Beyond cultural competence: shifting from individual traits to structural competence

Introduction: Transcultural nursing has traditionally relied on cultural competence to foster respectful, patient-centered care and improve communication across diverse populations. However, evidence suggests that while these frameworks enhance individual nurse-patient interactions, they often fail to mitigate the persistent health inequities driven by systemic forces.

The Reason for Raising the Issue: Current nursing models risk “culturalizing” health disparities—attributing complex inequities to static cultural traits while overlooking the institutional, political, and economic determinants of health. There is an urgent need to reframe the problem from one of “culture” to one of “structure,” ensuring that nursing practice addresses the root causes of oppression rather than merely describing their symptoms. Discussion and

Supportive Arguments: This paper proposes a synergistic framework that integrates intersectionality, structural competence, and decolonization to enrich transcultural nursing. Intersectionality is utilized not merely to list identity categories, but to analyze how overlapping systems of power (e.g., racism, heteronormativity, classism) mutually constitute health outcomes. We argue that structural competence complements this by providing the practical tools—such as “structural humility” and policy advocacy— required to intervene on these upstream determinants. Furthermore, a decolonial lens is applied to challenge the Eurocentric hegemony embedded in nursing curricula, moving education toward critical pedagogies that empower students to confront structural injustice.

Conclusions and Take-Home Messages: We conclude that achieving genuine health equity requires shifting from individual-centered cultural sensitivity to a broader, justice-oriented structural practice. By embedding these frameworks into education and practice, nurses can reclaim their role as agents of social justice, equipped to dismantle the structural barriers that perpetuate illness and construct a more equitable healthcare system.