Emancipatory Cultural Competency in Nursing

We are delighted to introduce the current ANS featured article, titled “An Emancipatory Approach to Cultural Competency: The Application of Critical Race, Postcolonial, and Intersectionality Theories” authored by Linda M. Wesp, MSN, RN, FNP-BC; Victoria Scheer, BSN, RN; Ashley Ruiz, BSN, RN; Kimberly Walker, MSN, RN, CHPN; Jennifer Weitzel, MS, RN; Leslie Shaw, MSN, RN, ACNP-BC; Peninnah M. Kako, PhD, RN, FNP-BC; and Lucy Mkandawire-Valhmu, PhD, RN. In this article the authors address the critical need for approaches in nursing education, research and practice that uphold the core nursing value of commitment to social justice.  Download a copy of this article at no cost while it is featured, and share you comments and ideas about these ideas on this blog!  Here is more information about this work from the authors:

Linda M. Wesp

Emancipatory \ i-​ˈman(t)-​sə-​pə-​ˌtȯr-​ē\ (adjective): freeing from any controlling influence¹

As peers pursuing a PhD in nursing at University of Wisconsin-Milwaukee, we have found common ground with our professors Dr. Lucy Mkandawire-Valhmu and Dr. Peninnah Kako in a passion for learning about and using critical and feminist theory to shape our thinking and our work, especially intersectionality, critical race theory, and postcolonial feminisms.  The idea of this paper was originally born from several brainstorming sessions between Linda Wesp and Victoria Scheer. As we sat and talked and thought, we kept coming back to our common frustration that the theories we were finding so helpful

Victoria Scheer

and informative in our research were not being talked about in nursing or health care at all, outside of a few PhD level classes.

Early in 2018, Dr. Mkandawire-Valhmu encouraged the group of us using critical theories in our research to join forces with one another and challenged us to think about how we could take these theories and apply them.  The special ANS issue on emancipatory nursing seemed like the perfect fit for the ideas we were already tossing around about various areas of the nursing profession that would benefit from a more critical approach.  Each of us brought a specific working knowledge about the various

Ashley Ruiz

theories we used for this paper, whether intersectionality theory, critical race theory, or postcolonial feminist theory.  One of the main goals of our project was to intentionally and carefully distill the main ideas of these theories and make them understandable and applicable for nurses who may be unfamiliar with them (see Figure).

As we considered our experiences as clinicians, educators, and scholars, we decided that the way nursing approaches “cultural competency” could benefit greatly from the tenets outlined in the various critical theories.  As it is currently conceptualized, “cultural competency” in nursing (and across all health care settings) does not

Kimberly Walker

provide nurses with the tools to identify and disrupt the major structural processes and oppressive ideologies that create marginalization and inequity.  These ideologies are a controlling influence on our profession and health care as a whole. And so, we thought, what if we could outline specific ways to bring an emancipatory approach to our current understanding of cultural competency?  We began in our knowledge of the theories that seek to disrupt oppression and hegemonic thinking that create health inequities, and used this to come up with tools to equip nurses with new ways of thinking about and caring for populations that are different from them (even, and especially, for nurses who are well intentioned and think they are being “culturally competent”).

Jennifer Weitzel

Diving deeply into the theories as we prepared this paper meant we had to do our own personal work about how power and privilege works in our own lives, and think about our own approach to caring for people who are different than us. We also thought a lot about the ways that power and privilege play out in the academy and in our health care institutions, and what that means for us as nurses occupying positions that are generally considered “less powerful.”  These are not always easy realizations,

Leslie Shaw

especially for people who benefit from having more power and privilege because of the color of our skin, or our gender identity, or the country where we were born, or the letters behind our name.

We do not take lightly the magnitude of the emancipatory approach we are proposing here, and yet we feel deeply that we must continue to push for change.  We as nurses must continue to understand how power and privilege work to create and maintain difference and inequality in our

Peninnah M. Kako

world.  Continuing to approach difference in the ways we always have will mean that we completely misunderstand and erase certain populations (e.g. people of transgender experience) and/or that we continue to create unintentional and implicit bias for other populations (e.g. people who experience racialization and are therefore considered “racial or ethnic minorities” in the U.S.).

We hope that this paper is just the beginning of a larger conversation within our profession that can create much needed dialogue and change.  Also, we have so many more ideas to talk about!  We hope to spark ongoing

Lucy Mkandawire-Valhmu

ideas, that might begin with questions like: Where else have nurses already been applying an emancipatory approach to cultural competency, as we suggested here, in our educational and clinical programs?  What does it look like for nurses to remain self-reflexive about our own biases?  How does implicit bias contribute to inequitable patient outcomes?  What would it look like for the nursing profession to shift from the phrase “cultural competency” to the concept of cultural safety², which more accurately represents the emancipatory approach we suggest here?

What have you already been doing or thinking about in this area? We would love to hear from you. As the largest health profession in the U.S., we can create a slow and steady shift that leads to lasting change and health equity for all people.  Please share your thoughts, publish your experiences, and let’s keep the conversation going!

References

1. Merriam-Webster Dictionary. Available at: https://www.merriam-webster.com/dictionary/emancipate. Accessed October 31, 2018.
2. Mkandawire-Valhmu L. Cultural Safety, Healthcare and Vulnerable Populations: A Critical Theoretical Perspective: Routledge; 2018.