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American Family Children's Hospital

Navigating through Cultural Congruency

By Monica Skeat, RN, BSN, CNOR


UW Health nurse Monica Skeat avoided cultural stereotypes in the service of providing the best possible care for a Hispanic family.I had the pleasure of caring for a 4-year-old boy from a Hispanic, Spanish-speaking family. Not being a Hispanic caregiver, I recognized the need to apply a culturally-congruent framework to my care plan to ensure I delivered high-quality care.


To lessen the health care disparities for my patient and his family, it required going beyond simple stereotypes and, instead, addressing them as individuals with their own set of needs and concerns. Also, having previously referenced the Providers Guide to Quality and Culture website, I recognize that not all cultures regard my position as a nurse and woman in the same way. However, I needed to get past any preconceived notions I had about this family not trusting the care I could deliver because of who I am, and instead focus on building a trusting relationship with them. In my experience, a high level of respect for health care providers will only occur when a bond of trust is established.

The Purnell Model for Cultural Competence proved to be a complete format for navigating through this situation to improve my patient's outcomes despite my limited awareness of this population. I brought in a hospital designated interpreter so the family would receive accurate information.


With the interpreter's assistance, I began my pre-op assessment by introducing myself to the patient and family. The interpreter directed my pre-operative questions to the mother, establishing her as the primary caregiver in the family. The child's grandmother was also present and I wanted to include her, knowing the important role extended family members can play within some Hispanic populations. I asked if she had questions about the care we would provide. She shook her head no and chose to sit off to the side and not involve herself.


Part of applying culturally-congruent care is knowing when traditional characteristics do not apply. In this family, the extended family member's role was not as significant as it may be in another family. My role as the nurse is fluid regardless of the care plan I start with. I redirected the rest of my preoperative teaching to the patient and his mother while allowing the grandmother to listen without feeling the need to participate.

Their smiles and relaxed postures indicated that I had developed a bond of trust and they viewed me as a competent health care provider, by making direct eye contact and asking me additional questions about the surgical process. The bonds of trust are tenuous. Understanding their individual needs and providing the family with an interpreter allowed them to participate in their care rather than just accept the care being provided.