1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Nursing Leadership & Management Patricia Kelly-Heidenthal 0-7668-2508-6

2. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 24 Cultural Diversity and Spirituality

3. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company3 Objectives  Upon completion of this chapter, the reader should be able to: Define culture. Discuss the U.S. population composition. Identify key cultural theorists. Discuss how culturally competent care can best be delivered. Integrate understanding and respect for spiritual and religious beliefs of different peoples.

4. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company4 Definitions  Culture refers to the behaviors, norms, belief sets, values, and folkways of a specific group.  Ethnicity is a component of cultural identity; people often describe themselves as being from a certain group of society, perhaps within a larger community.  Ethnocentrism is the belief that one’s own culture or ethnic group is better than all other groups.

5. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company5 Definitions  Values are those standards with which a society is maintained.  Acculturation is the process by which one adjusts and adapts to another culture by altering one’s own cultural behaviors.

6. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company6 Defining U.S. Diversity  The United States is a nation of immigrants.  America’s ethnic profile is changing.  Hispanic, African-American, and Asian populations are growing.  Health care provider racial and ethnic diversity: Studies show that the racial and ethnic composition of the health care industry does not reflect the national trend; however, the recent nursing shortage has resulted in an increase of foreign-born nurses in the United States.

7. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company7 Diversity Awareness  Increase in diversity awareness began in the 1980s.  The six primary diversity characteristics include: Age Race Ethnicity/culture Sexual/affectional orientation Gender Physical abilities

8. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company8 Nursing Organizations  The AACN defines the study of cultural competency and cultural awareness as one of the core competencies required of a baccalaureate nursing graduate in the 21st century.  The Expert Panel on Culturally Competent Nursing Care was convened in 1992 to develop and present recommendations for the care of the culturally diverse patient.

9. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company9 PEW Recommendations  Ensure that cultural sensitivity awareness be an active part of the training of all health professionals.  Place concerted effort on the recruitment of diverse students and providers.  Providers must develop the ability to administer culturally sensitive care to a diverse society

10. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company10 Cultural Nursing Theories  Cultural competence is care that is sensitive to issues related to culture, race, gender, and sexual orientation.  Ethnosensitive care is the ability to appreciate values and behaviors within the context of specific cultural norms and to apply this ability to practice.  Transcultural nursing is concerned with providing care that matches the patient’s expectations and cultural belief set.

11. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company11 Cultural Nursing Models  Sunrise model  Transcultural assessment model  Campinha-Bacote model  Spector

12. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company12 Providing Care in a Culturally Competent Manner  Understanding the health care provider’s culture  Understanding the patient’s culture

13. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company13 Creating an Environment of Acceptance  Actively seek an understanding of one another’s cultures.  Understand nonverbal communication patterns.  Understand meanings behind communications.  Know how to respond in a culturally competent manner.

14. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company14 Creating an Environment of Acceptance  Do not label one culture as preferable to another, or treat one culture as the majority culture.  Develop an environment in which people can ask questions and receive accurate answers.  Have work groups or teams composed of people with differing cultural backgrounds and abilities.  Confront, acknowledge, and work with prejudices and prejudgments so that effective communication can occur.  Model respectful behavior.

15. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company15 Managing a Culturally Diverse Team  When problem-solving, include a variety of team members from different cultural backgrounds, experiences, and abilities.  Understand how individual team members respond to conflict, and what their expectations are for the final result.  Focus on the cultural differences and build an appreciation for what everyone can contribute.  Do not assume all members of a certain group respond in the same manner.

16. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company16 Managing a Culturally Diverse Team  Value everyone’s differences and recognize their similarities.  Pay close attention to both verbal and nonverbal communications for cultural cues.  Ask for clarification. Do not assume.  Alter your assumptions about others based on their membership in certain groups.  Assist those who are not of the majority cultural group to be successful. Include the informal networking and the organization’s culture as starting points.

17. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company17 Spirituality and Nursing Care  Nurses are taught to look at patients holistically, and to include psychological and spiritual factors in the healing process.  People who are sick will often seek comfort from religious or spiritual beliefs.

18. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company18 Spirituality and Religion: Definitions  Spirituality refers to a belief in a higher power, an awareness of life and its meaning, the centering of a person with purpose in life. It involves relationships with a higher being, with self, and with world around the individual.  Religion is an organized and public belief system of worship and practices that generally have a focus of a god or supernatural power. It generally offers an arrangement of symbols and rituals that are meaningful and understood by followers.

19. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company19 Spiritual Distress  Spiritual distress includes questioning the purpose of life and its meaning, refusing to participate in one’s usual religious practices, and seeking unusual assistance rather than the usual spiritual or religious support.

20. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company20 Spiritual Assessment  There is increasing interest in the role that spirituality and religion play in a person’s physical health and well-being.  An integral part of a patient’s initial assessment should include data about the patient’s spiritual and religious beliefs.  Several tools exist for spiritual assessment.  Spiritual care needs to be individualized, with the patient given the opportunity to participate

21. Chapter 24Copyright © 2003 Delmar Learning, a Thomson Learning company21 Religious Beliefs Related to Health Care  What are health-related beliefs of these major religions? Buddhism Christianity Hinduism Judaism Islam Atheism