The Complexity of Cultural Humility in Healthcare
By CareerSmart® Learning Contributor, June 30, 2017, as published by Healthcare Hot Spot
For years, the healthcare profession has stressed the importance of “cultural competency,” delivering care to patients with at least a basic understanding of their culture. There are extensive articles and blog posts on this topic, encouraging healthcare professionals to learn about different cultures and to be open to the differences, leading to patient care improvement. But even though the term gets frequently thrown around, the actual definition is more complex than the term implies.
Cultural competency is defined as “developing an awareness of one’s own existence, sensations, thoughts, and environments without letting it have an undue influence on those from other backgrounds; demonstrating knowledge and understanding of the client’s culture; accepting and respecting cultural differences; adapting care to be congruent with the client’s culture” (Purnell & Paulanka, 1998 as cited in Flowers, 2004). Therefore, cultural competency has many facets to it—it means to have an understanding of oneself and one’s background and then using that understanding to accept and cultivate a knowledge about other cultures, as well as providing care that corresponds with patients’ cultures. But perhaps instead of striving toward cultural competency, there is a better guide to provide individualized and respectful care. Cultural humility is a term that is less used, but it guides an understanding of patients’ even more than cultural competency.
Melanie Tervalon and Jann Murray-Garcia introduced the term “cultural humility” in 1998 to describe an approach to the ongoing process of developing competency. Cultural humility is composed of three parts: “a lifelong commitment to self-evaluation and self-critique,” a desire to correct imbalances in power, and an “aspiration to develop partnerships with people and groups who advocate for others” (Tervalon & Murray-Garcia, 1998 as cited in Waters & Asbill, 2013). The pivotal difference between cultural humility and cultural competency is that cultural humility, as a construct, understands and accommodates human nature.
The principles of cultural humility demonstrate that humans are always changing and growing, which is why the first tenant is a lifelong commitment to self-evaluation. If people evaluate themselves when they are 20 years of age, there will be many things that will have changed in that self-evaluation if it is done again when 40, 60, or 80-years-old. The process of self-evaluation and self-critique is just that, a process that is ongoing and ever changing.
A desire to correct imbalances in power is not often considered in healthcare because much of healthcare revolves around those power imbalances, but it is the second tenant of cultural humility. There is a particular perceived hierarchy of power in healthcare—the physician on the highest level, then nurse, and the patient on the lowest level. But if healthcare providers’ goal is to improve patient care, then it is imperative to understand that the patient has equal power in the structure. Labs and diagnostics can only tell the providers so much; however, the patient and their self-knowledge imbue the team with the necessary information to provide treatment. While the physician and nurse went to school and have clinical experience, the patient brings their own experience of living in the body and mind that requires care. In addition to the healthcare provider-patient power imbalance, there are a multitude of other power imbalances in healthcare. If a racial power imbalance is apparent in the community, then it most likely also exists in the hospital. Gender, age, disability, these all come with a power imbalance that may or may not be subtle, but it is important to be aware of them.
The last aspect is to develop partnerships with people and groups who advocate for others. If healthcare providers practice cultural humility and develop cultural competency, the community will experience that awareness of care when they go to the hospital or doctor’s office. However, if healthcare providers work with advocacy groups to foster these ideas and practices, people and their communities can grow and develop as well.
Cultural humility has principles that expand on the ideas of cultural competency, but whereas the ideas of cultural competency are relegated to learning about the culture of others, cultural humility teaches that learning and self-assessment never end; it is learning that one cannot know everything about someone else’s particular culture and understanding that learning extends beyond a patient’s culture into every aspect of who they are.
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Flowers, D.L. (2004). Culturally competence nursing case: A challenge for the 21st century. Critical Care Nurse; 24(4): 48-52.
Waters, A., & Asbill, L. (2013). Reflections on cultural humility. CYF News, American Psychological Association.