Download Transcultural Communication Barriers Ethnocentrism

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HEALTHCARE CORE CURRICULUM
RESPECTING CLIENT & STAFF
DIVERSITY
RESPECT & DIVERSITY IN THE WORKPLACE
Dede Carr, BS, LDA
Karen Neu, MSN, CNE, CNP
U.S. Department of Labor Grant
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
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Respect & Diversity in the Workplace
Competencies 3 and 4:
 Explore personal responsibility as a healthcare
employee to treat each person as an individual.
 Discuss the appropriate workplace expectations
to interact with team members and care for
clients/individuals form diverse cultures,
genders, age groups and/or sexualities.
Respect & Diversity in the Workplace
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
In this lesson we will explore the role of cultures
and subcultures in the workplace, the healthcare
workers responsibilities in providing transcultural
(across cultures) care. The goal of transcultural
care is culturally congruent care or care that fits
the person’s valued life patterns and set of
meanings. Patterns & meanings are generated from
people themselves, rather than predetermined
criteria.
(Potter & Perry, p. 108)
Respect & Diversity in the Workplace
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

Culturally congruent care is sometimes different
from the values & meanings of the professional health
care system. Example, the healthcare workers’ values
& meanings may be different than the hospital’s,
nursing home’s , and clinical office’s.
It is important for healthcare workers to assume the
role of learners and partner with clients & their
families in defining characteristics of meaningful &
beneficial care by discovering the clients’ cultural
care values, meanings, beliefs, & practices as they
relate to nursing & healthcare. (Potter & Perry, p. 108)
Culturally Competent Care
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Culturally competent care is the ability of a
healthcare worker to bridge cultural gaps in caring,
work with cultural differences, & enable clients and
families to achieve meaningful & supportive caring.
 Cultural competence is the synthesis of three
distinct levels: individual, organizational, and
societal.
 Cultural competence is a process of development
of five interlocking components: cultural
awareness, knowledge, skill, encounters, & desire.
(Potter & Perry, p. 108)
Culturally Competent Care
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


Cultural awareness is an in-depth self-examination
of one’s own background, recognizing biases &
prejudices & assumptions about other people.
Cultural knowledge is obtaining sufficient
comparative knowledge of diverse groups, including
their indigenous values, health beliefs, care
practices, worldwide view, & bio-cultural ecology.
Cultural skills include assessment of social, cultural,
& biophysical factors influencing treatment and care
of clients.
(Potter & Perry, pp. 108-109)
Culturally Competent Care
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


Cultural encounters involve the engagement in cross
cultural interactions that provide learning of other
cultures & opportunities for effective intercultural
communication development.
Cultural desire is the motivation and commitment to
caring that moves an individual to learn from others,
accept the role as learner, & be open and accepting of
cultural differences, and build upon cultural
similarities.
Cultural competence is the process of acquiring
specific knowledge, skills, & attitudes that ensure the
delivery of culturally competent care. (Potter & Perry,
pp. 108-109)
Cultural Self-Awareness
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

Through the activities & from the power point
lecture “Personal Belief System,”
you explored the components, elements, and
types of a belief system as well as the
development of a belief system and completed a
personal self-assessment of your personal beliefs
and values.
This was part of the first step in providing
culturally competent care (cultural selfawareness).
Cultural Knowledge
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Culture and subcultures, the process of adjustment
& adaptation to a dominant & new culture, and
information about some specific cultural groups
were explored in “Cultural Belief System.”
“Cultural Belief System” provided you with an
opportunity to increase your knowledge about
some cultural groups which is the second step in
becoming culturally competent.
The remainder of developing your abilities of
culturally competent care will continue even as
you go into healthcare practice.
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Health Care Core Curriculum
Transcultural
Communication
Barriers
Transcultural Communication Barriers
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Misunderstandings between people and their cultures
occur for many reasons.
The barriers to transcultural communication that
will be addressed in the next few slides are:
Lack of Knowledge
Fear, Dislike, & Distrust
Racism
Bias & Ethnocentrism
Stereotyping
Ritualistic Behavior
Language Barriers
Differences in Perceptions & Expectations
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Transcultural Communication Barriers
Lack of Knowledge
Lack of Knowledge is the failure to understand
cultural differences in values, behaviors, &
communication styles, a common barrier for
individuals working in transcultural settings.
 Unless a person is knowledgeable in many areas
of transcultural communication, they risk
misinterpreting a person’s attempt to
communicate. As a result in the healthcare arena,
this may cause a patient to receive less than
proper care. (Juliar, p. 343-344)
Transcultural Communication Barriers
Lack of Knowledge
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
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
Lack of Knowledge
An example of lack of knowledge: Japanese patients
might react with silent obedience to your requests,
white middle-class patients might wish to discuss
their nursing care with you, Italian patients might
dramatically express their discomfort, while an inner
city youth might loudly demand your attention.
Health care workers who have not learned about
which behaviors are acceptable in different cultures
may attribute a client’s behavior (i.e. silence,
withdrawal) to the wrong reason or cause, which can
result in the wrong assessment & interventions.
(Juliar, p. 343-344)
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Transcultural Communication Barriers
Fear, Dislike, Distrust
Emotional Barriers: Fear, Dislike, Distrust
The emotions of dislike, fear, & distrust are common
when people from differing cultures come together.
There are seven stages of adjustment that individuals
progress through during their initial encounters with
different cultural people that they do not know or
understand.
Seven Stages of Adjustment
1.
2.
3.
4.
Fear
Dislike
Distrust
Acceptance
5. Respect
6. Trust
7. Like
Transcultural Communication Barriers
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Stages of Adjustment
#1-Fear is a common barrier to communication.
When first meeting a culturally different person,
many feel threatened, perceive the other as
different & dangerous.
Getting to know a person, & his/her culture will
often times dissipate the fear & turn it into dislike.
#2-Dislike is a milder emotion. Members of groups
tend to dislike people who behave or
communicate differently from what they consider
the “norm” of the culture or group.
Transcultural Communication Barriers
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Stages of Adjustment
#3-Distrust is another barrier to transcultural
communication. Distrust develops because people from
different cultural backgrounds are often apprehensive
of each other’s actions & motives.


“For example, a white nurse who does not realize the
importance of family in Vietnam, may be suspicious of the
new Vietnamese nurse who allows family members to
participate in a patient’s care instead of providing all of the
care herself.”
Unless there is pressure to change attitudes, some
people never progress beyond fear, dislike, & distrust
to the next stage of acceptance.
(Juliar, p. 345)
Transcultural Communication Barriers
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Stages of Adjustment
 #4-Acceptance of each other rather than
resentment of each other occurs if two different
cultural people share enough good experiences
over a period of time.
Transcultural Communication Barriers
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Stages of Adjustment
#5-Respect: If individuals from diverse cultures are
open-minded, they will allow themselves to see &
admire each other’s qualities.
 For
example, a Japanese physical therapist who had
been trained to defer to authority might admire the
white American physical therapist who challenges
authority.

Respect is fostered through acceptance &
admiration.
(Juliar, p. 345)
Transcultural Communication Barriers
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Stages of Adjustment
#6-Trust: Once diverse cultural people spend quality
time together, they usually begin to trust each other.

For example, a white American medical assistant will
eventually trust the foreign-born nursing assistant who
consistently provides good client care & finishes
assignments on time. Once people trust, they genuinely
learn to like each other.
#7-Like: Many things must be shared for people to like
each other. In order to reach this stage, diverse
cultural individuals must be able to focus on the
human qualities that bind people together rather than
differences which separate people. (Juliar, p. 346)
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Transcultural Communication Barriers
Racism
Racism in the American health care delivery system is a
transcultural communication barrier.
Three types of racism:
(Barbee, as cited in Juliar, p. 346)

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Individual racism-discrimination of individuals because of their
visible biological characteristics, such as skin color or eyelid folds,
Cultural racism-Individuals or institutions claim their heritage is
superior to other individuals or institutions (WWII Nazi’s claim of
superiority to the Jewish heritage so they were justified in
persecuting the Jewish people)
Institutional racism-(universities, businesses, hospitals, medical
offices) manipulate or tolerate policies that unfairly restrict
opportunities of certain races, groups, or cultures. (At one time black
nurses were not allowed to join the American Nurses’ Association
(ANA) preventing them from having a voice in the regulation of
nursing practice & policies.)
(Juliar, pp. 346-347)
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Transcultural Communication Barriers
Biases & Ethnocentrism
Over all, people have a tendency to be biased
towards their own culture & it’s values.
People feel that their values are right while the
values within other cultures are wrong or not as
good.
It is then surprising to many people when they
discover that what they value within their own
culture is often looked upon with skepticism or
suspicion from individuals within another culture.
Funny how these folks from another culture are then
equally biased.
(Juliar, p. 347)
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
Transcultural Communication Barriers
Ethnocentrism
Ethnocentrism is the belief that one’s own culture
or way of life is better than that of others.
(Berman et al., p. 315)

Simultaneous dual ethnocentrism is a component
of every health care professional-client relationship.
Healthcare professional are assessing, judging,
evaluating, & reacting to clients on the basis of their own
cultural values, medico-centric points of view, &
expectations.
 Simultaneously, clients are using their cultural values to
judge & evaluate healthcare professional & the Western
healthcare system.
(Juliar, p. 348)

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Transcultural Communication Barriers
Simultaneous Dual Ethnocentrism

“The concept of simultaneous dual
ethnocentrism makes healthcare
professionals keenly aware that they, their
patients, their colleagues, and everyone else
in the clinical setting are operating under
the influence of personal cultural rules,
some of which are shared & some of which
are not.”
(Juliar, p. 348)
Transcultural Communication Barriers
Ethnocentrism
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



Attitudes towards Western medicine are one of the
biggest barriers between clients & healthcare
workers.
Since most healthcare professionals have been
educated in Western medicine, many believe the
biomedical health belief system is the best approach
(even the only approach) to client care & treatments.
Healthcare professionals view other health belief
systems with suspicion or contempt & refuse to
acknowledge that another system might have some
merit.
This ethnocentric attitude can alienate clients from
other cultures who fully believe their therapeutic
interventions have merit. (Juliar, p. 348)
Transcultural Communication Barriers
Biases, Ethnocentrism, Prejudices
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


Ethnocentrism is the cause of biases & prejudices that
associate with negative permanent characteristics with
people who are different from the valued group.
When a person acts on these prejudices,
discrimination occurs.
(Potter & Perry, p. 109)
“Discrimination, the differential treatment of
individuals or groups based on categories, such as race,
ethnicity, gender, social class, or exceptionality, occurs
when a person acts on prejudice & denies other
persons one or more of their fundamental rights.”
(Berman et al., p. 315)
Transcultural Communication Barriers
Prejudice
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
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Prejudice is a negative belief or preference that is
generalized about a group & leads to “prejudgment.”
Prejudice occurs because either the person making
the judgment does not understand the particular
person or his/her heritage, or the person making the
judgment generalizes an experience with one
individual from a culture to all members of that group.
It may also be referred to as racism.
A related concept is xenophobia—the fear or dislike
of people different from one’s self.
(Berman et al., p. 315)
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
Transcultural Communication Barriers
Stereotyping
Stereotyping is assuming that all members of a culture
or ethnic group are alike.


Stereotyping may be based on generalizations founded
in research, or it may be unrelated to reality.


For example, a nurse may assume that all Italians verbally
express pain loudly or that all Chinese people like rice.
For example, research indicates that most Italians are likely
to express pain verbally; however a specific Italian client may
not do so.
Stereotyping that is unrelated to reality is frequently an
outcome of racism or discrimination. (Berman et al., p. 315)
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Transcultural Communication Barriers
Cultural Stereotype
The ancients first formed cultural stereotype when they
came upon a new race or tribe. They quickly had to decide
if the people were safe to encounter. Since there wasn’t
much time to figure if the group was safe or not,
judgments where made towards the race or tribe as a
whole, and not on an individual basis.
These assumptions, or stereotypes, were then passed down
from generation to generation & still impact our lives
today. Books & films have supported the aspect of
cultural stereotype.
For example, they depict the black man who is a great
basketball player or the black woman who is a servant for
a white woman.
(Eagle Feather Research Institute)
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Transcultural Communication Barriers
Assumptions of Stereotyping
All people within a culture believe in the same values
All people within a culture (racial & ethnic group) are alike.
Ex. All Eskimos are reserved, deliberate & noncommittal. Some
or maybe even the majority may be reserved, deliberate, &
noncommittal, but it is a cultural stereotype to state that all
Eskimos have these traits.
(Juliar, pp. 349-350)
All people within a culture look, talk, and act alike.


Stereotyping is particularly destructive when negative traits or
characteristics are imposed on all members of the cultural group.
Ex. All Native Americans are at risk for alcoholism. (Juliar, p. 350)
When assumptions & stereotypes influence our attitudes, we
may find that making a fair judgment about someone or
something is difficult. This influence on judgment is called a
"bias.”
(Juliar)
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Transcultural Communication Barriers
Assumptions about Stereotyping
There are many stereotypes about Americans.
Americans tend to be loud & boisterous is one
stereotype.
 If
you have ever been to a Vikings game, think of how
loud the stadium can get.
 How about when visiting a nice restaurant? It, too, can
be quite loud. Many people that you meet outside of the
American culture will tend to be quiet & polite.
Americans tend to be quite informal in their dress and
yet whenever there is a religious event to attend, i.e. a
wedding or funeral, they know how to dress up.
(Kantrowitz)
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Transcultural Communication Barriers
Assumptions about Stereotyping
Other stereotypes, or assumptions, that people have
about Americans are that Americans are:
Boastful and arrogant.
Insensitive.
Racist.
Disrespectful of Authority
Insensitive
Rich and wealthy
Drunkard
Lazy
Rude and immature
Think they know
everything.
Uninformed about politics
Snobbish
Thinks every country
should imitate the US
Extravagant and wasteful
Stingy
(Kantrowitz)
Transcultural Communication Barriers
Cultural Blind Spot Syndrome
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

Cultural blind spot syndrome is a belief that “just because
the client looks & behaves much the way you do, you
assume that there are no cultural differences or potential
barriers to care.” (Buchwald, as cited in Juliar, p. 350)
For example, white American nurses may assume that
white American patients believe in the same cultural values
as they do. This assumption is false.

White Americans come from many different ethnocultural
backgrounds—Irish, Russian, German, Jewish, & English to name
but a few. In addition, white nurses & patients may also belong to
different subcultures that have different values.

For example, a white male patient of Italian descent who is gay will
probably have somewhat different values than a white IrishAmerican nurse who is married with 3 children.
(Juliar, p. 350)
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Transcultural Communication Barriers
Ritualistic Behavior
Ritual is a set procedure for performing a task. There
are many healthcare rituals, such as performing
safety checks when preparing & administering
medications.
 However some rituals, such as always excluding
extended family from the bedside during
treatments are unnecessary & may upset the
clients & their families. Unfortunately, some
healthcare workers become deeply irritated &
disturbed when these rituals are challenged.
(Juliar, p. 351)
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Transcultural Communication Barriers
Language Barriers
Language Barriers
Because language is the tool to used to
communicate with one another, language
barriers present many obstacles to transcultural
communication.
These barriers include:
 Foreign
languages
 Different dialects
 “Street talk” and idioms
(Juliar, p. 351)
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Transcultural Communication Barriers
Foreign Languages and Dialects
Foreign Languages and Dialects
Some facts:
 Over
6,000 different languages & dialects are
spoken today
 The number of people in America who speak a
language other than English is growing
 10% of the population speak more than just English
To communicate effectively with clients you may need
an interpreter
(Juliar, p. 351)
Transcultural Communication Barriers
Definitions of Dialect
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Definitions of Dialect

“A distinctive way a language is spoken or written in a given
locality or by a group of individuals.”
(Webster’s Dictionary as cited in Juliar, p. 352)
“A regional or social variety of a language distinguished by
pronunciation, grammar, or vocabulary, especially a variety of
speech differing from the standard literary language or speech
pattern of the culture in which it exists.” (Dictionary .com)
 “The language peculiar to the members of a group, especially
in an occupation; jargon” (thefreedictionary.com)
Regionalism is a word, phrase, pronunciation, or custom
peculiar to a given region; example-three major Chinese
dialects: Mandarin, Cantonese, & Slanghainese (Juliar, p. 352)

Transcultural Communication Barriers
Street Talk, Slang, & Idioms
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Street Talk, Slang, Idioms & Medical Terminology
 Street talk, slang, & idioms are expressions that are
used by people that can sometimes create a language
barrier.


For example, if you are from a white middle class family, you
may not understand that when an African-American person
uses the word “hood” they are referring to their
neighborhood or that the “Amen Corner” refers to the
corner in the church where the older women of the church
sit. (Juliar, p. 353)
Language barriers may occur when clients &
healthcare workers use different terminology when
discussing health & illness.
(Juliar, p. 362)
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



Transcultural Communication Barriers
Gender-Communication Issues
There are more males entering the previously predominant
female occupation of nursing and healthcare. This brings
another subculture & the possibilities for stereotyping,
biases, and prejudices.
Even though women and men are more similar than
different, some communication patterns are identifiable.
The key to working effectively with the opposite gender is
to recognize communication differences & then realize
enormous contributions each style brings to the
workplace.
While men can be more direct and get right to the point,
women often bring valuable interpersonal skills to the
workplace. Both men & women are effective problemsolvers. Men usually think of one thing at a time & women
tend to consider several things at once. (Juliar, p. 390)
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


Transcultural Communication Barriers
Conflicting Perceptions & Expectations
When people from different cultures try to communicate,
their best efforts may be thwarted by misunderstandings or
even serious conflicts.
This happens in healthcare when people have different
perceptions or expectations & consequently misinterpret
each other’s messages.
When there are cultural, behavioral, & language differences
between healthcare workers, client’s & their families, there
is greater probability that clients will misunderstand care
instructions. To prevent conflicts & misunderstandings,
make sure that the message you send the client is the same
message that the client receives. When there is a language
barrier, you will need to work closely with an interpreter.
(Juliar, pp. 354-355)
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Transcultural Communication Barriers
Perceptions & Expectations Conflict
Example: Cultural differences frequently occur around food & drink. For
example, a post surgery Vietnamese client is constantly attended by her
family as culture dictates. You want the family not to give her any food or
drink. As the family only speaks Vietnamese, you motion that the client
should not drink & you explain via an interpreter that the client should not
drink.
When you return from a lunch break you find your client vomiting and you
observe a bowl of soup on her table. Obviously the family ignored your
instructions & fed the client soup. If you angrily say, I told you not to give
her anything to drink!” your reaction would be that of many health care
workers.
Later you learn from the interpreter that the family knew they should not give
the client water, but they assumed that broth would be beneficial as they
believe the sick need to drink broth for energy.
Your intended message (do not drink anything) was not understood by the
client’s family, & you failed to grasp the family’s perception of your
instructions (broth is not water and therefore all right to drink). As a result,
the client’s family gave her broth and you became frustrated.
(Juliar, p. 354)
Transcultural Communication Barriers
Perceptions & Expectations
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Conflict-Perceptions about health promotion &
disease prevention
 Example: Hispanics [culture based on honor & pride-may
be taught from childhood to bravely accept illness & pain as an
inevitable part of human existence]

Traditional Hispanics may see no reason for
mammograms or vaccinations (fatalist beliefs). “We’ve
been taught that you live, you suffer, you die. That’s the
way life is. The idea has never been presented to take
care of your health, if you go to the doctor early you won’t
have to suffer pain or discomfort.” (Juliar, p. 355)
Cultural Prejudice
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

As you have learned, interactions with people
from a cultural other than your own have many
different layers to it.
Cultural prejudice is not uncommon & yet
because the country we live in is such a large
melting pot, it is critical to be culturally aware &
sensitive to those around us & to those people
we care for in the healthcare field.
Cultural Prejudices
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As we strive to treat each person as an individual, it
is important to be aware of our own cultural
prejudices. These cultural prejudices can take on
a life of their own which can in turn be damaging
to many of the people around us.
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Health Care Core Curriculum
Overcoming
Transcultural
Communication Barriers
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Overcoming Transcultural
Communication Barriers
Now that you learned about the stumbling blocks to
transcultural communication:
 Lack of knowledge;
 Fear, dislike, & distrust
 Racism
 Bias & ethnocentrism
 Stereotyping;
 Ritualistic behavior
 Language barriers
 Differences in perceptions & expectations
What can YOU do as a healthcare worker to
overcome these transcultural barriers?
Overcoming Knowledge Deficits
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Overcoming knowledge deficits: There are several ways
healthcare workers can learn more about specific
cultures:
 Attend classes & seminars that provide valuable
information about transcultural communication.
 Many textbooks that describe the history, beliefs, &
practices of major American cultural groups.
 Read novels, short stories, biographies,
autobiographies, essays, & poems written by members
of the cultural group.
 Documentaries, films, & TV programs that portray
different cultures, foreign films, & films written,
produced & directed by these groups (Juliar, pp. 358-359)
Controlling Bias,
Ethnocentrism, & Stereotyping
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
It’s impossible to completely overcome personal biases
when caring for clients from different cultures, but
becoming aware (bringing biases to one’s
consciousness) & then controlling these biases when
working with clients is the best approach (Charonko, 1992,
as cited in Juliar, p. 359)


Acknowledge client’s traditional healthcare beliefs &
permit the client to follow those beliefs, provided they
do not interfere with the client’s medication &
treatment program
To acknowledge that clients have the right to their own
healthcare beliefs is a major step toward overcoming
personal & professional biases & ethnocentrism.
(Juliar, p. 360)
Overcome Terminology Differences
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
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

To overcome terminology differences listen to terms
that the client uses & use those terms when caring for
the client. Avoid using abbreviations, such as TPR or
MI without explaining what they mean to the client.
Clients who have difficulty with English may be
particularly confused by medical terms.
To provide optimal care take the time to explain
medical terminology, directions, & procedures to your
clients in terms they understand.
Encourage clients to ask questions & express feelings
& concerns.
(Juliar, pp. 362-365)
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Overcome Barriers to
Transcultural Communication
To reduce incompatibilities in transcultural
communication:



Strive to understand the client’s perceptions & expectations of
you & the biomedical system
Take the time to elicit information about the client’s healthcare
belief system
In simple terms, carefully explain your role in the assessment
process & why it is vital that the client answer your questions
(Juliar, p. 368)
Overcome Barriers to
Transcultural Communication
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To reduce incompatibilities in transcultural
communication:



Welcome questions from your client & answer them
as clearly & simply as possible
Allow the client’s traditional healing practices
provided that they do not interfere with the
prescribed treatment regimen
If the client’s health care practices do conflict with
the biomedical practices, communicate with your
client until you develop a plan of care that is
acceptable to you, the client, & the physician
(Juliar, p. 368)
Tips for Cross Gender Communication
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

When men & women recognize & appreciate the
strengths of both genders bring to the workplace, an
increase is seen in creativity, productivity, & profit.
Recognize that gender difference in communication
exist and try to understand their merits. Your success
at work will come not from abandoning your
communication style and adopting that of the other
gender, but rather from recognizing, appreciating, and
utilizing everyone’s strengths. (Juliar, pp. 390-391)
To communicate more effectively see the following
slides.
Cross-Gender Communication
Tips for Men
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
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
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


Seek input & ask questions to confirm understanding &
agreement.
Avoid interrupting & monopolizing the floor.
Be aware that your comments may be taken personally.
Tone down criticisms & sarcasm; focus on being more polite;
ask, don’t order.
Never refer to a co-worker as “sweetheart,” “dear,” or some
similar name.
Realize the rapport building is just as important as getting
results.
Avoid gender-based language. For example say “salesperson”
rather than “salesman” or “workers” instead of “workmen.”
Encourage others to communicate & value their input.
(Juliar, 390)
Cross-Gender Communication
Tips for Women
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
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

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Don’t give in to interruptions. Say, “I’m sorry, but I’m not finished
yet.”
Make a conscious effort to take comment less personally.
Avoid putting questions like “don’t you think?” and “is that okay?” at
the end of your comments. They make you sound unsure.
Strive to be more direct with comments and criticism. Get to the
point quickly.
Avoid inappropriate nonverbal signals, such as nodding too often, or
avoiding direct eye contact. They decrease your credibility.
Don’t expect that others will open up to you about personal things;
avoid discussing anything personal.
Realize that getting things done is just as important as relationship
building.
Encourage others to communicate and value their input.
(Juliar, 390)
References
55
Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008).Culture and heritage.
In A. Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s
Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp.
311-329). Upper Saddle River, NJ: Prentice Hall
Buchwald, D. et al. (1994). Caring for patients in a multicultural society.
Patient care 28(11):105–123.
Eagle Feather Research Institute. (2008). Ancient Cultural Stereotypes.
Retrieved from
http://eaglefeather.org/articles/why_ancient_cultural_stereotypes_formed.
php
Juliar, K. (2003). Transcultural communications stumbling blocks.
Retrieved from
http://webtools.delmarlearning.com/sample_chapters/0766802566_04.pdf
Kantrowitz, M. (2011). Stereotypes. Retrieved from
http://www.edupass.org/culture/stereotypes.phtml