In their article in the October 2021 issue of the Clinical Journal of Oncology Nursing (CJON), Nolan et al. outlined the opportunities for nurses at all levels of leadership and practice and challenged the profession to create a “foundation for prioritizing cultural humility as a clinical competency of nursing, with the goal of galvanizing the nursing pipeline and workforce and fostering high-quality cancer care.” The article was included in CJON’s supplement on health disparities.

Bias in Health Care

Studies have shown that 80% of nurses exhibit racial biases and 90% exhibit classist biases, Nolan et al. reported. “Healthcare providers can see skin color; hear inflections, tones, and languages spoken; and sense other differences from patient to patient,” they said.

When those observations affect patient interactions, unintended discrimination may be a consequence. Patients who have experienced those situations sometimes choose to delay or avoid health care for fear of future discrimination. 

Cultural Humility Is Patient-Centered Care

By recognizing our innate biases, we can overcome them to put patients first. Cultural humility expands on the factors of cultural competence and readdresses power imbalances, Nolan et al. explained. It allows providers to approach patients on a more personal level that considers the factors that influence their wishes for care. It’s an essential component of shared decision-making, the authors said.

Nolan et al. challenged the profession to confront cultural humility through two opportunities: (a) educating and building the nursing workforce and (b) taking individual responsibility to be self-aware and overcome our own personal biases that influence care.

Educate and Build the Nursing Workforce

By 2045, Black, Indigenous, and People of Color (BIPOC) will no longer be a minority population, Nolan et al. said. Nursing, which historically and continually is a profession dominated by White females, isn’t following suit in racially representing the patients they serve.

It starts at the faculty level, Nolan et al. explained, where fewer than 16% identify as non-White and only 7% male, and continues to the student level, where just 30% are non-White and fewer than 5% male. The profession cannot diversify the workforce until it can diversify incoming nurses.

The American Association of Colleges of Nursing advocates for the inclusion of diversity, equity, and inclusion principles in nursing curricula to teach nursing students that patients may be different than themselves but are welcomed, seen, and heard as nurses provide individualized patient care, both for health and its social determinants, such as food security and transportation, Nolan et al. said.

Additionally, the authors called for nurses to become “social justice champions” who understand the intersection of bias, structural racism, and social determinants with healthcare inequities and take action—in other words, move the needle of health toward equity.

Even if nursing school is long behind you, today’s nurses can receive education and training in diversity, equity, and inclusion practices. Institutions can provide training on a more formal level, and nurses can self-educate using the resources listed in the sidebar, among others.

Self-Awareness and Self-Development

“By nature, patient-centered care is antibiased and antidiscriminatory, with a focus on the needs of the patient,” Nolan et al. explained. Patients presents with their own lived experience, thoughts, beliefs, and preferences for care. Through unbiased, active listening, nurses must acknowledge those concerns without judgement or questioning. They empower patients by providing self-management strategies and recruiting supportive services as required.

Nolan et al. suggested the following strategies for nurses to apply cultural humility to their care.

• Start with self-reflection: Every nurse has biases, and acknowledging your own will help you approach patient care with cultural humility.
• Care begins with introducing yourself and indicating your pronouns: This sets the tone by establishing a respectful, culturally informed, and therapeutic care relationship.
• Never underestimate the social history’s power: Social determinants of health, including a patient’s culture, work history, living space, access to food, transportation, and support system, have a tremendous influence on their access to and desires for care. By listening to their social history, nurses can tailor care plans for each patient.
• Be careful not to stereotype or discriminate: Embrace lifelong learning, and allow patients to tell you their thoughts, beliefs, practices, and capacity to manage their care rather than relying on your preconceived beliefs. If a misstep happens, apologize and ask how best to avoid it in the future.
• Support diversity, equity, and inclusion in the nursing workforce: Those without similar lived experiences cannot fully understand the context of a patient’s life.

For more information about cultural humility, refer to the full article by Nolan et al. To learn about other health disparities among patients with cancer, read the CJON supplement online.

Then, listen to a conversation about racism in nursing and diversifying the profession on the Oncology Nursing Podcast Episode 178: Together We Can Stop Racism and Create Equity in Nursing.