Chapter 16 Cultural Diversity Fundamentals of Nursing: Standards & Practices, 2E

Chapter 16

Cultural Diversity

Fundamentals of Nursing: Standards & Practices, 2E

Copyright 2002 by Delmar, a division of Thomson Learning 16-2

What is Culture?

Culture refers to knowledge, beliefs, behaviors, ideas, attitudes, values, habits, customs, languages, symbols, rituals, ceremonies, and practices that are unique to a particular group of people.

Culture represents adaptive, dynamic processes learned through life experiences.


Culture is• learned and taught• shared• social in nature• dynamic, adaptive, and ever-changing


Ethnicity and Race

Ethnicity is a cultural group’s perception of themselves (group identity).

Race refers to a grouping of people based on biological similarities.


Labeling and Stereotyping

Problems arise when differences across and within cultural groups are misunderstood.

Ethnocentrism is the belief that one’s own culture is superior to all others.

Oppression occurs when the rules, modes, and ideals of one group are imposed on another group.


Racism is defined as discrimination directed toward individuals who are misperceived to be inferior due to biologic differences.

Stereotyping is an expectation that all people within the same racial, ethnic, or cultural group act alike and share the same beliefs and attitudes.


Dominant Values in the U.S.

A dominant culture is the group whose values prevail within a society.

Cultural differences refer to values, practices, and rituals that vary from those of the dominant culture.

The dominant culture of the U.S. is composed of white, middle-class Protestants of European ancestry.


Dominant values in the U.S.• Achievement, success, competition• Individualism, independence, self-reliance• Activity, work, ownership• Efficiency, practicality, reliance on

technology• Material comfort• Youth and beauty


A minority group can be comprised of an ethnic, racial, or religious group that constitutes less than a numerical majority of the population.

People assume the characteristics of the dominant culture through acculturation (process of learning norms, beliefs, and behavioral expectations of a group).


Cultural assimilation occurs when individuals from a minority group are absorbed by the dominant culture and take on the characteristics of the dominant culture.


Multiculturalism in the U.S.

A subculture is a group of people who differ from the dominant culture.

The U.S. has many subcultures with populations that are rising at a rapid rate.

White Americans will decline from 75% to 50% of the total population by the year 2050.


Cultural diversity is the difference among people that results from ethnic, racial, and cultural variables.

Nurses caring for clients who are different from themselves must remember to determine the client’s perception and significance (meaning) of the event (illness).


Organizing Phenomena

CommunicationSpaceOrientation to time


Social organization• Family

Nuclear Extended Attenuated Incipient Blended


• Vulnerable populations The poor The homeless Migrant workers Abused individuals The elderly Pregnant adolescents Individuals with STDs


• Gender• Lifestyle• Religion

Environmental controlBiological variations


Cultural Disparities in Health and Health Care Delivery

Language and other cultural differences often present barriers to health care.

There are disparities in the health of Americans as minorities experience some diseases at a much higher rate than white Americans.


Transcultural Nursing

Transcultural nursing focuses on the study and analysis of different cultures and subcultures with respect to cultural care, health beliefs, and practices.

The goal is to provide care within the context of the client’s culture.


Assumptions of transcultural nursing• When health care providers see

problems from the client’s cultural viewpoint, they are more open to understanding, appreciating, and working effectively with these clients.


• Every culture has some kind of system for health care that is based on values and behaviors.

• Cultures have certain methods for providing health care - these methods of care are often unknown to nurses from other cultures.


Cultural Competence

Cultural competence is the process through which the nurse provides care that is appropriate to the client’s cultural context.

Culturally competent nurses have knowledge about cultural values related to health and illness.


Culturally competent nurses demonstrate knowledge and understanding of the client’s culture, accept and respect cultural differences, and adapt care to be congruent with the client’s culture.


Campinha-Bacote's (1998 or 1999) Model of Cultural Competence

Five elements of cultural competence• Cultural awareness• Cultural knowledge• Cultural skill• Cultural encounters• Cultural desire


Cultural Competence and theNursing Process

Assessment• Cultural Assessment Factors

Client’s ethnic heritage Family role and function Religious practices Food preferences Native language


• Social networks

• Educational experiences (both formal and informal)

• Family patterns of health care

• Health care beliefs


Diagnosis• Some diagnoses may be culturally

biased Noncompliance Impaired verbal communication Impaired social interaction Deficient knowledge Disturbed thought processes Powerlessness


Planning and outcome identification• In order to develop effective care

plans, nurses need to understand Cultural groups’ perspectives on life

processes How cultural groups maintain wellness


Culture’s perspectives on the causes of illness

Use of healers in the cure and care of illness

The influence of the nurse’s cultural background on the delivery of care


Implementation• Three major nursing interventions

Self-awareness Use of a nonjudgmental approach Client education


Evaluation• Affirm client strengths and

potential for growth


Client Education

Education must be relevant not only to the client’s needs, but also must be provided in a culturally sensitive manner.

Evaluate the client’s current knowledge base.

Ask the client/family what they need/want to learn.


Observe the interaction between the client and family to determine family roles and authority figures.

Use language easily understood by the client.

Clarify your verbal and nonverbal messages with the client.

Have the client repeat the information taught.


References

Campinha-Bacote, J. (1999). A Model and Instrument for Measuring Cultural Competence in Health Care. Journal of Nursing Education, 38(5), 203-207.

Documents

Chapter 16 Cultural Diversity Fundamentals of Nursing: Standards & Practices, 2E