8 Cultural Humility

Cultural Humility

Healthcare curricula in nursing in the US primarily consist of discussion around culturally competent care and diversity in patients and providers in a perfunctory way that is not congruent with cultural humility (Brown et al., 2021). Cultural humility is described as an openness to differences, where the patient is the expert, rather than the clinician (Foronda et al., 2022). Cultural humility is neither colorblind nor self-serving and is respectful, open to exploration, and avoids making assumptions (Franco & McElroy-Heltzel, 2019; Pham et al., 2021). Cultural humility is caring and could be considered a precursor to cultural competence (Hemberg, 2020). Nursing students learn and gain competence through the use of humility while gaining experience. Cultural humility is a cultural competence that is perceived by the other for instance, how a student perceives cultural humility in faculty and how a patient perceives the skill in the nursing student (Hemberg, 2020).

Pham et al. (2021) adapted and expanded a cultural humility model originally developed by Goforth to include actional domains: 1) Openness and critical thinking, 2) Understanding and transforming power, privilege, and oppression, 3) Social justice advocacy, 4) Alliance building allyship/school community partnership, and 5) Leveraging strengths through relational empowerment. The model was developed for use within a school of psychology and is thoughtful and useful on both an individual and system level. Assessment and evaluation are tied to ongoing learning and accountability. Additionally, the model empowers the system to cultivate community capacity through empowerment tied to the actional domains to promote social justice within the institution in a way that leverages the strength of the participants utilizing cultural humility tied to research, practice, and policy (Pham et al., 2021).

The model development is in answer to the need for higher education in healthcare to contend with increasing diversity, inclusion, and equity within the institution and community with a stance of ethical comportment and grace that recognizes cultural humility as a way of being  (Franco & McElroy-Heltzel, 2019; Pham et al., 2021). Nursing students would benefit from faculty, mentors, and preceptors with strong racial socialization and social identity who can discuss issues surrounding social justice and health equity in safe settings to provide salience in culturally diverse healthcare environments (Franco & McElroy-Heltzel, 2019). Cultural humility speaks to openness to explore gender, race, religion, and socio-economic factors that affect the care and well-being of students and patients without deemphasizing or trivializing the uniqueness of people (Franco & McElroy-Heltzel, 2019).

Figure 8-1. Cultural Humility Model.

Note: https://doi.org/10.1080/2372966X.2021.1941245 (Pham et al., 2021, p. 698)

Abdul-Raheem (2018) conducted a descriptive correlational study to determine associations between student satisfaction with nurse education instruction and cultural humility. BSN program students in Oklahoma in the 3rd and fourth semesters were surveyed, and students from different races and genders were encouraged to participate to increase the diversity of the sample (Abdul-Raheem, 2018).

The students completed the Hook’s Cultural Humility Scale and measurements of the relationship between nursing student satisfaction with nurse educator instruction and nurse educator cultural humility were obtained. The findings included both negative and positive cultural humility items that were correlated with nurse educator instruction satisfaction. Negative correlates with student satisfaction were educators who acted superior, and who made assumptions (Abdul-Raheem, 2018). In addition, the positive correlates with student satisfaction were educators who were respectful, considerate, open-minded, open to exploring ideas, showed an interest in learning, were open to student perspectives, and asked questions (Abdul-Raheem, 2018). The results showed that the association between student satisfaction with nurse educator instruction and negative aspects of cultural humility is significant (r (115) = 0.38, p < 0.001).

Differences between non-minority (n = 72, M = 44.31, SD = 8.09) and minority (n = 45, M = 41.84; t(115) = 1.64, p = 0.10) nursing student’s perceptions of nurse educator cultural humility were not statistically significant, however when minority status was controlled for using the Pearson r partial correlation analysis a relationship between the variables of student satisfaction with instruction and perceived cultural humility was reported lower by minority students (Abdul-Raheem, 2018).

The study also looked at whether or not students felt they were similar to their nurse educators by answering yes or no. T-tests were conducted to determine whether those who felt similar to their instructor differed from those who did not in their overall satisfaction with instruction (Abdul-Raheem, 2018). Interestingly, those students who felt more similar (n =70, M = 7.28, SD = 0.87) were statistically more satisfied and had significantly higher perceptions of nurse educator cultural humility compared to those who did not (n = 45, M = 7.80, SD = 1.16; t(113)= -3.78, p < 0.01) (Abdul-Raheem, 2018). This finding correlates with Matthews et al. (2022) discussion of the significance of “the recruitment and retention of faculty that reflect the diversity of nursing students as essential” to providing a climate of inclusion that protects students from historically excluded groups (p. 102). Also, mirroring the importance of concordance discussed by Perez et al. (2019), a more diverse faculty would positively impact the delivery of nursing education to nursing students from diverse populations.

Many nursing students from rural underserved populations are first-generation college students and would benefit from interactions with faculty that utilize a culturally humble framework to help students with academic, social, financial, and emotional struggles (Rovitto, 2022). Faculty who recognize that students require connection not marginalization, are showing the students that cultural humility is a way of being through demonstration (Rovitto, 2022). The first-generation college nursing student realizes the opportunity as a privilege and can learn that being other-oriented is respect and builds mutual alliance (Rovitto, 2022). The action of enlisting cultural humility with students helps not only to retain these students but also assist the student in building resilience and coping skills (Rovitto, 2022) that the student can then mirror and provide care with cultural humility to patients in clinical settings (Nolan et al., 2021).

Nolan et al. (2021) describes that nurses and therefore nurse faculty can “retrain and retool” themselves to come away from a paternalistic provision of care to one that eliminates health care disparities. Sharing power, establishing rapport, and prioritizing cultural humility as a clinical competency can potentially “galvanize the nursing pipeline workforce” to assist patients in achieving health equity (Nolan et al., 2021, p. 4). Faculty can learn from students and develop social bonds by not overlooking differences but by valuing differences, honoring obligations, and capitalizing on the “power of shared culture” (McElroy-Heltzel et al., 2018; Nolan et al., 2021, p. 4).

References:

Abdul-Raheem, J. (2018). Cultural humility in nursing education. Journal of Cultural Diversity, 25(2), 66–73.

Brown, J. V, Spicer, K. J., French, E., & Author Affiliations, S. (2021). Exploring the Inclusion of Cultural Competence, Cultural Humility, and Diversity Concepts as Learning Objectives or Outcomes in Healthcare Curricula. Journal of Best Practices in Health Prof Diversity, 14(1), 63–81.https://www.jstor.org/stable/27097337#:~:text=https%3A//www.jstor.org/stable/27097337

Foronda, C., Prather, S., Baptiste, D. L., & Luctkar-Flude, M. (2022). Cultural Humility Toolkit. Nurse Educator, 47(5), 267–271. https://doi.org/10.1097/NNE.0000000000001182

Franco, M., & McElroy-Heltzel, S. (2019). Let me choose: Primary caregiver cultural humility, racial identity, and mental health for multiracial people. Journal of Counseling Psychology, 66(3), 269–279. https://doi.org/10.1037/cou0000317

Hemberg, J. (2020). Caring ethics as the foundation for cultural competence: views of health professionals working in the student healthcare context. Scandinavian Journal of Caring Sciences, 34(4), 989–1000. https://doi.org/10.1111/scs.12807

Matthews, A. K., Abboud, S., Smith, A. U., Smith, C., Jeremiah, R., Hart, A., & Weaver, T. (2022). Strategies to address structural and institutional barriers to success among students of color in nursing programs. Journal of Professional Nursing, 40, 96–104. https://doi.org/10.1016/J.PROFNURS.2022.03.005

McElroy-Heltzel, S. E., Davis, D. E., DeBlaere, C., Hook, J. N., Massengale, M., Choe, E., & Rice, K. G. (2018). Supplemental Material for Cultural Humility: Pilot Study Testing the Social Bonds Hypothesis in Interethnic Couples. Journal of Counseling Psychology.https://doi.org/10.1037/cou0000268.supp

Nolan, T. S., Alston, A., Choto, R., & Moss, K. O. (2021). Cultural humility: Retraining and retooling nurses to provide equitable cancer care. Clinical Journal of Oncology Nursing, 25, 3–9. https://cjon.ons.org/cultural-humility-retraining-and-retooling-nurses-provide-equitable-cancer-care#:~:text=DOI%3A%2010.1188/21.CJON.S1.3%2D9

Pham, A. V., N. Goforth, A., N. Aguilar, L., Burt, I., Bastian, R., & Diaków, D. M. (2021). Dismantling systemic inequities in school psychology: Cultural humility as a foundational approach to social justice. School Psychology Review. https://doi.org/10.1080/2372966X.2021.1941245

Rovitto, T. Le. (2022). (Cultural) Humility in Practice: Engaging First-Generation College Students. Journal of College Student Psychotherapy, 36(3), 294–309. https://doi.org/10.1080/87568225.2020.1819924