Contributor: Rebecca Lu MSN, FNP-C
The impacts of colonialism are entrenched in society and continue to oppress our systems in both apparent and subtle ways (Chinn, 2022). In healthcare, prioritization of Western care modalities and ideologies can alienate culturally diverse patients and lead to poorer health outcomes (Thomas et al., 2023). Increased awareness of colonialist influences is necessary to effectively check structural and individual prejudices that continue to perpetuate forced assimilation and exclusion (Iheduru-Anderson & Waite, 2024). This awareness is part of emancipatory/sociopolitical knowing.
Emancipatory/sociopolitical knowing includes an understanding of the sociopolitical climate and current structures that affect equitable care (Lindell & Chinn, 2024). Greater understanding of cultural competence has contributed meaningfully to the dialogue surrounding emancipatory knowing and led to a shift favoring cultural humility, a process-based position focused on self-reflexivity (Lekas et al., 2020). This should not undermine previous work in cultural competence, though, which has an important place in emancipatory praxis.
Existing emancipatory nursing models like Walter’s (2017) Emancipatory Nursing Praxis, Al-Chami et al.’s (2023) Red Deal, and Ballout et al.’s (2025) Decolonizing Nursing: A Global and Intersectional Framework for Praxis provide important theoretical foundations and have been valuable in emancipatory dialogue. However, these models have seen limited adoption and success in practice, with nurses viewing them as more theoretically significant (Elliot, 2024). Cultural competence nursing models have had measurable successes, but do not directly address systemic oppression.
This blog proposes a theoretical model adapting concepts of Jeffreys’s (2019) Cultural Competence and Confidence Model (CCC) with concepts of Freire’s (2000) Pedagogy of the Oppressed to build the Reflection to Liberation Model, a framework that emphasizes confidence, which is necessary for emancipatory praxis to occur.
Though there are several cultural competence models available, Jeffreys’s CCC is unique in that it focuses on using confidence to deliver culturally congruent care, which aligns with a patient’s cultural values and beliefs (Jeffreys, 2019). Jeffreys’s CCC is an ongoing process to build confidence when applying knowledge, skills, and attitude to achieve culturally congruent care. Freire’s (2000) Pedagogy of the Oppressed focuses on a process to achieve humanization and liberation involving the achievement of critical consciousness, cultural action, and the use of dialogue and reflection. Engagement of both produces individuals with greater awareness of their position in systems of oppression and can more thoughtfully and confidently apply their knowledge and skills to produce culturally congruent care, while moving towards a more liberated, decolonized society.
The Reflection to Liberation Model, depicted in the figure below, provides a theoretical framework for the practical application of decolonization. Jeffreys’s CCC model is valuable in nursing education, helping nurses build confidence to provide culturally congruent care. Alone, it is limited and does not explicitly address how nurses should identify and dismantle health inequities. Freire’s pedagogy provides a framework for liberation, but is difficult to apply in praxis. To address these gaps and limitation, I am proposing the “Reflection to Liberation Model.” My proposed model frames cultural humility within an emancipatory perspective that can change individual practice to more thoughtful, systems-oriented care.
How it Works
The Reflection to Liberation Model involves the interplay of three domains and uses reflection to mediate the dynamic relationship between Jeffreys’s CCC model and Freire’s (2000) Pedagogy of the Oppressed. The first domain is the Affective Domain, which includes Freire’s critical consciousness. Nurses gain greater awareness by examining personal beliefs through internal reflection. While nurses may have awareness of the cultural differences between themselves and their patients and respect that by providing culturally competent care, the application of Freire’s critical consciousness builds on that awareness. When nurses are able to understand the historical and social influences that affect their perception of other cultures, they gain cultural humility. They are able to see the broader effort to pursue liberation and restore human dignity.
The second domain is the Cognitive domain that works with Freire’s concept of dialogue. The nurse engages collaboratively through dialogue to deepen their understanding of the sociopolitical, cultural, and historical contexts that could influence patient care. This dialectic discourse not only helps the nurse to understand the “what,” but also the “why.” Nurses can increase their cultural knowledge independently, but transformative understanding occurs through active engagement with dialogue, which includes questioning and mutual critical reflection. This dynamic process leads to cultural action as it brings awareness and engages people.
The third domain is the Practical domain that incorporates Freire’s action. The understanding gained from the first and second domains drives praxis. Within this domain, nurses not only implement culturally appropriate interventions but also engage in advocacy to challenge existing oppressive structures. A culturally competent intervention is conciliatory if it overlooks the root problem.
True praxis occurs when the nurse can identify systemic inequities that may perpetuate care disparities that prevent culturally congruent care. Nurses can take action that not only addresses the immediate patient care issue but can also impact broader practice changes.
While this model flows in a linear progression from critical consciousness to action, the three domains fluidly interact with one another and can also be engaged at the same time. Moving through the domains generates a deeper understanding and stronger resolve, which ultimately builds the confidence to challenge longstanding structures of care that preserve colonialist influences.
For example, an elderly Asian patient may prefer acupuncture and herbal supplements over antidepressants to treat anxiety. A nurse caring for this patient may reflect on any intrinsic biases that may favor biomedical approaches over alternative modalities (Affective). The nurse may explore research into these alternative treatments and dialogue with the patient to better understand their healing practices (Cognitive). The nurse dialogues with other colleagues and organizational leaders to identify the position of alternative medicine in relation to Western, biomedical approaches. The nurse uses an understanding gained from the affective and cognitive domains to advocate for integrating the patient’s culturally preferred treatments into the care plan while also working to legitimize alternative healing modalities, whether through policy changes or even spreading awareness (Practical). The nurse’s reflection is informed by critical consciousness and dialogue, prompting praxis that drives the confidence to produce cultural congruence and liberation from unjust structures.
Providing just and equitable care is a nursing imperative. There is a need to explore theoretical frameworks that can advance the mission of decolonizing nursing. Adapting and harmonizing Jeffreys’s CCC and Freire’s Pedagogy of the Oppressed produces the Reflection to Liberation Model. This linear but dynamic framework is easily applicable, especially for novice nurses or nurses newly awakened to colonialist influences in healthcare. Cultural competence models have seen tremendous successes. However, this model enables nurses to go beyond individual competence to recognizing the deeper oppressive forces that continue to prevent health equity. For liberation from colonialism to occur, there must be self-liberation first, which can be gained through this model, which uses reflection to produce the confidence and empowerment needed to disrupt structures of inequity.
References
Al-Chami, M. H., Gifford, W., & Coburn, V. (2024). A visionary platform for decolonization: The Red Deal. Nursing philosophy : an international journal for healthcare professionals, 25(1), e12471. https://doi.org/10.1111/nup.12471
Ballout S, Mombrun C, Raymond N, Tolentino IN. Decolonizing nursing education: Beyond Indigenous perspectives through a global and intersectional lens. Nurs Outlook. 2025 Aug 13;73(6):102526. doi: 10.1016/j.outlook.2025.102526. Epub ahead of print. PMID: 40811997.
Chinn, P. L. (2022). Decolonizing nursing knowledge. Nursing Philosophy, 23(4), e12410. https://doi.org/10.1111/nup.12410
Chinn, P., & Lindell, D. (2024, January 19). Emancipatory and sociopolitical knowing. Nursology.net. https://nursology.net/patterns-of-knowing-in-nursing/emancipatory-knowing/
Elliott T. H. (2024). Theory analysis and evaluation of emancipatory nursing praxis: A theory of social justice in nursing. International journal of nursing knowledge, 35(1), 32–39. https://doi.org/10.1111/2047-3095.12414
Iheduru-Anderson, K., & Waite, R. (2024). Decolonizing nursing education: Reflecting on Paulo Freire’s pedagogy of the oppressed. Nursing Outlook, 72(4), 102183.. https://doi.org/10.1016/j.outlook.2024.102183
Jeffreys, M. R. (2019). Evidence-based updates and universal utility of Jeffreys’ Cultural Competence and Confidence framework for nursing education (and beyond) through TIME. Annual Review of Nursing Research, 37(1). http://doi.org/10.1891/0739-6686.37.1.43
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
Walter R. R. (2017). Emancipatory Nursing Praxis: A Theory of Social Justice in Nursing. ANS. Advances in nursing science, 40(3), 223–241. https://doi.org/10.1097/ANS.0000000000000157
About Rebecca Lu
Rebecca Lu, MSN, FNP-C is a research nurse practitioner at MD Anderson Cancer Center, where she specializes in the treatment and management of patients with Plasma Cell Dyscrasias. She has extensive experience in both outpatient clinical care and clinical trial conduct. Ms. Lu is currently pursuing her PhD at Texas Women’s University, building upon her Master’s degree from Prairie View A&M College of Nursing.
Ms. Lu is committed to scholarly excellence and knowledge dissemination, having authored multiple publications and delivered numerous presentations on multiple myeloma and plasma cell dyscrasias. She has a particular focus on improving the inclusivity of diverse populations in research and care. She currently serves on the International Myeloma Foundation Nurse Leadership Board, where she contributes to advancing patient care and research in the field.