I am Comanche Indian and I come from a long line of nurses five generations as a matter of fact my great-grandmother was considered a tribal healer my grandmother was a nurse in the 1800's my at my grandmother's daughter also was a nurse a surgical nurse for almost 30 years I have two daughters that are also nurses a NICU nurse and a labor and delivery nurse and I am NOT only American Indian but I'm also a nurse so I think my rich cultural heritage is one of the reasons that I have always been tuned in to
cultural competency I learned at an early age how important it was to understand your patients from their perspective so what is cultural competence what does that mean well I know you all are aware that you can go to ten different books and find ten different definitions of what cultural competency is I think that to me it's a continuum one end is cultural competency humility is on one foreign on the left and the far right is cultural competency but with extreme acceptance on that end so we've got extreme humility on one end and extreme acceptance on
another so what does extreme humility mean well cultural humility was actually a term that was coined by two physicians in 1998 Tara Valen and Marie Garcia and they decided that they wanted to incorporate this in medicine and it's come a long way since then but cultural humility means that you sit down with your patients and you listen to them you listen to them knowing that you're not necessarily the expert on health and illness where they're concerned from their perspective especially when they're culturally different than you are it's sort of suspending if you will your own
beliefs you still hold them close but you are not the expert on what their perspective is so when you're sitting down and listening to your patients you're also learning from them at the same time that's one of the most important pieces of that humility piece you're also humble enough to say I don't really know the answer to your question but I'll find out on the other end of the spectrum you have as I said before extreme acceptance what that means is you suspend your own beliefs hold them close but you don't abandon them by any
means you just hold them close it means you learn to respect differences that you're going to encounter in your career it means you embrace tolerance and acceptance so as you can see if you move from one end of the continuum to another you are moving towards cultural competency I want to tell you a story when I was first out of nursing school I took a job in the ICU I'd been working there for several months went on vacation for a few days came back and was sort of catching myself up on the patients in the
unit and what my assignment was going to be and the nurse that gave me the report just said you'll be having and taking care of an elderly man tonight that is terminal with cancer doesn't have much longer to live his family is here they're always in the room his wife is always at his bedside his two sons are there and their wives and they come and go there's only one thing I want to tell you specifically about them though the nursing staff has noticed that every time they go into the room everything's messed up okay
well what that means what does it mean miss tell me more what does that mean messed up I said doesn't mean they're leaving their food out or their newspapers everywhere you know what does that mean she said oh no nothing like that it has to do with moving furniture around they keep moving equipment around moving chairs around moving bed around no matter how many times the nurses have said this is not a good idea we need the equipment where it's located for emergencies etc etc it made no difference they come back in in a while
after they had gotten everything orderly again and you know how we are as nurses we're very orderly we like things just in the right place have you ever saw have you ever watched a nurse or yourself start an IV you care for pieces of tape that are four inches long three pieces of tape this we line them all up on the bedside table so that we can get access to them we just are orderly by nature I think so this was really frustrating to the staff that every time they came into that room it was
in disarray I said okay thank you for telling me all you know see what I can find out so I went in introduced myself checked on the patient and then I asked her if I could come back in a little while and sit down and talk with her that I wanted to get to know she and her husband a little bit better she said yes I went off thirty minutes later I came back sat down with her and we just did some superficial chitchat in the beginning I asked her some questions about her family she
told me that they she her husband had moved here three years ago and they were living with their sons so out of their comfort zone here in the United States especially with the healthcare system I just continued to listen as she talked and when she was finished I said you know I have a personal question to ask the nurses have told me that they have noticed that you all moved the furniture around a lot in this room and she looked at the floor for a minute she looked back up it means she said there's a
reason for that I didn't say anything I just listened and she said we're Muslim and our belief system a person that is dying we have to ensure that they're facing west the direction West so that's why we've been moving the furniture around to make sure that my husband's bed is pointing west and the reason for it is we believe that that's where Allah is waiting for God to take our loved one across so I sat there for a second and I thought this makes perfect sense to me why they have been moving the furniture around
so I thanked her and I said you know I'm really glad that you shared this information with me if you don't mind I'm gonna share it with the staff so that they can stop giving you looks and moving stuff back around and and everybody will understand what's going on she said that would be wonderful I discovered in that instance that this even the smallest thing that you can do for a patient that is different than yourself it becomes so appreciated by that person and the family so in that context you know it that was really
about humility extreme humility I sat down with her I listened to her I learned from her and then we made adjustments in accommodations as we could with that family let me tell you another story in the 1990s I was a faculty member and I had students in the labor and delivery area and when we got rapport that morning now remember this was 30 years ago a totally different time in place so when we got rapport that morning we were told that we had a couple in labor that happened to be lesbian so the staff was
you know sort of taken back and from the comments there was some a lot of only reluctance to care for the couple but resistance as well probably thinking back about it now more out of fear of the unknown so to speak so to my students decided they volunteered to take care of the couple so we left and we went out in the hallway and I said okay what's the plan gonna be and they were sort of overwhelmed by the whole situation at that point and I said okay why don't we just start out by treating
them as a normal laboring couple because that's what they are we went in did our job became very close with the couple they were delightful they had the same questions that any new parent that's in that situation has what's going to happen after the delivery how you know how long will the baby get to stay here goes to the nursery when do we get it back you know those kinds of questions the same you know what's gonna happen with my partner where's she gonna go from here same questions at anyone else asks that's in labor
so they gave us one of the most meaningful experiences probably in my nursing career because they were so overjoyed when the baby arrived we got to see the delivery the birth the students were crying the nurse was crying I was crying the parents were crying we were all crying because they were so excited about the birth of this baby so it was as I said one of the most meaningful experiences that I had had to that point so that's a situation of going towards the opposite end of the spectrum or the continuum where you become
accepting so these are some of the stories that I have had through the years and experiences that I've had that have led to stories so I just thought I would share those with you as examples of the continuum that I've been describing of cultural competency now we're gonna develop yours I'm a teacher you all knew this was going to happen didn't you yeah it's it's bound to happen when you get a teacher in front of you okay I'm not gonna ask you to do anything except think about some things so back to the continuum let's
look at it and just understand that the further right you go the more culturally competent you become so I want you to understand that there be there won't be situations that happen in your career patients that you will encounter that you were not anticipating and you will just be thrown for a loop it will happen I guarantee it happens to all of us but you've got to decide and figure out in a nanosecond what your response is going to be and how you're going to proceed so let me give you some situations I don't want
you to say anything I just want you to think about them first of all where do you think you are on the continuum at this point in your career and a lot of your students but some people bring other experiences to school that could certainly add to this so do you think that you're on the far end that you're still at the point of discovering what you're what you believe yourself and what you hold dear to you and what you can suspend are you at that point are you have you had some cultural humility already
going on with your patients where you've been sitting down talking to them learning from them making some accommodations for them as much as you can so just decide where you are on the continuum I just want you to think about that for a second once you sort of have that in your mind the next thing I want you to do is I'm going to give you a situation and I want you to think about very quickly what you would do in that situation let's say you came to work and you were told that one of
your patient assignments was a person that was a patient that was HIV positive what would you do how would you be thinking about that situation now think about you come to work and they say you're a patient tonight one of them is going to be a transgender patient think about that how would you react how would you respond what would be your plan or you came to work and your supervisor said one of your patients tonight is addicted to opioids what do you think about working with an addict so things you need to start thinking
about these are just some examples think of other ones since you're still students think of other scenarios that you think would just totally take you back and you'd really have to take pause when you heard the type of patient you were going to be taking care of I think that these are all tough questions but if you can give yourself some practice ahead of time it makes it easier when the surprise happens and you walk in and find out who you're going to be taken care of for eight hours or 12 hours so what I
want you to realize is that cultural competency is not about race ethnicity gender politics morality none of those things none of those things matter what's it about it's about patient outcomes you want to be culturally competent to produce better patient outcomes you want the patients to have a meaningful Hospital experience so how do you help them do that especially when they are different than yourself you know one of the big questions is how do I feel about taking care of someone that's different than I am you have to answer that yourself nobody can answer that
for you the bottom line is it's about openness and acceptance every single day with every patient you encounter thank you for your kind attention [Applause] you
