Sharmila Thiyagarajan 1, Anil Prasad Yadav 2


1 Scholar, Department of Management, School of Commerce and Management, YBN University, Namkum, Ranchi, Jharkhand, India

2 HOD, Department of Management, School of Commerce and Management, YBN University, Namkum, Ranchi, Jharkhand, India


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Healthcare sector is a multidisciplinary approach especially in hospitals effective leadership also necessitates acknowledgement of circumstances nurses should realize that their leadership and cultural care is as important in providing quality care. Demographic changes reflect a multicultural population and increasing the diversity of the nation brings significant challenges in providing individualized and holistic care. Leadership requires the identification of desired change and is capable of encouraging others to instigate change. In order to increase the quality of care for patients, it is imperative that healthcare leaders recognize and grow the skills which are needed for the upcoming batch of nurse leaders. Recent trend, that has influenced nursing and health professional, concerning to focus on culturally competent care in intensive stress healthcare environments.  Nursing and all health workers need to be trained in cultural competency; thus, this cultural competency education may minimize potential negative outcomes.


Received 24 March 2023

Accepted 25 April 2023

Published 10 May 2023

Corresponding Author

Sharmila Thiyagarajan,

DOI 10.29121/granthaalayah.v11.i4.2023.5141  

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Copyright: © 2023 The Author(s). This work is licensed under a Creative Commons Attribution 4.0 International License.

With the license CC-BY, authors retain the copyright, allowing anyone to download, reuse, re-print, modify, distribute, and/or copy their contribution. The work must be properly attributed to its author.


Keywords: Healthcare Organization, Nurse Leaders, Cultural Competence, Management





The diverse cultures coexist in India. India is a multi-ethnic society, diverseness in languages, habits, and religion, The People's Linguistic Survey of India (PLSI), which was conducted in 2010, revealed that there are 780 different languages India has major high diversity in terms of religion is 80% of people in Hindu and 20 % of them is Christian and Muslim, Sikh, Buddhist, Jain, and Zoroastrian. As a result, cultural understanding of the Indian health care system is essential. The primary purpose is to identify and close the cultural awareness and nursing leadership gap in care delivery. Cultural base care cannot be obtained by all people in today's society. so that health practitioners have a clear awareness of varied cultural variances and beliefs

 Because it is a life process, the organization needs support at all levels, from leadership to individual, to assess cultural competence Healthcare is a complicated industry that necessitates the leadership of a different group of health care experts in order to manage efforts towards enhance efficiency quality of care. Nursing leaders are the most powerful members of these leadership teams. The nurse leader is responsible for leading clinical, operational, patient safety, and patient satisfaction advancements and outcomes in healthcare systems. The ability to be a transformational leader is critical in today's quickly changing healthcare environment. Healthcare companies must continue to develop and provide leadership training while also seeking strategies to sustain and promote leadership growth in practice Sfantou et al. (2017), Huber (2010), AL-Hussami (2008).

Leadership traits have an impact on nurses' leadership skills and practice when they are effectively taught and implemented into clinical practice. Nursing leadership is required at all levels and in all contexts. Nurse should recognize that their leadership is just as important in providing quality healthcare as their technical skills to provide safe and effective care at the bedside.


2. Culturally competent definitions and concepts

Cultural awareness is the capacity to work effectively across cultures.

Cultural competence is characterized as health care professionals' and organizations' capacities to successfully deliver health care services that satisfy patients' social, cultural, and language needs.

seeks to make health care more accessible and acceptable for persons from varied ethnocultural cultures.


2.1. concepts

As "a combination of congruence behaviours, attitudes, and regulations that combine in an organization, or among professionals to enable that system, organization, or professions to work effectively in cross-cultural circumstances.”. Cross et al. (1989)

Describe that, cultural phrase has several meanings. People perceive their own experience and ability in their own acts, demonstrating culture as a tool for individuals to communicate, maintain, and grow their knowledge about life attitudes. By adding cultural knowledge into healthcare, the healthcare organization will improve the quality of care Cross et al. (1989)

According to the American Hospital Association Anderson et al. (2003), "a cultural competence health system recognizes the value of cultural context, integrates the evaluation of cross-cultural relationships, identifies the potential culture and its impact, continues to expand cultural understanding, and able to adapt services to meet culturally unique needs."





Cultural competence components include:

The capacity to operate well including both on organizational and individual level within the framework of clients' and their communities' cultural ideas, attitudes, and needs Anderson et al. (2003)

According to the United States Department of Health and Human Services' Office on Developmental Disorders, "cultural competence" refers to the capacity to engage successfully with individuals from various cultural backgrounds...

Papadopoulos and Taylor (1998) established a model for Cultural Competence that includes four elements: awareness, knowledge, skills, and attitude. These components seek to enhance the delivery of cultural care, which consequently toward quality patient safety.

·        Awareness—the state of being aware of your own reactions and perceptions of other individuals with different points of view.

·        Personal values and beliefs about cultural differences.

·        Knowledge--A person has knowledge and wisdom about different cultures worldwide.

·        Skills—concentrates on perfecting cultural competence.

The various methods of communication, which include gestures, verbal and other nonverbal communication that varies across cultures, are the fundamental essential tools used by the people who interact in the organization. Many studies in healthcare have found that a lack of cultural understanding can have irreversible consequences.

The health system must emphasize cultural variations, variance, and awareness. In order to provide personalized care while accounting for society's different beliefs and cultural demand NHMRC (National Health & Medical Research Council) (2006), Andrews (2003), Chicago : IL. (2011, June), Goodman (2014).


The evolution of cultural competence in health care:

The concept of cultural competence in healthcare is universal. The idea of cultural competence was first introduced by Carter G. Woodson in 1927. Goggin (1993). Madeleine Leininger's genesis theory of multicultural culture care, published in 1978, served as the foundation for cultural awareness Leininger (1991). Due to the demands of a growingly diverse society, the term "cultural knowledge" first appeared in 1980s Sarah Stewart (2006).

The National League of Nursing started talking about race, nationality, religion, and diversity in 1983. It wasn't until the early 1990s that the term "cultural competence" started to appear routinely in healthcare literature DeSantis & Lipson (2007). Many models relating to patient cultural aspects in nursing process were established in the 1990s. Purnell & Paulanka (2003) approach of cultural competency in healthcare service delivery is one of these models Purnell & Paulanka (2003).

Around three-quarters of the publications reported in nursing and medical journals using the terminology "cultural competence" and "cultural awareness" in their headlines as well as academic papers have been submitted since 2000. A large body of literature on cultural competency has been produced, with the most of it coming from the countries of the United States Bigby (2003).

Cultural competence education and training for healthcare personnel first started in 2002. Following that, a series of paper promoting cultural competency in healthcare and training were launched Bigby (2003). Based on models of cultural competency developed in the United States, a number of frameworks and guidelines were presented to assist healthcare practitioners in recognizing clients' cultures and performing culture observations Saha et al. (2008).


Cultural competency in health care has the following advantages:

 Culturally competent organizations have better health outcomes, cheaper costs, and less care inequities, as well as more respect from the local population. health care has great advantages in various aspect such as:

1)     Helps and promotes patients as well as their family’s health responsibility.

2)     It fosters mutual respect and understanding between the patient and the organization.

3)     Develop innovative conflict strategies and approaches.

4)     Apply new viewpoints and ideas;

5)     Increases members of the multicultural population who lead to increased business efficiency in the organization.

6)     It boosts local community engagement and involvement in health-related issues.

7)     Contributes to the effectiveness of public perception of health-care services.

8)     Increase equity across age group in the population.

9)     Reduced ethnic disparities in health care;

10) increased consumer "health literacy," as well as decreased delays in health medical attention and therapy.

11) Better comprehension and interaction among health customers and healthcare professionals

12) Reduce medical errors

13) ensure wellness quality assurance

14) Promote patient satisfaction

15) Lower incidence of mortality and mobility hospitalization. Anderson et al. (2003), NHMRC (National Health & Medical Research Council) (2006), Douglas et al. (2009) , Chicago : IL. (2013)


The relationship of cultural competence in patient-centeredness care and nursing leader:

Patient-centred care is a clinical method to gain an understanding of the patient and the disease, focusing on the patient's needs and concerns. Leadership should be taken into account when creating and putting into practice culturally competent solutions.

 Balint (1969) stated that Lipkin and Levenstein et al. (1986) Patient-centred care is a clinical method to gain an understanding of the patient and the disease, focusing on the patient's needs and concerns. Leadership should be taken into account when creating and putting into practice culturally competent solutions. Balint (1969). With a focus on the patient's needs and concerns, Stewart outlined six dimensions of a patient-centred approach to hospitals and healthcare services in 1995. Levenstein et al. (1986)

 Healthcare professionals can improve their cultural competency with the aid of leadership. Social interactions and the implications of leadership within the health services should be taken into account when developing and implementing culturally competent solutions. This necessitates caution because the most significant individuals aren't always the same as the ceremonial leaders Stewart et al. (1995).

The forerunners of cultural competence understood that inequalities in the quality of healthcare necessitated both the training of culturally competent providers and the creation of culturally competent health care systems. With a growing focus on the significance of comprehending and addressing social determinants of health, patient-centeredness and cultural competence have been promoted as essential elements of high-quality health care delivery in recent years. Due to this, healthcare is now being approached more holistically, taking into account the particular requirements and experiences of each patient. enhancing the standard of healthcare. Mead & Bower (2000)

Healthcare organizations should measure and track patient-centeredness and cultural competence to ensure high-quality care. his highlights the importance of having culturally competent leaders who can effectively mediate and understand different cultural paradigms, as it positively impacts the cultural competency of medical personnel. Therefore, investing in leadership development programs that focus on cultural competence may ultimately improve healthcare outcomes for diverse patient populations. Saha et al. (2008), U. S. Department of Health & Human Services, Office of Minority Affairs. (2007)


Ways to developing cultural competence in health care:

  Some ways to develop cultural competence in health care include attending cultural competency trainings, seeking out resources and information on different cultures, and engaging in open and respectful communication with patients from diverse backgrounds.

It is also important to recognize and challenge one's own biases and assumptions in order to provide equitable care to all patients.

The front-line health care provider needs to implement the main elements while providing culturally competent care, such as awareness,  knowledge,  skill, and cultural encounter.

Cultural competency is an ongoing learning process and assessment. Every health organization should perform a cultural self-assessment and determining their own strengths and weaknesses

The United States of the Department of Health and Human Services establishing a blueprint national culturally and linguistically appropriate service standards for health care organizations.

 These standards provide guidance on how to provide effective, equitable, and respectful care to diverse populations. By following these standards, organizations can improve their cultural competence and better serve their patients or clients.

Nurses should advocate for culturally competent nursing care, including encouraging fairness,  reflective critical thinking, cross-cultural knowledge  and practice, cultural diversity workforces, education and training, and policy development. These standards should be implemented to ensure that healthcare providers understand the unique cultural needs of their patients and can provide care that is respectful and effective. Additionally, incorporating cultural competence into nursing education and training programs can help to prepare future nurses to work with diverse populations. Huber (2010), Purnell & Paulanka (2003), U. S. Department of Health & Human Services, Office of Minority Affairs. (2007), Paul (2009).



The value of cultural competence must be recognized by the health care system. In order to care for patients who, have different values, beliefs, and behaviours, one must be culturally competent. Understanding the history of the society and its diverse population is the first step in becoming culturally competent. Healthcare organizations and systems are making a diverse range of efforts to train their staff to be culturally competent as part of their mission to reduce differences in care. A cultural assessment, a variety of training techniques, and ongoing instruction are all components of effective training materials and mentoring for hospital staff. The delivery of health services with careful and appropriate application of sound cultural competency techniques may contribute to the reduction of disparities. cultural competency is crucial in healthcare as it can improve patient outcomes, increase patient satisfaction, and reduce healthcare costs. By embracing cultural diversity and understanding the unique needs of each patient, healthcare providers can deliver high-quality care that is respectful and responsive to the patients' cultural beliefs and practices.









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