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Fundamentals of Nursing:
Standards & Practices, 2E
Chapter 16
Cultural
Diversity
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
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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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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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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.
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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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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
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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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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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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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Campinha-Bacote's (1998 or 1999)
Model of Cultural Competence
Five elements of cultural
competence
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Cultural awareness
Cultural knowledge
Cultural skill
Cultural encounters
Cultural desire
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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
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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), 203-207.
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