September 5, 2023

Practice Expectation Spotlight

Practice Expectation Spotlight: Cultural Humility in Action 

To practice cultural humility, we need to understand that everyone has a natural tendency toward bias.  

Bias is one way we try to make sense of our world. It is a pattern of thinking where we take shortcuts to reach a quicker judgement or decision. While thought patterns can help with quick decision-making, when those patterns are based on wrong assumptions, you end up with inaccurate decisions and bad judgements. Actions based on inaccurate decisions and bad judgements cause more harm than good.     Image:
A cartoon iceberg

Text:
Appearance and dress
Food and celebrations
Communications styles
Concepts of time
attitudes toward others
approach to making decisions and solving problems

How do we prevent the harmful outcomes of bias? 

Practice Expectations for RNs, RN(AP)s and RN(NP)s express our obligation to reflect, learn, act, and work collaboratively to create an environment that promotes cultural safety and anti-racism in practice. We have a responsibility to reflect on our values, assumptions, beliefs, and privileges, then consider how they impact our therapeutic relationships with Indigenous Peoples and with other clients vulnerable to discrimination and health inequity.  

It can be useful to compare understanding a culture to looking at an iceberg. As with an iceberg, we cannot see all elements of another person’s culture because so much lies below the surface. We initially observe appearance and dress but that is only a small piece of a culture. Looking below the surface, at aspects such as communication styles or concepts of time can show you more, but not everything. It is when we can tune into a person’s reasons and approaches to decision-making or problem-solving that we may gain a closer understanding of a culture. Seeking to understand a person’s culture demonstrates respect and builds trust, which are essential to nursing care. 

Humility is a trait typically defined as being without pride or arrogance. Combined with our understanding of culture, cultural humility is a life-long process of self-reflection and scrutiny of your own assumptions, beliefs and privilege embedded in understanding and practice. Cultural humility allows your clients’ voices to be front and centre. It promotes a client-healthcare provider relationships based on respect, open and effective dialogue, and mutual decision-making. 

What does cultural humility look like in action?  

There is no one way to demonstrate cultural humility in practice. Consider the following examples of cultural humility in practice. 

  1. A group of community RNs, who are new to working in a community, initially think there is not much to do when they are not working. They reflect on their own leisure preferences and how they do not typically get outside during cold weather. They wonder what people in the community like to do and ask the local staff at the community centre. They ask if they may join in and begin to learn what fishing means to the community in terms of leisure, work, connection to others, and nutrition. 
  2. An outpatient clinic RN’s client shows up a bit late. He is dressed in a worn plaid jacket and old untied boots, his hair falling out of a loose ponytail. He carries a couple of large bags. The RN stops to reflect on her feelings as she was taught to never be late and to always dress well for all appointments. She asks herself what would need to be going on in her life for her to arrive at an appointment in this manner. She thinks she might be late to an appointment if she did not have time to change after working outdoors. She then realizes that this is her perspective (not his) and that there could be many other reasons. She could ask him if he had difficulty finding the location, but she is aware that this could seem like blaming him and create a barrier for the client in accessing care. So instead, she asks him about his day before asking about his needs and goals for this appointment.
     
  3. A clinical resource nurse (CRN) supports an RN after a visitor began to physically remove the client from the ward. The visitor, who was the client’s partner, said the client needed to help her find a place to stay. The partner left unhappily with some resources on finding a place to stay, but the client was upset. The client wanted to leave with his partner but knew he needed in-hospital treatment. Some staff were shocked, commenting that the client should break up with the partner. The CRN asked them to consider what may be influencing the client to consider taking care of his partner before himself. The CRN acknowledged, as staff, they value adherence to care as prescribed, but this may not be the same for the client. So, the RN approached the client to ask what is important for him at this time. They learn, in the client’s culture, loyalty to family and safety is more important than caring for oneself, which is viewed as selfish. From this new perspective, they can support the client’s choices. 
  4. A critical care RN is caring for a client who is trying to turn around in his bed, disrupting tubes and wires. The client cannot speak and makes a hand gesture which the RN interprets as asking for help to get comfortable. The RN asks the client not to pull on the tubes. On seeing the client’s gestures, a visiting family member mentions the client prays five times a day. The RN did not grow up with religious or spiritual practice in her family, so she did not think the client’s hand gesture indicated prayer. The RN was not familiar with this practice, so she asks the family member about its importance for the client. Then, the RN asks the client if she can assist by adjusting the bed and its direction so the client can pray as he needs.
  5.  After a client’s discharge, the family calls about the whereabouts of a medicine bag which was tied around the client’s neck. The RN had not heard of this, and her first thought was it would not be safe. When she learned that a traditional medicine pouch typically contains Indigenous herbs, plants or significant items, she decided to ask the family member about its importance. The family member was able to share its meaning and importance to the client and to the family, which helped the RN to approach the situation with more sensitivity. 

Practising cultural humility offers us the chance to think about our worldview and the privilege we hold when we provide care. Approaching client interactions with curiosity and openness allows the client to share their cultural beliefs and customs. This way, you and the client can work together to meet their care needs in a more effective way. 

We recognize there are many ways to practice cultural humility. We want to hear from you. 

Describe how you approached a health care situation with cultural humility: https://www.surveymonkey.com/r/ZPJZ386 

References and Resources 

CRNM (2022). RN-practice-expectations-FINAL.pdf (crnm.mb.ca) 

Virstis, K., et al. (2021). A 4-part strategy to engage frontline nurses in cultural humility. Journal of Nursing Administration, 51(12), 597-9.