22 CHAPTER 2 Cultural Competency Achieving cultural competence is a learning process that requires self-awareness, reflective practice, and knowl- edge of core cultural issues. It involves recognizing one’s own culture, values, and biases and using effective patient- centered communication skills. A culturally competent healthcare provider adapts to the unique needs of patients of backgrounds and cultures that differ from his or her own. This adaptability, coupled with a genuine curiosity about a patient’s beliefs and values, lay the foundation for a trusting patient-provider relationship. A Definition of Culture Culture, in its broadest sense, reflects the whole of human behavior, including ideas and attitudes, ways of relating to one another, manners of speaking, and the material products of physical effort, ingenuity, and imagination. Language is a part of culture. So, too, are the abstract systems of belief, etiquette, law, morals, entertainment, and education. Within the cultural whole, different populations may exist in groups and subgroups. Each group is identified by a particular body of shared traits (e.g., a particular art, ethos, or belief; or a particular behavioral pattern) and is rather dynamic in its evolving accommodations with internal and external influences. Any individual may belong to more than one group or subgroup, such as ethnic origin, religion, gender, sexual orientation, occupation, and profession. Distinguishing Physical Characteristics The use of physical characteristics (e.g., gender or skin color) to distinguish a cultural group or subgroup is inap- propriate. There is a significant difference between distin- guishing cultural characteristics and distinguishing physical characteristics. Do not confuse the physical with the cultural or allow the physical to symbolize the cultural. To assume homogeneity in the beliefs, attitudes, and behaviors of all individuals in a particular group leads to misunderstandings about the individual. The stereotype, a fixed image of any group that denies the potential of originality or individuality within the group, must be rejected. People can and do respond differently to the same stimuli. Stereotyping occurs through two cognitive phases. In the first phase, a stereotype becomes activated when an individual is categorized into a social group. When this occurs, the beliefs and feelings (prejudices) come to mind about what members of that particular group are like. Over time, this first phase occurs without effort or awareness. In the second phase, people use these activated beliefs and feelings when they interact with the individual, even when they explicitly deny these stereotypes. Multiple studies have shown that healthcare providers activate these implicit stereotypes, or unconscious biases, when communicating with and providing care to minority patients (Stone and Moskowitz, 2011). With this in mind, you can begin learning cult.