Cultural Competency and Cultural Humility in Nursing Practice

Cultural Competency and Cultural Humility in Nursing Practice Lisa Watson UMASS Boston Online Professional Issues in Nursing NU 360 Ms. Carol Moran November 08, 2012 Abstract You may not like how the Presidential election turned out, but the victory of the Democrats was won partly by focusing on going after the Hipic vote. The Hipic population who voted for President Obama put him over the top to win. Hipics identified with Obama. Somehow, he made a connection with this culture.
Nursing can use that lesson to improve cultural sensitivity and provide respectful care of our numerous cultures. Every American makes up this country regardless of heritage. This country was built from immigrants from all over the world. America is referred to as “the melting pot. ” The diversity of American culture continues to grow. Each patient a nurse interacts with is important, regardless of the color of their skin, the language they speak or the cultural traditions they follow. The diversity of America’s population continues to increase.
The challenges of providing cultural sensitivity to a multi cultural America is an important variation healthcare organizations must be aware of. In an attempt to standardize terms and concepts to explain cultural competency to student nurses, the Purnell Model was developed by Larry Purnell, PhD. The Purnell model is a guide to adapting care that takes into account the diversity of beliefs from a variety of cultures. It is based on multiple theories and research. A circular schematic was developed that contains 12 domains (pieces of pie) or considerations.

They include and represent the person’s: heritage, language, family roles, issues in workforce, bio cultural ecology, high risk behaviors, nutrition, pregnancy, death rituals, spirituality, health care practices and health care providers. Within the 12 domains it addresses: sociology, psychology, anatomy and physiology, biology, ecology, nutrition, pharmacology, religion, history, economics, politics and language. The inner 12 domains are encapsulated by a second circle that represents family, a third rim that represents society and finally an outer ring that represents global society.
The “saw tooth” at the bottom of the diagram is cultural consciousness. ( see Figure 1. ) Nurses must learn how to communicate with a variety of people who speak other languages, have other beliefs, and ways that cultures influence the people we care for. Healthcare is becoming more and more personalized. People have more options of how to pursue their own health wellness, where to obtain their care and with whom. Nursing care of a growing diverse population must be addressed. As nurses we have to make our hospitals competitive and make people want to bring their care to our doors.
Nurses need to learn how to better communicate with a variety of cultures and must know how to interact with these cultures in cultural sensitive ways depicting that culture if we want to remain competitive. Cultural Competency and Cultural Humility in Nursing Practice must be addressed. It is not an easy task. The term competence means to be competent, adequacy, in possession of required skills, knowledge, qualification, or capacity” ( Dictionary. com, 1995). To have qualifications or knowledge in all cultures is an impossible venture.
However, humility as described by Tervalon (1998), “incorporates a lifelong commitment to self-evaluation and self-critique…. , and to developing mutually beneficial…. partnerships with communities on behalf of individuals…” (p. 117). A task that can be accomplished in healthcare education is cultural humility. After all nurses do have a career lifetime to develop this self-evaluation. Cultural competence is too broad to tackle. The task of developing education to teach cultural competence is a vague goal and has been called stereotyping. This goal is too large and not specific.
According to Roux and Halstead, “a number of reviewed approaches in nursing education concluded that there is a lack of consensus on what and how it should be taught…”(p. 323). There are just too many cultures that healthcare provides care to. It would be impossible to become proficient at all of them. Nurses can learn the basics cultural beliefs and even learn to speak the language, but that alone does not make nurses competent. However, a nurse can continue to do self evaluation of how he/she perceives the patient’s differences. The nurse can try to understand how the patient’s culture makes hem have certain views related to their healthcare. “One of the best ways to learn about diverse cultures is to interact with people from those cultures. However, opportunity to become immersed in another culture are not always available” (Roux and Halstead, p. 325). Nurses can develop an awareness of cultural beliefs that guide patient’s to view healthcare in certain ways. This is an ongoing reflection the nurse must make by building on cultural humility. Nurses may learn the basic cultural beliefs of the patients they care for, but this does not make them culturally competent.
This is an ongoing growth that can occur throughout the nurse’s career with cultural humility. Nurses must embrace trying to understand the beliefs of other cultures to understand how this guides that culture’s healthcare and views. It may help to understand why people act the way they do. “…the perception, attitudes, and treatment approaches advocated by mental health professionals form the Western biological.. viewpoint precipitate mental health disparities among the older Afro-Caribbean population,” (Ellis, p. 41). Many Afro-Caribbean elders may not trust the nurse of fear being judged.
They may not understand the questions on questionnaires and may take offense in the way they are worded. Many beliefs occur from birth and throughout life and are instilled through our culture and upbringing. As things change in our lives, our beliefs can change and grow. Cultural beliefs can change as well. It is an ongoing process. These are lessons learned throughout a nurse’s career. It is achieved through constant learning, reflection and by keeping an open mind while using humility. When nurses are open minded they can understand how their own cultural beliefs can influence their understanding of other’s beliefs.
As described by Levi, “we need to realize that we are likely to have biases about how others should behave based on our own cultural norms,” (p. 97). By using cultural humility nurses can continue to build on what they do know about a culture and reflect on how their own beliefs effect how they interact with patients of this culture. We must take ownership of our interactions with others while being aware of how we view cultural differences. “The essential aspect is to become aware of our own values, so that we can better understand the values of another,” (Roux and Halstead, p. 24). Nurses must be able to reflect on their own beliefs to realize how they view other cultures views. They must be able to set aside their own views to be able to provide care in the best interest of the patient. Of, course nurses must abide by the law. However, there are interventions that nurses can provide for their patient, even if it is unconventional in the nurse’s belief. It may be uncomfortable to allow a comatose patient’s family to bath them, but it may what they have been taught. It can even be an ethical dilemma.
In Chinese families they often do not tell the elder family member they have cancer. By trying to understand and allowing a family this cultural tradition it may be what is in the patient’s best interest. Cultural humility is a goal every nurse can work on throughout their career. It can be adapted as the nurse’s self reflection occurs. All healthcare professionals must be able to set aside their own beliefs to focus on the patient specific care needed at that time. Questions must be asked of patients and of the healthcare providing the care to tailor care for that patient.
Healthcare must provide cultural sensitive care to their patients. Nurses should not be happy with providing the same care to every patient. The care must be patient centered and conscious about the whole patient and what their beliefs are. To obtain cultural humility every nurse should ask themselves have they “checked” their own beliefs at the door? Figure 1: The Purnell Model [pic] References American Association of Colleges of Nursing (AACN) and Commission on Collegiate Nursing Education. (2003). Accreditation Standards.
Retrieved November 8, 2012 from http:// www. aacn. nche. edu. Dictionary. com. Dictionary. com, n. d. Web. 09 Nov. 2012. . Horace, E. , (2012). Mental Health Disparities in the Older Afro-Caribbean Population Living in the United States: Cultural and Practice Perspectives for Mental Health Professionals. Journal of Psychosocial Nursing, 50, 37-44. Levi, A. (2009). The Ethics of Nursing Student International Clinical Experiences. The Association of Women’s Health, Obstetric and Neonatal Nurses, JOGNN, 38, 94-99: 2009. DOI: 10. 1111/j. 1552-6909. 008. 00314x. Purnell, L. (2002). The Purnell Model for Cultural Competence. J. Transcult Nursing 2002, 13: 193. DOI: 10. 1177/10459602013003006. Roux, G. , & Halstead, J. A. (2009). Issues and Trends in Nursing: Essential Knowledge for Today and Tomorrow. Sudbury, MA: Jones and Bartlett Publishers Tervalon, M. , Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved; May 1998, 9, 2; 117-125.

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