N512 Module 1 assignment: Staircase Self-Assessment Model cultural reflection essay, a full sample

"I Treat Everyone the Same": A Staircase Self-Assessment of One Emergency Nurse's Cultural Competence

Student Name

Master of Science in Nursing Program, Aspen University

N512: Diverse Populations & Health Care

Instructor Name

Month Day, Year

"I Treat Everyone the Same": A Staircase Self-Assessment of One Emergency Nurse's Cultural Competence

For most of my 11 years as an emergency nurse, I have said with some pride that I treat everyone the same. The Staircase Self-Assessment Model asked me to test that sentence against six stages of cultural competence, and the exercise was uncomfortable in a useful way. This essay describes the model, places me on it with specific evidence from my practice, explains why self-knowledge matters for nursing care, and considers how the assessment and reflection are changing my interactions with patients.

The Staircase Model

The staircase used in this course arranges cultural competence as six ascending steps, adapted from the continuum Cross and colleagues proposed for systems of care (Cross et al., 1989). At the bottom is cultural destructiveness, in which attitudes, policies, or practices actively harm other cultures. Cultural incapacity follows: no intent to harm, but a lack of ability to respond, often with bias in hiring, stereotyping, or low expectations. Cultural blindness is the belief that culture makes no difference and that approaches used with the dominant group work equally well for everyone. Cultural pre-competence begins when a person or organization recognizes its weaknesses and makes efforts to improve, though these efforts may be isolated or superficial. Cultural competence involves respect for difference, ongoing self-assessment, expanding knowledge, and adapting care. At the top, cultural proficiency means holding culture in high regard, advancing knowledge through research and teaching, and advocating for others.

The staircase image is apt because a person can stand on different steps for different groups and can slip down as well as climb. It is a tool for locating oneself honestly, not a ladder to be climbed once.

Where I Stand, and the Evidence

When I first read the stages, I placed myself at cultural competence. When I looked for evidence, I had to move down. My conviction that I treat everyone the same is almost a definition of cultural blindness. Treating every patient identically means applying the norms I learned in my own family and training, a white, English-speaking, Protestant household in the Midwest, and calling them neutral.

Three recent shifts illustrate the problem. I asked an adolescent to interpret for his mother because the phone interpreter line was busy, even though the conversation involved her miscarriage. I became impatient with a large family gathered in a small treatment room and asked most of them to leave without asking who needed to be present for decisions. And I charted a Somali patient's pain as "stoic" without asking how she usually expressed pain or whether she understood that pain medicine was available. None of these actions was intended to harm, but each placed my routines ahead of the patient's needs.

At the same time, there is evidence that I have begun climbing. I requested training on working with medical interpreters last year, I now ask patients what they call their illness and what they think caused it, and I have learned to ask about fasting practices during Ramadan before scheduling medications. These efforts are real but uneven, which fits cultural pre-competence. My honest placement is between blindness and pre-competence, with pre-competence describing my better days. The step I occupy depends less on what I believe about myself than on what I do when I am busy.

Why Self-Knowledge Matters

Self-knowledge matters because culture works through the clinician as well as the patient. In the process model of Campinha-Bacote (2002), cultural competence develops through five constructs: cultural awareness, knowledge, skill, encounters, and desire. The first of these, cultural awareness, is the self-examination of one's own cultural and professional background, including biases and assumptions. Without it, knowledge about other groups tends to become a list of stereotypes applied to individuals.

Tervalon and Murray-García (1998) argue for cultural humility rather than competence as a fixed endpoint: an ongoing, never-finished practice of examining and critiquing oneself, redressing power imbalances between clinician and patient, and building partnerships with communities. Their point applies directly to my stage. The belief that I treat everyone the same assumed that I had nothing left to learn about my own position, and that assumption kept me from noticing that my "standard" care fit some patients better than others.

Self-knowledge also matters for outcomes. When I asked the adolescent to interpret, I risked inaccurate information and harm to his relationship with his mother, and I may have discouraged her from returning for follow-up care. Knowing my own habits under pressure lets me plan for the moments when they are most likely to fail.

How the Assessment Influences Awareness

The staircase assessment changed my awareness in three ways. First, it replaced a general sense of goodwill with a specific location, which made improvement concrete. Second, it made me notice that my competence differs by group: I am more comfortable with Spanish-speaking families, whose language I partly share, than with families from cultures I know less about, where I am more likely to default to my own routines. Third, it showed me that my organization shapes my step. My department has phone interpreters but no clear expectation about using them for sensitive conversations, and our visitor policy does not account for family decision-making. Individual competence is harder to sustain when the system around it sits lower on the staircase.

The Knowledge I Still Need

Moving up the staircase also requires knowledge I do not yet have. Our emergency department serves growing Somali, Karen, and Guatemalan Maya communities, and I know little about their health beliefs, family roles, or experiences with health systems in their countries of origin. Campinha-Bacote (2002) warns that cultural knowledge must be learned without turning it into a script, since individuals vary widely within any group. My plan is to learn the broad patterns, such as who usually makes decisions, how illness and pain are discussed, and which practices around birth and death matter most, while treating each pattern as a question to ask the patient rather than an answer to assume.

I also need knowledge about my own system: which of our policies, forms, and routines assume a single cultural norm. Learning where our intake questions, visiting rules, and discharge teaching fall short is as much a part of competence as learning about any community.

How Reflection Changes Patient Interactions

Reflection has already changed specific behaviors. I now use a qualified interpreter for every clinical conversation with patients who prefer another language, and I document the interpreter's identification number. I ask who the patient wants involved in decisions before limiting visitors. And I use a few questions drawn from explanatory model interviewing, asking patients what they believe brought the illness on, what worries them most, and what treatment they hope to receive, which take less than two minutes and often change the plan.

I also plan to keep climbing deliberately. Completing the Think Cultural Health course for nurses this term, seeking feedback from colleagues from other backgrounds, and bringing the interpreter and visitor issues to our unit practice council are steps from pre-competence toward competence. Campinha-Bacote (2002) names cultural desire, the motivation to engage rather than the obligation to comply, as the construct that drives the others. This assignment has given me that motivation.

Conclusion

The staircase model turned a comfortable sentence into a question. Treating everyone the same, I realized, is not neutrality but blindness, and my honest place is between cultural blindness and pre-competence. Self-knowledge matters because my habits under pressure shape each patient's care, and the assessment helped me see my uneven competence and the systems that hold it back. Reflection is already changing how I use interpreters, involve families, and ask about beliefs. The next steps are deliberate, and they belong on the same staircase.

References

Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181-184. https://doi.org/10.1177/10459602013003003

Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Towards a culturally competent system of care: A monograph on effective services for minority children who are severely emotionally disturbed (Vol. 1). Georgetown University Child Development Center, CASSP Technical Assistance Center.

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125. https://doi.org/10.1353/hpu.2010.0233