Danielle Brochu

With the increasing spotlight on the demand for implementing diversity, equity, and inclusion (DEI) initiatives through the healthcare industry and beyond, nurses will likely encounter ideologies and perspectives that may be unfamiliar to them in the context of their work. A common concept, albeit one that is waning in popularity, is cultural competence, which can be defined as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations” (Centers for Disease Control and Prevention, 2024). The concept of cultural competence is yielding to the more appropriate practical ideology of cultural humility, which focuses more on recognizing one’s own limitations and implicit biases, as well as their openness to learning (Grauf-Grounds & Rivera, 2020). Decentralizing the clinician and indicating the humility that they should practice denotes that the clinician simply cannot be an expert on every culture, and gives deference to the lived experience of the patient (Lekas et. al., 2020). Replacing the notion of cultural competence with cultural humility works to uplift patient perspectives and experiences.

In my formative years of undergraduate nursing education, I had little to no idea about the nuances between these terms and unfortunately, I found myself falling into the common trap of “being the white savior” through anthropologic voyeurism. In 2017, I found myself on a “mission trip” to Haiti with seven other people, where I spent a week bouncing between orphanages, nursing homes, and various American-run nonprofits that were meant to uplift and provide living wages and meaningful work for Haitian people. With no shortage of both candid and posed photos for various forms of social media, I returned to the United States with a feeling that I had “made a difference”, simply by preparing lunch for a handful of orphaned children and reading books to them. At the time, It wasn’t until a few years later that I began to understand how problematic and self-serving these trips are, and the ways in which they uphold racism and exploitation of marginalized populations. Additionally, “mission” trips emphasize the volunteer’s emotional experience, rather than establishing long-term relationships that could foster solutions that benefit the locals. This reinforces a dynamic where the needs and voices of the marginalized are secondary to the personal growth or satisfaction of the volunteer. In some cases, these trips may also contribute to harmful stereotypes or reinforce colonial mindsets that portray the volunteer as “superior” in some way.

Education on the nuances of “white saviorism” and similar issues should be discussed as a foundational tenant of basic nursing practice. Nurse educators are particularly influential in regard to providing the content and fostering student development of the knowledge, skills, and attitudes necessary to successfully practice the art and science of nursing with cultural humility. Serving as positive role models in clinical groups by interacting with diverse patient populations in a humble manner and demonstrating strong communication skills will empower students to behave similarly. In didactic settings, incorporating interactive classroom activities in and instilling a sense of lifelong learning and consistent focus on providing holistic care is a crucial role of the nurse educator.

Foronda’s Theory of Cultural Humility (2020), depicted by a rainbow model, is appropriate for consideration in this context. This nursing theory demonstrates that cultural conflict is directly impacted by various factors including the physical environment, situation, personal values, political climate, historical precedent, and diversity. It also articulates that cultural humility is a lifelong process that can lead to positive outcomes for oneself or others. Additionally, Foronda explores how imbalances of power and perspectives can lead to cultural conflict, which could result in negative outcomes.
Had I known about Foronda’s theory in my undergraduate years, I would have thought twice before signing up for those trips. In the situation described earlier, there was certainly an imbalance of power and perspective as I, a financially comfortable white American, traveled to an impoverished location with minimal understanding of the people and their culture, to “help” them- but in what way? My actions were neither culturally competent or humble in hindsight; at the time, my ignorant worldview directly influenced the thoughts and actions that I believed to be morally correct at the time. Engaging in lifelong learning, seeking to continuously educate oneself, and grow from previous mistakes are quintessential facets of adopting cultural humility as an enduring trait.

Words can hold great power: They can make or break any situation, incite strong emotions, and significantly alter the context of a given concept. (Hughes et. al., 2020). Teaching, and more importantly, practicing cultural humility consistently and intentionally, will have an impact patients and healthcare workers alike in the journey towards creating a more just society. In summary, shifting the focus of nursing and nurse education from cultural competence to cultural humility will contribute to improved health outcomes and a reduction in health disparities for diverse and marginalized populations.

References

Centers for Disease Control and Prevention. (2024, June 24). Cultural competence in health and human services. Centers for Disease Control and Prevention. https://npin.cdc.gov/pages/cultural-competence-health-and-human-services

Foronda, C. (2020). A theory of cultural humility. Journal of Transcultural Nursing, 31(1), 7-12.

Grauf-Grounds, C., & Rivera, P. M. (2020). The ORCA-Stance as a practice beyond cultural humility. In A practice beyond cultural humility (pp. 8-25). Routledge.

Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R. A., Cudjoe, J., & Han, H. R. (2020). Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty. Journal of Professional Nursing, 36(1), 28-33.

Lekas, H. M., Pahl, K., & Fuller Lewis, C. (2020). Rethinking Cultural Competence: Shifting to Cultural Humility. Health services insights, 13, 1178632920970580. https://doi.org/10.1177/1178632920970580

About Danielle Brochu

Danielle “Dani” Brochu, DNP, RN, CNEcl is a clinical nurse educator at the University of Saint Joseph in West Hartford, Connecticut. She earned her DNP and MSN in nursing education at Sacred Heart University and a BSN from University of Saint Joseph. She is a member of the Mu Delta Chapter of Sigma Theta Tau International as well as the American Nurses Association. She is a member of the Board of Directors for The Health Collective, a Hartford-based nonprofit that provides healthcare to LBGTQ+ and HIV+ patients. Dani has a strong passion for encouraging DEI initiatives in healthcare and promoting increased diversity in the nursing profession.