In this week’s blog, the first in the Children and Young People’s (CYP) Series for September, CYP Nursing Lecturers from Birmingham City University @MyBCU: Laura Maguire @Laurama37358999, Kathryn Sethi @katsethi, Emma Tonks @EmmaT31, Waheeda Zaman discuss
Cultural humility in CYP nurses
As patient populations become more diverse, the intersection of multiple identities increasingly requires nurses to develop personal attributes of cultural humility and incorporate cultural competence within their practice (Nguyen et al 2020, Ide & Beddoe 2022). Cultural Competence models have been criticised for implying that knowledge of cultures can be mastered by learning or gathering information without challenging individual biases and assumptions (Sedgwick & Atthill 2020, Allwright et al 2019). Cultural humility frameworks have been described as a lifelong ‘process’ whereby individuals develop self-awareness through reflection and maintain a culturally humble approach to care and remain open in relation to aspects of cultural identity that are most important to individuals in their care (Srisarajivakul et al 2023, Allwright et al 2019).
Nguyen et al (2020) argue against the use of a single approach and suggest that that by combining the knowledge and understanding achieved through practice of cultural competence, with the awareness and openness to lean from others that is promoted through a cultural humility framework, professional may provide care that is responsive to child and family needs.
Embedding Culturally humility within CYP nursing practice
Integrating cultural humility into nursing practice is essential for enhancing patient journeys and outcomes. This can be accomplished through family-centred care (Department of Health, 2004), an initiative originally focused on children and young people’s nursing that emphasises building partnerships with patients and their families. Given that families come from diverse backgrounds and experiences, it is imperative for nurses to practice cultural humility to effectively collaborate in delivering family-centred care, ensuring that needs are met while preventing discriminatory attitudes and behaviours (Shields, 2015).
To achieve success in this area, nurses should prioritise reflective practice, which fosters self-awareness and enables the identification and management of both conscious and unconscious biases, thereby minimising the risk of harm to patients and their families (Yeager and Bauer-Wu, 2013). For instance, nurses must be attentive to families who speak English as an additional language or who may not speak English at all. This language barrier does not necessarily indicate a lack of health literacy; rather, it is the responsibility of nurses to recognise these signs through cultural awareness to improve patient outcomes. NHS England (2023) offers an eLearning course titled “Cultural Competence and Cultural Safety,” which can assist healthcare professionals in providing effective care to an increasingly diverse population.
Decolonising curriculum in CYP nurse education
Providing an Anti-Racist curriculum is vital to ensure that CYP nursing curriculum is appropriate for all students and ultimately the wider community that they will be serving. Anti-Racist curriculum is a continual process that needs to be constantly reviewed, we must acknowledge and teach about racism and anti-racism both past and present (AdvanceHE 2024). An intersectional approach is vital to ensure that the curriculum considers how race intersects with other protected characteristics, global majority students and staff need to see themselves reflected in the curriculum throughout their courses (AdvanceHE 2024). Appropriate resources need to be used to reflect the diversity of patients, for example: https://www.nhsrho.org/wp-content/uploads/2023/07/Infographic_neonatal-report.pdf (NHS Race and Health Observatory, 2023).
Culturally relevant pedagogy (CRP) is also essential to transform the educational experience of historically marginalised groups (Wen-Chia and Viesca, 2022), in addition this will enhance cultural humility within nursing practice through education that is inclusive and open (Amoaka Kayser, 2021).
Embedding a decolonised curriculum in CYP nurse education
The Closing the gap report (UK Universities, 2019) highlighted that there was a 13% attainment gap between white and Black, Asian and minority ethnic students, suggesting that there is an issue with racial equality across UK universities. Embedding a decolonised curriculum in children and young peoples (CYP) nursing requires a holistic approach with educator training playing a vital role in this. Equipping academics with the skills to teach culturally relevant curriculum, creates learning environments that challenge students to not only broaden their perspectives but strengthens their cultural identities within the classroom (Freire, 2000). This involves ongoing professional development and creating spaces for critical dialogue to take place.
Engaging with stakeholders is another step towards a decolonised curriculum; by developing and supporting a culture of inclusiveness within the nursing curriculum we can effect change that will improve the historically marginalised demographics that the healthcare service represents. When replacing a single voice within the curriculum with multiple cultural perspectives, it prepares a workforce that better reflects its patients (Gay, 2000; Kim and Slapac, 2015). By embedding a decolonised curriculum in CYP nurse education leads to a more inclusive and effective workforce that are better placed to serve the diverse population within the UK
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References:
AdvanceHE (2024) Anti-Racist Curriculum Project – What we mean by Anti-Racist Curriculum. Available at: Anti-Racist Curriculum Project – What we mean by Anti-Racist Curriculum | Advance HE (advance-he.ac.uk)
Allwright, K., Goldie, C., Almost, J. and Wilson, R., 2019. Fostering positive spaces in public health using a cultural humility approach. Public Health Nursing, 36(4), pp.551-556.
Amoaka Kayser, A. (2021) What Is Culturally Relevant Pedagogy? Available at: What Is Culturally Relevant Pedagogy? – Peers and Pedagogy (achievethecore.org)
Chang, W.C. and Viesca, K.M., 2022. Preparing teachers for culturally responsive/relevant pedagogy (CRP): A critical review of research. Teachers College Record, 124(2), pp.197-224.
Department of Health (2004) National Service Framework: Children, Young People and Maternity Services. Department of Health and Social Care: London. Available at: https://assets.publishing.service.gov.uk/media/5a7b6cc540f0b6425d5930fe/National_Service_Framework_for_Children_Young_People_and_Maternity_Services_-_Core_Standards.pdf
Freire, P. (2000). Pedagogy of the Oppressed: 30th anniversary edition. New York, NY: Continuum
Gay, G. (2000). Culturally responsive teaching: Theory, research and practice. New York: Teacher College Press
Ide, Y. and Beddoe, L., 2022. Attitude or skills? Cultural competence development within an Aotearoa New Zealand bicultural framework. Aotearoa New Zealand Social Work, 34(4), pp.47-60.
Kim, S., and Slapac, A. (2015) Culturally responsive, transformative pedagogy in the transnational era: Critical perspectives. Educational studies: Journal of the American Educational Studies Association, 51(1), pp.17-27. https://doi.org/10.1080/00131946.2014.983639
Nguyen, P.V., Naleppa, M. and Lopez, Y., 2021. Cultural competence and cultural humility: A complete practice. Journal of Ethnic & Cultural Diversity in Social Work, 30(3), pp.273-281.
NHS England (2023) Cultural Competence (CMW). Available at: https://portal.e-lfh.org.uk/Component/Details/438885
NHS Race and Health Observatory (2023) Not All Babies Look the Same. [pdf]. Available at: Full page photo (nhsrho.org)
Sedgwick, A. and Atthill, S., 2020. Nursing student engagement in cultural humility through global health service learning: An interpretive phenomenological approach. Journal of Transcultural Nursing, 31(3), pp.304-311.
Shields, L. (2015) What is family-centred care? European Journal of Person Centered Healthcare, 3(2), pp. 139-144. https://doi.org/10.5750/ejpch.v3i2.993
Srisarajivakul, E.N., McPhee, K., Choe, E.J.Y., Rice, K.G., Varjas, K., Meyers, J., Davis, D.E. and Graybill, E., 2023. The Cultural Humility Scale for Students: Development and initial validation among adolescents. Journal of School Psychology, 99, p.101224.
Universities UK, (2021) Black, Asian and Minority Ethnic student attainment at UK universities: #Closing the Gap. London: Available at bame-student-attainment.pdf (universitiesuk.ac.uk)
Yeager, KA. and Bauer-Wu, S. (2013) Cultural humility: essential foundation for clinical researchers. Applied Nursing Research, 26(4), pp. 251-256. https://doi.org/10.1016/j.apnr.2013.06.008