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

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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.
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Culture is
learned and taught
shared
social in nature
dynamic, adaptive, and ever-changing
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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.
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5. 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.
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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.
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7. 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.
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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
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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).
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Cultural assimilation occurs when individuals from a minority group are absorbed by the dominant culture and take on the characteristics of the dominant culture.
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11. 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.
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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).
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Organizing Phenomena
Communication
Space
Orientation to time
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Social organization
Family
Nuclear
Extended
Attenuated
Incipient
Blended
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Vulnerable populations
The poor
The homeless
Migrant workers
Abused individuals
The elderly
Pregnant adolescents
Individuals with STDs
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Gender
Lifestyle
Religion
Environmental control
Biological variations
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17. 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.
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18. 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.
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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.
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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.
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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.
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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.
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23. 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
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24. Cultural Competence and the Nursing Process
Assessment
Cultural Assessment Factors
Client’s ethnic heritage
Family role and function
Religious practices
Food preferences
Native language
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Social networks
Educational experiences (both formal and informal)
Family patterns of health care
Health care beliefs
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Diagnosis
Some diagnoses may be culturally biased
Noncompliance
Impaired verbal communication
Impaired social interaction
Deficient knowledge
Disturbed thought processes
Powerlessness
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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
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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
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Implementation
Three major nursing interventions
Self-awareness
Use of a nonjudgmental approach
Client education
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Evaluation
Affirm client strengths and potential for growth
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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.
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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.
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References
Campinha-Bacote, J. (1999).  A Model and Instrument for Measuring Cultural Competence in Health Care.  Journal of Nursing Education, 38(5),
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