Journaling and Development of CULTURAL HUMILITY
Journaling and Development of CULTURAL HUMILITY
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Cultural humility requires self-evaluation and the awareness that one’s own culture is not the only or best one. Teaching health
care providers to become culturally humble includes the development of critical thinking skills and the ability to reflect on practice. Journaling as
a teaching strategy helps students develop these skills. This article describes the use of reflective journaling as students progressed through four
semesters of a community clinical experience. This qualitative, descriptive study was based on the principles of naturalistic inquiry with person-
centered written reflections. Two hundred journal entries from 50 students were reviewed, and 11 themes were identified. Cultural humility can-
not be learned merely in the classroom with traditional teaching methods. Reflection on experiences over time leads to the development of cul-
tural humility.
ULTURAL HUMILITY, AND THE COMMITMENT TO ADDRESS
POWER IMBALANCES IN THE PATIENT-CLINICIAN
DYNAMIC, REQUIRES LIFELONG DEDICATION TO SELF-EVALUATION
AND CRITIQUE (Tervalon & Murray-Garcia, 1998). For faculty, the
challenge involves more than teaching concepts and their applica-
tion in the performance of clinical skills. It expands to include the
development of critical thinking skills, self-understanding, and the
ability to reflect on one’s own practice. Essentially, cultural humil-
ity requires embracing the belief that one’s own culture is not the
only or best culture.
For more than a decade, the Auburn University School of Nursing
(SON) in Auburn, Alabama, has been in partnership with the local
housing authority (AHA), a low-income public housing provider. This
partnership, described elsewhere (Hamner, Wilder, & Byrd, 2007),
includes a nursing care clinic staffed three days per week by the nurs-
ing outreach instructor and Auburn students. The SON has a commu-
nity-based curriculum, founded on the belief that nursing is not
bound by the four walls of a hospital and that nursing care is a uni-
versal need. Part of bringing this belief to life is the requirement that
students participate in the partnership as part of their clinical experi-
ences as they matriculate through the curriculum.
When this clinical experience was first introduced, students
perceived it as different and somewhat stressful. These students,
the vast majority of whom were young, upper-middle-class white
women, had little experience with people different from them-
selves. It also became apparent that learning took place affectively
and cognitively in ways that could not be assessed by traditional
clinical evaluation tools and formal evaluation of teaching presen-
tations. Faculty determined that reflective writing, a useful mecha-
nism for understanding and internalizing experiences, would be
helpful to students participating in these clinical experiences
(Craft, 2005). This article reports on a study based, in part, on the
principles of naturalistic inquiry (Erlandson, Harris, Skipper, &
Allen, 1993). The primary question was, “What does reflective
journaling reveal about the experience of cultural humility in nurs-
ing students participating in the community partnership clinical?”
Why Reflective Journaling Journaling helps students
develop critical thinking, self-understanding, and reflection
(Billings, 2006; Craft, 2005; Daroszewski, Kinser, & Lloyd, 2004;
King & LaRocco, 2006). Pedro (2006) stated that writing is a good
tool for learning reflection that helps students solve problems and
learn about what they do. Journaling involves writing to learn, and
the journal becomes a permanent record of thoughts. When a
learner writes down a thought, the thought takes shape and form.
Journaling helps students engage in introspection and analyze sit-
uations critically. It should not be too structured, because students’
thoughts and reflections can become be constricted (Craft).
The practice of reflection, making meaning out of life experi-
ences, is inherent in journaling (Kerka, 2002). Diekelmann (2003)
described how reflection ultimately fosters thinking in action and
encourages students to have a critical eye and promote a safe envi-
ronment. Reflection fosters thinking that changes practice, and is
not merely a rote or routine expeience. When reflective thinking is
paired with journaling as a learning activity, students develop self-
analysis and an increased awareness of their environment.
Method The Internal Review Board for the Protection of Human
Subjects of Auburn University approved this study. For each of the
four semesters students had community partnership clinical expe-
C
REF L E C T I V E J O U R N A L I N G / N U R S I N G E D U C AT I O N R E S E A R C H
R E S E A R C H
March / Apr i l Vol .33 No.2 97
riences at the AHA, semi-structured interview questions were
assigned. For the first semester experience, students were asked to
reflect on their expectations of what the clinical experience would
be like before they went and what the reality of the experience was.
For the second and third semesters, students were asked to
describe and reflect on their clinical time at the AHA. For the
fourth and final semester, students were asked to reflect on their
thoughts about the entire experience and its impact on their profes-
sional development.
