Chapter 5 Cultural Diversity Jennifer Dremann RN MSN

Introduction The U.S population is becoming bigger, older, more Hispanic and Asian, and less wedded to marriage and traditional families than in 1990 Cultural diversity-people of varying cultural background, racial and ethnic origin, religion, language, physical size, gender, sexual orientation, age, disability, socioeconomic status, occupational status, and geographical location

Culture Shared system of beliefs, values, and behavioral expectations Provides social structure for daily living Defines roles and interactions with others and in families and communities Apparent in the attitudes and institutions unique to the culture

Characteristics of Culture Helps shape behavior of specific group Learned by each new generation through formal and informal learning experiences Practices of a particular culture often arise because of the groups social and physical environment Cultural practices may evolve over time Cultural influences the way people of a group view themselves and behave in response to certain situations

Tell whether the following statement is true or false. Culture includes the beliefs, habits, likes and dislikes, and customs and rituals learned from one’s family. A. True B. False Answer: A. True. Rationale: Culture is defined as a shared system of beliefs, values, and behavioral expectations that provides social structure for daily living. It includes the beliefs, habits, likes and dislikes, and customs and rituals learned from one’s family

Subculture Large group of people who are members of a larger cultural group Members have certain ethnic, occupational, or physical characteristics not common to the larger culture. Nursing is a subculture of the larger health care field

Tell whether the following statement is true or false. The health care system is a culture of its own, with nursing being its largest subculture. A. True B. False Answer: A. True. Rationale: The health care system is a culture of its own, with nursing being its largest subculture.

Groups in Society Dominant group (usually largest group) Group has the most authority to control values and sanctions of society Minority group (smaller group) A physical or cultural characteristic identifies the people as different from dominant group.

Cultural Definitions Cultural assimilation (acculturation) Minorities living within a dominant group lose the characteristics that made them different. Values replaced by those of dominant culture Culture shock The feelings a person experiences when placed in a different culture May result in psychological discomfort or disturbances

C. Cultural assimilation D. Cultural shock Which of the following occurs when members of a minority group, living with a dominant group, begins to blend in and lose the characteristics that made them distinct? A. Cultural imposition B. Cultural conflict C. Cultural assimilation D. Cultural shock Answer: C. Cultural Assimilation Rationale: Cultural assimilation occurs when one’s values are replaced by the values of the dominant culture. Cultural imposition is the belief that everyone should conform to the majority belief system. Cultural conflict occurs when people become aware of cultural differences, feel threatened, and act negatively. Cultural shock refers to the feelings a person experiences when placed in a different culture.

Ethnicity Sense of identification with a collective cultural group Largely based on group’s common heritage One can belong to an ethnic group through birth or adoption of characteristics of that group. Groups share unique cultural and social beliefs and behavior patterns including dialect, religious practices, literature, folklore, music, food preferences. Largely develops through day-to-day life with family and friends within the community.

Race Typically based on specific characteristics Skin pigmentation, body stature, facial features, hair texture Five major categories per federal standards: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Factors Inhibiting Sensitivity to Diversity Stereotyping The assumption that all members of a culture or ethnic group act alike May be positive or negative Negative includes racism, ageism, and sexism Cultural imposition Belief that everyone should conform to the majority belief system Cultural blindness Ignores differences and proceeds as if they did not exist Culture conflict People become aware of differences and feel threatened. Response—ridiculing beliefs and traditions of others to make themselves feel more secure Ethnocentrism Belief that one’s ideas, beliefs, and practice are the best or superior, or are most preferred to those of others

Tell whether the following statement is true or false. Stereotyping occurs when people ignore differences in the cultures in which they live and proceed as if they do not exist. A. True B. False Answer: B. False Rationale: Cultural blindness occurs when people ignore differences in the cultures in which they live and proceed as if they do not exist.

Identifying Prejudices: the First Step to Eliminating Them

Which term describes what occurs when a nurse believes that one’s own ideas, beliefs, and practices are the best or superior to those of colleagues and patients? A. Cultural diversity B. Culture shock C. Stereotyping D. Ethnocentrism Answer: D. Ethnocentrism Rationale: Ethnocentrism is the belief that one’s ideas, beliefs, and practices are superior or preferred to those of others. Cultural diversity refers to the existence of diverse groups in society with varying cultural characteristics. Culture shock describes the feelings a person experiences when placed in a different culture. Stereotyping is the practice of assuming that all members of a cultural group act alike.

Cultural Influences on Health Care Physiologic variations-certain ethnic or racial groups more prone to certain illnesses Reactions to pain-some cultures allow open expression of pain and some do not Mental health-Chinese consider mental illness a stigma, Hispanic prefer to deal with the problems within the family Gender roles-some cultures have male dominance, some have female dominance (Caucasian, African American) Language and communication-different languages in different cultures Orientation to space and time-personal space different in different cultures Food and nutrition-food preferences and preparation methods culturally influenced Family support-different cultures have different family support Socioeconomic factors-income different in different cultures, poverty cultures have similar characteristics (unstable family structure)

Culturally Competent Nursing Care—Patient in Pain Recognize that each person holds various beliefs about pain and that pain is what the patient says it is. Respect the patient’s right to respond to pain in one’s own fashion. Never stereotype a patient’s responses to pain based on the patient’s culture. Be sensitive to nonverbal signals of discomfort, such as holding or applying pressure to the painful area or avoiding activities that intensify the pain.

The Culture of Poverty Feelings of despair, resignation, and fatalism Day-to-day attitude toward life; no hope for future Unemployment and need for financial or government aid Unstable family structure; possibly characterized by abusiveness and abandonment Decline in self-respect and retreat from community involvement

Culturally Competent Nursing Care Cultural competence includes these elements: Nurses should first be aware of their personal beliefs and prejudices Developing self-awareness Demonstrating knowledge and understanding of a patient’s culture Accepting and respecting cultural differences Not assuming that the health care provider’s beliefs and values are the same as the client’s Resisting judgmental attitudes such as “different is not as good” Being open to and comfortable with cultural encounters Accepting responsibility for one’s own cultural competency

Cultural Assessment Nurses need to understand the following: enhance their understanding of beliefs, values, traditions, practices of a culture Culturally defined, health related needs of individuals, families, and communities Culturally based belief systems of the etiology of illness and disease and those related to health and healing Attitudes toward seeking help from health care providers

Factors That Affect Culturally Diverse Interactions Cultural background of each participant Expectations and beliefs of each person about health care Cultural context of the encounter Degree of agreement between the sets of beliefs and values of the two persons Andrews & Boyle, 2008

Guidelines for Providing Culturally Competent Nursing Care Develop cultural self-awareness. Develop cultural knowledge. Accommodate cultural practices in health care. Respect culturally based family roles. Avoid mandating change. Seek cultural assistance.