Cultural Diversity: Issues in Education and Practice Nataliya Lishchenko

Cultural Diversity Issues Cultural Diversity Issues in Education and Practicein Education and Practice

Nataliya LishchenkoNataliya Lishchenko

Cultural Diversity and Health Cultural Diversity and Health CareCare

bull We All Have ItWe All Have It

bull Obvious ManifestationsObvious Manifestationsndash ReligionReligionndash Ethnicity (Race)Ethnicity (Race)ndash National Origin (language)National Origin (language)ndash GenderGender

bull Less Obvious ManifestationsLess Obvious Manifestationsndash AgeAgendash EducationEducationndash Educational StatusEducational Statusndash Mobility (including handicaps)Mobility (including handicaps)

bull What is CultureWhat is Culture Definition the sum total of the way of Definition the sum total of the way of

living includes values beliefs living includes values beliefs standards language thinking patterns standards language thinking patterns behavioral norms communications behavioral norms communications styles etc Guides decisions and styles etc Guides decisions and actions of a group through timeactions of a group through time

bull Expressions of Culture in Health CareExpressions of Culture in Health Care

ndash Health Belief SystemsHealth Belief Systems

bullDefine and categorize health and illnessDefine and categorize health and illnessbullOffer explanatory models for illnessOffer explanatory models for illnessbullBased upon theories of the relationship between Based upon theories of the relationship between

cause and the nature of illness and treatmentscause and the nature of illness and treatmentsbullDefines the specific ldquoscoperdquo of practice for healersDefines the specific ldquoscoperdquo of practice for healers

bull The Culture of Western MedicineThe Culture of Western Medicinendash Meliorism ndash make it betterMeliorism ndash make it betterndash Dominance over nature ndash take controlDominance over nature ndash take controlndash Activism ndash do somethingActivism ndash do somethingndash Timeliness ndash sooner than laterTimeliness ndash sooner than laterndash Therapeutic aggressiveness ndash stronger=betterTherapeutic aggressiveness ndash stronger=betterndash Future orientation ndash plan newer=betterFuture orientation ndash plan newer=betterndash Standardization ndash treat similar the sameStandardization ndash treat similar the same

bull ldquoldquoOursrdquoOursrdquondash Make it BetterMake it Betterndash Control Over NatureControl Over Naturendash Do SomethingDo Somethingndash Intervene NowIntervene Nowndash Strong MeasuresStrong Measuresndash Plan Ahead ndash Plan Ahead ndash

Recent is BestRecent is Bestndash Standardize ndash Treat Standardize ndash Treat

Everyone the SameEveryone the Same

bull ldquoldquoOthersrdquoOthersrdquondash Accept With GraceAccept With Gracendash BalanceHarmony with BalanceHarmony with

NatureNaturendash Wait and SeeWait and Seendash Cautious DeliberationCautious Deliberationndash Gentle ApproachGentle Approachndash Take Life As It Comes ndash Take Life As It Comes ndash

ldquoTime HonoredrdquoldquoTime Honoredrdquondash Individualize ndash Individualize ndash

Recognize DifferencesRecognize Differences

Growing Diversity in America

During the Past 20 years

bull 1048708 White population increased 10

bull 1048708 African American population increased 30

bull 1048708 Native American population increased 58

bull 1048708 Hispanic population increased 125

Diversity Demographics for theyear 2000

bull Whites 70

bull 1048708 Hispanic 13

bull 1048708 African Am 12

bull 1048708 Asian 4

bull 1048708 N Am 1

Projected Demographics for2030

bull White 60

bull 1048708 Black 13

bull 1048708 AsianPI 7

bull 1048708 N AmAk N 1

In CaliforniaIn California

Population of 38 Million

bull 13 of the population is of Hispanic origin

bull Over 10 Asian

bull Over 4 more than one race

bull Nearly 17 identify as ldquoOther racerdquo

bull1 in 4 are foreign born 37 of these entered the US after 1990

bull Nearly 40 of the population over the age of 5 speaks a language other than English at home

bull Over 25 of the population is under the age of 18

Diversity related facts

bull The population is becoming increasingly diverse

bull 1048708 underrepresented groups make up approximately 30 of the population

bull 1048708 Health care workforce has not kept up with the changing demographics

bull 1048708 Physicians from underrepresented groups make up only about 7 of the current workforce

bull 1048708 Nurses only 3bull 1048708 Pharmacy only 3

Ethnic Health Disparities

African Americans

bull1048708 Highest death rate from colon and rectal cancer of any ethnic group in the US

bull1048708 African Am women diagnosed with breast cancer have a 71 survival rate vs an 86 rate for white women

Native Americans

bull1048708 2-3 times more likely to have diabetes mellitus that the general population

bull1048708 Higher than average mortality rates associated with heart disease TB suicide Pneumonia Influenza homicide and alcoholism

Reports of Disparities in HealthCare

Disparities in health care do existand are associated with higher

mortality among minorities

Reported Racial and EthnicDisparities in Healthcare

Research has shown that clinicians spend less time with and prescribe more medication for blacks compared with whites

Blacks are also more frequently labeled as psychotic

(Segal et al 1996- Psychiatr Serv Flaskerud and Hu 1992- Am JPsychiatry)

Minority children with fractures of unknown origin had more skeletal studies ordered than white children with injuries of unknown origin (Lane et al 2002- JAMA)

Reports of Racial and EthnicDisparities in HealthcareMinorities are less likely to be given

appropriate cardiac medications or to undergo bypass surgery There is evidence to suggest significant racial differences in who receives appropriate diagnostic tests and treatment for cancer

Minorities are less likely to receive kidney dialysis or transplants

Racial differences have been reported in the provision of analgesics in the emergency room (Bach et al 1999- NEJM Todd et al 1993- JAMA)

Client (Patient) NeedsClient (Patient) NeedsSafe Effective Care Safe Effective Care EnvironmentEnvironmentbull Acting as a client advocateActing as a client advocatebull Client rightsClient rightsbull ConfidentialityConfidentialitybull Respecting clientrsquos control of personal Respecting clientrsquos control of personal

environment and propertyenvironment and propertybull Establishing prioritiesEstablishing prioritiesbull Ethical practiceEthical practicebull Legal responsibilitiesLegal responsibilitiesbull Organ donationOrgan donationbull Communicating the need for referrals to Communicating the need for referrals to

memebers of the health care teammemebers of the health care team

Client (Patient) NeedsClient (Patient) NeedsHealth Promotion and Health Promotion and MaintenanceMaintenancebull Disease preventionDisease prevention

bull Family planning and family systemsFamily planning and family systems

bull Health and wellnessHealth and wellness

bull Lifestyle choicesLifestyle choices

Client (Patient) NeedsClient (Patient) NeedsPsychosocial IntegrityPsychosocial Integrity

bull Coping mechanismsCoping mechanisms

bull Religious and spiritual influences on Religious and spiritual influences on healthhealth

bull Support systemsSupport systems

bull End of lifeEnd of life

bull Therapeutic interventionsTherapeutic interventions

Client (Patient) NeedsClient (Patient) NeedsPhysiological IntegrityPhysiological Integrity

bull Basic care and comfort practiciesBasic care and comfort practicies

bull Nutritional preferencesNutritional preferences

bull Therapeutical proceduresTherapeutical procedures

bull Practicies or restrictions related to Practicies or restrictions related to procedures and treatmentsprocedures and treatments

Dietary PreferencesDietary Preferences

African-AmericansAfrican-Americansbull Fried foodsFried foodsbull Pork greens ricePork greens ricebull Some pregnant African-Americans engage Some pregnant African-Americans engage

in picain picaAsian-AmericansAsian-Americansbull Soy sauceSoy saucebull Raw fishRaw fishbull RiceRice

European (White) ndash Origin AmericansEuropean (White) ndash Origin Americansbull Carbohydrates (potatoes)Carbohydrates (potatoes)bull Red meatRed meatHispanic-AmericansHispanic-Americansbull BeansBeansbull Fried foodsFried foodsbull Spicy foodsSpicy foodsbull ChiliChilibull Carbonated beveragesCarbonated beverages

American Indians EskimosAmerican Indians Eskimos

bull Blue cornmealBlue cornmeal

bull FishFish

bull GameGame

bull Fruits and berriesFruits and berries

bull Navajos prefer meat and blue cornmeal Navajos prefer meat and blue cornmeal and tend to avoid consumption of milkand tend to avoid consumption of milk

Religion and Dietary Religion and Dietary PracticiesPracticiesSeven Day Adventist (Church of God)Seven Day Adventist (Church of God)bull Alcohol coffee and tea prohibitedAlcohol coffee and tea prohibitedbull Some groups prohibit meatSome groups prohibit meatBaptistBaptistbull Alcohol prohibitedAlcohol prohibitedbull Discourage consumption of coffee and teaDiscourage consumption of coffee and teaBuddhismBuddhismbull Alcohol and drug use discouragedAlcohol and drug use discouragedbull Some sects are vegetarianSome sects are vegetarian

Religion and Dietary Religion and Dietary PracticiesPracticies

Roman CatholicsRoman Catholics

bull Avoid meat on Ash Wednesday and Avoid meat on Ash Wednesday and Good FridayGood Friday

bull Optional fasting during lent seasonOptional fasting during lent season

bull During Lent discourage meat on During Lent discourage meat on FridayFriday

bull Children and the ill are exempt from Children and the ill are exempt from fastingfasting

Church of Jesus Christ of Latter-Church of Jesus Christ of Latter-Day Saints (Mormon)Day Saints (Mormon)

bull Alcohol prohibitedAlcohol prohibited

bull Limited consumption of meatLimited consumption of meat

bull First Sunday of the month is time for First Sunday of the month is time for fastingfasting

Religion and Dietary Religion and Dietary PracticiesPracticiesHinduismHinduism

bull Beaf and veal prohibitedBeaf and veal prohibited

bull Many individuals are vegetariansMany individuals are vegetarians

bull Fasting occurs on specific days of week Fasting occurs on specific days of week according to which god the person worshipaccording to which god the person worship

bull Children are not allowed to participate in fastingChildren are not allowed to participate in fasting

bull Fasting rituals vary from complete abstinence Fasting rituals vary from complete abstinence to consumption of only one meal per dayto consumption of only one meal per day

Religion and Dietary Religion and Dietary PracticiesPracticiesIslamIslambull Pork prohibitedPork prohibitedbull Any meat product not ritually Any meat product not ritually

slaughtered is prohibitedslaughtered is prohibitedbull Avoidance of Alcohol and DrugsAvoidance of Alcohol and Drugsbull During Ramadan (ninth month of During Ramadan (ninth month of

Mohammedan year) fasting occurs Mohammedan year) fasting occurs during daytimeduring daytime

Jehovahrsquos WitnessJehovahrsquos Witness

bull Prohibition of any foods to which Prohibition of any foods to which blood has been addedblood has been added

bull Can consume animal flesh that has Can consume animal flesh that has been drainedbeen drained

Cultural features African-Cultural features African-AmericansAmericansCommunication Communication 1 Languages include English and Black 1 Languages include English and Black

EnglishEnglish2 Head nodding does not necessarily mean2 Head nodding does not necessarily mean

agreementagreement3 Direct eye contact is often viewed as 3 Direct eye contact is often viewed as

being rudebeing rude4 Nonverbal communication is very 4 Nonverbal communication is very

importantimportant5 It is considered to be intrusive to ask 5 It is considered to be intrusive to ask

personalpersonalquestions of someone on initial contact orquestions of someone on initial contact ormeetingmeeting

African-AmericansAfrican-Americans

Time orientation and spaceTime orientation and space1 Oriented more to the present 1 Oriented more to the present

than the futurethan the future2 Close personal space is 2 Close personal space is

importantimportant3 Touching anothers hair is 3 Touching anothers hair is

sometimes viewed as offensivesometimes viewed as offensive

Social rolesSocial roles1 Large extended-family networks are 1 Large extended-family networks are

importantimportant2 Many single-parent female-headed 2 Many single-parent female-headed

householdshouseholds3 Religion is usually Protestant (Baptist)3 Religion is usually Protestant (Baptist)4 Strong church affiliation with 4 Strong church affiliation with

community iscommunity isimportantimportant

5 Social organizations are strong within 5 Social organizations are strong within com-com-munitiesmunities

Health and illnessHealth and illness1 Harmony with nature1 Harmony with nature2 No separation of body mind and spirit2 No separation of body mind and spirit3 Illness is a disharmonious state that 3 Illness is a disharmonious state that

may bemay becaused by demons or spiritscaused by demons or spirits

4 Illness can be prevented by nutritious 4 Illness can be prevented by nutritious meals rest and cleanlinessmeals rest and cleanliness

Health risks Health risks

1 Sickle cell anemia1 Sickle cell anemia

2 Hypertension2 Hypertension

3 Coronary heart disease3 Coronary heart disease

4 Cancer (especially stomach and 4 Cancer (especially stomach and esophageal)esophageal)

5 Lactose intolerance5 Lactose intolerance

6 Coccidioidomycosis6 Coccidioidomycosis

Implementation Implementation 1 Avoid1 Avoid stereotyping stereotyping2 Do not label Black English as an 2 Do not label Black English as an

unacceptableunacceptableform of languageform of language

3 Clarify meaning of clients verbal and 3 Clarify meaning of clients verbal and nonverbalnonverbalbehaviorbehavior

4 Be flexible and avoid rigidity in scheduling 4 Be flexible and avoid rigidity in scheduling carecare

5 Encourage involvement with family5 Encourage involvement with family6 A folk healer or herbalist may be consulted 6 A folk healer or herbalist may be consulted

before an individual seeks medical treatmentbefore an individual seeks medical treatment

Asian AmericansAsian Americans

CommunicationCommunication

1 Languages include Chinese Japanese 1 Languages include Chinese Japanese KoreanVietnamese EnglishKoreanVietnamese English

2 Silence is valued2 Silence is valued

3 Eye contact is considered rude3 Eye contact is considered rude

4 Criticism or disagreement is not expressed verbally 4 Criticism or disagreement is not expressed verbally

5 Head nodding does not necessarily mean 5 Head nodding does not necessarily mean agreementagreement

6 The word no is interpreted as disrespect for 6 The word no is interpreted as disrespect for othersothers

Time orientation and spaceTime orientation and space

1 Oriented more to present1 Oriented more to present

2 Social distance is important2 Social distance is important

3 Usually do not touch others during conversation3 Usually do not touch others during conversation

4 Touching is unacceptable with members of 4 Touching is unacceptable with members of opposite sexopposite sex

5 The head is considered to be sacred therefore5 The head is considered to be sacred therefore

touching someone on the head is disrespectfultouching someone on the head is disrespectful

Social RolesSocial Roles11 Devoted to traditionDevoted to tradition22 Large extended-family networksLarge extended-family networks33 Loyalty to immediate and extended family andLoyalty to immediate and extended family and

honor are valuedhonor are valued44 Family unit is very structured and hierarchicalFamily unit is very structured and hierarchical55 Man have the power and authority and women are Man have the power and authority and women are

expected to be obedientexpected to be obedient66 Education is viewed as importantEducation is viewed as important 77 Religions include Taoism (Buddhism) Islam Religions include Taoism (Buddhism) Islam

Christianity Christianity 88 Social organizations are strong within the communitySocial organizations are strong within the community

Health and illnessHealth and illness1 Health is a state of physical and spiritual harmony 1 Health is a state of physical and spiritual harmony

with nature and a balance between positive and with nature and a balance between positive and negative energy forces (yin and yang)negative energy forces (yin and yang)

2 A healthy body is viewed as a gift from ancestors 2 A healthy body is viewed as a gift from ancestors 3 Illness is viewed as an imbalance between yin and 3 Illness is viewed as an imbalance between yin and

yangyang4 Yin foods are cold and yang foods are hot cold 4 Yin foods are cold and yang foods are hot cold

foods are eaten when one has a hot illness and hot foods are eaten when one has a hot illness and hot foods are eaten when one has a cold illnessfoods are eaten when one has a cold illness

5 Illness is contributed to prolonged sitting or lying or 5 Illness is contributed to prolonged sitting or lying or to overexertionto overexertion

Health risksHealth risks

2 Cancer (stomach 2 Cancer (stomach and liver)and liver)

4 Thalassemia4 Thalassemia

ImplementationImplementation1 Avoid physical closeness and excessive touching only touch 1 Avoid physical closeness and excessive touching only touch

a clients head when necessary in-forming the client before a clients head when necessary in-forming the client before doing sodoing so

2 Limit eye contact2 Limit eye contact3 Avoid gesturing with hands3 Avoid gesturing with hands4 Clarify responses to questions4 Clarify responses to questions5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care6 Encourage involvement with family6 Encourage involvement with family7 A healer may be consulted before an individual7 A healer may be consulted before an individual

seeks out traditional treatmentseeks out traditional treatment

Hispanic-AmericanHispanic-American

Communication Communication 1 Languages include Spanish and Portuguese with various 1 Languages include Spanish and Portuguese with various

dialectsdialects2 Tend to be verbally expressive yet confidentiality is 2 Tend to be verbally expressive yet confidentiality is

importantimportant3 Eye behavior is significant for example the evil3 Eye behavior is significant for example the evil

eye can be given to a child if a person looks ateye can be given to a child if a person looks atand admires a child without touching the childand admires a child without touching the child

4 Avoiding eye contact indicates respect and attentiveness4 Avoiding eye contact indicates respect and attentiveness5 Direct confrontation is disrespectful and the expression of 5 Direct confrontation is disrespectful and the expression of

negative feelings is impolitenegative feelings is impolite6 Dramatic body language such as gestures or facial 6 Dramatic body language such as gestures or facial

expressions is used to express emotion or painexpressions is used to express emotion or pain

2 Comfortable with close proximity to others2 Comfortable with close proximity to others

3 Very tactile and use embraces and 3 Very tactile and use embraces and handshakeshandshakes

4 Value the physical presence of others4 Value the physical presence of others

5 Politeness and modesty are essential5 Politeness and modesty are essential

Social rolesSocial roles1 The nuclear family is the basic unit also there are large 1 The nuclear family is the basic unit also there are large

extended-family networksextended-family networks2 The extended family is highly regarded2 The extended family is highly regarded3 Needs of the family take precedence over individual family 3 Needs of the family take precedence over individual family

members needsmembers needs4 Men are the decision makers and breadwinners and women 4 Men are the decision makers and breadwinners and women

are the caretakers and homemakersare the caretakers and homemakers5 Religion includes Catholicism 5 Religion includes Catholicism 6 Strong church affiliation6 Strong church affiliation7 Social organizations strong within the community7 Social organizations strong within the community

Health and illnessHealth and illness1 Health may be a reward from God or a result of1 Health may be a reward from God or a result of

good luckgood luck2 Health results from a state of balance be-2 Health results from a state of balance be-

tween hot and cold forces and wet and drytween hot and cold forces and wet and dryforcesforces

3 Illness occurs as a result of Gods punishment3 Illness occurs as a result of Gods punishmentfor sinsfor sins

4 Folk medicine traditions4 Folk medicine traditions

2 Diabetes mellitus2 Diabetes mellitus

3 Parasites3 Parasites

ImplementationImplementation

1 Communicate with male head of family1 Communicate with male head of family

2 Protect privacy2 Protect privacy

3 Offer to call priest or other clergy because of3 Offer to call priest or other clergy because of

the significance of religious practices related tothe significance of religious practices related to

illnessesillnesses

4 Always touch a child when examining him or her4 Always touch a child when examining him or her

5 Be flexible and avoid rigidity in scheduling care5 Be flexible and avoid rigidity in scheduling care

Native AmericansNative Americans

CommunicationCommunication1 Languages include English Navajo and other1 Languages include English Navajo and other

tribal languagestribal languages2 Silence indicates respect for the speaker2 Silence indicates respect for the speaker3 Speak in a low tone of voice and expect 3 Speak in a low tone of voice and expect

others to be attentiveothers to be attentive4 Eye contact is avoided because it is a sign of4 Eye contact is avoided because it is a sign of

disrespectdisrespect5 Body language is important5 Body language is important

Time orientation and spaceTime orientation and space11 Oriented more to presentOriented more to present22 Personal space is very importantPersonal space is very important33 Will lightly touch another persons hand Will lightly touch another persons hand

during greetingsduring greetings44 Massage is used for the newborn infant to Massage is used for the newborn infant to

promote bonding between infant and promote bonding between infant and mothermother

55 Touching a dead body is prohibited in Touching a dead body is prohibited in some tribessome tribes

Social rolesSocial roles11 Very family orientedVery family oriented22 Basic family unit is the extended family which often includes Basic family unit is the extended family which often includes

people from several householdspeople from several households33 I some tribes grandparents are viewed as family leadersI some tribes grandparents are viewed as family leaders44 Elders are honoredElders are honored55 Children are taught to respect traditionsChildren are taught to respect traditions66 The father does all the work outside the home and the The father does all the work outside the home and the

mother assumes responsibility for domestic dutiesmother assumes responsibility for domestic duties77 Sacred myths and legends provide spiritual guidanceSacred myths and legends provide spiritual guidance88 Religion and healing practicies are integratedReligion and healing practicies are integrated99 Community social organizations are important Community social organizations are important

Health and illnessHealth and illness11 Health is a state of harmony between the Health is a state of harmony between the

person the family and the environmentperson the family and the environment22 Illness is caused by supernatural forces Illness is caused by supernatural forces

and disequilibrium between person and and disequilibrium between person and environmentenvironment

33 Traditional health and illness beliefs may Traditional health and illness beliefs may continue to be observed natural and continue to be observed natural and magicoreligious folk medicine traditionmagicoreligious folk medicine tradition

44 Traditional healer medicine man or Traditional healer medicine man or womanwoman

Health risksHealth risks11 Alcohol abuseAlcohol abuse22 AccidentsAccidents33 Heart diseaseHeart disease44 Diabetes mellitusDiabetes mellitus55 TuberculosisTuberculosis66 ArthritisArthritis77 lactose intolerancelactose intolerance88 Gallbladder diseaseGallbladder disease99 American Eskimos are susceptible to glaucomaAmerican Eskimos are susceptible to glaucoma

ImplementationImplementation11 Clarify communicationClarify communication22 Understand that the client may be attentive even Understand that the client may be attentive even

when eye contact is absentwhen eye contact is absent33 Be attentive to own use of body languageBe attentive to own use of body language44 Obtain input from members of extended familyObtain input from members of extended family55 Encourage client to personalize space in which Encourage client to personalize space in which

health care is delivered for example encourage health care is delivered for example encourage client to bring personal items or objects to the client to bring personal items or objects to the hospitalhospital

66 In the home assess for the availability of running In the home assess for the availability of running water and modify infection control and hygiene water and modify infection control and hygiene practices as necessarypractices as necessary

PROLONGATION OF LIFEPROLONGATION OF LIFE

AA Christian Science religion is unlikely Christian Science religion is unlikely to use medical means to prolong to use medical means to prolong lifelife

BB Jewish faith generally opposes Jewish faith generally opposes prolonging life after irreversible prolonging life after irreversible brain damagebrain damage

DEATH AND DYING DEATH AND DYING PRACTICESPRACTICESAA Autopsy may be prohibited opposed or discour-Autopsy may be prohibited opposed or discour-

aged by Eastern Orthodox religions Muslims Jeho-aged by Eastern Orthodox religions Muslims Jeho-vahs Witnesses and Orthodox Jewsvahs Witnesses and Orthodox Jews

BB Organ donation is prohibited by Jehovahs Wit-Organ donation is prohibited by Jehovahs Wit-nesses and Muslimsnesses and Muslims

CC Buddhists in America encourage organ donationBuddhists in America encourage organ donationand consider it an act of mercyand consider it an act of mercy

DD Cremation is discouraged opposed or prohibitedCremation is discouraged opposed or prohibitedby the Mormon Eastern Orthodox Islamic andby the Mormon Eastern Orthodox Islamic andJewish faithsJewish faiths

EE Hindus prefer cremation and cast the ashes in a Hindus prefer cremation and cast the ashes in a holyholyriverriver

Try your knowledgeTry your knowledge

A nurse in an ambulatory care clinic is performingA nurse in an ambulatory care clinic is performingan admission assessment for an African-Americanan admission assessment for an African-Americanclient scheduled for a cataract removal with anclient scheduled for a cataract removal with anintraocular lens implant Which of the followingintraocular lens implant Which of the followingquestions would be inappropriate for the nurse toquestions would be inappropriate for the nurse toask on an initial assessmentask on an initial assessment

1 Do you have any difficulty breathing1 Do you have any difficulty breathing2 Do you have a close family relationship2 Do you have a close family relationship3 Do you ever experience chest pain3 Do you ever experience chest pain4 Do you frequently have episodes of headache4 Do you frequently have episodes of headache

A nurse is providing discharge instructions to aA nurse is providing discharge instructions to aChinese client regarding prescribed dietary modifi-Chinese client regarding prescribed dietary modifi-cations During the teaching session the clientcations During the teaching session the clientcontinuously turns away from the nurse Whichcontinuously turns away from the nurse Whichnursing action is most appropriatenursing action is most appropriate

1 Continue with the instructions verifying client1 Continue with the instructions verifying clientunderstandingunderstanding

2 Tell the client about the importance of the2 Tell the client about the importance of theinstructions for the maintenance of health careinstructions for the maintenance of health care

3 Walk around the client so that the nurse3 Walk around the client so that the nursecontinuously faces the clientcontinuously faces the client

4 Give the client a dietary booklet and return later4 Give the client a dietary booklet and return laterto continue with the instructionsto continue with the instructions

A nurse is preparing a plan of care for a client whoseA nurse is preparing a plan of care for a client whosereligion is Jehovahs Witness The client has beenreligion is Jehovahs Witness The client has beentold that surgery is necessary The nurse considerstold that surgery is necessary The nurse considersthe clients religious preferences in developing thethe clients religious preferences in developing theplan of care and documents thatplan of care and documents that

1 Surgery is prohibited in this religious group1 Surgery is prohibited in this religious group2 The administration of blood and blood products2 The administration of blood and blood products

is forbiddenis forbidden3 Medication administration is not allowed3 Medication administration is not allowed4 Faith healing is primarily practiced4 Faith healing is primarily practiced

It is because we are different It is because we are different that each of us is specialthat each of us is special

bull We All Have ItWe All Have It

bull Obvious ManifestationsObvious Manifestationsndash ReligionReligionndash Ethnicity (Race)Ethnicity (Race)ndash National Origin (language)National Origin (language)ndash GenderGender

bull Whites 70

bull 1048708 N Am 1

bull White 60

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull Whites 70

bull 1048708 N Am 1

bull White 60

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull Whites 70

bull 1048708 N Am 1

bull White 60

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull Whites 70

bull 1048708 N Am 1

bull White 60

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull Whites 70

bull 1048708 N Am 1

bull White 60

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull Whites 70

bull 1048708 N Am 1

bull White 60

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull Whites 70

bull 1048708 N Am 1

bull White 60

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull Whites 70

bull 1048708 N Am 1

bull White 60

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull White 60

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull Over 10 Asian

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

African Americans

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

Native Americans

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

bull FishFish

bull GameGame

illnessesillnesses

Documents

Cultural Diversity: Issues in Education and Practice Nataliya Lishchenko