The American Association of Colleges of Nursing defines cultural competency as "the attitudes, knowledge, and skills necessary for providing quality care to diverse populations." Cultural competency recognizes that people's diversity, an increasing issue in most Western countries, affects their health, access to health care and attitudes about when to seek help from a medical professional. As nursing students develop their cultural competency skills they should take into account how their own beliefs about race and ethnicity, and those of the medical establishment, affect the care that they provide a patient. This will include understanding how cultural differences affect patients, being open to diverse research and working with translators to ensure information is communicated to patients and families.
Developed by Dr. Dennis Raphael, the Social Determinants of Health model looks at non-medical factors that influence someone's health and their health care needs. These sociopolitical factors are issues outside of someone's individual control; they are imposed by society or life circumstances.
According to Dr. Raphael the 14 determinants are:
1. Income and income distribution
2. Education
3. Unemployment and job security
4. Employment and working conditions
5. Early childhood development
6. Food insecurity
7. Housing
8. Social exclusion
9. Social safety network
10. Health services
11. Aboriginal status
12. Gender
13. Race
14. Disability
Social justice includes issues covered by cultural competency and the social determinants of health framework, but also has broadened to include awareness of stereotypes and oppression. For nursing students this includes understanding how someone's gender presentation may not match their biological sex, or differing needs for health care of someone who identifies as gay or lesbian. Understanding social justice also includes looking at issues of power, within and outside of the health care system. In order to best understand social justice issues students need to be able to examine their own privilege or marginalization and how it may affect services that they deliver.
As technology advances and access to health care improves people are living longer. The National League for Nursing says that "By 2020, more than 20 percent of the population will be 65 and older, with those over 85 constituting the fastest growing age group." This adds challenges for the health care system. Nursing students need to be trained to understand the needs of the elderly and their families. The "sandwich generation," those people raising both children and caring for their aging parents, is faced with increased pressure and needs support from health care professionals. Nurses are well-placed to be able to watch for signs of elder abuse. They also can look out for frailty in aging spouses who accompany their partner to doctor's appointments or visit during hospitalization.