How many nurses have had cultural competency training?
Let me share a personal story with you. I was working at the bedside and another nurse and I were chatting after report and she was telling me about her patient. She said that her patients name was Jemima and that she was calling her “Aunt Jemima”. I asked her why and she said the patient said it was “ok”. My mouth dropped on the inside. Let’s unpack this a little. I’m going to give you a little history if you are unfamiliar with who Aunt Jemima is in American history.
According to the R. T. Davis Milling Company , they hired former slave Nancy Green as a spokesperson for the Aunt Jemima pancake mix in 1890. Nancy Green was born in Montgomery County, Kentucky, and played the Jemima character from 1890 until her death on September 23, 1923.
If we look at the imagery of the actor that was portraying Aunt Jemima we can see that over time her look evolved. The character of Aunt Jemima started out in minstrel shows following the Civil War as a female counterpart to the Uncle Tom character. Jemima was an obese Mammy stereotype exemplifying the happy cook on the
plantation during slavery. Before the turn of the 20th century Aunt Jemima was placed on pancake boxes invoking happy morning memories for many 1950’s baby boomers and a collection mania for Aunt Jemima inspired kitchenware. It was fairly recently Aunt Jemima’s breakfast image put the head scarf down and donned pearls and a more matronly coif to represent a more modern, if still politically incorrect, woman.
First of all, let’s talk about language, if you saw what I wrote above, the writer said she was hired as a slave. Have you ever heard of a slave being hired?
I find that language very interesting, but without the lens of cultural humility you might not even pick up on that. I’m sure that the argument can be made this was a harmless act by a nurse, who just didn’t realize how inappropriate it was to make this conclusion; I would disagree. One can even argue that it didn’t cause any “physical” harm. However, psychological and emotional slights can be just as harmful and can result in patients delaying treatment for care that they really need.
Perceptions of nurses and health care professional’s matter a great deal in patients outcomes. According to Marilyn Gardner, an author, and cultural competence blogger, perception can change an outcome and can be the difference between life and death or life and permanent, irreversible damage.
- The misinterpretation of the word “intoxicado” caused a misdiagnosis resulting in an 18-year-old becoming a quadriplegic, for in reality he had suffered a brain bleed and lay for two days in a hospital bed without proper treatment. Had the hospital staff made the correct diagnosis the man would have left the hospital in a few days, on his way to college and a normal life. This tragic event resulted in a 71 million dollar lawsuit.
- The story of a Japanese mom who ‘didn’t sound worried’ over the phone so was not given an appointment for her small child. By the time she did get the appointment, it was too late and the child died.
Cultural competency in general is knowing how to function in the midst of cultural differences. Competency implies that you have to obtain a certain skill set and that there is an endpoint in teachable actions that will transpire into a culturally competent person.
Cultural humility is necessary for all nurses in order to provide the best quality patient care. Cultural humility is a life-long process of self-reflection and self-critique, which allows nurses to examine differences and similarities between their own beliefs, values, and health care goals with those of their patients.
Can you sense the difference between cultural competency and cultural humility?
In my hospital orientation, we were taught about general practices and customs of certain ethnic groups. For instance, African American and Latino patients may not ask for pain medication for an injury because they feel “strong” enough to take the pain. That was our cultural competency component of hospital training. And perhaps there is nothing inherently wrong with the intention, but culture is not easily definable, it’s not narrow, it’s wide and often amorphous.
Since that time, I have learned a lot more about how health care professionals think about cultural competency training. According to an article by NPR: the traditional cultural competency training of the ’80s and ’90s weren’t working.
“People who seemed to have ‘aha’ moment — particularly people in the dominant group, later, actually felt quite wounded by the experience,” Sometimes participants seemed to become more defensive and hardened in their biases after those early training’s, not less prejudiced.
Do you think this there has been improvement in cultural competency training’s?
A 2007 study described in the Harvard Business Review examined cultural competency training at more than 800 companies over 30 years, and the results are about the same. Overall, cultural competency training seemed to do nothing to change people’s prejudices or improve diversity. Instead, in some cases, they reinforced bias. Cultural competency training’s tend to be inadequate and are a potentially harmful model of professional development because participants feel shame, guilt and blamed.
Cultural humility on the other hand is the process of life-long self reflection.
It allows room for not knowing, which is generally a place of discomfort because nurses want to know it all, and are trained to do so. It allows room for the patients voice and choice and gives them the option to tell you what they believe. And because of the nature of humility, it need not feel threatening. Folk don’t have to feel as though they are being tested on this as a competency.
We have learned that just increasing standards, which is a very common practice in nursing, and rigor won’t reverse the epidemic of bias in health care.
An increase in knowledge without a change in behavior is of little value to our patients.
So I want to share with you a few tools that you can use to increase your own culturally humility and decrease biases. The first tool that you can use to increase your own cultural humility is:
1. Assessment- asses your own multidimensional culture and background.
The simplest exploration of you as a mom, dad, wife, husband, partner, nurse, friend, co-worker, church-goer, student etc can be profound in learning to understand your patients. How do these roles inform your identity? How do all of these perspectives inform your work as a nurse? Practicing self-awareness will assist you to see your patient as multidimensional as well.
2. Attempt new behaviors that promote cultural humility
One simple practice you can start today is to notice when you are steering most of the conversation with your patient by asking most of the questions. See if you can shift into allowing the patient to speak more, letting them choose the direction of the conversation, giving them space. (I know some folk really like taking space and will talk your ear off lol!!)
3. Last and my most favorite point is to engage in culturally immersive experiences.
Am I telling you to go abroad? Nope! If you live in Baltimore, you can find yourself in a low-income setting with no problem. Wherever you are, seek out something different. Travel outside of your own comfort zone to make others more comfortable. Perhaps volunteering in a food pantry, at a clinic for under-served patients with mental health challenges, or in a location where the language spoken is not your primary language.
According to former president Barack Obama:
“The best way to not feel hopeless is to get up and do something. Don’t wait for good things to happen to you. If you go out and make some good things happen, you will fill the world with hope, you will fill yourself with hope.”
My course, the Nurse’s Influential Leadership Lab (coming soon!!), work is just the step-by-step approach you need for utilizing strategies and processes to express cultural humility.
- I teach you how to regularly attempt new behaviors with support
- To provide strategies to get you unstuck
- And how to use cultural humility as a patient advocacy tool
And that’s just some of it! Feedback from many of my students gets me excited because they are saying they feel more comfortable providing nursing care with patients from diverse cultural backgrounds, they have an increase in self-awareness of their own values and beliefs, and a strong feeling of gratitude.
Most importantly, nurses are learning that this is a life-long reflective process, that they can take with them everywhere they go. I hope you enjoyed learning with me today as much as I enjoyed sharing! Find something that will inspire you to action and give you hope so that you can fill the world with hope.