1. CONCEPT: DIVERSITY

2. Definition – Diversity: The unique variations among and between individuals, variations that are informed by genetics and cultural background, but that are refined by experience and personal choice.

3. UNIT OBJECTIVES 1.Explain the concept of Diversity (including definition, antecedents, and attributes). 2.Analyze conditions which place a patient at risk for cultural incompetence. 3.Identify when cultural incompetence (negative consequence) is developing or has developed. 4.Discuss exemplars of common diversity disorders. 5.Apply the nursing process (including collaborative interventions) for individuals experiencing cultural incompetence and to promote normal sleep.

4. Definition of Culture Diversity and Culture are closely linked. To understand the link, culture is defined as “a pattern of shared attitudes, beliefs, self-definitions, norms, roles, and values. Culture occurs among : Those who speak a particular language Those who live in a defined geographic region

5. InterrelatedConcepts Coping Patient Education Communication InterpersonalPatient-Centered Care

6. Nursing Care - Those things which must be known about a diverse population in order to provide care.  Cultural norms influence how people make decisions about treatment preferences, medication adherence, self-care, and perceptions of illness, which affects nursing care and healthcare delivery.

7.  Attributes  A pattern of shared attitudes, beliefs, self- definitions, norms, roles, and values that occur among those who speak a particular language or live in a defined geographical region.  Examples:  Enculturation,  Acculturation,  Biculturalism,  Application/Use of: Diversity implications when interacting/educating/providing care.

8. Antecedents – Individual Differences and Similarities in: Age Religious/Spiritual Ethnic/Race Cultural Sexual Orientation Education Life Experiences

9. Related Terms and Examples of Attributes  Enculturation:  Process by which a person learns norms, values, and behaviors of another culture  Example:  A high school student from the United States spends a summer abroad with a family in Switzerland

10. Related Terms and Examples of Attributes  Acculturation:  Process of acquiring new attitudes, role, customs, or behaviors  Example:  An immigrant from China develops a preference for Western foods and music 

11.  Assimilation:  Process by which a person gives up his or her original identity and develops a new cultural identify by becoming absorbed into the dominant cultural group  Example:  A Native American loses his Native identity after living in Chicago for 10 years

12.  Biculturalism:  Duel pattern of identification  Example:  A woman of Christian faith married to a Muslim adopts Muslim practices and also maintains some traditional Christian practices

13. Other Related Terms  Ethnicity and ethnic identity  Influenced by culture and common ancestry  Race  Influenced by physical or biologic characteristics

14. Consequences Negative Culture specific illness Breakdown in communication Non compliance Stress, no hope Fearful patient Positive Culturally congruent care Patient satisfaction Appropriate child rearing practices Culture identity Inner peace and strength Faith and hope

15. Subconcepts

16. Nursing Diagnoses Attachment, Risk for Impaired Anxiety Body Image, Disturbed Coping: Defensive Coping: Family, Compromised Decisional Conflict Family Processes, Interrupted Fear Health Maintenance, Ineffective Moral Distress Social Interaction, Impaired

17. EXEMPLARS Hispanic Traditions Maternity w Complementary/Alternative Medicine Jehovah’s Witnesses Use of blood products Traditional Islamic Ritual dying patient Spirituality Spiritual distress Exemplars to include Race, Gender, Sexual Orientation, Age, Education, Abilities & Life Experiences

18. APPLICATION OF DIVERSITY IN THE CONTEXT OF NURSING AND HEALTH CARE

19. Health Care Disparities Collaborative Learning In your learning group, discuss the term health care disparities. What does this term mean? How is it linked to the concept of diversity? How can this be minimized by nurses?

20. Competence: Diversity in Nursing Expected component of professional nursing practice Requires Underlying acceptance of patient’s health beliefs Requires adapting care to meet unique needs and perspectives of individuals

21. BIAS All people are biased Examples include: Stereotyping people Tendency to act, think, or feel in a certain way toward other people. How do biases affect nursing care?

22. Assessment (Norm/Deviations & implications for concept) Comprehensive History (focused assessment questions and review of symptoms) Physical & Psychological (Clinical Manifestations) Diagnostic Test (s)

23. Clinical Management Nursing Interventions Learn and use a few phrases of greeting in the patient’s native language Use an interpreter; share this with the patient and stop periodically When speaking or listening, watch the patient, not the interpreter

24. Clinical Management Nursing Interventions Repeat important information more than once Always give the reason or purpose for a treatment or prescription Make sure the patient understands by having them explain it themselves Teach patients their options and let them decide

25. Collaborative Interventions (Inter- professional partnerships) Massage Heat Treatment Sweat bath Yucca Root Accupuncture Chiropractic Medicine Complementary and alternative medicine

26. Conveyed Acceptance and Nonacceptance Verbal and nonverbal communication demonstrates acceptance or nonacceptance of others What are examples of verbal and nonverbal communication by a nurse that could demonstrate acceptance and nonacceptance toward a patient who has not followed a prescribed treatment plan?

27. Interrelated Concepts Collaborative Learning In your learning group, discuss the concepts interrelated to diversity. What is the link to the concept? What additional concepts can you think of that link to diversity? Interrelated ConceptLink to Diversity Communication Family Dynamics Coping

28. REFERENCES Carpentino, L.J. Nursing Diagnosis: Application to Clinical Practice. 12 th Ed. Lippincott. Spector, M. Cultural Diversity in Health and Illness. New York: Appleton, Century, & Crofts, 1979 Ignatavicius, D.D., Workman, M.L. Medical Surgical Nursing: Patient-Centered Collaborative Care. 7 th Ed. St. Louis: Mosby Elsevier, 2013. Giddens, J.F. Concepts for Nursing Practice. 1 st Ed. St. Louis: Mosby Elsevier, 2013.