Nursing and Global Health: Ethics, Cultural Humility, and Active Partnerships

Vocabulary practice flashcards covering global health ethics, maternal mortality, social justice, human rights, cultural safety, cultural humility, and the ethical dilemmas of medical volunteerism.

Global Health Ethics (Pratt & de Vries, 2023)

The ethics of public health and healthcare problems characterized by a global-level effect or requiring action beyond individual countries, including the ethics of research related to such problems.

Four Levels of Global Health Ethics (Robson et al., 2019)

A four-tier ethical framework categorized into interpersonal ethics (doctor patient, researcher subject), institutional ethics (hospitals, systems, academic institutions), international ethics (roles of governments in international contexts), and structural ethics (factors beyond realm of national governance, like environmental health and climate change).

Autonomy

• The right to self-determination, free from controlling influences or limitations, centered on an individual's capacity to make informed decisions.

• This is transferable to different settings and countries, but might mean different things. In the west, autonomy is an individual endeavour. Somewhere else, it may be the autonomy of a family, community, or larger group of people.

• there are barriers to informed consent in resource constrained areas

• issues of poverty, discrimination like failing to protect vulnerable citizens

Ethics of Affluence

An ethical perspective that places great importance on personal autonomy and individual rights, which may not be transferable to resource-constrained settings where family survival is tied to the joint efforts of each family member.

Beneficence (Beauchamp & Childress, 2013)

• A moral obligation to act for the good of others to help further their interests, often by preventing or removing harms.

Nonmaleficence

• The moral obligation to not inflict harm on others, exemplified in global health by criticisms against the restrictive intellectual property rights of pharmaceutical companies, limiting access to drugs

Lifetime Risk of Maternal Death Disparity (WHO, 2025)

The stark geographic disparity in the lifetime risk of dying in pregnancy and childbirth, recorded as $1\text{ in }7{,}100$ in Canada compared to $1\text{ in }40$ in Sub-Saharan Africa.

Global Causes of Maternal Death (Mallick et al., 2020)

• The global distribution of maternal mortality causes: maternal hemorrhage ($27\%$), indirect causes ($27\%$), hypertensive disorders ($14\%$), sepsis ($11\%$), other direct causes ($10\%$), abortion ($8\%$), and embolism ($3\%$).

• things like a culture of giving birth at home, without access to emergent help if needed

global health issues w pregnancy and birth

women living in poverty disproportionately impacted by obstetric causes of maternal mortality because:

• less access to contraception and the unwillingness of partners to use contraception

• desire to have large families to ensure survival of some children

• large number of pregnancies causing uterine atony

• lack of access to emergency OB care

nurses role in women’s health

• advocate for people around the world! advocate for more equitable power, access to education and rights. focus on things like preventing violence, improving education, promoting health, respectful relationships

• frontline care]education and counselling

• advocate for access to basic nursing and midwifery care to be a basic human right

• research

Social Justice (Matwick & Woodgate, 2017)

• A state of health equity characterized by the equitable distribution of services affecting health and helping relationships, achieved through recognizing social oppression and inequity and enacting caring actions toward social reform.

• requires work at population levels

• shift from focusing on individual care to global approach to health equity

Human Rights-Based Approach to Health (WHO, 1948)

A framework grounded in international human rights law recognizing that governments are legally responsible for the health of their peoples through the provision of adequate health and social measures.

Moral Imagination (Acumen, 2013)

• The ethical premise for cross-cultural engagement employed in creating healthy and respectful cross-cultural collaborations.

• defined as having the humility to accept things as they are and the audacity to see things as they could be, aimed at improving the quality of life for all human beings.

key assumptions in concept of moral imagination

• there is a shared humanity

• human dignity is a priority and ethical standpoint

• holistic perspective of health

• call for consciousness of cultural and interpersonal humility

• acceptance of another’s lived experience and circumstances as they are

• a commitment to change

CRNA Entry Level Competency 2.5

A professional nursing standard from the College of Registered Nurses of Alberta requiring that registered nurses maintain awareness of positional power over clients and actively take action to reduce bias and personal influences.

Cultural Humility (Breakey et al., 2015)

A lifelong commitment to self-evaluation and self-critique that challenges power differentials, seeks to understand the self and other, recognize prejudice and misperceptions, develops an attitude of not knowing, and seeks to learn from others.

key aspects for implementing culturally safe nursing care

• knowledge of cultures

• being humble

• education and training in culturally competent care

• recognizing power dynamics and privilege

• critical reflection

• patient advocacy and empowerment

Cultural Safety (Danso, 2018)

An approach focused on creating environments where clients feel comfortable, treating people with dignity and respect, validating Indigenous epistemologies, empowering clients as partners, embracing diversity

Cultural Competence (Danso, 2018)

A framework centered on developing awareness of one's own beliefs and biases, acquiring knowledge about other cultural groups, recognizing culture as fluid and dynamic, acknowledging diversity and difference as resources rather than barriers to overcome

Core Attributes of Cultural Humility (Foronda et al., 2016)

The five defining characteristics of cultural humility: openness, self-awareness, being egoless, supportive interaction, and self-reflection and critique.

Outcomes of Cultural Humility (Foronda et al., 2016)

The resulting benefits of practicing cultural humility: mutual empowerment, respect, partnerships, optimal care, and lifelong learning.

Issues with International Volunteering (Bauer, 2017)

Potential harms associated with medical volunteerism, including neo-colonialism and exploitation, structural violence, overburdening local communities, reducing local healthcare capacity, leaving people with your poor work, and disproportionately benefiting foreign volunteers.