All that we experience creates within us what is referred to as ‘personal culture.’ With the incredible diversity of people that span our world, and the progressive domains with which diversity is defined today, we can no longer put people in categorical boxes with how they operate and receive information. How we approach and interact with a person needs to be aligned with the uniqueness of every individual, an engagement known as the Culturally Humble approach.     

Rami Shami has been serving within hospice palliative care for over three decades and participated in a DWDC webinar in June 2021 on cultural humility and grief. To begin our series on meaningful end-of-life care, we thought a refresher on the Culturally Humble approach would be a great place to start.  

The essence of cultural humility is the purest and most authentic expression of ourselves in the here and now. The concept of grouping people into cultural categories is not appropriate nor is it accurate. The idea of personal culture is to see the person for who they are and to receive from the person how they are in this present moment of time and space. We emphasize ‘here and now’ because there is an evolution of who we are. Your personal culture five minutes ago or ten years ago is different from what it is now, and it’s different from what it will be in five minutes or ten years from now. It requires a nimbleness in how we approach each person, every time, and it requires being okay with not knowing all the answers.  

Cultural humility is a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involved humbly acknowledging oneself as a learner when it comes to understanding another’s experience.

Creating a Climate for Change, First Nations Health Authority  

Culture is often defined as a set of shared attitudes, values, goals, beliefs and practices that characterize an institution, organization or a group, but it fails to consider the individual and their life experiences. We can’t categorize people according to what we think their culture is so that we can provide them support, it’s the other way around, we need to focus on the individual and then tailor the support to them and their needs at that time.  

Our experiences throughout our life – both good and bad – become part of our makeup of who and what we are, and, in its essence, it becomes the fabric and tapestry of who we are, which is what we call personal culture.  

These concepts and approaches are universal in any interaction with another person, including when we talk about end-of-life choice and care. We often focus on language and culture when we engage with people in health care (often called cultural competency), but in an outreach project on outcomes of the multicultural that Rami was involved in, experiences such as immigration, trauma, gender specificity, insulation and even the influence of social media have a stronger impact on our personal culture.   

If we afford an environment where somebody can feel autonomy, self-direction and empowerment in their care, that’s when we see the authentic nature of a person’s being. It’s a curiosity for ‘that which I don’t know’ and I’m going to be taught by my interaction with this individual. It’s a two-way therapeutic relationship between two potentially very different perspectives. It is a lifelong process and commitment to self-reflection, -critique and –awareness.  

Cultural humility is a practice, and Rami shares an example of a hospice in California that placed floor decals of two footprints outside every patient’s door. This was a simple reminder to health care providers to stop and check themselves before they entered the room. This simple practice allows the person to check their sympathetic nervous system, their feelings and any other energy they might be carrying from previous interactions before they begin a new interaction.  

To understand our own personal culture, we need to ask:  

• Am I self-reflective?  
• Am I clear about my personal values, beliefs, thoughts, feelings in a particular situation?  
• How do my values and beliefs affect how I perceive others?  
• What are my biases, sensitivities, triggers with respect of another’s expression of personal culture?  
• What is my own personal culture?  

The tools we can bring to our work and to the care we provide include:  

• Our genuine selves  
• A comfort with not knowing the answers  
• Using the ‘teach me’ method  
• To listen inwardly, outwardly, with your body, mind and heart  
• Embrace the individual, let them decide who they are