verbal communication r/t inability to speak English and interpreter unavailable, Social Isolation r/t recent move away from neighborhood and friends of same ethnic group, Impaired parenting r/t use of culturally based discipline considered inappropriate or abusive by current country of residence and Spiritual distress r/t inability to take part in significant culturally based rituals regularly, should be competent in providing culturally diverse nursing care.

Summary of Evidence

Ardoin & Wilson (2010), as previously noted, argue that the lack of cultural diversity and competency amongst nurses often put the patient at risk. Certain problems have led to lawsuits among hospitals and patients. Nurses have failed to consider cultural diagnosis while dealing with patients. In some cases, it has resulted in the violation of the patients’ religious beliefs (Ardoin & Wilson, 2010). This poses a serious problem as one of the nurses’ primary role considers being an advocate for the patient.

Nurses are also responsible for establishing a therapeutic environment by creating comfort for the patient. Therefore, it is essential that the nurse and patient have a mutual understanding because communication is critical to the healing process (Bernice, 2011). The more culturally diverse the nursing workforce is, the better they cater to patients of different backgrounds.

Similarly, Berenholtz & Pronovost (2007) discuss the notion of a safety culture for patients. In their analysis of a patient safety culture, they also stress the vital role of communication by stating that “failures in communication are the most common contributing factor to sentinel events and errors” (p. 665). For instance, Clark, Meyers, Frye & Perlin (2011) elaborate on the importance of uniformity via communication and how it will “generally yield improved results” (p.1) with regards to patient safety.

Some examples of cultural differences that are independent of the Islamic community are that the Islamic religion does not allow the use of healthcare professionals of the opposite gender unless it is impossible to locate one of the same gender, some Muslims might not participate in health promotion activities because they believe God has preordained their life, abortion is prohibited, unless the mother's life is threatened by the pregnancy and giving intravenous fluids leads Muslims to break their fast (Ackley, 2011). It is important for the nurse to be aware of these differences in culture to provide care for patients with these beliefs.

In some instances, the patients lean on interpreters to help overcome the cultural barrier obstacles (Ardoin & Wilson, 2010). While interpreters also serve as mediators between nurses and patients, meanings can often get misinterpreted. The nurses that are culturally diverse and competent are seen overcoming those misunderstandings to better the patient (Aldroin & Wilson, 2010). However, according to Otto & Gurney (2006), the culturally diverse nurses are currently underrepresented.

The underrepresentation of such nurses in a world that is getting more culturally intertwined only proves the exigency of the matter. Otto & Gurney (2006) urge that it is imperative that more research is conducted to display the benefits of a diverse workforce. For various reasons, the diversity among nursing students is also relatively low. Hispanics and Blacks have been underrepresented within the nursing program, thus leading to an overall shortage on the professional level.


In conclusion, the role of cultural diversity in patient safety is only going to increase as we move forward. The importance of communication, understanding of cultural uniformity between nurses and patient will be vital in patient safety. In order to promote that idea, more information is required regarding specific problems caused by cultural diversity, which lead to affecting patient safety. Precise numbers of incidences such as medication errors, patient maltreatment, and patient dissatisfaction are necessary. Patients need access to education materials in their own language (or one of the top 5 common languages in the world) as well as sign language, hearing impaired and visual impaired media. Hospitals also need more pamphlets, educational videos and more culturally competent nurses. These suggested changes to the Healthcare organizational culture can initially turn into huge financial constraints. However, one could limit the long-term financial constraints by determining the root of the problem- Education. There needs to be concise effort, despite additional financial constraints, to promote cultural diversity not only within the nursing workforce, but also make it appealing on the academic level (Otto & Gurney, 2006). Furthermore, the continuous cultural transparency in the world calls for the practice of Transcultural Nursing- Nursing in a manner that caters to the needs of individuals who represent a diverse cultural population within a society (Narayanasamy & White, 2005). As previously stated, cultural diversity continues to play a greater role in patient safety and needs constant reinforcing in the world of nursing.


  1. Ackley, B.J., Ladwig, G. B. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care (9th ed.). St Louis, MO: Mosby Inc.
  2. Ardoin, K.B. & Wilson, K.B. (2010). Cultural diversity: What role does it play in patient safety? Nursing for Women’s Health, 14(2), 322-326.
  3. Berenholtz, S.M. & Pronovost, P.J. (2007). Monitoring patient safety. Critical Care Clinics, 23(3), 659-673.
  4. Bernice, B. (2011). Cultural diversity and patient safety. Nursing for Women’s Health, 15(1), 11-12.
  5. Clark, S.L., Meyers, J.A., Frye, D.K. & Perlin, J.A. (2011). Patient safety in obstetrics- the hospital corporation of America experience. American Journal of Obstetrics & Gynecology, 204(4), 283-287.
  6. Narayanasamy, A. & White, E. (2005). A review of transcultural nursing. Nursing Education Today, 25(2), 102-111.
  7. Otto, L.A. & Gurney, C. (2006). Ethnic diversity in the nurse workforce: A literature review. Journal of The New York State Nurses Association, 37(2), 16-21.