In the complex map of the Canadian healthcare system, principles such as cultural competency, humility, and safety act as fundamental frames that ensure equitable and respectful care to all Canadians. These initial concepts are of primary importance because of the uniqueness of different cultural groups, including Indigenous groups’ health beliefs and practices and their impact on the health service delivery process. Cultural competency is about continuous learning about diverse cultural backgrounds, knowledge, and needs and being flexible to such needs when providing care (Canadian Nurses Association, 2018). Cultural humility goes beyond awareness and engages people in deep reflection and ongoing learning on cultural assumptions and biases (Canadian Nurses Association, 2018). Cultural safety transcends awareness and sensitivity; therefore, the activities should include the recognition and respect of the unique cultural identities of each patient, which also builds a safe healthcare environment for them (Canadian Nurses Association, 2018).
The importance of these concepts is demonstrated in the following clinical experience narrative of a patient who previously had a stroke and suffered mobility issues. The patient’s belief in the smudging ritual and his willingness to teach the ritual to us during my clinical rotation gave me the chance to analyze the usage of cultural humility, competency, and safety in nursing practice. It makes us think about what these practice models can contribute to improving patient outcomes, directing the health care system, developing the nursing profession, and teaching us for future nursing practice.
The paper provides a personal reflection of the scenario, evaluating this experience and adding up the statutes on cultural competence, humility, and safety. The aim is to provide insight into the significance and role of these concepts in achieving the outcome of skillful, culturally competent, and safe care. Through this investigation, the paper analyzes the consequences of cultural considerations for healthcare system administration, the profession of nursing, patient results, and further development of nursing practice in a multicultural society.
Description of the Scenario
I first met the patient during my third-year mental health clinical rotation in a local community health center in Canada. The patient, who had previously suffered a stroke and experienced mobility challenges, expressed a desire to share with my classmates and me the sacred ritual of smudging. This patient had expressed how integral smudging was to his spiritual and physical well-being, especially in his recovery journey post-stroke.
Smudging is a cleansing ceremony used by various Indigenous cultures to purify the body, aura, and space of negative energies (Noah, 2022). This ceremony involves the burning of specific plants, including sage, tobacco, sweetgrass, that are regarded as sacred. It is believed that the smoke takes away bad thoughts, bad feelings, and hazards through burning, which is thought to contribute to healing, healthy living, and a deeper connection to the earth and ancestral knowledge (Noah, 2022). To participate in the smudging ceremony, the patient-guided us to a tipi set up within the community center grounds, a space designated for such cultural practices.
Application of Key Concepts
Cultural Competence
The journey to cultural competence started with a genuine need to unveil the health perceptions and cultural beliefs that the patient held. Understanding these aspects was key because it showed that I acknowledged his beliefs and identity as an individual from the Cree community. This understanding was facilitated through open, respectful dialogue, which served as a bridge between two worlds: Indigenous healing practices and medical settings (Foronda et al., 2016). This experience was not just about me becoming accustomed to participating in the smudging ritual, but understanding the importance that this ritual held to the patient’s life and identity. While conversing with the patient, I learnt the benefits of smudging and its cultural and spiritual meanings in the indigenous community, where health, nature, and spiritual life are in one whole. It pointed to the fact that aside from medical knowledge, healthcare delivery equally hinges on respecting and understanding the patient’s cultural background (Foronda et al., 2016). This encounter clarified why cultural competence enriches therapeutic contact, building a healthcare environment where the patients are seen, listened to, and respected, which always contributes to more integrated and patient-oriented treatment.
Cultural Humility
Through the experiences with the patient, I have discovered that my path of self-awareness and learning has led me to know that I have biases and limits on engaging with Indigenous cultures. According to Greene-Moton and Minkler (2020), cultural humility is a lifelong work of admission to self-evaluation and learning from cultural exchanges, and this also reminds me of my own experience after participating in the ritual. Admitting my ignorance and the enormity of how much I did not know about the smudging ritual was humbling. It was a genuine awakening that cultural humility is not solely about knowing; it is about creating non-patronizing relations with mutual trust (Zghal et al., 2020). This was a pivotal moment as it encouraged cultural humility and curiosity to learn about the community and different indigenous practices that may arise in my practice. Practicing cultural humility implies that this process is continuing learning and exploration – one that means listening more than speaking, asking rather than assuming, and acknowledging that the patient has been the target culture’s expertise. Through this way of doing things, cultural humility became not just a term but a practice that will always determine my attitude toward nursing and relation with all patients, especially those from diverse cultural backgrounds.
Cultural Safety
Making the healthcare system safe for the patient necessitated deliberate actions and reflection on how the healthcare system and its providers could include and honour his cultural requirements and preferences. It meant lobbying for the incorporation of traditional healing practices along with modern medical solutions, which must be safely and respectfully done. For example, although I did not believe in smudging, I had to observe the patient’s guidelines when entering the tipi. We had to take off all metal jewelry, which could have interfered with energy balance, and with silence and reverence walk into the tipi, acknowledging that we were crossing from the world of the mundane into the sacred. Respecting these created a safe space where patients felt safe and comfortable expressing their needs without discrimination or prejudice. (First Nations Health Authority, n.d.). It also brought forth an initiative to organize and participate in such consultations with the whole healthcare team to ensure that traditional practices are respected and acknowledged. This approach was not only about respecting individual choice and cultural background; it also helped in the creation of the mood of safety and belongingness, which is a basic requirement for overall healing (First Nations Health Authority, n.d.). The actualization of cultural safety emerged as practicable steps that honoured and protected the patient’s cultural identity within the healthcare centre. This experience has indeed pointed out the key role nurses play in advocating and ensuring cultural safety in the healthcare setting, making it a peaceful place with high responsiveness and inclusiveness where all patients are treated with respect.
Implications for Practice
Health Care System
As pointed out by the Canadian Nurses Association (2018), the incorporation of traditional healing methods within Canadian healthcare can be accomplished by focusing on cultural awareness among nurses. Including traditional and modern medicine methods within the health system reflects a holistic view of health care, embracing the multidimensional nature of health and wellness among indigenous peoples. Considering practices like smudging in a conventional medical setting opens the door to numerous implications for the Canadian healthcare system. It highlights the importance of policies that acknowledge and reflect Indigenous healing practices in addition to Western medicine (Canadian Nurses Association, 2018). Implementing such integrative care requires designing guidelines to safeguard both safety and efficiency; hence, this calls for collaboration between the traditional healers, the healthcare providers, and policymakers. This approach pushes the health care system to shift from the current model into one that gives recognition to indigenous knowledge as an equal part of the medical system, potentially leading to diversity in the health care options available as well as improved outcomes for indigenous patients (Allen et al., 2020).
Yet, it gives rise to certain obstacles, including getting into disagreements among conventional practices and evidence-based medical treatments, and the responsibility of healthcare workers to know different traditional healing procedures. Nevertheless, the advantages outweigh the drawbacks. It fosters patient participation in their care, boosts the trust between patients and healthcare providers, and can yield better health outcomes if all the strengths are capitalized on (Allen et al., 2020). Healthcare policies must be more proactive in including and respecting local traditional healing practices that can coexist with conventional medicine while promoting safety in practice.
Nursing Profession
Cultural competence and humility in nursing education and practice are indispensable concepts. My experience with the patient and the smudging ritual highlighted my knowledge gap and the need to continue educating myself to supplement my nursing education to better understand Canadian cultural issues better as we work towards reconciliation. For instance, I learned that menstruating women do not enter the tipi because it is a holy place, a factor I would be insensitive to before this experience. Nurses with this knowledge and who have true cultural diversity respect will certainly be more inclined to provide empathic, effective care that will cater to the needs of all patients, including those who belong to different cultures, especially Indigenous communities (Tremblay et al., 2023). The evolution of nursing practice towards a culturally sensitive approach can promote the profession as a bridge between the healthcare system and the culture gap, thereby enhancing the patient care experience of Indigenous people (Foronda et al., 2016). It enables nurses to apprehend health care in a broader sense, which involves cultural, social, and personal factors that affect health. This method encourages a more respectable and appreciative healthcare setting where patients realize their voices are valued.
Patient Outcomes
The patient’s example shows the value of cultural sensitivity in healthcare provision and its ability to improve patient satisfaction and outcomes. By agreeing to participate in the ritual and combining it with regular stroke treatment, the patient felt important and well-understood, which motivated him to follow his care plan even more carefully. We witnessed his attitude and motivation to share his beliefs with us, that we may understand his source of strength in the way he wanted it to be understood. Through our weeks there and monitoring how this patient engaged with his therapies, I got to witness this patient share a piece of himself and his beliefs with all those around him, and a respectful response to that invitation encouraged a high degree of engagement toward his healthcare workers (Allen et al., 2020). Thus, this experience is a strong reason for implementing culturally based care practices across the healthcare system, which can bring about more positive health results and greater patient satisfaction.
Future Nursing Practice
This experience triggered a totally new point of view and method of delivering care that resonates with cultural specifics. I have come to appreciate how essential it is to keep striving to learn and incorporate the cultural history of my patients in their individual care plans. This encounter has brought home to me a determination to make cultural competence and humility the governing principles for all my practice as a nurse in future (Zghal et al., 2020).
The participation of interdisciplinary collaboration played a substantial role in applying the systematic approach towards the patient’s care. The teamwork among nurses, physicians, traditional healers, and cultural liaison officers that they represented was the foundation of healthcare (Foronda et al., 2016). Coming together as a team, it became possible to assess all health care and lifestyle issues holistically, leading to creating a more effective treatment plan. This raised the issue that, to work together, health workers have to respect each other’s skills and the efforts they make to benefit the patients.
Conclusion
I found my experience of participating in the smudging a wonderful learning opportunity. This reflection has, therefore, highlighted the critical role of cultural sensitivity, humility and safety in nursing practice and the healthcare system in general. Such theories are not only hypothetical and imaginary but are rather practical methods which alter the provision of healthcare delivery, clinical care, and individual growth.
Participating in the patient’s cultural beliefs and practices demonstrated to me how significant cultural value is in both respectful and patient-centred care. It demonstrated the importance of cultural humility, the need for self-exploration, and life-long learning of one’s bias and the culture of others. Moreover, addressing this with cultural safety revealed the efforts that should be taken to make the healthcare environment free from bias and safe for patients of all cultural backgrounds. This experience was groundbreaking; it has changed my way of caring for patients and created a deep understanding of nursing’s impact on the operation of the healthcare system. It has reinstated the fact that becoming culturally humble is a process that can only be achieved by an ongoing commitment to ensuring that each patient, regardless of their background, gets fair and appropriate attention. During my nursing career, I will use this example as a major source to remind me about the lessons of humanity. This encounter will remain a great example of the role of culture-sensitive care in patient outcomes and satisfaction. This situation has taught me to continue working on improving myself regarding cultural humility. The path towards culturally secure care is considered to be an ongoing process; it is essential to nursing.
References
Allen, L., Hatala, A. R., Ijaz, S., Courchene, E. D., & Bushie, E. B. (2020). Indigenous-led health care partnerships in Canada. Canadian Medical Association Journal, 192(9), E208–E216. https://doi.org/10.1503/cmaj.190728
Canadian Nurses Association. (2018). Position statement: Promoting cultural competence in nursing.
Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S.-J., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition. https://doi.org/10.1186/s12939-019-1082-3
First Nations Health Authority. (n.d.). FNHA’s policy statement on cultural safety and humility. https://www.fnha.ca/Documents/FNHA-Policy-Statement-Cultural-Safety-and-Humility.pdf
Foronda, C., Baptiste, D-L., Reinholdt, M. M., & Ousman, K. (2016). Cultural humility: A concept analysis. https://doi.org/10.1177/1043659615592677
Greene-Moton, E., & Minkler, M. (2020). Cultural competence or cultural humility? Moving beyond the debate. https://doi.org/10.1177/1524839919884912
Noah, E. (2022). Exploring Indigenous People in Canada and Traditional Health Practices. https://ir.lib.uwo.ca/headandheartprogram_2022/4/
Tremblay, M., Olivier-D’Avignon, G., Garceau, L., Échaquan, S., Fletcher, C., Leclerc, A., Poitras, M., Neashish, E., Maillet, L., & Paquette, J. (2023). Cultural safety involves new professional roles, such as a rapid review of interventions in Australia, the United States, Canada, and New Zealand. AlterNative: An International Journal of Indigenous Peoples, 19(1), 166–175. https://doi.org/10.1177/11771801221146787
Zghal, A., El-Masri, M. M., McMurphy, S., & Pfaff, K. (2020). Exploring the impact of health care provider cultural competence on new Immigrant Health-Related Quality of Life: A Cross-Sectional Study of Canadian Newcomers. Journal of Transcultural Nursing, 32(5), 508–517. https://doi.org/10.1177/1043659620967441
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