Nurse patiently explaining a diagnosis to an elderly lady.

Cultural Competency and Implicit Bias

Nurses work in an ever-changing environment with many nuances to manage. Each person brings their own values, beliefs, and unique culture with them to work each day. This blog topic is meant to bring awareness to some of the key factors that may influence nurses as they care for patients in a variety of settings. The elements that often converge are each person’s culture, bias, and stereotypes.

Defining Cultural Competency

We are all individuals

In order to provide high-quality, culturally competent care to all patients, it’s important to consider the cultural context of each individual you are caring for. Cultural competence in healthcare is often defined as providing patient care in a way that meets the social, cultural, and linguistic needs of each individual.
Along with considering the cultural needs of patients, it’s important to take a step back and reflect on any personal influences or bias that might impact how care is actually delivered and received. Understanding culture is not as simple as asking a question and checking a box when a patient is admitted to your healthcare setting. It involves so much more, and often, we are not be aware of the unconscious mind and how it influences our thoughts and behaviors.

Defining Implicit Bias

Keeping an open mind.

The term implicit bias (also referred to as unconscious bias) refers to the idea that we are not neutral in our judgment and behavior, and that unconscious experience-based associations and preferences may occur, often without any awareness. Such biases may lead to unequal treatment of patients based on race, ethnicity, nationality, gender, gender identity, sexual orientation, religion, socioeconomic status, age, disability, or other characteristics, such as weight or disability.

Have you ever considered how your unconscious mind works to influence your behaviors? Researchers have designed tests that make implicit biases visible. For instance, Harvard University’s Project Implicit has developed an Implicit Association Test (IAT) that can identify preconceived in-group preferences and implicit biases in individuals. (See the link in the website section at the end of this blog to explore this topic in more detail.)

In order to provide high-quality, culturally competent care to all patients, it’s important to consider the cultural context of each individual you are caring for.

Getting to know someone else for who they truly are.

Take the Implicit Association Test

Explore the Implicit Association Test (IAT) to help you understand how you associate positive or negative thoughts with people from different ethnicities, gender, sexual orientation, age, and other characteristics.

The IAT measures beliefs and attitudes that most people normally are unable to or unwilling to report. This can be especially powerful if it shows you a belief or attitude that you had no idea you held. For example, some people may believe they consider all genders to have equally associated strong skills in math, but their automatic reactions in the Implicit Association Test might show that they associate one gender more than another with math skills.

During the test, respondents are shown the faces of black or white people and are asked to instantly pair the image with various words shown on the screen. Response times and any patterns or associations indicate the degree to which someone may be biased. A shorter response time tends to show a stronger association with certain stereotypes (unconscious bias).

Often, we are not actually aware of these stereotypes and thoughts. Most people tend to have an ingrained prejudice due to ethnocentrism, which is the tendency to judge other cultures based on one’s own culture.

Defining Stereotypes

A group of diverse people having a good time outdoors.

A stereotype is the belief that people in similar groups have similar characteristics. An example of this might be associating females with being nurturing and being natural caregivers and males with being strong and the provider for a family.

Another example might be believing that a young person is more skilled with technology than someone who is over age 65. It’s important for all professionals to think about the stereotypes we might have formed in our minds and to consider how this might impact how we interact with our patients on a daily basis.

The Convergence of Elements

Nurse takes a moment off to deal with a stressful day

Unconscious (implicit) biases are those stereotypes or prejudices we hold deep in our brain, often formed outside of our own consciousness. None of us is immune to this. The beliefs we hold are the collective result of our previous life experiences, culture, upbringing, and even external influences such as the media.

It’s not uncommon for unconscious bias to be in direct conflict with our conscious values and beliefs. There may even be times when unconscious bias might take over, such as when we are working under pressure or multitasking. This is often when it is more difficult to think through our actions and reflect on what behavior or reaction is most appropriate.

Strategies to Reduce Bias

It can be a big challenge to know how to address unconscious bias on a personal level. Simply having an awareness that this exists is one of first steps. However, there are a few additional steps you may want to take:

  • Be curious and respectful. Ask questions and learn about your patient. Questions should show your genuine interest and be open ended. Listen to their stories without judgment or blame. Reflect what they are saying back to them so that they know you are listening.
  • Discover what is most important to your patient while they are in your care. Remember that each of your patient’s lived experiences have shaped their own values and beliefs, just like yours did. You might even want to ask them how they define good health. This can be a valuable way to learn what is most important as you work together to achieve the best health outcome for your patient.
  • Reflect on the impact of your actions or words. How might your patient be affected in a negative or positive way. Stop and check in with yourself if you think something is not quite right. Your gut instinct often is one that you should listen to.
  • Consider what you have learned about yourself. Through self-discovery, you may have better insight into some of the unconscious beliefs you hold. Tune in to your thoughts and emotions. Understand how your own experiences have influenced how you react and feel about others. Do your best not to make assumptions about others.
  • Expand your ideas and beliefs. Place a focus on learning to be more flexible and open to ideas. Be accepting and nonjudgmental when listening to the perspective of others. You will learn so much more about yourself in the process. Consider that there is no “right” or “wrong” way to feel or think about most things. This will give you the confidence you need to be more comfortable working with others who may not share the same beliefs and values that you do.


Project Implicit

Think Cultural Health (U.S. Department of Health and Human Services)


Ackerman LS & Chopik WJ. (2020). Cross-cultural comparisons in implicit and explicit age bias. Personality and Social Psychology Bulletin, 0146167220950070.

Georgetown University, Health Policy Institute. (n.d). Cultural competence in health care: is it important for people with chronic conditions? Retrieved from

Kaihlanen AM, Hietapakka L, & Heponiemi T. (2019). Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC nursing, 18, 38. Retrieved from

League of European Research Universities (LERU). (2018). Implicit bias in academia: a challenge to the meritocratic principle and to women’s careers—and what to do about it. Retrieved from

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