{"id":208,"date":"2021-09-24T16:19:58","date_gmt":"2021-09-24T20:19:58","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/moving-beyond-culture-in-health-assessment\/"},"modified":"2024-07-09T10:28:59","modified_gmt":"2024-07-09T14:28:59","slug":"moving-beyond-culture-in-health-assessment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/moving-beyond-culture-in-health-assessment\/","title":{"raw":"Moving Beyond Culture in Health Assessment","rendered":"Moving Beyond Culture in Health Assessment"},"content":{"raw":"<p style=\"padding: 10px;border: 2px solid grey\">As healthcare professionals, <strong>nurses have power<\/strong>. You have power.<\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">If not applied carefully, this <strong>professional power<\/strong> can make clients feel marginalized or dismissed. In recent years, progressive developments in theoretical perspectives have guided nursing practice toward more humanistic care and considerations for marginalized clients and communities. New concepts have been introduced to help inform clinical judgement, honour the cultural values\/beliefs of clients, and support therapeutic relationship building. These concepts include: cultural sensitivity, cultural competence, cultural humility, and cultural safety. They have helped clarify how personal biases can influence health assessments and other nursing interventions, and have also helped many nurses learn how to minimize their own biases.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Culture <\/strong>can be defined as the <strong>beliefs<\/strong>, <strong>practices<\/strong>, and <strong>values<\/strong> of a racial\/ethnic group; it can also include other dimensions such as <strong>gender<\/strong>, <strong>sexual orientation<\/strong>, <strong>ability\/disability<\/strong>, <strong>age<\/strong>, <strong>class<\/strong>, and <strong>language<\/strong> (Greene-Moton &amp; Minkler, 2020; Hughes et al., 2019). <\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Reflect on each client\u2019s culture: <\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">What are their cultural beliefs, values, and identity? <\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">What should you do once you are aware of a client\u2019s culture and cultural differences? <\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Most importantly, can this understanding of culture help you conduct an inclusive health assessment? <\/span><\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">The following discussion explores these questions, beginning with an exploration of how four main concepts of culture relate to health assessments.<\/span>\r\n<h2><span style=\"color: #000000\"><strong>Cultural Sensitivity<\/strong><\/span><\/h2>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">In nursing, cultural sensitivity<strong> focuses on self<\/strong> in terms of the <strong>nurse's awareness<\/strong> and <span style=\"font-size: 1em\"><strong>understanding<\/strong> of <\/span><span style=\"font-size: 1em\">a client's culture as well as attitude toward culture<\/span><span style=\"font-size: 1em\"> (Srivastava, 2007). <\/span><\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000;font-size: 1em\">Cultural sensitivity, therefore, largely rests on the nurse\u2019s ability to be compassionate, considerate, and understanding of clients, including effective communication with clients from different cultures (Foronda, 2008).<\/span><\/li>\r\n<\/ul>\r\n<h2><span style=\"color: #000000\"><b>Cultural<\/b><strong> Competency<\/strong><\/span><\/h2>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">In the past, cultural competency has been narrowly operationalized as a <strong>checklist of cultural knowledge<\/strong> required by healthcare providers to demonstrate competence when working with various racial and ethnic groups (Curtis et al., 2019; Greene-Moton &amp; Minkler, 2020). <\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">A nurse who is culturally competent is able to provide effective care to clients from different cultural backgrounds (Sharifi et al., 2019). <\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">However, if you do not know the cultural beliefs and practices of an ethnic group, does that make you culturally \u201cincompetent\u201d? This kind of ambiguity in the concept of cultural competency has led to the urgency of other effective frameworks for nurses to use, including cultural humility and cultural safety.<\/span><\/li>\r\n<\/ul>\r\n<h2><span style=\"color: #000000\"><strong>Cultural Humility<\/strong><\/span><\/h2>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Cultural humility is a <strong>life-long process of reflection<\/strong> and <strong>self-critique<\/strong> in addressing <strong>power imbalances<\/strong> within systems to develop mutually beneficial partnerships and relationships (Tervalon &amp; Murray-Garcia, 1998). <\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Healthcare professionals should engage in continuous, critical reflection on power and privilege, and find ways to interact with clients of different race, sex, gender, age, and ability that don\u2019t perpetuate oppression.<\/span><\/li>\r\n \t<li>It involves being able to \"humbly\" recognize and be open to the idea that you are a learner as related to understanding a patient's experience (First Nations Health Authority, n.d.).<\/li>\r\n<\/ul>\r\n<h2><span style=\"color: #000000\"><strong>Cultural Safety<\/strong><\/span><\/h2>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Cultural safety requires that nurses <strong>recognize power differentials<\/strong> and broader social structures that affect <strong>health equity<\/strong> (Curtis et al., 2019). <\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Nurses must challenge power imbalances in client care, considering the effects of oppression on health (Parisa et al., 2016). <\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Culturally safe practice is essential in addressing health and social disparities and inequities, to ensure equitable and client-centred care.<\/span><\/li>\r\n<\/ul>\r\n<h2><span style=\"color: #000000\"><strong>Integr<\/strong><strong>ation of Concepts<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\"><span style=\"font-size: 1em\">Nurses can <\/span><strong style=\"font-size: 1em\">apply these four concepts of culture<\/strong><span style=\"font-size: 1em\"> to understand cultural differences and embrace respectful ways of interacting with clients from different cultural backgrounds. This can be a starting point for broader considerations of historical, social, economic, and political factors that also shape health inequities (Smye &amp; Browne, 2002).<\/span><\/span>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Despite the large body of theoretical work on culture and safe practices, many healthcare professionals continue to be intolerant of differences. So, beyond an understanding of culture, <strong>what else is needed for nurses to uphold all the elements of social justice<\/strong> in nursing care broadly and in health assessments specifically?<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">The next section explores how you can apply an <strong>anti-oppressive perspective<\/strong> to ensure health assessments are inclusive. This involves confronting and dismantling oppressive practices that are accepted as the status quo in health assessments and the healthcare system more broadly, especially in the care of marginalized groups.<\/span><\/p>\r\n&nbsp;\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><b>Activity: Check Your Understanding <\/b><\/span><\/h2>\r\n<span style=\"color: #000000\">[h5p id=\"1\"]<\/span>\r\n\r\n&nbsp;\r\n<h2><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S.-J., &amp; Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition.\u00a0<em>International Journal for Equity in Health, 18<\/em>(1), 174\u2013174.\u00a0<\/span><a href=\"https:\/\/doi.org\/10.1186\/s12939-019-1082-3\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1186\/s12939-019-1082-3<\/a>\r\n\r\nFirst Nations Health Authority (n.d.). #itstartswithme: Creating a Climate for Change. <a href=\"https:\/\/www.fnha.ca\/Documents\/FNHA-Creating-a-Climate-For-Change-Cultural-Humility-Resource-Booklet.pdf\">https:\/\/www.fnha.ca\/Documents\/FNHA-Creating-a-Climate-For-Change-Cultural-Humility-Resource-Booklet.pdf<\/a>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Foronda, C. L. (2008). A concept analysis of cultural sensitivity.\u00a0<em>Journal of Transcultural Nursing<\/em>,\u00a0<em>19<\/em>(3), 207-212.\u00a0<\/span><a href=\"http:\/\/doi.org\/10.1177\/1043659608317093\" target=\"_blank\" rel=\"noopener\">http:\/\/doi.org\/10.1177\/1043659608317093<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Greene-Moton, E., &amp; Minkler, M. (2020). Cultural competence or cultural humility? Moving beyond the debate.\u00a0<em>Health Promotion Practice, 21<\/em>(1), 142\u2013145. <\/span><a href=\"https:\/\/doi.org\/10.1177\/1524839919884912\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1177\/1524839919884912<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R.-A., Cudjoe, J., Ford, A., Rushton, C., D\u2019Aoust, R., &amp; Han, H.-R. (2020). Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty.\u00a0<em>Journal of Professional Nursing, 36(<\/em>1), 28\u201333. <\/span><a href=\"https:\/\/doi.org\/10.1016\/j.profnurs.2019.06.005\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/j.profnurs.2019.06.005<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Parisa, B., Reza, N., Afsaneh, R., &amp; Sarieh, P. (2016). Cultural safety: An evolutionary concept analysis.\u00a0<em>Holistic Nursing Practice, 30<\/em>(1), 33\u201338. <\/span><a href=\"https:\/\/doi.org\/10.1097\/HNP.0000000000000125\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1097\/HNP.0000000000000125<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Sharifi, N., Adib-Hajbaghery, M., &amp; Najafi, M. (2019). Cultural competence in nursing: A concept analysis.\u00a0<em>International Journal of Nursing Studies<\/em>,\u00a0<em>99<\/em>.<\/span><span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.1016\/j.ijnurstu.2019.103386\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/j.ijnurstu.2019.103386<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Smye, V., &amp; Browne, A. J. (2002). \u201cCultural safety\u201d and the analysis of health policy affecting aboriginal people.\u00a0<em>Nurse Researcher<\/em>,\u00a0<em>9<\/em>(3), 42\u201356.<\/span><span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.7748\/nr2002.04.9.3.42.c6188\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.7748\/nr2002.04.9.3.42.c6188<\/a><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Srivastava, R. (2007).\u00a0<em>The healthcare professional\u2019s guide to clinical cultural competence<\/em>. Mosby Elsevier.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Tervalon, M., &amp; Murray-Garc\u00eda, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education.\u00a0<em>Journal of Health Care for the Poor and Underserved, 9(<\/em>2), 117\u2013125. <\/span><a href=\"https:\/\/doi.org\/10.1353\/hpu.2010.0233\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1353\/hpu.2010.0233<\/a><\/p>","rendered":"<p style=\"padding: 10px;border: 2px solid grey\">As healthcare professionals, <strong>nurses have power<\/strong>. You have power.<\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">If not applied carefully, this <strong>professional power<\/strong> can make clients feel marginalized or dismissed. In recent years, progressive developments in theoretical perspectives have guided nursing practice toward more humanistic care and considerations for marginalized clients and communities. New concepts have been introduced to help inform clinical judgement, honour the cultural values\/beliefs of clients, and support therapeutic relationship building. These concepts include: cultural sensitivity, cultural competence, cultural humility, and cultural safety. They have helped clarify how personal biases can influence health assessments and other nursing interventions, and have also helped many nurses learn how to minimize their own biases.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Culture <\/strong>can be defined as the <strong>beliefs<\/strong>, <strong>practices<\/strong>, and <strong>values<\/strong> of a racial\/ethnic group; it can also include other dimensions such as <strong>gender<\/strong>, <strong>sexual orientation<\/strong>, <strong>ability\/disability<\/strong>, <strong>age<\/strong>, <strong>class<\/strong>, and <strong>language<\/strong> (Greene-Moton &amp; Minkler, 2020; Hughes et al., 2019). <\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Reflect on each client\u2019s culture: <\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">What are their cultural beliefs, values, and identity? <\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">What should you do once you are aware of a client\u2019s culture and cultural differences? <\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Most importantly, can this understanding of culture help you conduct an inclusive health assessment? <\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000\">The following discussion explores these questions, beginning with an exploration of how four main concepts of culture relate to health assessments.<\/span><\/p>\n<h2><span style=\"color: #000000\"><strong>Cultural Sensitivity<\/strong><\/span><\/h2>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">In nursing, cultural sensitivity<strong> focuses on self<\/strong> in terms of the <strong>nurse&#8217;s awareness<\/strong> and <span style=\"font-size: 1em\"><strong>understanding<\/strong> of <\/span><span style=\"font-size: 1em\">a client&#8217;s culture as well as attitude toward culture<\/span><span style=\"font-size: 1em\"> (Srivastava, 2007). <\/span><\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000;font-size: 1em\">Cultural sensitivity, therefore, largely rests on the nurse\u2019s ability to be compassionate, considerate, and understanding of clients, including effective communication with clients from different cultures (Foronda, 2008).<\/span><\/li>\n<\/ul>\n<h2><span style=\"color: #000000\"><b>Cultural<\/b><strong> Competency<\/strong><\/span><\/h2>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">In the past, cultural competency has been narrowly operationalized as a <strong>checklist of cultural knowledge<\/strong> required by healthcare providers to demonstrate competence when working with various racial and ethnic groups (Curtis et al., 2019; Greene-Moton &amp; Minkler, 2020). <\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">A nurse who is culturally competent is able to provide effective care to clients from different cultural backgrounds (Sharifi et al., 2019). <\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">However, if you do not know the cultural beliefs and practices of an ethnic group, does that make you culturally \u201cincompetent\u201d? This kind of ambiguity in the concept of cultural competency has led to the urgency of other effective frameworks for nurses to use, including cultural humility and cultural safety.<\/span><\/li>\n<\/ul>\n<h2><span style=\"color: #000000\"><strong>Cultural Humility<\/strong><\/span><\/h2>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Cultural humility is a <strong>life-long process of reflection<\/strong> and <strong>self-critique<\/strong> in addressing <strong>power imbalances<\/strong> within systems to develop mutually beneficial partnerships and relationships (Tervalon &amp; Murray-Garcia, 1998). <\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Healthcare professionals should engage in continuous, critical reflection on power and privilege, and find ways to interact with clients of different race, sex, gender, age, and ability that don\u2019t perpetuate oppression.<\/span><\/li>\n<li>It involves being able to &#8220;humbly&#8221; recognize and be open to the idea that you are a learner as related to understanding a patient&#8217;s experience (First Nations Health Authority, n.d.).<\/li>\n<\/ul>\n<h2><span style=\"color: #000000\"><strong>Cultural Safety<\/strong><\/span><\/h2>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Cultural safety requires that nurses <strong>recognize power differentials<\/strong> and broader social structures that affect <strong>health equity<\/strong> (Curtis et al., 2019). <\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Nurses must challenge power imbalances in client care, considering the effects of oppression on health (Parisa et al., 2016). <\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Culturally safe practice is essential in addressing health and social disparities and inequities, to ensure equitable and client-centred care.<\/span><\/li>\n<\/ul>\n<h2><span style=\"color: #000000\"><strong>Integr<\/strong><strong>ation of Concepts<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\"><span style=\"font-size: 1em\">Nurses can <\/span><strong style=\"font-size: 1em\">apply these four concepts of culture<\/strong><span style=\"font-size: 1em\"> to understand cultural differences and embrace respectful ways of interacting with clients from different cultural backgrounds. This can be a starting point for broader considerations of historical, social, economic, and political factors that also shape health inequities (Smye &amp; Browne, 2002).<\/span><\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Despite the large body of theoretical work on culture and safe practices, many healthcare professionals continue to be intolerant of differences. So, beyond an understanding of culture, <strong>what else is needed for nurses to uphold all the elements of social justice<\/strong> in nursing care broadly and in health assessments specifically?<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">The next section explores how you can apply an <strong>anti-oppressive perspective<\/strong> to ensure health assessments are inclusive. This involves confronting and dismantling oppressive practices that are accepted as the status quo in health assessments and the healthcare system more broadly, especially in the care of marginalized groups.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><b>Activity: Check Your Understanding <\/b><\/span><\/h2>\n<p><span style=\"color: #000000\"><\/p>\n<div id=\"h5p-1\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-1\" class=\"h5p-iframe\" data-content-id=\"1\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch.2 - Moving beyond culture\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S.-J., &amp; Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: A literature review and recommended definition.\u00a0<em>International Journal for Equity in Health, 18<\/em>(1), 174\u2013174.\u00a0<\/span><a href=\"https:\/\/doi.org\/10.1186\/s12939-019-1082-3\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1186\/s12939-019-1082-3<\/a><\/p>\n<p>First Nations Health Authority (n.d.). #itstartswithme: Creating a Climate for Change. <a href=\"https:\/\/www.fnha.ca\/Documents\/FNHA-Creating-a-Climate-For-Change-Cultural-Humility-Resource-Booklet.pdf\">https:\/\/www.fnha.ca\/Documents\/FNHA-Creating-a-Climate-For-Change-Cultural-Humility-Resource-Booklet.pdf<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Foronda, C. L. (2008). A concept analysis of cultural sensitivity.\u00a0<em>Journal of Transcultural Nursing<\/em>,\u00a0<em>19<\/em>(3), 207-212.\u00a0<\/span><a href=\"http:\/\/doi.org\/10.1177\/1043659608317093\" target=\"_blank\" rel=\"noopener\">http:\/\/doi.org\/10.1177\/1043659608317093<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Greene-Moton, E., &amp; Minkler, M. (2020). Cultural competence or cultural humility? Moving beyond the debate.\u00a0<em>Health Promotion Practice, 21<\/em>(1), 142\u2013145. <\/span><a href=\"https:\/\/doi.org\/10.1177\/1524839919884912\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1177\/1524839919884912<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R.-A., Cudjoe, J., Ford, A., Rushton, C., D\u2019Aoust, R., &amp; Han, H.-R. (2020). Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty.\u00a0<em>Journal of Professional Nursing, 36(<\/em>1), 28\u201333. <\/span><a href=\"https:\/\/doi.org\/10.1016\/j.profnurs.2019.06.005\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/j.profnurs.2019.06.005<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Parisa, B., Reza, N., Afsaneh, R., &amp; Sarieh, P. (2016). Cultural safety: An evolutionary concept analysis.\u00a0<em>Holistic Nursing Practice, 30<\/em>(1), 33\u201338. <\/span><a href=\"https:\/\/doi.org\/10.1097\/HNP.0000000000000125\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1097\/HNP.0000000000000125<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Sharifi, N., Adib-Hajbaghery, M., &amp; Najafi, M. (2019). Cultural competence in nursing: A concept analysis.\u00a0<em>International Journal of Nursing Studies<\/em>,\u00a0<em>99<\/em>.<\/span><span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.1016\/j.ijnurstu.2019.103386\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1016\/j.ijnurstu.2019.103386<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Smye, V., &amp; Browne, A. J. (2002). \u201cCultural safety\u201d and the analysis of health policy affecting aboriginal people.\u00a0<em>Nurse Researcher<\/em>,\u00a0<em>9<\/em>(3), 42\u201356.<\/span><span>\u00a0<\/span><a href=\"https:\/\/doi.org\/10.7748\/nr2002.04.9.3.42.c6188\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.7748\/nr2002.04.9.3.42.c6188<\/a><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Srivastava, R. (2007).\u00a0<em>The healthcare professional\u2019s guide to clinical cultural competence<\/em>. Mosby Elsevier.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Tervalon, M., &amp; Murray-Garc\u00eda, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education.\u00a0<em>Journal of Health Care for the Poor and Underserved, 9(<\/em>2), 117\u2013125. <\/span><a href=\"https:\/\/doi.org\/10.1353\/hpu.2010.0233\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.1353\/hpu.2010.0233<\/a><\/p>\n","protected":false},"author":34,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[49],"contributor":[61],"license":[56],"class_list":["post-208","chapter","type-chapter","status-publish","hentry","chapter-type-numberless","contributor-61","license-cc-by-nc"],"part":200,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/208","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":4,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/208\/revisions"}],"predecessor-version":[{"id":2921,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/208\/revisions\/2921"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/200"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/208\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=208"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=208"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=208"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=208"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}