An example where I witnessed an act of a lack of cultural humility was when I was in the hospital and it was my first day of my first clinical rotation as an Emory University nursing student. The otolaryngologist entered the contact enteric precaution room where I was taking vitals, to assess how the patient’s tracheostomy removal was healing post procedure. Instead of introducing himself and explaining why he was in the room, he immediately removed the bandage and assessed the wound, cleaning up the excess drainage. I looked over at the patient, and she looked uncomfortable as he continued his assessment and applied a new dressing. Not once did he ask how the patient was feeling or if she had any concerns about her healing. In addition, he was using medical terms that the patient had never heard before. It was clear she couldn’t discern whether her surgery went well and if the skin around the tracheostomy was on the right track for healing properly. His blatant lack of awareness created distance between him and his patient. The physician did not make much eye contact when talking with the patient and he did not allow the patient the opportunity to ask any questions, generally leading the patient to believe the physician has no interest in her overall well-being. Certainly, this is not the ideal patient-provider relationship.
This is where I first witnessed power and privilege dynamics in a clinical setting. Healthcare professionals have an immense knowledge base on health issues relating to their patients and the healthcare system, and can sometimes disregard a patient’s knowledge of his or her culture. Although, this is usually unintentional, it can really affect the patient’s comfort and trust levels. For instance, if a patient is in distress and is grimacing, some healthcare providers do not see this as a way of communicating pain and will just go on with their assessment not adjusting their interventions to relieve the patient’s pain. In addition, sometimes providers will go in with assumptions that a certain culture is more prone to complain about pain or perhaps reject a certain routine medical procedure, and they do not provide the patient the opportunity to explain their situation and feelings regarding their concerns about medical interventions and their options.
As a soon-to-be nurse, I expect to work in a clinical setting with a diverse population and perhaps one that is different than what I am used to. I anticipate situations where I will feel challenged to support lingually and culturally diverse clients. I will strive to always employ cultural humility, and allow my patients the time and respect they deserve, unlike the physician I observed during my first clinical experience.
Question 2: Describe a situation where you demonstrated a lack of/absence of cultural humility. How would you act differently if the same situation occurred again?
There are times, although I am not proud of this, where I have demonstrated a lack of cultural humility. I would like to consider myself a citizen of the world, as I have lived on various continents across the globe and I consider myself to be aware of other’s cultures and beliefs. However, there are still moments where I am unable to recognize my own subconscious insensitivity and fail to realize the cultures around me.
In high school, I decided to be an Indian for Halloween. Some of my friends went as cowgirls and the rest of the friend group went as Indians. At the time we thought this was more creative than the traditional cat and witch costumes that we’ve all repeated in the past. However, we soon realized that deciding to be an Indian for Halloween was extremely culturally insensitive, and was borderline cultural appropriation. At the time, I didn’t realize how I was lacking a sense of cultural humility by using another’s culture for the fun of Halloween, without recognizing the struggles in their own cultural history. My high school educated me to not be tone deaf and approach all situations with an open-mind and caring heart, something that was absent in that very moment when deciding what to be for Halloween with my friends.
The high school I attended has a proud history of being the first boarding school to admit Native American Indians and takes pride in their rich history of diversity. The preparatory school even renamed their Diversity Day after the first female Native American graduate of the first graduating class of 1884: Lydia Keys from the Cherokee Tribe in Oklahoma. This day highlights the inclusion embedded in the school’s history and mission, and also serves as an opportunity for students to discuss identity, power, social justice, oppression, and civil discourse. From now on, I try to view cultural differences and incidences of cultural appropriation as an opportunity to learn and improve upon the divide that exists among different ethnic and cultural groups, and I will certainly never use Halloween as an excuse for my personal lack of cultural humility again.
Conclusion
We should be empathetic to other cultures in everything we do daily. Not only from a humanistic perspective, but as the health professionals responsible for caring for and ensuring the well-being of everyone. While, cultural competence will educate me to help make informed decisions about appropriate patient care, it can also impede my ability to properly assess the health status of a patient. However, employing cultural humility throughout my career is what will differentiate me as an outstanding nurse. By shifting my mindset and making the patient the expert, I am in turn letting that individual be in charge of communicating and expressing what they consider their heritage and culture to be. In order to employ cultural humility, I must suspend my assumptions about a person. These assumptions often come from generalizations that I have made about their culture, attitudes, and beliefs— whether inaccurate or not, it is not up to me to decide if these beliefs are upheld by the patient. We are all guilty of making generalizations, but it is important to recognize this and actively attempt to place them on hold while providing care to patients.
The cultural identity that is most important to the patient should be decided by the patient themselves. Unfortunately, the concept of cultural humility is larger than ourselves and needs systemic reform in order for all of us to actively and properly practice cultural humility. I am expecting to see more incidents of a lack of cultural humility in my nursing clinical experiences, but I am now better prepared and educated on ways to avoid repeating these instances with my patients. By constantly self-reflecting and striving to be a life-long learner, these values will allow me to approach all situations with an open-mind and through a lens of cultural humility.