Understanding the Importance of Cultural Competence in Nursing for the Provision of Inclusive, Equitable and Respectful Health Care

Abstract

In increasingly multicultural healthcare environments such as those in major cities of Pakistan—including Islamabad, Lahore, Karachi, and Quetta—cultural competence in nursing has become vital for ensuring inclusive, equitable, and respectful care. Nurses often face challenges in understanding, communicating with, and effectively serving patients from diverse cultural and linguistic backgrounds. This study aims to explore how cultural competence influences nursing care and to identify strategies to strengthen culturally responsive practices in the Pakistani context. A qualitative exploratory design was employed using semi-structured interviews and focus groups with registered nurses (n=20) working in public and private hospitals across four major cities in Pakistan. Document analysis of relevant healthcare policies was also conducted. Thematic analysis was used to identify emerging patterns, and trustworthiness was ensured through credibility, dependability, confirmability, and transferability measures in accordance with Lincoln and Guba’s framework. Four key themes emerged: (1) Cultural awareness and sensitivity gaps; (2) Communication barriers and language diversity; (3) Need for culturally inclusive training and policies; (4) Respectful, individualized care as a foundation for equity. Participants emphasized that current curricula and institutional practices inadequately prepare nurses for the cultural diversity encountered in practice. A conceptual framework was developed to illustrate the interaction between personal, institutional, and socio-cultural factors influencing culturally competent care. Cultural competence is not yet embedded in Pakistan's nursing education and clinical practice frameworks. Strengthening training, policy enforcement, and ongoing professional development is essential to improving health equity and patient outcomes. The study provides a locally grounded framework for embedding cultural competence in nursing systems and suggests practical pathways for institutional change.