| Course | NU 305 Professional Role Transition |
|---|---|
| Unit | Unit 4 |
| Paper type | Cultural humility self-examination |
| Length | About 1,020 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | RN to BSN |
| Updated | October 2026 |
Free sample paper for NU 305 Unit 4
The Patient Who Was Not Refusing: A Cultural Humility Self-Examination
Student Name
Department of Nursing, Herzing University
NU 305: Professional Role Transition
Instructor Name
February 9, 2026
The Patient Who Was Not Refusing: A Cultural Humility Self-Examination
Starting With My Own Assumptions
Cultural humility, as Tervalon and Murray-Garcia (1998) described it, asks clinicians to keep examining their own assumptions for as long as they practice, to correct the unequal power between themselves and the people they care for, and to build real partnerships with communities. It differs from the older idea of cultural competence, which suggested that a clinician could learn enough facts about a group to be competent in caring for its members. A concept analysis of cultural humility described its core as openness and self-awareness, a willingness to set one's own status aside, supportive interaction, and continuing critical reflection on oneself (Foronda et al., 2016). This paper applies that stance to me rather than to a patient group. I grew up in a white, English-speaking, middle-class family in a small Midwestern town, trained in an associate program where most instructors and students shared that background, and have worked for six years on a surgical unit in a hospital where most nurses do too. Those facts shaped what I treat as normal before I notice I am doing it.
The Encounter
Two years ago I cared for Mr. O., a composite 64-year-old man from Nigeria who had lived in the United States for 20 years, on the second day after a colectomy. My plan for the shift included getting him out of bed to walk three times, because early mobility after abdominal surgery prevents complications. At 9 a.m. he said, politely, that he would walk later. At 11 a.m. he said the same. At 1 p.m. he said he was waiting for his wife. I documented "patient refused ambulation times three" and, at the afternoon huddle, described him as "noncompliant with mobility." The charge nurse suggested I ask him what "later" meant.
When I asked, Mr. O. explained that he did not want to walk in a hospital gown that opened at the back, in front of female nurses and other patients, and that his wife was bringing a robe and trousers from home. He had not said so earlier because he did not want to seem difficult. His wife arrived at 3 p.m. with the clothes, and he walked twice that afternoon without any further prompting.
What I Assumed, and Where the Assumption Came From
I made three assumptions. First, that a patient who politely postpones a request is refusing it. That came from my training, in which "refused" was the only documentation option for a care activity not done, and from a unit culture that treats mobility as a task with a deadline. Second, that the barrier was motivation or pain, since those were the reasons I had been taught to look for. The possibility that the barrier was dignity never crossed my mind, because the hospital gown is so normal to me that I no longer see it. Third, and least comfortably, I assumed that a patient's reluctance was his problem to solve rather than a question for me to ask. That assumption reflects the power I hold as the nurse who writes the chart. My note labeled him before I understood him, and that label would have followed him through the rest of his stay.
Research on implicit bias among health care professionals has found that clinicians hold unconscious attitudes that can influence their interactions and judgments (FitzGerald & Hurst, 2017). I cannot say whether Mr. O.'s being a Black immigrant influenced how quickly I wrote "noncompliant," but I cannot rule it out either, and I noticed afterward that I had not used that word for a white patient who postponed walking the same week.
How the Setting Reinforced the Assumption
My assumptions were not only personal. The unit's systems made them easy. The electronic record's mobility field offered three choices, completed, refused, and unable, so the software itself classified a postponed walk as a refusal. The huddle format asked nurses to report "barriers to the plan," which framed patients' reasons as obstacles rather than information. Productivity pressure mattered too: I had five patients and a mobility target for each, and it was faster to document a refusal than to sit down and ask a question that might take ten minutes. Cultural humility includes looking at these structures, because the power imbalance Tervalon and Murray-Garcia (1998) describe is built into forms and routines, not only into individual attitudes. Changing my own habits without asking for the documentation options to change would leave the next nurse with the same three boxes.
What I Do Differently Now
I now ask "What would make this easier for you?" before I document a refusal, and I document the answer. I offer patients the option of walking in their own clothes or a second gown worn backward as a robe, and I ask whether they prefer a nurse of a particular gender for care that involves exposure. I have asked our unit's practice council to add "deferred, patient preference" to the mobility documentation options, so that refusal is not the only category available. And I try to notice when I reach for a label, such as noncompliant or difficult, and treat that as a signal to ask a question instead.
What Humility Does Not Mean
Cultural humility is sometimes misread as never knowing anything about a patient's background. That is not the lesson of this encounter. It would have been useful to know that modesty norms differ across cultures, and that knowledge would have prompted a better question. The lesson is that knowledge about groups is a starting point for asking, not a substitute for it. Mr. O.'s reasons were his own, and I only learned them because someone suggested that I ask.
Continuing the Work
Self-examination is not a single paper. I plan to review my own documentation monthly for labels such as refused, noncompliant, and difficult, and ask whether the patient behind each would describe the situation the same way. I also plan to seek feedback from colleagues who come from backgrounds different from mine, and to listen to it without defending myself first.
References
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18, Article 19. https://doi.org/10.1186/s12910-017-0179-8
Foronda, C., Baptiste, D.-L., Reinholdt, M. M., & Ousman, K. (2016). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27(3), 210-217. https://doi.org/10.1177/1043659615592677
Tervalon, M., & Murray-Garcia, 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
Reading the NU 305 Unit 4 instructions
Unit 4 asks you to examine your own cultural assumptions through an encounter from your practice. Expect to define cultural humility, describe the encounter, identify your assumptions and their sources, consider how systems reinforced them, describe what you now do differently and explain how you will continue. Many versions ask how humility differs from cultural competence. Check whether your section expects a specific framework. Humility is about examining yourself and the power imbalance in care, not memorizing what a group believes. Avoid describing a culture as a set of traits. Systems matter too, so look at documentation, scheduling and staffing. Concrete changes, such as a question you now ask, make the reflection credible.
How the NU 305 Unit 4 example is put together
The paper opens with the definition and why it suits the encounter. The encounter is described factually, including what the nurse saw and documented. The assumptions section names three, each with a source in the writer's training or experience. The systems section is the paper's distinctive move, showing how a documentation field and time pressure made the assumption easy. The changes section names specific behaviors, such as asking before charting. The section on what humility does not mean clarifies that knowledge about cultures still matters when held lightly. The final section plans ongoing review of documentation. The reflection stays focused on the writer and avoids describing Nigerian culture as a fixed set of beliefs.
Where the points sit in the NU 305 Unit 4 rubric
Herzing's rubric for a cultural humility paper typically covers the definition of the concept, the description of the encounter, depth of self-examination, attention to systems, concrete changes and ongoing commitment. Self-examination is weighed most heavily, since graders want specific assumptions with their sources named honestly. Definition points reward accurate use of Tervalon and Murray-Garcia. Systems criteria look for structural factors beyond the individual. Change points go to specific, observable behaviors. Commitment earns credit for a realistic plan. Avoiding stereotypes is scored throughout. Foronda's concept analysis and FitzGerald and Hurst's review belong in the APA 7 list. Credit also goes to an encounter told plainly enough that the assumption is visible before the writer names it.
Common NU 305 Unit 4 mistakes, and how to avoid them
Cultural humility papers in Unit 4 commonly lose points by describing the patient's culture instead of examining the writer's assumptions. Another frequent problem is vague self-examination, such as I realized I had biases, without naming them. Students often ignore systems, so the problem appears purely personal. Changes are general, such as be more open-minded. Humility is confused with competence. The encounter is not described clearly. The paper ends with the insight and no plan. Finally, name specific assumptions and where they came from, because graders reward honest, concrete self-examination over general statements of good intent. The monthly documentation review is a good model, because it turns humility into a habit that can be checked.
Get a NU 305 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NU 305 classroom, plus the encounter you want to work from. We write a custom example that stays inward, separates structural from cultural and lands on a behavior, returned in 24 to 48 hours. The first custom sample is free.
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NU 305 Unit 4 questions, answered
What is the difference between humility and competence here?
Competence implies a body of knowledge about groups that can be acquired and completed; humility treats each patient as the authority on their own situation and treats the nurse's assumptions as the thing needing examination. The shift matters because the first framing produces generalizations and the second produces questions, and the course is grading the second.
Why avoid describing what a group believes?
Because it replaces the person with a category. Any statement about what a culture thinks will be wrong about a substantial share of its members, and a nurse who arrives with that framework asks fewer questions rather than more. Write about your own assumptions and about what individual patients told you, and the paper stays accurate.
How do I separate structural from cultural?
Ask whether money, transport, hours or language would explain it. A patient who does not attend follow-up may face a copayment, a bus route or a shift they cannot leave, none of which is cultural. Attributing a structural obstacle to belief is a common error and it directs effort at the wrong thing entirely.
Where can I find a free NU 305 Unit 4 sample paper?
The complete NU 305 Unit 4 cultural humility paper is posted here free, the encounter, three named assumptions and the changes since. A self-examination built on a different encounter can be prepared on request.
What is the difference between cultural humility and cultural competence?
Cultural competence suggests mastering knowledge about groups. Cultural humility, as Tervalon and Murray-Garcia described, means continually examining your own assumptions and the power imbalance in care. This sample applies humility to a patient wrongly charted as refusing.