Cynthia Foronda: Theory of Cultural Humility

The Theory of Cultural Humility is a framework that emphasizes a lifelong commitment to self-evaluation, self-critique, and respectful engagement with diverse cultural identities. Unlike cultural competence which implies mastery of cultural knowledge cultural humility recognizes that no one can be fully competent in another’s culture and instead promotes openness, reflection, and learning

Life story of Cynthia Foronda

Dr. Cynthia L. Foronda is a visionary nurse educator, researcher, and innovator whose work has transformed how healthcare professionals are trained—especially through simulation and cultural humility.

Her academic journey laid the foundation for a career focused on educational technology, patient safety, and interprofessional collaboration.

Earned her BS in Nursing from Virginia Commonwealth University, MS in Nursing from Cardinal Stritch University, and PhD in Nursing from Marquette University.

Career Highlights

• Currently serves as Assistant Dean for Innovation, Clinical Research, and Scholarship at the University of Miami School of Nursing and Health Studies.
• Former President of the International Nursing Association for Clinical Simulation and Learning (INACSL) (2019–2020).
• Named a Josiah Macy Jr. Foundation Faculty Scholar (2018–2020), where she developed simulation and telehealth interventions to support family caregivers of children with asthma.

Innovations & Contributions

• Pioneer in Virtual Simulation: Among the first nurse researchers to develop and validate virtual simulations for clinical education.
• Developed the Theory of Cultural Humility and tools to measure it—used in over 25 countries and cited by the World Health Organization and National Council of State Boards of Nursing.
• Her work targets underserved populations, using culturally tailored virtual reality and mHealth technologies to improve caregiver knowledge and health outcomes.

Recognition & Impact

• Serves on editorial boards for Nurse Educator, Advances in Simulation, and Clinical Simulation in Nursing.
• Recipient of multiple international awards for excellence in academia and research.
• Published over 70 peer-reviewed articles, many of which are considered high-impact in nursing education.

Cynthia Foronda: Theory of Cultural Humility

In a multicultural world where power imbalances exist, cultural humility is a process of openness, self-awareness, being egoless, and incorporating self-reflection and critique after willingly interacting with diverse individuals. The results of achieving cultural humility are mutual empowerment,
respect, partnerships, optimal care, and lifelong learning.

Major Concepts

• Diversity
• Context
• Power Imbalance
• Cultural Humility
• Lifelong Learning

Key Attributes of Theory of Cultural Humility

Below are the key Attributes of Cultural Humility theory which are conceptualized by Dr. Cynthia Foronda.

1.Openness.

An individual must have an open mind or be open to an interaction with a culturally diverse individual for cultural humility to take place. Openness is defined as possessing an attitude that is willing to explore new ideas. This word was expressed
in contexts including physician-clinicians in a teaching capacity, social workers training child welfare workers, practicing medicine with diverse patients, physical therapist life histories, a minority occupational therapist working with patients of the majority group, and preparing nurses to work
with lesbian, gay, bisexual, or transgendered patients.

2.Self-Awareness.

Self-awareness is defined as being aware of one’s strengths, limitations, values, beliefs, behavior, and appearance to others. The exact terms of awareness and self-awareness were noted repeatedly throughout the literature. Self-awareness was used in contexts including medicine, medical education, clinical research, nursing, nurse education, physical therapists, community health, psychotherapy, and social worker education.

3.Egoless.

This encompassed various terms that referred to one requiring humbleness or throwing away ego. Descriptive terms included requiring modesty, being egoless, humble, down to earth, having neutrality, having humble attitude, being equitable, having a quiet ego, humility, approach (others) as equals, and lack of superiority.

4.Supportive Interaction.

This term was chosen because it was broad enough to encompass the many different types of engagements and actions that occur when cultural humility is being implemented. Supportive interactions are defined as intersections of existence among individuals that result in positive human exchanges. The actions that fall under this heading include the following: interactions of two persons, interaction, intersectionality, sharing, taking responsibility for interactions with others, interactions, supportive interactions, engage, engaging, and engaged/active

5.Self-Reflection and Critique.

This is defined as a critical process of reflecting on one’s thoughts, feelings, and actions. Terms used that fall under this heading included self-reflection, self-critique, thinking critically about oneself, self-evaluation and critique, self-reflection and discovery, self-questioning and critique, reflection, self-reflective process, knowledge acquisition and reflective practice, reflective openness, and introspection

She also Explained her theory by a Model Case and a Contrary Case

Model Case

To provide an example of cultural humility in action, the following case is presented in the context of interprofessional diversity.

A nurse calls to notify a physician about a subtle change in patient status and suggest an order for a medication. The nurse feels uncomfortable providing a suggestion to the physician due to a perceived hierarchy and having less education, but she was trained to provide a thorough report
including a recommendation when communicating with physicians.

The physician hears the nurse’s report and is frustrated because the nurse is taking too long to get to the point and disagrees with the recommendation. However, the physician considers the power imbalance and recognizes that physicians and nurses have different training.

With a sense of cultural humility, the physician recognizes the nurse has
more face-to-face or “front-line” interaction with the patient and is open to hearing her opinion. She is aware of the nurse’s position in the hierarchy and takes care to exude an egoless, approachable demeanor. The physician addresses the nurse’s concern. Although she disagrees with the nurse’s recommendation, she provides rationale and educates the nurse in a
nonthreatening manner.

After the interaction, the physician reflects about her actions and how the nurse responded. The physician reflects and notes what went well and what could be improved in the interaction. Based on this reflection, she
continually modifies and tailors her communications with nurses in a demonstration of lifelong learning. The nurse and physician feel empowered because they have strengthened their partnership, have respect for each other, and have reached a plan of optimal care for the patient.

Similarly, the nurse reflects on how the communication transpired, considers the rationale provided as well as how she felt afterward. She has learned to make future communications more concise and will continue to attempt to frame her communications in a way that physicians will appreciate.
Because the physician responded in a respectful manner, the nurse feels empowered to continue to communicate with physicians regarding her patients’ needs. As cultural humility is a process, the physician and nurse will continue to learn, modify, and build in their respective knowledgebases
throughout their journey as practitioners.

Contrary Case

The following example is provided to illustrate when cultural humility is not exuded.

Example:1

As noted above, the nurse calls the physician to notify of a patient’s change in status. This time, the physician becomes annoyed at the nurse’s lengthy report and cuts her off saying, “Get to the point already.” The nurse, who already feels disempowered states her recommendation.

The physician disagrees with her recommendation and gives her orders for a different medication followed by ending the call abruptly without explanation. The nurse loses confidence, reflects, and has learned to avoid calling the physician and avoid providing recommendations. The physician
reflects and determines that nurses are incapable of drawing out the critical information to convey.

Example:2

This second example is provided in a public health context.

An American nurse visits a developing country with the interest of providing health care screening to a community. The nurse approaches an individual to ask about participation. The native inhabitant becomes irritated with the nurse and refuses to communicate; thus, removing himself from the opportunity.

The nurse becomes frustrated and feels like returning to her home country. In this case, the native inhabitant viewed the nurse as someone different. She was an outsider with privilege and due to historical precedents of injustice, pain, and oppression, viewed this person as someone to be distrusted and avoided. The nurse recognized the diversity and power imbalance in the vein of socioeconomic status; however, she failed to respect the cultural values of the community and attend to the process of obtaining the approval of gatekeepers. She was not fully self-aware, open, or supportive in her interactions because of this unintentional ignorance. Although there are additional complex phenomena that are oversimplified in
these examples, the outcomes of mutual empowerment, partnerships, respect, optimal care, and lifelong learning are clearly impeded when cultural humility is not achieved.

Application of Theory of Cultural Humility

1. Clinical Practice

• Engage in active listening to understand the patient’s cultural beliefs about illness and treatment.
• Avoid assumptions based on ethnicity, religion, or background.
• Adapt care plans to respect cultural preferences, including diet, modesty, or family involvement.
• Collaborate with interpreters when language barriers exist.

2. Education and Self-Reflection

• Continuously reflect on personal biases and how they may affect patient care.
• Seek cultural competence and humility training to enhance understanding.
• Encourage peer discussions about cultural challenges in healthcare.

3. Community and Public Health

• Partner with community leaders to provide culturally sensitive health education.
• Tailor health promotion programs to align with cultural beliefs and practices.
• Advocate for equitable access to healthcare for marginalized communities.

Case Scenarios and Nursing Interventions

Case 1: Muslim Patient Requiring Medication During Ramadan

• Scenario:
  A 50-year-old Muslim male is admitted for hypertension. He is fasting during Ramadan and is reluctant to take morning medication.
• Nursing Diagnosis:
  • Ineffective Health Management related to cultural practices of fasting.
• Nursing Interventions:
  1. Assess patient’s beliefs and preferences regarding fasting.
  2. Collaborate with the physician to adjust medication schedule after sunset.
  3. Educate the patient on the importance of adherence to therapy while respecting religious practices.

Case 2: Hispanic Family Preferring Traditional Remedies

• Scenario:
  A 35-year-old Hispanic woman with type 2 diabetes uses herbal teas and home remedies before considering insulin therapy.
• Nursing Diagnosis:
  • Readiness for Enhanced Health Management related to interest in integrating traditional and medical treatment.
• Nursing Interventions:
  1. Ask about and validate the patient’s cultural practices without judgment.
  2. Collaborate to integrate safe traditional remedies with prescribed therapy.
  3. Provide culturally sensitive education about blood glucose monitoring and diet.

REFERENCES

1. Foronda C., Baptiste D., Reinholdt M., Ousman K. (2016). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27, 210-217.
2. Foronda, C.L. (2021). Debriefing for cultural humility. Nurse Educator, 46(5), TBD.Published online. doi: 10.1097/NNE.0000000000000957
3. Foronda, C. (2020). A theory of cultural humility.  Journal of Transcultural Nursing, 31(1), 7-12. https://doi.org/10.1177/1043659619875184
4. Foronda, C.L., Porter, A., Phitwong, A. (2020 E-Pub ahead of Print). Psychometric testing of an instrument to measure cultural humility. Journal of Transcultural Nursing.  https://doi.org/10.1177/1043659620950420

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

Connect with “Nurses Lab Editorial Team”

I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.