Given the diversity in our world today, take a moment and ask yourself: Are you a culturally competent nurse or nursing student? Do you demonstrate cultural humility?
You may have explored the concepts of cultural competence and humility in nursing school, but let’s take it a step further and consider how to apply these concepts in everyday interactions with members of diverse groups and communities.
Whether working in a hospital, walking into a local store, or interacting with neighbors, cultural competence and humility are cornerstones of building strong relationships. Practically speaking, this isn’t a skill you check off your to-do list once. Instead, developing cultural competence and humility is a lifelong process and journey involving continuous reflection, learning, and unlearning. It makes the individuals and groups we interact with feel seen, heard, and valued.
What is Cultural Competence vs Cultural Humility?
Cultural competence is about equipping yourself with knowledge of diverse cultural practices and beliefs, which enables you to provide respectful and appropriate care to patients from varied backgrounds. According to the American Academy of Nursing, cultural competence includes integrating knowledge, attitudes, and skills to facilitate intercultural communication and interactions between people from different racial, ethnic, socio-economic, and religious backgrounds. It’s understanding different cultural customs, traditions, beliefs, and behaviors and utilizing this knowledge to communicate effectively with others.
Here’s what cultural competency as a nurse might look like:
Using appropriate words and phrases that are familiar to the individual
Respecting an individual’s choices and preferences (e.g., diet, treatment)
Refraining from labeling an individual who comes from a particular group
Advocating for an interpreter to translate to facilitate informed decision-making
Acknowledging what is acceptable and not acceptable to say or do with an individual from another culture/background
Cultural humility, a new concept introduced more than thirty years ago, embraces the idea that we must all critically explore and critique ourselves as the first step to learning from and about others. It’s more than being knowledgeable about other cultures and practices. Cultural humility is being ‘others-oriented’ instead of “me-oriented” and recognizing that our understanding of different cultures constantly evolves. It’s a lifelong process of critical self-reflection and an openness to learning from the experiences of others. Humility acknowledges the power imbalances, emphasizing the importance of being receptive to learning from those who may not look, act, or believe in the same things we do.
Demonstrating cultural humility can include:
Participating in cultural competency training
Actively listening to an individual’s beliefs and practices without judgment
Respecting individual autonomy and cultural values when making decisions
Asking open-ended questions to understand an individual’s cultural preferences
Customizing healthcare delivery to align with the individual’s cultural, religious, or linguistic needs
These examples above, rooted in an attitude of openness and self-reflection, can lead to strengthening and maintaining effective relationships built on trust, respect, and collaboration.
How Do I Become More Culturally Competent and Demonstrate Cultural Humility?
Being culturally competent and demonstrating cultural humility takes time to happen. It is also not about choosing cultural humility over cultural competence or vice versa. Instead, it’s about cultivating and enabling both to work in unison.
Here’s how you can begin your journey towards cultural competence and humility.
1. Examine your ‘Blind Spots’
Start by examining and reflecting on your biases, assumptions, attitudes, and values and how they may influence your interactions with others. Identify any implicit bias that might be at play. Implicit biases are those unconscious stereotypes and attitudes you’ve learned and carried toward specific groups of people. These biases are like “blind spots”—you aren’t aware they exist unless you intentionally look!
Identifying your blind spots may involve asking yourself:
Am I tolerant enough to learn from others?
Are there privileges that I have that others don’t?
What do I think about other cultures that are different from my own?
Do I actively seek out perspectives or experiences that differ from my own?
Do I recognize and challenge my assumptions about people different from me?
Do I refrain from having deep conversations about social issues? If I do engage in dialogue, am I listening with intent or just talking?
Once we can identify our blind spots, the work can begin to address those stereotypes and attitudes. We can start unraveling, challenging, and correcting our learned biases.
2. Consider Others’ Point of View
Putting ourselves in another person’s shoes, or “shoe-shifting,” helps us begin to consider the experiences and perspectives of others. Cultural humility and competence require us to avoid being distracted by what we think we know. It’s asking ourselves whether there is anything we ought to know and framing our interactions with others as a partnership. So next time you’re interacting with someone who may appear different than you or may hold different beliefs and values, ask yourself, “What else should I know?” instead of “What do I know?” Be intentional about incorporating humility into your interactions – listening more than speaking, feeling comfortable with not knowing or understanding everything, and demonstrating genuine curiosity. Although we know empathy and compassion are the right things to do, it can be challenging to put these into practice when faced with our stereotypes and implicit biases. Why, though? Perhaps because to truly put ourselves in another person’s shoes, we must be willing and able to remove our shoes first!
3. Get to Know People Different From You
It’s easy to get along with people who are similar to us. Seriously, think about those people who are closest to you, and more than likely, many of them will resemble….well, you! But if you want to develop cultural competence and humility, you’ve got to stretch a little and step outside your backyard. This involves active and intentional efforts to experience others.
Reading books (e.g., autobiographies) to gain new perspective/appreciation
Volunteering or participating in organizations that serve diverse communities
Attending community/multicultural events to promote direct dialogue and interaction
Listening to podcasts with hosts/guests who have different lived experiences or beliefs
When we stretch ourselves this way, we can challenge our stereotypes and attitudes toward others and begin to value their unique experiences. We can create meaningful connections built on respect, appreciation, and a deeper understanding beyond superficial interactions. These proactive strategies allow you to enhance cultural competence and humility and contribute to more inclusive and united communities.
Conclusion
As you strengthen your cultural competency and humility skills, consider yourself and the individuals you live, learn, and work with. Every interaction with an individual is an opportunity to practice, demonstrate, and enhance these skills.
Gradellini, C., Gómez-Cantarino, S., Dominguez-Isabel, P., Mecugni, D., & Ugarte-Gurrutxaga, M. I. (2021). Cultural Competence and Cultural Sensitivity Education in University Nursing Courses. A Scoping Review. Front Psychol, 12(1).
Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R.-A., Rushton, C., . . . 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.
McDaniel, V. P. (2021). Cultural Humility in Nursing Building the Bridge to. Virginia Nurses Today, 29(2), 12-14.
Stubbe, D. E. (2020). Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Focus (Am Psychiatr Publ), 18(1), 49–51.
Cultural competence and cultural safety are crucial to delivering effective care. They are also key to creating working environments where everyone feels valued and able to function at the highest level. If we invest time and energy in understanding and implementing these concepts, the dividends can be invaluable, both individually and collectively.
Defining Cultural Competence and Cultural Safety
Dr. Raj Sundar is a physician, community organizer, and the Healthcare for Humans podcast host. As a healthcare leader, Dr. Sundar uses various platforms to bring a human scale to care delivery. In his view, the importance of cultural competence and safety cannot be overstated.
“Understanding cultural competence and safety is crucial when working with diverse cultures,” Dr. Sundar shares. “However, the definitions of cultural competence have evolved from diverse perspectives. One definition that’s commonly used is the following: having the capacity to function effectively within the context of diverse cultural beliefs, behaviors, and needs, as highlighted by the CLAS Standards (culturally and linguistically appropriate services).”
He continues, “On the other hand, cultural safety goes beyond individual competency, focusing on creating environments where everyone feels safe and respected, particularly addressing historical and structural causes of inequity. It builds upon cultural humility, which involves recognizing personal biases while understanding and respecting others’ perspectives.”
Where Does Cultural Competence Fall Short?
However well-meaning cultural competence initiatives can be, they don’t always hit the mark. Dr. Sundar explains, “Competence-focused approaches can sometimes overlook individual differences, leading to stereotyping and neglecting unique experiences.” He continues, “Additionally, while cultural competence training is valuable, it often emphasizes surface-level cultural differences, neglecting deeper issues such as systemic biases and power dynamics.”
Sundar uses his cultural background and experience to illustrate how cultural competence can fall short. “My identity as an Indian-American from North Carolina who likes lacrosse, sweet tea, and country music illustrates the complexity [of individual experience] beyond cultural identity. Individual differences always matter, but my history and values are deeply connected to my Indian ancestry.”
“A plethora of training is designed to expose providers to different cultures and expand their understanding of the beliefs, values, and behavior, thus achieving competence. Although this intention is commendable, training providers to become competent in various cultures presents the risk of stereotyping, stigmatizing, and othering patients and can foster implicit racist attitudes and behaviors.
“Further, by disregarding intersectionality, cultural competence training tends to undermine provider recognition that patients inhabit multiple social statuses that potentially shape their beliefs, values, and behavior.”
Parallel Concepts
When it comes to other concepts that parallel cultural competence, Sundar adds that two other terms to be familiar with are cultural humility and responsiveness.” He describes them thus: “Cultural humility is an attitude or mindset characterized by an ongoing willingness to engage in self-reflection, self-critique, and lifelong learning about one’s own cultural biases and the cultural backgrounds of others. It emphasizes recognizing the limitations of one’s perspective and being open to learning from diverse experiences and perspectives.”
He states, “Cultural responsiveness involves recognizing, respecting, and integrating individuals’ cultural backgrounds, values, and beliefs into designing and delivering services and interventions. It goes beyond cultural competence by emphasizing the importance of engaging with communities, co-creating solutions, and adapting practices to meet diverse populations’ specific needs and preferences.”
Strategies and Tools for Increasing Cultural Competence
There are many strategies and tools for increasing cultural competence. Dr. Sundar shares, “While insufficient, cultural awareness training can be essential opportunities to connect with peers to reflect on conflicts, tension, or care pathways that can be improved.” His examples include asking questions like:
Why does our Russian community have the lowest mammogram rate?
When a Jehovah’s Witness refuses blood in a life-threatening situation, are we all aware of what to do and have the support we need?
When families come together to care for an individual, can we navigate that context in our highly individualistic environment?
Sundar adds, “It’s often essential to have cultural liaisons, which allows for collaboration with community leaders and organizations serving diverse populations.” This strategy can provide insights into cultural norms and various practices and behaviors that community members engage in when seeking healthcare.”
As a community organizer, Sundar has other recommendations. “Building relationships with your community is helpful. Part of my podcasting journey with Healthcare for Humans is building relationships with local immigrant and refugee communities, amplifying their voices, and caring for them in the way they want in the context of their history and structural inequities.”
Patients’ perspectives must also be taken into consideration. “It can be beneficial to actively seek patient input about cultural preferences, needs, and concerns,” Sundar advises. “Take time to listen attentively and respectfully to patients’ perspectives and incorporate their feedback into your approach to care. Ask, ‘How can I be a better advocate and caregiver for your community?’”
Dr. Sundar reminds us that we must also reflect on our cultural biases, assumptions, and privileges. “If we consider how these factors influence our interactions with patients and colleagues from diverse backgrounds, that self-awareness is a step toward becoming a more culturally aware healthcare professional.”
A Learning Process
In the end, Dr. Sundar has specific recommendations for nurses.
“Nurses should recognize cultural awareness as a continual learning process rather than a static achievement. For example, it’s been a journey for me to realize how to incorporate the values of the Native Hawaiians and Pacific Islander community in my care. I have had to be intentional about how I say hello and talk about suffering to meet the community where they are. It takes time and building relationships to realize this.”
Dr. Sundar believes that achieving health equity requires ongoing self-reflection and that we remain open to diverse perspectives.
“Health equity is the idea that everyone should have the same opportunities to be as healthy as possible, regardless of their circumstances, and we must be committed to it. Doing this work isn’t always easy, but it’s worth the effort and will always be needed in our diverse world.”
As rates of diabetes continue to rise, endocrine nursing is a specialty that will continue to have a pressing need.
Diabetes care is only one aspect of an endocrine nurse’s specialty—thyroid disorders and adrenal gland disorders also are endocrine system problems—but November’s designation as American Diabetes Month highlights this particular condition.
An endocrine nurse can choose to work with adult or pediatric patients, and they will see different presentations of the same disease across all populations. Because diabetes can present in varying ways for each individual and treatment plans can differ widely, an endocrine nurse must have a broad expertise in how diabetes impacts many body systems.
Cultural competence is especially important in this nursing specialty as traditions around food alone—eating, feasting, or fasting—will have an immediate and potentially dangerous impact on someone with diabetes.
Diabetes is so prevalent today that most people know of someone who has Type 1, Type 2, or gestational diabetes. The different types of diabetes stem from separate issues, but result in the same inability to use insulin.
According to BeyondType1.org, these are the more common forms of diabetes:
Type 1 is a chronic autoimmune disorder that seems to have genetic and environmental causes and is something that cannot be prevented.
Type 2 is when the body is unable to use insulin (also called insulin resistance). This type has several causal factors including lifestyle factors like obesity, inactivity, or smoking, but there’s some research that notes a genetic cause for some minority populations with Type 2.
Gestational diabetes happens during pregnancy when hormones can interfere with the body’s normal use of insulin.
Like many chronic conditions, diabetes has a direct and significant impact on a person’s daily life and activities. Blood sugar rises and falls throughout a normal day, but other factors like an illness, stress, or travel can pose particular challenges for people with diabetes. They need to be vigilant and prepared for any red flags in their insulin numbers.
As an endocrine nurse, you’ll need to help your patient put the pieces of their personal diabetes puzzle together and then take it apart to examine all the factors that could change their typical treatment. Understanding your patient’s cultural norms will go a long way to developing a diabetes plan that will work and that the patient can and will follow.
Diabetes management will look different for each person, but it’s helpful to ask questions that might reveal religious or lifestyle preferences and choices that could play a part in how they can manage their condition. Children and teenagers can be particularly challenged by social pressures to keep on track. And many patients, young and old, go through a period of denial when they think they don’t need to worry too much about their disease. If you’re a nurse with diabetes, you know the challenges first-hand.
Educating patients about the severe complications that can arise from mismanaging this condition, no matter what type it is, is essential. But it’s also important to let people know how the diagnosis of a chronic condition like diabetes can cause changes in mental health and that help is available. You can share resources about the diabetes communities—both online and local—so that patients can learn from others and know they aren’t alone.
Endocrine nurses have the responsibility of helping patients follow their treatment plans and of having the compassion to understand why it is so hard to do. Nurses who understand their patient populations have an advantage, so learning as much as you can about the cultural norms will help.
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