Dawn Mangine

    It is estimated that by 2050, that minority populations will constitute half of the general population in the United States. Minority populations face different healthcare issues than the majority population; cultural issues can come into play as well.

    Simulation is a wonderful way to educate healthcare workers on the needs and challenges that different populations face. Cultural competence education provides

    “learners with the opportunity to engage and provide care for patients from different cultural backgrounds, ethnic heritages, gender roles, and religious beliefs is crucial to preparing them for the realities of their professional careers.”

    The use of simulation to support cultural competency does the following:

    • Provides a safe environment to conduct a cultural assessment.
    • Elicits student attitudes toward cross cultural situations
    • Improves communication, critical thinking, and nursing skills.

    Improving communication and nursing skills will help students and healthcare workers recognize cross-cultural issues in interviewing, communicating medical information, and providing treatment and culturally competent care for patients from diverse backgrounds.1

    Read the post "The Importance of Language and Cultural Competencies in Healthcare Education."

    The ABCDEs of Cultural Influence

    To enable cross-cultural discussions, students need instruction about what types of questions and strategies to address to patients and their families. A paper in the Journal of the American Medical Association lays out some assessment strategies to adopt.2

    • Attitudes of patients and families: What attitudes do this ethnic group in general have toward truth telling about diagnosis and prognosis?
    • Beliefs: What are the family’s spiritual and religious beliefs, especially as relates to the idea of the afterlife?
    • Context: Asking questions about the historical and political context of their lives demonstrates a willingness to understand why patients are coming from where they are. Place of birth, refugee status, poverty, past lack of access to care – these influence current context of seeking healthcare.
    • Decision-making style: What are the decision making styles of the group in general, as well as the patient and family in particular? Is the emphasis on individual decision making by the patient, or is the process more family-centered?
    • Environment: What resources are provided to aid the understanding of cultural dimensions of care? Translators, diverse care givers, community or religious leaders, and so on?

    Practicing Empathy

    At Indiana University of Pennsylvania, faculty from the Department of Theater and Dance have developed exercises for nursing and healthcare students to practice empathy, communication, and interpretation of non-verbal cues. Rachel DeSoto-Jackson, MFA, and Professor Richard Kemp designed the Minute Conversations Exercise, which is designed to enhance inter-personal communication.

    For more information, see the Simulated Patient-Applied Theater page at the IUP website.

    Culture fundamentally shapes how individuals make meaning out of illness, suffering, and dying. The risk for cross-cultural misunderstandings are increasing as patient diversity and differences between professionals and patients rise. Simulation scenarios that build skilled use of cross-cultural understanding and communication techniques increase satisfactory outcomes for all involved.2



    1. Baily, Lance, “Healthcare Simulation is a Powerful Tool to Train for Cultural Competency,” Healthy Simulation.
    2. Kagawa-Singer M., Blackhall L. “Negotiating Cross-Cultural Issues at the End of Life: ‘You Got to Go Where He Lives,” JAMA, Dec. 19, 2001, Vol 286.
    3. “Minute Conversations Exercise,” adapted from McIntosh, Peggy, White Privilege: Unpacking the Knapsack (2003).