In a time of staggering diversification in the U.S. population, training in cultural competence has garnered more and more attention over the years.
According to the U.S. Census Bureau's 2013 American Community Survey, the nation’s 41.3 million immigrants make up 13 percent of the total population, a 1.3 percent increase from 2012. When their U.S.-borne children are factored in, the total climbs to 80 million or one-quarter of the overall U.S. population.
The resulting cultural diversity creates unique challenges for healthcare providers, including language barriers and nuanced cultural, ethnic and religious differences that can present obstacles to communication and trust, according to the Transcultural Nursing Society (TCNS), the leading organization dedicated to advancing the cultural competence of nurses.
But in a recent column for The Huffington Post, contributor and nurse academic Mona Shattell, PhD, RN, FAAN, suggests such training may be missing the mark. Big time.
“Although the educational institutions who train our future healthcare professionals are well-intentioned, cultural competence training often falls way short because it places emphasis on traditional characteristics of minority cultures, and not real, open and frank discussions about discrimination and oppression,” writes Dr. Shattell, a professor and department chair in the college of nursing at Rush University in Chicago.
“Unfortunately then, the cultural competence model of teaching doesn’t produce culturally aware professionals, but rather, it perpetuates stereotypes by teaching what to expect within certain racial and cultural groups — for example, that Latinx/o/a folks often arrive at the clinic late and/or are joined by several members of their extensive family.”
Reality is, in the melting pot of our amazingly diverse country, cultures and races are not separate and preserved. We watch each other. We live with each other. We learn from each other. We rub off on each other.
Furthermore, we are each more than a single, specific cultural background anyway. Dr. Shattell explains that our complex identities as referred to as “intersectionality.” Current cultural competence training pays too little attention to intersectionality, she suggests, and, as a result, teaches simplistic, inaccurate views.
“By sending students into the field with incomplete knowledge about the reality of co-existing identities, for example, of being female, lesbian and Black, we send students into practice without the ability to empathize with the complex and multidimensional nature of the human experience, and without the skills needed to challenge their own personal biases,” she writes.
“Despite the messages conveyed by much of the cultural competency education we see in today’s healthcare curricula, the reality is that most of us don’t have identities that fit neatly into predetermined boxes.”
So what does Dr. Shattell propose to improve cultural competency training for nurses and other healthcare providers?
Cultural humility, for starters. Add to that some honest self-evaluation about conscious as well as unconscious biases, a desire to correct unequal power dynamics, and also the formation of some nonoppressive community partnerships. (This is in contrast to the current tide of populist nationalism anti-immigration sentiment in the United States and abroad, she notes.)
“We should be teaching our students how to understand, respect and celebrate personal expression of culture, not to see cultural groups as being distinct and mutually exclusive,” she advises.
Ultimately, the result will be better, truly culturally aware patient care.
“We must look at patients as people,” she writes, “who often define themselves based on their own uniquely personal experiences and intersectional identities.”
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