In: Nursing
How does such reduction effect true cultural humility? Do you have a personal example of culturally competent care(or culturally incompetent care) that you would feel comfortable to share with the class?
The National Institutes of Health (NIH) defines cultural humility as “a lifelong process of self-reflection and self-critique whereby the individual not only learns about another’s culture, but one starts with an examination of her/his own beliefs and cultural identities.” The term was first coined in 1998 by healthcare professionals Melanie Tervalon and Jann Murray-García, who originally described cultural humility as a tool to educate physicians to work with culturally, ethnically, and racially diverse populations in the United States. The concept, however, carries meaning for any clinical researcher or social advocate who is studying and/or working with someone different from themselves – in terms of race, ethnicity, gender, religion, sexual preference, socioeconomic status, or geographic location – in any cultural context and in any part of the world.
Here are three things to know about cultural humility:
1. We move between several different cultures – often without
even thinking about it.
Though the term “culture” is often used when describing different
ethnic or religious affiliations, most people experience and
participate in different cultures just by moving through their
daily lives. For example, a person’s family or home culture will
likely have distinctly different qualities and behavioral
expectations than their work culture, school culture, or social
group culture. Because the overall purpose of practicing cultural
humility is to be aware of one’s own values and beliefs, it is
important to understand that those notions come from the
combination of cultures that people experience in their everyday
lives. A person cannot begin to understand the makeup and context
of another person’s life without being aware and reflective of
their own background and situation first.
2. Cultural humility is distinct from cultural competency and
reflexivity.
It is important to know the differences between cultural humility
and closely related concepts like cultural competency and
reflexivity. Cultural competency is a tool for leveling imbalanced
patient-provider power dynamics. The shortcomings of this practice,
however, have been identified by researchers who reviewed
frequently used cultural competency measures. They found that in
many frequently used competency measures, whiteness was understood
and represented as the norm. Cultural incompetence is then framed
as being due to a lack of knowledge about the ‘other.’ In short,
the goal of cultural competency is to learn about the other
person’s culture rather than reflect on one’s own background.
Reflexivity, on the other hand, calls on researchers to explore
their own personal beliefs in order to be more aware of potential
judgements that can occur during data collection and analysis. It
is the research practice of placing oneself within the experience
of the participant and then examining the participant-researcher
relationship. But even reflexivity falls short of the lifelong
process of self-reflection that is synonymous with cultural
humility.
3. Cultural humility requires historical awareness.
It is not enough to think about one’s own values, beliefs, and
social position within the context of the present moment. In order
to practice true cultural humility, a person must also be aware of
and sensitive to historic realities like legacies of violence and
oppression against certain groups of people. For example, the
Public Health Service’s Syphilis Experiment at Tuskegee serves as a
tragic reminder of how African Americans have been historically
deprived of adequate healthcare and have experienced abuse and
disrespect in the name of clinical research. The history of
mistrust between vulnerable populations and public health
institutions has led to understandable skepticism about the purpose
and outcomes of research. In order to build trust, the historic,
systemic reasons for mistrust must be excavated and made visible.
These reasons include the history of slavery, racism, segregation,
and more recent lived experience of disrespect at the hands of
healthcare providers. By recognizing the failures of the past,
researchers, clinicians, providers, and advocates can all
contribute to building a better future that is founded in practices
of cultural humility.