cultural competency

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VI. Self-awareness: Becoming aware of your own worldview (Adapted from Buhin et al. 2004)

1. Learning About Your Own Culture
2. Understanding Your Personal Worldview
3. Appreciating Your Own Multiple Identities
4. Acknowledging assumptions and biases.
5. Accepting Responsibility and Tolerating Ambiguity
6. Recognizing Limits of Your Competence

1. Learning About Your Own Culture

According to Tervalon and Murray-Garcia, cultural self-awareness requires a life-long commitment to self-evaluation and critique (14). Before entering into a client-caregiver relationship, the individual must become aware of her/his cultural and historical background. By recognizing the different influences from his/her cultural background, the individual will be able to recognize the different influences in the client’s background and will be more likely to engage in a sensitive, therapeutic relationship.

Exercise #1: Adapted from

Think of yourself as a cultural being whose life has been influenced by various historical, social, political, economic, and geographical circumstances. This exercise will help you become aware of your historical, ethnic and cultural background.

  1. Where were you born?
  2. When were you born?
  3. Where did you grow up?
  4. Where did your parents grow up?
  5. Where did your grandparents grow up?
  6. Where did your great grandparents grow up?
  7. What is your earliest memory as a family?
  8. What is your earliest school memory?
  9. As a family, what events did you celebrate?
  10. Have you traveled or moved as a child?
  11. Have you traveled or moved as an adult?
  12. Recall on international event that happened before you turned 18. Try to answer the following: Who was involved, what was the event, where did it happen, how did it happen, and why did it happen?
  13. Recall an event that happened in the country where you were born, before you turned 18. Try to answer the following: Who was involved, what was the event, where did it happen, how did it happen, and why did it happen?
  14. What is your earliest recollection as a member of a group?
  15. What was your first job?
  16. As an adult, what events or holidays do you currently celebrate?

2. Understanding Your Own Worldview

Since our perceptions are shaped by our view of the world, the caregiver needs to examine and understand how she/he sees the world.  One’s worldview is learned through socialization, from childhood to adulthood, and constantly reinforced by the culture in which we live. It is the taken-for-granted view of “the way things are” and most of the time unquestioned and invisible.

“To understand worldviews, therefore, we must examine the beliefs/belief systems and the social values that they contain.” (LeBaron, M. 2003). An example of a belief system was Social Darwinism which held that life is a struggle for survival and dominance, and the most competent and hard-working individuals will be most successful, while the incompetent and inferior will be the least successful.

What is your worldview?

One Western worldview is “I am the captain of my soul,”
which is in contrast to the worldview of “God will provide” which other cultures hold.

When one is blind to his own culture, he will not be able to see the differences in values between cultures. This could lead to cultural destructiveness, cultural imposition and cultural pain. This stems from cultural ignorance of one’s own and other’s cultural identities, due to intentional or unintentional isolation or separation. This leads to dehumanizing others with different values than one’s own. The greater the difference, the more negative the evaluation of the other culture (16)


The manner of their living is very barbarous, because they do not eat at fixed times, but as often as they please. Amerigo Vespucci, when he discovered America.


Exercise #2:  How do you view the following?


Aspects of Worldview

What is your worldview?


(Time is money?)

Space between you and the next person

(When do you start feeling uncomfortable?)


(Work relationships vs. personal relationships)


( How do you see technology?)

Religion or spirituality

(What about religion?)


(Tell the truth no matter what.)


3. Appreciating Your Own Multiple Identities

We all live within and identify with multiple identities. Most of us can claim different identities related to gender, age, religion, ethnicity, socioeconomic status, profession, national origin, educational level, etc.

When working with clients from other cultures, the caregiver should examine differences and similarities between herself/himself and the client. The caregiver takes into account  “issues related to diversity, marginalization, and vulnerability due to culture, race, gender, and sexual orientation (National Academy of Nursing expert panel, 1990.)

By recognizing one’s multiple identities, one is less likely to stereotype others based on minimal information about another person’s historical, social, and cultural backgrounds.

What are the shared identities between two 30-year-old men, one is  a 30-year-old nurse who works full-time, goes to school in the evenings to work on his master’s degree and raises three children and another 30-year-old man who works at two jobs and raises three children?

Exercise # 3. “I am_."

Take a blank sheet of paper and write the numbers 1-10 on the left hand column. Complete the statement “I am______” using the first words that come to mind.


What were your first 5 answers? When did you start to slow down in writing your answers?

What were the last 3 answers? Do you feel that your list accurately captures your multiple identities?


4. Acknowledging assumptions and biases

ANA Code of Ethics: Nurse provides care with respect to the inherent worth of the individual. “The nurse establishes relationships and provides care with respect to human needs and values, and without prejudice.”(Provision 1.1, 1.2. ANA Code of Ethics.) (17)

 “Culturally skilled counselors possess knowledge and understanding about how oppression, racism, discrimination, and stereotyping affect them personally and in their work. This allows them to acknowledge their own racist attitudes, beliefs, and feelings” (18)

 Caregivers are expected to be aware of their own cultural identifications in order to control their personal biases that interfere with the therapeutic relationship. Self-awareness involves not only examining one’s culture, but also examining perceptions and assumptions about the client’s culture.

Through a self-reflective assessment of their personal values, attitudes, and assumptions about other cultures, and articulating these assumptions and attitudes, the caregiver will gain the ability to sort out or “bracket” the influences of their own cultural background in order to provide respectful and unbiased care. (20)

Exercise # 4: Answer the following questions:


  1. What racial group do you identify with?
  2. What ethnic group(s) do you identify with?
  3. What socioeconomic class do you identify with?
  4. What is your earliest memory of belonging in a group (other than your family)?
  5. What is your earliest memory of being excluded from a group?
  6. What is your earliest memory of excluding someone from a group?


Exercise 5: Adapted from Luckman (1999)

How do you relate to various groups of people in society? Please answer honestly, not as you think might be socially or professionally desirable. Please do not record your answers for this exercise.

Level of response:


  1. I feel I can genuinely try to help this person without prejudice.
  2. Even though I do not agree with this person, I feel I can accept this person as he is and comfortable enough to listen to him/her.
  3. I do not feel that I have the background knowledge or experience to help this person.
  4. I feel uncomfortable taking care of this person.
  5. I feel biased and prejudiced against this person.


Your Response

Iranian immigrant


Child abuser


Mexican American


Elderly person with dementia




Methodist minister




Unmarried expectant teen


White Anglo-saxon American




Anorexic teenager


Morbidly obese man in his 30s




Person with AIDS


Person with cancer


Person who does not speak English



5. Accepting Responsibility and Tolerating Ambiguity

Caregivers accept responsibility for the continuous process of becoming “aware of their own assumptions about human behavior, values, biases, preconceived notions, personal limitations, and so forth” (Sue et al., 1998, p.38).

Tolerating ambiguity means the caregiver keeps her certainty that “her way is the right way” in check, and will attempt to understand the issues about a client’s supposed “non-compliance” with prescribed treatment. Accepting responsibility means the caregiver will not assume that a failed outcome to treatment stems solely from the client’s “non-compliance” with prescribed therapy.

Ethnocentrism is defined as the tendency of human beings  “to think that their ways of thinking, acting, believing are the only right, proper, and natural ways” and that beliefs, values and practices that differ from one’s own are wrong.” (Purnell 1998).

 Unexplored assumptions about our biases and preconceived ideas about others will “blind” us to our ethnocentric behaviors and attitudes. Leininger refers to cultural imposition and cultural pain as consequences of ethnocentrism (2)

Ethnocentrism is not an acceptable attitude in health and social care because it deters from relationship building between the professional and the patient (23).

Exercise 6: (Adapted from Luckmann 1999)

Indicate the degree to which you agree to the following statements:


  1. People are responsible for their own actions.
  2. The outcome of events is beyond our control.
  3. It is dishonest to give vague and tentative answers.
  4. It is best to avoid direct and honest answers in order not to hurt or embarrass someone.
  5. Intelligent, efficient people use time wisely and are always punctual.
  6. Being punctual to work or meetings is not as important as spending time with family or close friends.
  7. Stoicism is the appropriate way to grieve.
  8. Loudly crying and moaning is the appropriate way to grieve.
  9. The best way to gain information is to ask direct questions.
  10. It is rude and intrusive to ask direct questions.
  11. It is proper to call people by their first names to show that you are friendly.
  12. It is disrespectful to call people by their first names unless they give you permission to do so.
  13. It is rude not to look at a person who is speaking to you.
  14. It is rude to engage in direct eye contact with persons of higher status.
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