NR 394 Week 2 Cultural Competence Self-Assessment Example

Culturally Aware, Not Yet Competent: What a Self-Assessment Inventory Showed About My Practice

Student Name

College of Nursing, Chamberlain University

NR 394: Transcultural Nursing

Instructor Name

Month Day, Year

Culturally Aware, Not Yet Competent: What a Self-Assessment Inventory Showed About My Practice

The Instrument and the Result

I completed the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals, Revised, a 25-item self-report instrument developed by Campinha-Bacote to measure the five constructs of her model of cultural competence: cultural awareness, cultural knowledge, cultural skill, cultural encounters and cultural desire (Campinha-Bacote, 2002, 2007). I chose it over the other inventories offered in the course because it is built on a nursing model and because its items ask about behaviors as well as attitudes. Scores range from 25 to 100 and are grouped into four levels: culturally incompetent, culturally aware, culturally competent and culturally proficient. I answered each item as I actually practice rather than as I think a nurse should.

My total score was 68, which places me in the culturally aware range, below the threshold for culturally competent. My highest-scoring items concerned cultural desire and awareness: I want to care well for patients from backgrounds different from mine and I recognize that my own background shapes how I see patients. My lowest-scoring items concerned cultural skill, especially conducting a cultural assessment, and cultural knowledge of specific groups in my community.

What the Result Asserts and What I Accept

The result asserts that I am aware of cultural difference and motivated to respond to it but do not yet have the skills to act on that awareness consistently. I accept most of that. The low skill scores fit my practice closely: I do not use a structured cultural assessment on admission, and I rarely ask patients about beliefs or practices that might affect their care unless a problem forces the question. I also accept that my knowledge of specific groups is thin. My hospital serves large Somali, Hmong and Mexican American communities, and I could not describe basic health practices or concerns in any of them with confidence.

Where I disagree with the instrument is on cultural desire. My high score there reflects what I said I want, and the inventory has no way of checking whether that desire shows up in behavior. Tervalon and Murray-García (1998) argue that cultural competence framed as mastery can mislead clinicians into thinking they have finished learning, and they propose cultural humility, an ongoing practice of examining one's own assumptions and correcting the imbalance of power between clinician and patient, as a better goal. By that standard, a high desire score means little unless it produces a habit of asking patients about their own values, which I have not yet built.

Evidence From My Practice

Three recent encounters support this reading. First, last spring I charted an older Somali woman's untouched meal trays as poor appetite for two days before her daughter asked whether the food was halal. My desire to care well for her did not produce the one question that mattered, because my admission assessment did not include it. That encounter is the clearest evidence for the skill gap the inventory reported. Second, I cared for a Hmong man after surgery whose family wanted to place a string around his wrist, and I told them it had to be removed because of the identification band on the same arm. I later learned that the string is a common practice associated with protecting the patient's spirit, and that it could have been placed on the other wrist. I acted on a hospital rule without asking what the practice meant. Third, and in the other direction, I have learned from a Spanish-speaking colleague to ask Mexican American patients whether they are using any home remedies or teas, and patients have usually answered openly. That habit came from a colleague, not from an assessment tool, and it is the kind of skill the inventory asks about.

What the Result Means for Care

The practical meaning of a culturally aware but not competent score is that I will recognize cultural difference when it announces itself, as when a family member raises a question, but I will miss it when it does not. Patients who do not volunteer their beliefs, often those with the least power in the encounter, are the ones my current practice fails. Campinha-Bacote (2002) places cultural encounters at the center of her model because direct interaction with patients from other backgrounds is how knowledge and skill develop, and she describes cultural competence as a process rather than an endpoint. My result suggests that the encounters are happening every shift but that I am not using them to learn, because I rarely ask the questions that would make them informative.

Where My Blind Spots Come From

The inventory does not ask why a nurse scores as she does, but the question matters for change. My own background explains some of my blind spots. I grew up in a small town where nearly everyone shared my language, religion and food habits, and my nursing education presented culture mostly as a list of facts about groups, which I memorized for an examination and did not use. My unit's routines reinforce the pattern. The admission assessment asks detailed questions about medications, falls and skin but only one question about religion, a yes or no about wanting a chaplain visit. When the tools I use every shift ask nothing about beliefs, it is easy to believe that beliefs rarely matter to care.

Knowing where the blind spots come from also suggests where to push. The unit's admission assessment is revised every year by a committee, and I can propose adding the explanatory questions I plan to use myself, so that the habit does not depend on my memory alone.

One Change I Could Fail At

The change I am committing to is narrow on purpose. At every admission for the next two months, after the standard admission questions, I will ask three open questions adapted from the explanatory model approach: what the patient thinks caused the problem, what the patient is most worried about, and whether there is anything about the patient's beliefs, religion, food or family that the care team should know. I will record the answers in the admission note. To check myself, I will review my own admission notes for one week each month; if fewer than four in five of my admissions include the answers, I have not met the goal. I will retake the inventory at the end of the course, but I will treat my admission notes, not the score, as the evidence of change.

References

Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181-184. https://doi.org/10.1177/10459602013003003

Campinha-Bacote, J. (2007). The process of cultural competence in the delivery of healthcare services: The journey continues (5th ed.). Transcultural C.A.R.E. Associates.

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125. https://doi.org/10.1353/hpu.2010.0233