Cultural Diversity
Mandatory Nursing Orientation Competency
Developed by: Staff Development Education
April 2009
Pledge to Diversity:
We believe that the differences among us enrich our human encounters and our lives.
Throughout the hospital, with this as our premise, we embrace:
The DIFFERENCES among us and the COMMONALITIES that bind us.
We do not merely tolerate diversity, we welcome it.
We are committed to be aware, knowledgeable, skillful, and competent in our encounters
with our culturally diverse patients and with each other.
Cultural Diversity:
Cultural diversity is embedded in the relationships we have with our patients, with our
co-workers, and with society.
Culture is an integrated system of learned beliefs, values, and customs common to a
particular group of people.
Culture Influences: (Refer to table of “Cultural & Religious Considerations”)
The ways individuals think about health
The ways in which they express pain
What they consider to be symptoms
How they seek and accept help and care
Who they consider to be healers
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Cultural Diversity in Nursing Practice:
Knowledge about cultures and their impact on interactions within health care is
essential for nurses, whether they are practicing in a clinical setting, education,
research or administration.
Knowledge and skills related to cultural diversity can strengthen and broaden
healthcare delivery systems.
Concepts of illness, wellness, and treatment modalities evolve from a cultural
perspective or world view.
Nurses Need to Understand!!!
(Refer to table of “Cultural & Religious Considerations”)
How cultural groups understand life processes
How cultural groups define health and illness
What cultural groups do to maintain wellness
What cultural groups believe to be the cause of illness
How healers cure and care for members of cultural groups
How the cultural background of the nurse influences the way in which care is
delivered.
Nurse Patient Encounters include the interaction of three Cultural systems:
The culture of the:
Nurse
Patient
Setting
Nurses in clinical practice must use their knowledge of cultural diversity to
develop and implement culturally sensitive care.
Cultural beliefs and practices are as integral to the nursing process as are physical
and psycho-social factors.
Pain (example of cultural influences):
Not all social or cultural groups respond to pain in exactly the same way.
How people perceive, experience and respond to pain is influenced by their social
and cultural background.
Whether and how people communicate their pain to health professionals and
others is also influenced by social and cultural background.
Pain relievers are often seen as incomplete and unsatisfying treatment.
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KEYPOINT: The following are basic considerations for a variety of cultures. It is
imperative to recognize that not all cultures or faiths will follow all parameters exactly
the same. When it comes to considerations of a patient’s beliefs and values, it is always
best to ask the patient. Do NOT ever assume.
Cultural and Religious
Considerations with Nursing Care
Culture/Religion Beliefs Considerations
Asian-American Male Dominated household Avoid conflict in groups or
Male children are highly direct confrontation
valued May eat or drink special
Elderly highly respected herbs
Health is viewed as a May use coining techniques
harmony between social and for removing illness
spiritual worlds
Baptist Some believe in the “laying Resist some procedures (e.g.
on of hands” abortion)
God functions through the May respond passively to
physician care
Some believe in
predestination
African-American Highly heterogeneous Caution in labeling patients;
(referred to as black, colored, may prefer a term to which
Negro, African-American dignity is attached
Considerable variations in Illness may be perceived as
health attitudes and behaviors punishment/sin, requiring use
Family is oriented around of prayer to remove illness
women Many seek medical care
Frequently strong religious because of the control of
orientation medicines, not because they
feel the physician is superior
in knowledge or training
Black Muslim Prohibit alcohol, pork, and Maintain personal habits of
foods traditional among cleanliness
African-Americans (e.g. corn Do not engage in certain
bread, collard greens) activities, such as sleeping
Faith healing unacceptable more than is necessary
Buddhist Some sects are strict Illness possibly due to
vegetarians Karmic causes
Alcohol and drug use are May show reluctance for
discouraged procedures on holy days
Cleanliness of great
importance
May request Buddhist priest
for counseling
Christian Scientist See illness and sin as errors May refuse emergency
of the mind that can be treatment until a reader is
altered by prayer consulted
Disease is a human mental Oppose human intervention
concept that can be dispelled with drugs or other therapies
by “spiritual truth” Unlikely to donate organs
for transplant
Church of Jesus Christ Prohibit tea, coffee, and Medical therapy not
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of Latter Day
Saints (Mormon) Anointments and “laying May wear undergarments
on of hands” that should not be removed if
Encourage sparing use of at all possible
meats Have strong family/religious
May ask for “elders” to network and support
participate in call
Eastern Orthodox Restrictions depend on Medical therapy not
specific sect prohibited
In general, rely on family Include family in care
support
Episcopal (Anglican) Some believe in spiritual Religious icons very
healing important
Greek Orthodox Health crisis handled by Believe every reasonable
ordained priests effort should be made to
Discourage autopsies preserve life
Hindu Many dietary restrictions: Accept most modern
no beef/veal, some are strict medical practices
vegetarians Multi deity-society, with
Illness/injury represent sins various rituals
committed in previous life
Islam(Muslim/Moslem) Prohibit all pork products May delay treatment before
Ritual washing before consulting family
prayer (3-5 times daily) May oppose autopsy
Strong family influence Family may not desire for
deceased to go to morgue
Family may require to stay
with body until placed in
funeral home
Jehovah’s Witness Eat nothing to which blood Oppose blood transfusions
has been added (can eat May be opposed to albumin,
drained animal flesh) globulin, factor, and vaccines
Autopsy approved if
required by law
Judaism Numerous dietary kosher Illness is grounds for
laws violating dietary laws
May allow only meat from May resist some procedures
animals that are vegetable during Sabbath (Saturday)
eaters, cloven hoofed, chew Oppose all forms of
their cud, and are ritually mutilation, including
slaughtered, or fish with autopsies, amputations,
scales and fins donation of body parts
Lutheran Anointments important Medical therapy not
prohibited
Methodist Communion important Encourage donation of body
(parts)
Mexican American Highly variable population Seeking Medical help is
(rural, villager, agricultural usually at the expense of pride
laborer, low income resident, and dignity
urban lower class) Solicit opinions of other
Close-knit kinship; usually family members with medical
turns to family first for needs information or teaching
Health is viewed as Many are Roman catholic,
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May shave children’s heads
Male-dominated household to treat respiratory illness
Middle Eastern (Arab- Male dominated culture Caution in involving wife in
American) Usually Arabic language discussion without the
and Islamic religious husband present
preference Females commonly request
Tend to give little female physician or RN to
information about self or preserve modesty during
family to strangers specific procedures
Females may or may not Usually do not seek advice,
wear hijab (head dress) but feel help should be offered
Certain times of year without requesting it
require fasting from sunrise Western medicine is usually
to sunset; with medical highly valued for its cure;
conditions and pregnancy personal care is preferred
exempt from a family member, not
Islamic religious leader is staff
known as Imam Visiting during illness is a
social obligation
Some questions may be
perceived as too personal
Native American Each nation or tribe has its Health beliefs are usually a
(American Indian) own language, religion and combination of Western
belief system medicine and traditional
Family usually includes religious practices
extended family of several Include family members in
households care
Other individuals, through Important to explain how to
a religious ceremony, can give the treatment (e.g.,
become the same as parents medication) and why the
in the family network prescribed regiment (e.g., 10
Respect for elderly, days of antibiotics) so as not
grandparents are family to disrupt “harmony”)
leaders Children are extremely
Usually health is viewed as autonomous; parents may not
harmony between social and be aware of child’s recent
spiritual worlds behaviors
Pentecostal (Assembly Abstain from alcohol, Medical therapy not
of God, Four eating blood, strangled prohibited
Square) animals, or anything to which
blood has been added; some
do not eat pork
Illness may be perceived as
divine punishment
Orthodox Presbyterian Believe science should be Medical therapy not
used to relieve suffering prohibited
Pastor or elder should be
called for ill person
Roman Catholic Anointments important Religious articles important
Church does not approve of Amputated limb for burial;
contraception or abortion transplants accepted
Russian Orthodox Believe in divine healing, Cross necklace is important;
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Opposed to autopsy,
embalming and cremation
Unitarian Universalist Believe God helps those Some prefer clergy not to
who help themselves visit in hospital
Zoroastrianism At time of death, there are Tend to worship fire
customs that must be May observe cleansing
observed to cleanse the body: rituals throughout the day
the body is to be washed and
placed in a shroud.
Assess the Needs of the Patient:
Determine the level of fluency in English.
Ask how the patient prefers to be addressed.
Be aware of personal space & eye contact.
Avoid body language that may be offensive.
Speak directly to the patient, even if an interpreter is present.
Choose a speech rate and style that promotes understanding and demonstrates
respect for the patient.
Use open-ended questions.
Determine the patient’s reading ability before using written materials for teaching.
Many Hand Gestures Mean Different Things in Different Cultures:
OK sign: zero, threat, never used.
Peace sign: Victory, peace, sexual insult, horns.
The fingers crossed: protection, OK, break friendship, swear oath.
The thumbs up: OK, one, sexual insult, hitch hiker, directional.
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We could learn a lot
From crayons:
Some are sharp,
Some are pretty,
Some are dull,
Some have weird names,
And all are different colors…
But they all have to learn
To live in the same box
References
Berry-Caban, C. S., & Crespo, H. (2008). Cultural competency as a skill for health care
providers. Hispanic Heath care International, 6(3), 115-121.
Bougere, M. H. (2008). Culture, grief and bereavement: application for clinical practice.
Minority Nurse, (Winter), 26-29.
Garret, P. W., Dickson, H. G., Whelan, A. K., & Roberto-Forero. (2008). What do non-
English-speaking patients value in acute care? Cultural competency from the
patient’s perspective: a qualitative study. Ethnicity & Health, 13(5), 479-496.
Glazener, L. K. (2008). Cultural diversity. AAOHN Journal, 56(10), 440.
Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient centeredness, cultural
competence and healthcare quality. Journal of the National medical Association,
100(11), 1275-1285.
Seeleman, C. Suurmond, J., & Stronks, K. (2009). Cultural competence: a conceptual
framework for teaching and learning. Medical Education, 43(3), 229-237.
Webb, R. (2008). Culturally appropriate care: respecting differences among ethnic
groups. American Journal of Nursing, 108(9), supp. 30.
Wright, S. M. (2008). Education news. Cultural competency training in nurse anesthesia
education. AANA Journal, 76(6), 421-424.
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