Cultural Humility and the Importance of Long-Term Relationships in International Partnerships

doi:10.1111/j.1552-6909.2008.00313.x

Journal of Obstetric, Gynecologic & Neonatal Nursing

Volume 38, Issue 1, January–February 2009, Pages 100-107

https://doi.org/10.1111/j.1552-6909.2008.00313.x Get rights and content

ABSTRACT

This article describes an education, leadership, and health professional interchange project in the Dominican Republic. It emphasizes the importance of long-term relationships and explores how over time, dialogue has led to cultural humility, self-reflection, and empowerment among nursing colleagues across national boundaries, despite differences in assumptions. The project is an example of a north–south collaboration encouraged by the World Health Organization to strengthen nursing and midwifery globally.

Section snippets

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Learning Objectives

After reading and studying this article, the reader will be able to:

1
Define cultural humility.
2
Explain why developing

A Cross-Cultural Nursing Partnership in the DR

Project ADAMES (an acronym for ADelante, Asegurando Madres E Infantes Sanos [Working toward Healthy Mothers and Babies]) is a nonprofit, nongovernmental organization created in 2004 as a collaborative partnership between the maternity nurses in one public hospital in the DR and a team of certified nurse-midwives from the United States. The primary aim of Project ADAMES is to improve the quality of maternal and newborn care in this public hospital through the education and leadership development

Participant Observation and Nursing Practice Exchange

Some of the participants in Project ADAMES have been involved since the project's inception, so they have been participant observers of the interchange experiences over time. Participant observation is a method well known by, but not limited to, anthropologists; it is a way to get to know and garner a deep understanding of the tacit knowledge of cultural others (Spradley, 1980).

For the midwives who have returned frequently, the lived experience of shouldering responsibility for maternal-newborn

Stillbirth in the DR

The experience of the Dominican nurses with U.S. nursing students also provided moments of self-reflection. The following ethnographic vignette describes an incident in which the differences in cultural orientation to stillbirth between U.S. and Dominican nurses was painfully played out but ultimately contributed to self-reflection.

During a period when a group of volunteer nursing students were visiting the DR, a 19-year-old single mother of three boys, who arrived alone at the hospital late in

Reciprocal Self-Reflection

This ethnographic vignette is one example of many experiences in which the nurses involved in Project ADAMES learn from each other, despite the markedly contrasting environments in which they usually work. The U.S. nurses, encountering the resource deprivation and low staffing the Dominican nurses face, have a deeper understanding how the environment can make the Dominican nurses numb to the psychological needs of individual women and their families experiencing the death of their infants. The

Results of the Partnership

One successful outcome of the partnership in Project ADAMES is that the Dominican nurses articulated their own vision for the care of mothers and babies, which is posted on the Project ADAMES website as a guiding message (Proyecto ADAMES, 2005). The knowledge that their vision is viewable as a globally public statement has been a source of pride for the Dominican nurses; they appreciate public acknowledgment of the strides they are making to improve the quality of care in their setting.

Other

Discussion

Cultural humility is an essential orientation to the continued success of Project ADAMES activities. As a small, grassroots organization, Project ADAMES has limited scope; nevertheless, it is one contribution toward the achievement of two of the widely publicized goals of the United Nations (UN) and the World Health Organization (WHO).

At the Millennium Summit in 2000 and reaffirmed in 2005, the UN prioritized eight Millennium Goals, two of which pertain to reducing the disparities in

Post-Test Questions

1
Cultural humility is
- a.
  a lifelong process of self-reflection and self-critique.
- b.
  an essential part of the Dominican culture.
- c.
  best eliminated by learning culturally competent techniques.
2
An effective way to prepare nurses to advocate for the reduction of social inequities is to
- a.
  participate in a cultural immersion program where health disparities exist.
- b.
  study abroad for a semester.
- c.
  take a course in public policy.
3
Compassion fatigue is caused by
- a.
  ignorance of the International Council of Nurses Code of Ethics.
- b.

Acknowledgments

The author thanks all the participants of Project ADAMES in the DR for their efforts to improve maternal-newborn care.

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The students that participated in these cultural immersions learned the importance of adopting an “ethic of attention” by listening attentively and becoming comfortable with being present (Coulehan 2006, p. 817). They developed partnerships, willingly engaged others and saw the similarities in values and beliefs (Foster 2009), and appreciated the differences of the cultures, cultivating what Levi (2009) and others call cultural humility. The AACN acknowledges the importance of teaching cultural humility, but delay introduction of the topic until graduate education.
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: The author and planners for this activity report no conflict of interest or relevant financial relationships. The article includes no discussion of off-label drug or devise use.

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CNECultural Humility and the Importance of Long-Term Relationships in International Partnerships

ABSTRACT

Section snippets

Continuing Nursing Education (CNE) Credit

Continuing Nursing Education

A Cross-Cultural Nursing Partnership in the DR

Participant Observation and Nursing Practice Exchange

Stillbirth in the DR

Reciprocal Self-Reflection

Results of the Partnership

Discussion

Post-Test Questions

Acknowledgments

Journal of Midwifery and Women's Health

Journal of Midwifery and Women's Health

Lancet

Lancet

Improving birth outcomes

Goals in maternal and perinatal care in Latin America and the Caribbean

Birth

Social justice as a framework for professional nursing

Journal of Nursing Education

Opening our hearts and minds

Nursing and Health Sciences

Pathologies of power

The International Confederation of Midwives' study of the essential competencies of midwifery practice

Midwifery

Beyond cultural competence

The implementation of a study abroad course for nursing

Nurse Educator

CNE
Cultural Humility and the Importance of Long-Term Relationships in International Partnerships