Global Perspectives
Volume 22 Number 1
Steven L. Baumann, Contributing Editor
Beyond Cultural Competence
Nursing Practice With Political Refugees
Steven L. Baumann, RN; PhD
Professor, City University of New York
Keywords: nursing; refugees
I t is now widely espoused that all nurses and other
healthcare providers should be culturally competent.
This usually means that nurses and healthcare organiza-
tions are willing to do the work needed to understand and
provide quality nursing and other healthcare services to
persons from diverse backgrounds and lifestyles. Nurses
and nurse leaders recognize that one size does not fit all,
and that nursing and other healthcare services need to be
modified for each client and not the other way around.
Ethnocentrism on the other hand is recognized as a bar-
rier to both quality care and productivity in the culturally
diverse workplace. It should be recognized that not mea-
suring the value of individuals and groups by the domi-
nant culture remains counter cultural in the United
States.
Nursing practice with political refugees, as suggested
in the column that follows, goes beyond this definition of
culturally competent practice. The value proposition that
is here exposed is that nursing should not only recognize
and respect differences, but also be especially responsive
to those who have suffered because of their differences.
While the primary mission of nursing is not the work of
justice or nonviolence, nurses should be infused with
such a value proposition. This is particularly important if
the culture and norms where nurses work are discrimi-
nating and oppressive. Nursing practice with political
refugees does in an obvious way what most nurses do in
more subtle ways: counter injustice and untruths. The
essential assumption of this type of practice of nursing is
not to deny that there are genuine differences among
individuals, families, and groups, but to appreciate that
fundamentally there is a unity to humankind and a com-
mon human condition. Parse’s (2007) commitment to the
study of universal lived experiences contributes to this,
as does Roy’s (2007) concern with the world’s unjust
distribution of resources and opportunities. Many nurses
have outstanding commitments to the liberation of the
Nursing Science Quarterly
January 2009 83-84
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politically oppressed; they also show their professional-
ism by working for the liberation of the oppressor.
The next section of this column points out that the
experience of being a political refugee is similar to the
experience of having emigrated from one’s homeland, in
that the process of gaining entry into and establishing
oneself in a new and different country involves many
changes, hardships, and challenges. The more unfamiliar
the new country is, the more difficult the process. As most
nurses know, differences of language and dialect are bar-
riers to effective work. The challenge is made more diffi-
cult when the fundamental beliefs and values of the
individual or family are very different from the dominant
beliefs and values in the new country. In the case where
the core assumptions of the person reflect countless dif-
ferences in habits and customs, these should be reflected
upon and either accepted or altered in acquiescence.
Unlike immigrants, political refugees are much more
likely to have suffered discrimination, persecution, and
political oppression in their country of origin and in
other places. Being a witness to or a victim of intentional
violence and oppression is not only traumatizing, but is
also accompanied with loss of meaning and belief in the
essential goodness of others in the world. Political
refugees may also be taken advantage of by others, in
part because their journey has been such an arduous one
with many losses. Political refugees and immigrants may
have come to hold unrealistic expectations of opportuni-
ties in this new country, and because of this suffer a cer-
tain degree of disappointment and disillusionment.
Editor’s Note: Send abstracts, outlines, or query letters about ideas
for this column to Steven L. Baumann, RN, PhD, Professor, Hunter
College, City University of New York, 82 Sherman Avenue, Williston
Park, New York 11596; phone: (212) 481-4344 ; e-mail: sbaumann@
hunter.cuny.edu.
83
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Most political refugees are fleeing from a country that
was not committed to diversity or tolerance of opposing
ideologies and lifestyles. They are leaving places that are
exclusionary and not averse to using violence or the
threat of violence. They hope to find a new place to live
that is more inclusive of people from diverse back-
grounds to enjoy a life of greater meaning and political
freedom. While many nurses do not work with political
refugees as described in this column, many do work with
persons who are from groups that carry the legacy of
political oppression and violence.
References
Parse, R. R. (2007). The humanbecoming school of thought in 2050.
Nursing Science Quarterly, 20, 308-311.
Roy, C. (2007). Update from the future: Thinking of theorist Callista
Roy. Nursing Science Quarterly, 20, 113-116.