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Comment 1
Community health nurses can apply the strategies of cultural competence by being culturally aware. Nurses should start by assessing the patient to determine the person’s knowledge and beliefs before providing care. This will give the nurse insight as to how to proceed with education and treatment.
     An example of a nurse practicing cultural preservation would to acknowledge the use of traditional healers within the Hispanic community. Latinos term illnesses as either “hot” or “cold” and treat such illnesses with herbs or other measures, such as massage on the affected area or steam baths. The treatment of such illnesses is termed cultural accommodation and should be encouraged if these forms of treatment have been proven harmless. An example of cultural repatterning would be for the nurse to work with the patient to change a person’s behavior(s) that would be harmful to him/her. Cultural brokering is recognized as connecting differing cultural backgrounds so that a change in behavior can be made to produce a successful outcome. Barriers to applying any of these strategies is a lack of understanding on the nurse’s part and recognizing that family plays a major role in influencing behavior. For example, research shows that Latino adolescents that battle substance abuse are more successful with their treatment and have better outcomes with family support. This is due to, in part, because Hispanic families rely on the entire family (aunts, uncles, cousins, grandparents, etc.) as a unified support system (Burrow-Sanchez). However, some barriers to Latinos obtaining treatment could be a lack of access to needed healthcare/treatment, language barriers, etc.
     Therefore, it is very important for nurses to be culturally aware and practice patience and understanding while maintaining respect when it comes to providing care for people that come from different cultures.

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A community health nurse has a great challenge in applying cultural competence because they see and treat such a variety of culturally different people. It is key for the community health nurse to assess their own beliefs and be aware that they may greatly vary from the people in their care. Being open minded and setting aside personal biases while implementing the four strategies of cultural competence is needed to achieve success (Maurer & Smith, 2013).
Midwives work in facilities, but also work in the community as well assisting with birthing in homes. Cultural preservation can be seen by only using a female midwife in the home birth of a Muslim baby as well as respecting that the father will most likely not be present for the birth. Cultural accommodation example would be to allow a mother soon after giving birth to eat a ratb, which is a type of date. This is thought to help promote excellent breast milk for the baby. Cultural repatterning would be discussing that the tradition of placing khakhe shafaa, a type of mud, in the infant’s mouth after birth as unhealthy. Cultural brokering involves another person of the persons culture to help negotiate between the community health nurse and the patient. In the case of the khakhe shafaa, there is an additional practice of using Euphrates water in the baby’s mouth. Using someone based in the same culture will increase the trust level and possible help repattern the behavior that is unhealthy for the infant (Ahlul Bayt Digital Islamic Library Project [Islamic Library], 2018).
Another example of cultural accommodation would be to show support of fasting during Ramadan. Unfortunately, if the Muslim client is diabetic and being seen in a community setting, the nurse may recommend monitoring blood glucose levels and “breaking the fast” if the blood sugar levels were to drop too low. This may create a barrier for applying this strategy (Rassool, 2015).

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