Cultural competence or humility: Which is the better fit for nurses?

by Miriam Dobson, DNP, RN, CPH, CHW-I, NHDP-BC

As a 15-year public health nurse veteran, I’ve noticed that cultural competency has been an often spoken of and often taught concept.  During graduate school for my MSN degree, I read a book about a Hmong child who was prone to seizures.  The clinical staff and the parents both viewed this phenomenon from totally different perspectives.  The imperative was bridging the gap so the parents were able to understand the phenomenon through the lens of their own culture.  Culture is important, it is sacred, and it is part of who we are.  There is no homogeneity in culture as two persons from similar backgrounds can have dissimilar cultures.  Another two persons from different racial backgrounds can have the same or similar culture. 

I recently had the opportunity to address public health student scholars from George Washington University, and the topic of cultural competence was raised as a question.  I responded that I am a Black, Indigenous and Hispanic woman who only recently learned of my indigenous roots.  I therefore am not fully competent in my own culture.  I cannot, therefore, expect anyone else to be fully competent in my culture either. 

As a nurse who has worked in acute care and now is a public health nurse, using the commonality of respect is the foundational substance of both the nurse patient relationship and interaction.  Common decency toward humanity can be summed up as cultural humility.  Cultural humility is superior to cultural competence because cultural humility does not have the audacity to say “I am competent in YOUR culture.”  Cultural humility says “you are a human being…I respect you…You are entitled to receive quality clinical care, respectful treatment, and health education in your own language with respect to your values.”  

As mentioned, my background is blended.  The elders in my family speak Spanish, Garifuna (Arawak) and English.  When my eldest was born, we had a christening party.  My family spoke Spanish mostly.  My husband’s family spoke English, as did our church family.  We played Abbott and Costello movies, and everyone laughed without ever listening to or understanding what words were spoken.  The commonality was the humor.  The nurse ought to have the commonality of respect tempered with humility to resonate with the intrinsic dignity of each patient. 

In 2004, I returned to acute care nursing after having been in outpatient care for many years.  I had a different outlook for my patients, especially those who were getting older.  I began to see myself in them, not in a strange way.  I began to realize that though unique, they are no different than me.  I needed to treat them just as I would want to be treated if I were in a similar situation.  That is the heart of cultural humility which is often mistaken for cultural competence.  Cultural humility is essential to any and all nurses.  We are a people focused profession and cultural humility should always be one of our essential pillars.

Miriam Dobson, DNP, RN, CPH, CHW-I, NHDP-BC is a division director in a Health Department located in Western Maryland.

Dr. Dobson is also liaison to the Board of Directors of the Association of Public Health Nurses. 

Dr. Dobson has been a registered nurse for 37 years, is the mother of two accomplished adult sons with autism and is happily married.

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