Contributor: Kunta Gautam, MSN, MPH, CPNP-PC
I was required to complete a DEI course for the Ph.D. qualifying exam. While meeting my need, I came across a TED talk by Jodi-Ann Burey on “Why you should not bring your authentic self to work” (TED, 2020). Her speech intrigued me to write about my experiences on Diversity, Equity, and Inclusion issues. I said to myself- “I have so much to share.”
On a personal level, I am a Southeast Asian immigrant (race) in the US, a divorced female (gender) in the society, and a mother of a child on the autism spectrum (disability). Stereotypically, Asians are considered competent, intelligent people primarily engaged in the technical field. We can debate this as a “privilege” to be labeled as an intelligent person without putting in one’s effort. On the flip side, as a divorced female, society does not verbalize, but the environment makes you uneasy and makes you run away from your neighborhood. You feel stalked by your neighbors, families, and friends. You are uncomfortable attending social events because of a “fear mindset.” Your mind tells you there is no inclusion there! In addition, as a mother of a child with autism, your priorities are different from other mothers with typical children. You fear meltdowns and having to face any embarrassing moments at birthday parties. Please take note that I did not call autism a “disorder.” Growing up together in a journey of autism with my son and including him as an equally abled individual, I strongly oppose attaching the word disorder to the autism spectrum. Nonetheless, children with autism belong to the neurodiverse group who still have to fight for equity and inclusion in our society.
On a professional level, I am a health care provider who is a minority immigrant. Fortunately, I work in an organization incorporating diversity, equity, and inclusion to its maximum potential. A large percentage of the population in my organization constitutes of diverse groups. I feel respected and equally treated with a sense of belonging. However, I live with two disadvantages on a daily basis among the patient population, whom I am referring to as the general public. I am an individual with color and an accent, and female gender. Most of the time, my patient population is respectful and receptive to me. But sometimes, I find myself struggling to convince the patient and the families and win their confidence in my evaluation and management.
Being an immigrant, an individual comes from not only a different race and ethnicity but also from a different world. On a positive note, I consider myself to have an opportunity to grow, learn and understand different cultures and different societies. But there is always a fear of being a victim of unconscious bias. I get worried about being unconsciously authentic to the point that I might make other people uncomfortable around me. Everyone’s lived experiences may vary depending upon their circumstances.
The theory of Cultural Humility developed by Cynthia Foronda (2020) describes being flexible and inclusive. “Cultural humility refers to the recognition of diversity and power imbalances among individuals, groups, or communities, with the actions of being open, self-aware, egoless, flexible, exuding respect and supportive interactions, focusing on both self and other to formulate a tailored response. Cultural humility is a process of critical self-reflection and lifelong learning, resulting in mutually positive outcomes.” (Foronda, 2020, p. 9).
She explains a worldview of diversity that comes along with different perspectives. These different perspectives are embedded in contexts of historical precedents, political environment, personal beliefs, physical environment, and situational influences. Cultural collectiveness and valuing humankind irrespective of race, gender, and disability lead to positive outcomes. This theory guides individuals, groups, and communities to be flexible and adaptive.
Overall, the definitions and perspectives of diversity, equity, and inclusion may differ for different people. Cultural conflicts and differences stem from diverse religious, spiritual, personal, and past experiences of people. Along with flexibility, we need to cultivate a growth mindset. A growth mindset enables us to be open to new ideas, make changes and adapt to a healthier way of doing things. Our self-limiting belief system creates an internal environment within ourselves that is more like dwelling in your comfort zone. This self-limitation comes from a fear mindset. Our self-imposed restrictions and perceptions need to be broken to allow ourselves to overcome the barriers and embrace inclusion. We should not feel the need to silence ourselves to express who we are. We have to rise, speak, and be heard. It is needed for individual growth, team growth, and community growth. The community, society, and organizations should be able to provide a safe environment for everyone to feel they belong and where they can still bring their authentic self.
References:
Foronda, C. (2020). A Theory of Cultural Humility. Journal of Transcultural Nursing, 31(1), 7–12. https://doi.org/10.1177/1043659619875184
TED. (2020, December 26). Why you should not bring your authentic self to work / Jodi-Ann Burey. YouTube. https://www.youtube.com/watch?v=HRi-jpzBiGo
About Kunta Gautam
I am a Pediatric Nurse Practitioner with a background in public health. I work in urgent care clinics at Texas Children’s Hospital, Houston, Texas. I am pursuing a Ph.D. in Nursing Science at Nelda Stark School of Nursing, Texas Woman’s University, Houston. I am a student, health care provider, nurse, clinical instructor, researcher, blogger, peer reviewer, community volunteer, and mother of two children. I like to empower women to know their self-worth and fiercely advocate independence, equality, and social justice. My area of focus is children and families with autism spectrum.
The concept of cultural humility was developed by two female, African-American identifying physician scholars, Melanie Tervalon, MD, MPH, and Jann Murray-Garcia, MD, MPH. In 1998, Tervalon and Murray-Garcia published their ideas in an article entitled “Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education” in the Journal of Health Care for the Poor and Underserved.
Their conceptualization of cultural humility included this process being a “life-long commitment to self-evaluation and self-critique” focused on “redressing the power imbalances in the patient-health care provider dynamic” while “developing mutually beneficial and non-paternalistic clinical advocacy partnerships with communities on behalf of individuals and defined populations” (Trevalon & Murray-Garcia, 1998).
In addition to their published work, they have generously shared their work as public scholars in cultural humility in an excellent YouTube documentary by Vivian Chavez (2012) that I have been assigning undergraduate and doctoral nursing, global health, and social medicine students for a decade. https://youtu.be/SaSHLbS1V4w.
There is a long history in the discipline of nursing of appropriating the work of Black scholars. Nursing has appropriated, without attribution or critical analysis, the work of the Black, radical, queer, feminist theorist Audre Lorde’s concept of self-care. Lorde’s conceptualization of “self-care” was radically different than what is presented in nursing schools today- “caring for myself is not self-indulgent, it is self-preservation and that is an act of political warfare”.
The concept of “holism” was first written about by the Black, male nurse and anthropologist, Oliver H. Osborne, PhD, RN, currently Emeritus Professor at the University of Washington in 1969 (Harrison, Johnson-Simon, & Williams, 2018). Dr. Osborne earned his PhD in Anthropology at the University of Michigan (one of the top 5 anthropology programs in the US then and now) because he was denied admission into every nursing PhD program to which he applied. His ethnographic work in anthropology was done in the Yoruba Kingdom of Nigeria where he studied the relationship/interface between indigenous ethnomedicine and the ethnomedicine of Western biomedicine. The origins of holistic nursing come from Osborne’s anthropological education and research work though I have never seen a single nursing source that attributes this work to him. I learned about his work during my training as a medical anthropologist not during my four formal degrees in nursing.
Monica McLemore, PhD, CNM, an African-American identifying associate professor of family health care nursing at UCSF, who has studied reproductive health and is a long-time activist in the reproductive justice movement, talks about the growing problem within academic healthcare of “health equity tourists” (McFarling, 2021). Health equity research, including anti-racism, is now in vogue, it is the “sexy” new thing which is now being funded. This has attracted many white academics who have no theoretical, research, or experiential knowledge in this field. Dr. McLemore notes that “Medicine does that, they Columbus everything” and that she is “increasingly seeing ‘neutered and watered-down’ work as people without proper training, background, or skills publish in her area” (McFarling, 2021).
As a practicing NP for nearly four decades, nursing professor for over two decades, and a medical anthropologist and social medicine practitioner and educator whose activist scholarship is focused on anti-racism in healthcare, I fully support the use of concepts like cultural humility in the provision of nursing care. I do not, however, support the ongoing appropriation of the work of Black scholars. I think that some reparations are in order, along with a big dose of critical consciousness.
Thank you for the insight on Cultural Humility. It is very educational to understand where the term cultural humility originated from. I have attached the reference below for the article that is mentioned above.
Tervalon, M., & Murray-García, 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, 9(2), 117–125. https://doi.org/10.1353/hpu.2010.0233
I also found the youtube documentary very interesting. https://youtu.be/SaSHLbS1V4w
Thank you so much for providing this depth of content and knowledge around cultural humility. I could also see how holistic nursing and cultural competence are integrated into anthropological education.