Culture And Professionalism


The healthcare system has been experiencing numerous structural changes aimed at improving patient access and safeguarding care quality. In most cases, these changes have has significant consequences on the healthcare system as well as on the nursing professionals. When chaos emerges when implementing change, culture has been among the stabilising forces sought. According to Smits, Bowden and Wells (2016), culture is a socially constructed attribute that serves as a social glue binding the organisation together. The culture of the healthcare system undergoes several changes aimed at restoring, refining, and preserving the traditional care components as well as facilitating necessary change and improvements in the delivery of care. McCance, Gribben, McCormack and Laird (2013) state that it is the relationship and interaction between patients and nurses that have shaped healthcare culture. However, this culture keeps evolving as changes in the profession should by no means diminish the patient-physician relationship. Therefore, it is evident that culture has significant impact on the nursing profession, which this essay seeks to explore.


Smits, Bowden and Wells (2016) write that organisational culture has been an imperative variable for performance and behaviour in healthcare and affects teamwork and care outcomes. The culture shared within the organisation also determines the extent to which employees are satisfied with their jobs (Komer et al. 2015). Culture has a strong effect on interprofessional teamwork. Interprofessional teamwork can be defined as a partnership in collaborative, co-ordinated, and participatory approach to shared decision making around social and health issues of patients (Weller, Boyd and Cumin 2014). Based on their culture, employees have various beliefs, which influences the extent to which they are able to collaborate with their peers for shared decision making. This implies that unless employees have a shared culture, they cannot be able to collaborate in making decisions.

Culture also determines the care quality patients receive. This is so because the quality of the relationship between a physician and a patient influences the quality of care the patient receives. A patient that shares beliefs and values with the physician is more likely to receive quality care since the physician is able to gain a deeper understanding of the need of the patient (Komer et al. 2015). However, this is unfortunate since patients from different cultures are likely to receive low quality care, which affects organisational performance. As a mitigation strategy, it is in order to create an organisational culture in which all professionals within a hospital work as a team for improved care outcomes. This will result to an interprofessional approach to care, which is more participative and interactive assuring patients better care outcomes (Komer et al. 2015). Additionally, a shared organisational culture will ensure every employee has a sense of belonging, which results to higher job satisfaction.

Culture also affects the way in which patients are treated. Given that some elements of professionalism are informed by universal humanistic values, which have varied meanings across cultures, individuals have different ways of attending to patients. For example, respect for patients has varied meanings across cultures. In the Western culture, respect for patients is seen as giving patients autonomy thus allowing them make their own decisions. On the other hand, respect in the Arabian culture means entrusting nurses to make professional decisions on behalf of the patients (Chandratilake, McAleer and Gibson 2012). Therefore, culture has a significant impact on the humanistic values guiding care delivery.

In today’s world, we have physicians from different cultures in the same institution. Additionally, we have patients from diverse cultures being attended in the same health institution. These two factors have led to the concepts of culturally responsive and culturally competent practices. According to Ring, Nyquist and Mitchell (2016), culturally responsive practice can be defined as an extension of patient centred care, which has to do with paying close attention to cultural and social factors while caring for patients from different cultural and social backgrounds. From this perspective, a physician must understand the social and cultural needs of the patient and the care given should respond to the identified needs. This implies that a physician must continuously reflect through the care process and proactively respond not only to the needs of the patient but also to those of his/her family and community. In order for the physicians to attain this, they must be culturally competent and engage in culturally competent practice.

According to Jha and Robinson (2016), physicians must develop a deeper understanding of the cultural background of their patients for them to provide patients with culturally competent care. In agreement, Betancourt, Green, Carrillo and Owusu Ananeh-Firempong (2016) state that if nurses have culturally competent attitudes, skills, and knowledge, they can be able to offer improved care for all their patients. From this perspective, culturally competent practice can be defined as caring for patients and responding to their needs and expectations. This implies that nurses should respond to the needs of patients and offer patients care they need and not care that nurses think could be the best for the patients.

For culturally responsive and culturally competent practice to succeed, nurses ought to spend quality time in understanding the social and cultural background of patients and offer care that responds to the identified needs. Here, cultural competence refers to the skills that nurses should have in order for them to care for patients from diverse cultural backgrounds (Ho and Al-Eraky 2016). This implies that a nurse should have a wide array of skills for them to choose from after they have identified the cultural and social needs of the patient. The ultimate outcome for such care should be high quality care for all patients irrespective their social and cultural backgrounds. Among the factors that a nurse needs to understand before providing care are the patient’s ethnicity, race, nationality, sex, age, religion, economic and social status, sexual orientation, and education among other factors (McFarland and Wehbe-Alamah 2014).

Considerations of culturally responsive and culturally competent practice have led to emergence of the cultural safety concept (Truong, Paradies and Priest 2014). Cultural safety is concerned with providing care to patients irrespective their culture and has been shaped by education that empowers patients to define quality care. Cultural safety has become common in many healthcare institutions and part of the nursing competent standards stipulated by some healthcare councils across the world.

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  • Betancourt, J.R., Green, A.R., Carrillo, J.E. and Owusu Ananeh-Firempong, I.I., 2016. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.
  • Chandratilake, M., McAleer, S. and Gibson, J., 2012. Cultural similarities and differences in medical professionalism: a multi‐region study. Medical education, 46(3), pp.257-266.
  • Ho, M.J. and Al-Eraky, M., 2016. Professionalism in Context: Insights From the United Arab Emirates and Beyond. Journal of Graduate Medical Education, 8(2), pp.268-270.
  • Jha, V. and Robinson, A., 2016. Religion and medical professionalism: moving beyond social and cultural nuances. Journal of graduate medical education, 8(2), pp.271-273.
  • Körner, M. et al. (2015) ‘Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams’, BMC Health Services Research, 15(1), pp. 1–12.
  • McCance, T., Gribben, B., McCormack, B. and Laird, E.A., 2013. Promoting person-centred practice within acute care: the impact of culture and context on a facilitated practice development programme. International Practice Development Journal, 3(1).
  • McFarland, M.R. and Wehbe-Alamah, H.B., 2014. Leininger's culture care diversity and universality. Jones & Bartlett Publishers.
  • Ring, J., Nyquist, J. and Mitchell, S., 2016. Curriculum for culturally responsive health care: The step-by-step guide for cultural competence training. CRC Press.
  • Smits, S.J., Bowden, D.E. & Wells, J.O. 2016, "The role of the physician in transforming the culture of healthcare", Leadership in Health Services, vol. 29, no. 3, pp. 300-312.
  • Truong, M., Paradies, Y. and Priest, N., 2014. Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC health services research, 14(1), p.99. Weller, J., Boyd, M. and Cumin, D., 2014. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate medical journal, 90(1061), pp.149-154.

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