immigrants, migrant farm workers, and other vulnerable groups. People living between cultures tend to live in areas characterized by limited employment and educational opportunities (Baah et al., 2019). 3. Creation of vulnerabilities : Creation of vulnerabilities are created by the cumulative impact of the creation margins and living between cultures. Vulnerability is defined as a state of being exposed to and unprotected from health-damaging environments (Baah et al., 2019. Marginalized groups often do not receive the same access to societal resources such as high- quality education, healthcare, housing, or equal access to voting as those groups that are not marginalized. The marginalization of oppressed groups prevents them from having a voice and helps to sustain the status quo in the United States in which White, economically well-off, and able-bodied individuals control access to social, economic, and political power. The concept of cultural humility was first discussed in the medical world to better understand and address health inequities and disparities (Tervalon & Murray-García, 1998). The concept has evolved to include ideas related to the creation of a broader and more inclusive society. Unlike the concepts of cultural competency and multicultural competency, which focus on gaining knowledge about Trinh, a 17-year-old first-generation American of Hmong decent, is graduating first in her high school class. Her school counselor has encouraged her to apply to top-level colleges, several of which are hours from home. When Trinh asks about some nearby colleges, the counselor simply tells her that they are “well below her abilities,” even though one is highly regarded. She is accepted by the top-level colleges to which she applied, including two Ivy League schools. Despite generous financial aid packages, Trinh does not accept offers from any of these schools. Past the deadline to apply to the local 4-year colleges, Trinh decides to go to the local community college and live at home. Her counselor tries to persuade Trinh to reconsider one of the Ivy League schools. Trinh tells the counselor that she needs to stay home to help care for younger siblings and translate for her parents during doctors’ visits. The counselor engages Trinh in a role play to help her tell her parents that she needs to Attending to diversity Critical Thinking Exercise make her own decisions and go away to college. Although school counselors do want their students to succeed, what underlying values might have clouded the counselor’s judgment in working with Trinh? Trinh had given the counselor signals that she was not ready to move hours away when she asked about local colleges. Perhaps the counselor, working from a belief that individualism is preferred, ignored these clues, hoping not to play into Trinh’s “separation anxiety.” If the counselor had viewed her Trinh and her family as both being her clients, rather than only a young woman needing to be more independent, she could have worked with the family to make a decision that addressed both Trinh’s needs and those of her family. By ignoring Trinh’s cultural background and her sense of Self-reflection and self-critique Self-reflection and self-critique are ongoing, lifelong processes that allow healthcare professionals to continually refine their understanding of themselves and their actions and reactions within counseling contexts and to continually
Healthcare Professional Consideration: Healthcare professionals should recognize the power imbalances that result from oppression, privilege, and marginalization and work to correct the imbalances within the delivery of healthcare services and within the broader institutional and societal context. Self-Assessment Quiz Question #6 When discussing themes related to marginalization, the concept of being exposed to and unprotected from health-damaging environments is referred to as: a. Creation of margins. b. Living between cultures. cultural groups differing from the individual’s own with the hopes of better understanding those cultures and thus better meeting the needs of different groups who enter counseling, cultural humility focuses on the cultural context within America that marginalizes and oppresses some groups of people, while privileging and empowering other groups of people (Foronda et al., 2016). responsibility to the family, the counselor could not help in an informed way. Given the vast diversity within the United States, both healthcare professionals and counselors must develop cultural humility as they work with individuals whose life experiences vary in myriad ways based on many intersecting dimensions of diversity. A primary component of cultural humility is self-awareness. As a healthcare professional, completely exploring one’s own identity is of extreme importance. It is through knowing and understanding oneself that counselors and healthcare professionals can uncover their beliefs, values, and, moreover, their implicit biases. Implicit bias is defined as an unconscious and unintentional bias (van Nunspeet et al., 2015). Individuals may not be aware of their implicit biases (Byrne & Tanesini, 2015). These biases are the result of combinations of factors including an individual’s early experiences and learned cultural biases. Thus, ongoing critical self-reflection that understands the existence of implicit biases within everyone is necessary. Repeated and evolving processes of self-reflection make healthcare professionals’ implicit biases explicit and, therefore, subject to examination and change (Byrne & Tanesini, 2015). In addition to understanding their own implicit biases, healthcare professionals, especially those from dominant societal groups (e.g., White, heterosexual, male), need to explore their own racial, ethnic, sexual, and class identity. Individuals from dominant cultural paradigms often consider themselves without racial, ethnic, sexual, or class identity as they have privilege; their identities are considered the norm. However, without deep exploration of intersecting aspects of personal diversity, it is difficult to understand oneself and where biases might insert themselves into healthcare professional relationships (Fisher- Borne et al., 2015). broaden and deepen their cultural understanding through introspection (Foronda et al., 2016). Through ongoing self- reflection and critique, the healthcare professional develops a better understanding of the dynamics within and outside
c. Vulnerability. d. Boundaries. PROVIDING PATIENT CARE WITH CULTURAL HUMILITY
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Book Code: SWNY1224
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