LEAD 6173 Module 3 Culturally Responsive Practice Analysis Example

Responsive in Both Directions: Culturally Relevant Practice for Internationally Educated Nurses, Their Colleagues and Houston's Patients

Student Name

American College of Education

LEAD6173: Global Perspectives

Module 3 Assignment

Instructor Name

October 26, 2026

Introduction

The composite Houston health system where I direct nursing workforce planning recruits about 150 nurses a year from abroad, mostly from the Philippines, to care for patients who are largely Hispanic and Black, many of them speaking Spanish at home. That arrangement creates a three-way cultural encounter: recruited nurses adapting to American practice, domestic colleagues working with recruits and both caring for patients from yet other cultures. Most cultural competence training in our system addresses only the last of these. This paper examines culturally relevant practice in all three directions, using three frameworks, and recommends changes at the levels where they would matter.

Three Frameworks

Campinha-Bacote (2002) proposed a model of cultural competence in health care as a process rather than an endpoint, resting on five elements: awareness, meaning honest scrutiny of one's own assumptions; knowledge of other groups' beliefs and patterns of illness; skill in assessing a patient without forcing a template on them; encounters, the face-to-face contact through which competence actually grows; and desire, the wish to engage in the first place. A competing view proposed cultural humility instead of competence as the goal (Tervalon & Murray-García, 1998), emphasizing lifelong self-reflection and critique, attention to power imbalances in clinical relationships and institutional accountability, rather than mastery of facts about groups. Betancourt et al. (2003), reviewing the literature on disparities, located sociocultural barriers at three levels of health care: organizational, including leadership and workforce; structural, meaning processes of care; and clinical, the encounter between provider and patient.

Each framework adds something. Campinha-Bacote's constructs describe what individuals need; cultural humility warns against treating culture as a checklist; and the three-level framework insists that organizations, not only individuals, must change.

Direction 1: The Organization Toward Recruited Nurses

Cultural responsiveness usually means staff adapting to patients, but at the organizational level, as the three-level framework suggests, it also means the organization adapting to its staff. Recruited nurses described orientation materials written entirely around American norms, no acknowledgment of the Filipino family obligations that shape their schedules and holiday requests and a common assumption that their more deferential communication with physicians signaled lack of confidence rather than a different professional culture. An organization that expects recruited nurses to adapt to everything while adapting to nothing itself is practicing assimilation, not responsiveness. Cultural humility, with its insistence on institutional accountability, points to concrete changes: orientation co-designed with experienced Filipino nurses, scheduling policies that consider family obligations across time zones and recognition that speaking up is a skill to be taught, not a trait some nurses lack.

Direction 2: Colleagues Toward Each Other

On the units, recruited and domestic nurses work side by side, and tension sometimes follows. Domestic nurses have complained that recruits are reluctant to challenge orders; recruits have described being excluded from social life on units and assigned the least desirable shifts. Campinha-Bacote's construct of cultural encounters is relevant here: competence develops through direct engagement, and our units provide plenty of contact but little structured engagement. Pairing recruits with domestic preceptors who have themselves been trained in cultural humility, and creating space in unit meetings to discuss differences in professional norms openly, would turn contact into learning in both directions. Some of the friction also runs the other way: recruits have noticed domestic colleagues speaking about patients in ways they find disrespectful, and they have had no safe channel to say so, which a structured unit conversation could provide.

Direction 3: Nurses Toward Patients

For patients, the central issue is language and trust. More than a third of the system's patients prefer Spanish, and few recruited nurses speak it. Clinical-level responsiveness, in the three-level framework, requires that nurses use professional interpreters rather than family members or improvised Spanish, and that they understand patients' health beliefs without assuming them. Here recruited nurses often have an advantage that training overlooks: many come from family-centered care traditions similar to those of Hispanic patients, and several have become the units' most trusted nurses for large families at the bedside. Cultural humility suggests building on that common ground while recognizing that a Filipino nurse and a Mexican American family do not share a single culture. Black patients in the system's south campus raise different concerns, including distrust rooted in historical mistreatment, which no nurse of any background should be expected to resolve alone and which the organization must address directly.

What Recruited Nurses Recommended

When I asked a group of six experienced Filipino nurses what would have helped them most in their first year, their answers were more practical than any framework. They asked for a named contact other than their manager whom they could approach with questions they were embarrassed to ask, such as how to address a physician by first name or how to decline an overtime request without seeming disloyal. They asked that orientation include a session on American patients' expectations, including how directly patients expect to be told bad news, which differs from the more indirect style several had learned at home. And they asked that the hospital recognize Filipino holidays and community events, not by closing units but by not scheduling every recruit on the same holidays every year. Their requests fit cultural humility's emphasis on institutional accountability: each one asks the organization to change something, not the nurse.

Recommendations by Level

Organizational: add two experienced internationally educated nurses to the orientation design team; review scheduling and leave policies for cultural assumptions; report retention and satisfaction for recruited nurses separately so problems are visible. Structural: build interpreter access into the electronic health record workflow so that using a professional interpreter is the easiest option; include communication with physicians in orientation as a skill with practice scenarios, for all new nurses. Clinical: replace the current one-hour online cultural competence module with case-based sessions that include recruited nurses as co-facilitators and address all three directions.

The Leader's Part

Recommendations like these succeed or fail on leadership. In my role, that means three things: making sure recruited nurses' voices reach the committees that design orientation and schedules, holding nurse managers accountable for how recruits are treated on their units, which our current manager evaluations do not measure, and modeling cultural humility myself, starting by admitting that our system's training addressed only patients for years.

Limits

Evidence that cultural competence training improves patient outcomes is limited, and frameworks like these are easier to endorse than to evaluate. The recommendations above will therefore be tested with measures: interpreter use rates from the record, recruited nurses' retention at two years and patients' ratings of communication on Spanish-language surveys.

Conclusion

In a hospital that brings nurses from one culture to care for patients from others, cultural responsiveness has to run in several directions at once. The three frameworks together show what that requires: individual awareness and skill, humility about the limits of what anyone knows about another culture and changes at the organizational and structural levels where training alone cannot reach. Module 4 will step back to the global issue underneath all of this, the migration of nurses itself.

References

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-302. https://doi.org/10.1016/S0033-3549(04)50253-4

Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181-184. https://doi.org/10.1177/10459602013003003

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125. https://doi.org/10.1353/hpu.2010.0233