From Cultural Competence to Cultural Respect: A Critical Review of Six Models

Abstract

Background: Despite the development of cultural competence models in response to the increase in cultural diversity in the United States, health disparities based on ethnicity and cross-cultural mismatches in health care practices still exist. Method: This article critically reviews six noteworthy conceptual models of cultural competence and enlists multilayered definitions of culture from cultural anthropology, critical multicultural education, and critical literary theory, as well as critical discourse analytical tools to deconstruct these frameworks. Results: Although these models assist providers to become more culturally sensitive, they can essentialize and oversimplify patients' cultural experience, as well as mask the dynamism and complexities of their communities and power relations. Conclusion: Competence implies that practitioners can master diverse cultural experiences. Building on some of the promising practices of these six models and the practices of cultural humility and relational ethics, processes and practices are proposed for practitioners to reconstruct their ongoing cross-cultural work in nursing. [ J Nurs Educ . 2020;59(6):311–318.]

Rethinking Cultural Competence: Shifting to Cultural Humility

“…Providers' humble disposition counterbalances their authority and by equalizing the patient-provider relationship, it can improve communication and quality of care. [15][16][17] Therefore, cultural humility trainings are process-oriented and aim to enhance providers' capabilities to deliver patientcentered care, while cultural competence trainings are contentoriented and aim to increase providers' knowledge, confidence and self-efficacy in communicating with and treating diverse patients. 10 The suggestion to focus on fostering provider awareness, openness and humility through the recognition of their own bias, privilege and the limits of their knowledge and expertise was suggested in a seminal article by Tervalon and Murray-García in 1998.…”

“…Cultural humility training encourages providers to reflect on their own beliefs, values and biases—explicit and implicit—through introspection thus, revealing their own culture’s impact on patients. 16,17 On an interpersonal level, guiding providers to adopt a person-centered stance, open to and respectful of patients’ views, promotes real patient-provider partnerships. Providers’ humble disposition counterbalances their authority and by equalizing the patient-provider relationship, it can improve communication and quality of care.…”

“…Providers’ humble disposition counterbalances their authority and by equalizing the patient-provider relationship, it can improve communication and quality of care. 15-17…”

“…4 Yet, only recently, have researchers and practitioners began to advocate for humility trainings, and most of this work is theoretical. 2,6,16,17 In an attempt not to reproduce the limitations of the cultural competence trainings and evaluations, cultural humility scholars have recognized the need for assessing the trainings’ effectiveness from both the provider and, more importantly, the patient point of view. 15,17 We also add the need for a clear conceptualization and measurement of cultural humility, and advise against the proliferation of similar constructs such as cultural safety, cultural sensitivity and cultural respect.…”

“…15,17 We also add the need for a clear conceptualization and measurement of cultural humility, and advise against the proliferation of similar constructs such as cultural safety, cultural sensitivity and cultural respect. 3,16…”