Retired Position Statement: Cultural Diversity in Nursing Practice

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Effective Date: October 22, 1991
Status: New Position Statement
Originated by: Council on Cultural Diversity in Nursing Practice, Congress of Nursing
Adopted by: ANA Board of Directors

Related Past Action:
Cultural Diversity in Nursing, 1986 ANA House of Delegate


This statement describes the features of an operational definition of cultural diversity as it is expressed in nursing practice, education, administration and research. (note: See Attachment which further defines specific terms related to cultural diversity).

Knowledge of cultural diversity is vital at all levels of nursing practice. Ethnocentric approaches to nursing practice are ineffective in meeting health and nursing needs of diverse cultural groups of clients. Knowledge about cultures and their impact on interactions with health care is essential for nurses, whether they are practicing in a clinical setting, education, research or administration. Cultural diversity addresses racial and ethnic differences, however, these concepts or features of the human experience are not synonymous. The changing demographics of the nation as reflected in the 1990 census will increase the cultural diversity of the U.S. population by the year 2000, and what have heretofore been called minority groups will, on the whole constitute a national majority (Census, 1990).

Knowledge and skills related to cultural diversity can strengthen and broaden health care delivery systems. Other cultures can provide examples of a range of alternatives in services, delivery systems, conceptualization of illness, and treatment modalities. Cultural groups often utilize traditional health care providers, identified by and respected within the group. Concepts of illness, wellness, and treatment modalities evolve from a cultural perspective or world view. Concepts of illness, health, and wellness are part of the total cultural belief system. Culture is one of the organizing concepts upon which nursing is based and defined. Nurses need to understand:

  • how cultural groups understand life processes;
  • how cultural groups define health and illness;
  • what cultural groups do to maintain wellness;
  • what cultural groups believe to be the causes of illness;
  • how healers cure and care for members of cultural groups; and
  • how the cultural background of the nurse influences the way in which care is delivered.

It is important the nurse consider specific cultural factors impacting on individual clients and recognize that intra cultural variation means that each client must be assessed for individual cultural differences.

Nurses bring their personal cultural heritage as well as the cultural and philosophical views of their education into the professional setting. Therefore, it is important for the nurse to understand that nurse-patient encounters include the interaction of three cultural systems: the culture of the nurse, the culture of the client and the culture of the setting. Access to care can be improved by providing culturally-relevant, responsive services. Individuals need choices of delivery systems in seeking health care. Nurses in clinical practice must use their knowledge of cultural diversity to develop and implement culturally sensitive nursing care. Nurses take pride in their role as client advocates. Recognizing cultural diversity, integrating cultural knowledge, and acting, when possible, in a culturally appropriate manner enables nurses to be more effective in initiating nursing assessments and serving as client advocates. All nursing curricula should include pertinent information about diverse health care beliefs, values, and practices. Such educational programs would demonstrate to nursing students that cultural beliefs and practices are as integral to the nursing process as are physical and psycho-social factors. Nurse administrators need to foster policies and procedures that help ensure access to care that accommodates varying cultural beliefs. Nurse administrators need to be knowledgeable about and sensitive to the cultural diversity among providers and consumers. Nurse researchers need to utilize the cross-cultural body of knowledge in order to ask pertinent research questions. Through exploration of other cultures, nurse researchers and practitioners find that while cultures differ, there are also many similarities among groups. Nurses are in a position to influence professional policies and practice in response to cultural diversity.


Cultural diversity in nursing practice derives its conceptual base from nursing, other cross-cultural health disciplines, and the social sciences such as anthropology, sociology and psychology. Culture is conceptualized broadly to encompass the belief systems of a variety of groups. Cultural diversity refers to the differences between people based on a shared ideology and valued set of beliefs, norms, customs, and meanings evidenced in a way of life. Culture consists of patterns of behavior acquired and transmitted symbols, constituting the distinctive achievement of human groups, including their embodiment in artifacts; the essential core of culture consists of historically derived and selected ideas and especially their attached values (Kroeber and Kluckhohn, 1952).

The impact of culture as a causative influence on the perceptions, interpretations and behaviors of persons in specific cultural groups is important. Issues such as cultural differences in defining health and in designing treatments are also important. As knowledge of specific cultures is gained, cross cultural comparison can lead to recognition of possible universal aspects as well. Ideology is comprised of the ideas of a group, their nature and source, and the doctrines, opinions or ways of thinking of a group. These are attached to an agreed upon set of beliefs or a creed. Value(s) refer to the especially favorable way of regarding the ideas, behaviors, customs, and institutions of a group as desirable, useful, estimable, important, or truthful. Ethnocentrism is the belief that one's own culture is superior to all others. This belief is common to all cultural groups, all groups regard their own culture as not only the best but also the correct, moral and only way of life. This belief is pervasive, often unconscious and is imposed on every aspect of day-to-day interaction and practices including health care. It is this attitude which creates problems between nurses and clients of diverse cultural groups.


  • American Nurses Association, Code With Interpretive Statements, Kansas City, Missouri: 1985. Kroeber, A. L.; Kluckhohn, C., Culture: A critical review of concepts and definitions, New York: Random House, 1952.
  • American Nurses Association, "Cultural Diversity in Nursing," ANA House of Delegates, 1986. U.S. Census Bureau, The 1990 Census, 1990.

Reading List

  • Anderson, J. "Health Care across cultures," Nursing Outlook,38(3) 136-139, 1990.
  • Boyle, J.S.; Andrews, M.M. Transcultural concepts of nursing care, Glenview, Fla: Scott Foresman and Company: 1989.
  • Chrisman, N. "The health seeking process: An approach to the natural history of illness," Culture, Medicine, and Psychiatry, 1(4), 351-377, 1977.
  • DeSantis, L. "Developing faculty expertise in culturally focused care and research," Journal of Professional Nursing 7(5), 1991.
  • Foster, G.M. Applied anthropology. Boston: Little, Brown and Company: 1969. Helman, C. Culture, health and illness, Bristol, G.B.: John Wright and Sons Ltd: 1990.
  • Leininger, M.M. "Becoming aware of types of health practitioners and cultural imposition," Journal of Transcultural Nursing 2(2), 32-39, 1991.
  • Leininger, M.M., Nursing and Anthropology: Two Worlds to Blend, New York: J. Wiley and Sons, Inc., 1970.
  • Stewart, E.C.; Bennett, M.J. Cultural Patterns: A Cross-Cultural Perspective, Yarmouth, ME: Tripp-Reimer, T.; Brink, P.S. "Cultural brokerage," In G.M. Bulenchek and J.C. McCloskey (Eds.) Nursing interventions Philadelphia: W. B. Saunders, 352-364, 1985.
  • Weidman, H.H. "The transcultural view: Prerequisite to interethnic (intercultural) communication in medicine, " Social Science and Medicine 13B(2), 85-87, 1979.