● How am I extending my responsibility beyond individual patients? ● How am I advocating for policy and practice changes at institutional, community, state, and national levels? ● What institutional structures are in place that address inequalities? ● What training and professional development activities are offered at our institution or in our community that address inequalities? ● How can we engage our community to make sure its voice is heard in this work? These types of questions can provide a starting point for healthcare professionals to address social injustices. Healthcare professionals can use their positions to advocate for changes in society to promote social justice. Working toward social justice, patients are empowered and can help create an environment in which equal rights, treatment, and opportunity are available to all. Self-Assessment Quiz Question #10 The factors that are common to all definitions of social justice include: a. White identity. b. Equal opportunity. c. Equal incomes. d. Diversity in all groups include the following: Asian Americans push their children to succeed in school and to be obedient to adults, Latina/o men have “machismo,” and African Americans are assertive (Sue & Sue, 2021). Although the intent to understand the diversity within the U.S. is meant to be helpful to counselors, it often leads to strengthening the status quo (i.e., “White” as the norm and all other racial and ethnic groups as outside that norm). Because of the desire to describe various racial and ethnic norms, multicultural counseling and cultural competency frameworks tend to overlook the diversity within ethnic and racial minority groups and also within “White” groups (Sue & Sue, 2021). For instance, Asian American and Latina/o categorizations lump together individuals from a wide array of countries, suggesting, for example, that if you are Chinese American, Vietnamese American, or Japanese American, you are similar because you are Asian. Categorizing whole regions of the world as similar is likely to present problems, as individuals from a wide array of countries are very diverse. Moreover, individuals and groups within groups have a great deal of intragroup diversity. For example, a Chinese American family that has been in the U.S. for five generations is likely to be quite different from a Chinese American family that immigrated to the U.S. during the past decade. Cultural humility suggests that counselors should not assume cultural knowledge about clients; rather, they should ask clients questions about their cultural experiences and identities and view the client as the expert on this topic (Gallardo, 2014). Although the intent to understand the diversity within the U.S. is meant to be helpful to healthcare professionals, it often leads to strengthening the status quo (i.e., “White” as the norm and all other racial and ethnic groups as outside that norm). Because of the desire to describe various racial and ethnic norms, multicultural patient care delivery and cultural competency frameworks tend to overlook the diversity within ethnic and racial minority groups and within “White” groups (Carten, 2016; Fisher-Borne, 2015).
Traditionally some healthcare professionals may have considered issues of social justice outside the realm of their practice; however, if social justice is relegated to a select few, oppression will flourish and efforts to heal communities will be blocked. The healthcare professional practicing within a social justice framework would not locate the problem within the individual but would look to the environmental factors that contribute to the actions and reactions of the individual (Sue & Sue, 2021). Social justice is the view that everyone deserves equal economic, political, and social rights and opportunities. Social justice depends on economic justice. Proponents of social justice explain that there must be fair and compassionate distribution of economic growth. Social justice requires that all persons be provided with access to what is good for the person and in associations with others. According to the principles of social justice, all people have a personal responsibility to work with others to design and continually perfect societal institutions for both personal and social development (DeBlaere et al., 2019). It is imperative that healthcare professionals ask themselves key questions that facilitate the acquisition of social justice. Examples of such questions include the following (adapted and updated from Fisher-Borne et al., 2015, p. 176): ● How do my behaviors within patient interactions actively challenge any power imbalances and involve communities experiencing marginalization? ● How, as healthcare professionals, do we address inequalities? backgrounds is not sufficient to develop an effective patient– healthcare professional relationship with each individual. The cultural competency and multicultural counseling frameworks are most often criticized for creating a model that serves to “other” ethnic, racial, and various minority groups (Carten, 2016, p. xlii) while not acknowledging “Whiteness” as an identity and as a culture. Othering is the term used for the “biased assumptions about populations viewed as ‘the other’ at various times in the country’s history” as well as in the present (Carten, 2016, p. xlii). Othering assumes that various oppressed and marginalized populations are different from the American “norm,” commonly understood as a White, middle class, able-bodied, straight, male, and individually responsible for any difficulties they may experience. Multicultural patient care delivery and cultural competency frameworks commonly assume that the healthcare professional is White and that patients are the “other” and set out to describe what various racial and ethnic groups believe and how they act as a group. On the other hand, a cultural humility framework emphasizes self-understanding as primary to understanding others. To facilitate self- understanding, cultural humility encourages ongoing critical self-reflection, asking healthcare professionals to delve into their cultural identity and its effect on the delivery of patient care. Cultural humility makes no assumptions regarding the healthcare professional’s identity and especially challenges White practitioners to explore and understand their “White identity” (Carten, 2016). Table 7 illustrates the differences between (multi)cultural competence and cultural humility frameworks. Multicultural and cultural competency frameworks inevitably lead to the stereotyping of various racial and ethnic groups by attempting to define and categorize entire ethnicities by a few cultural traditions and practices. Examples of such stereotypes
Differences between multicultural competency and cultural humility Cultural humility is a conceptual framework that was first developed and utilized in the field of medicine and nursing in the 1990s. Since that time, it has become more widely applied to all helping professions. The framework is intended to address some of the shortcomings within the cultural competency and multicultural counseling frameworks. The approach of cultural humility differs from the multicultural competency approach in that it recognizes that knowledge of different cultural
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