1. Chapter 5 Cultural Diversity
Jennifer Dremann RN MSN

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. 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

10. 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.

11. 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.

12. 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

13. 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

14. 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.

15. Identifying Prejudices: the First Step to Eliminating Them

16. 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.

17. 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)

18. 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.

19. 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

20. 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

21. 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

22. 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

23. 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.