Chapter 09

Chapter 9Chapter 9

Cultural Diversity in Health CareCultural Diversity in Health Care

Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

22Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.Copyright © 2011 by Mosby, Inc., an affiliate of Elsevier Inc.

ObjectivesObjectives

Evaluate the use of concepts and principles Evaluate the use of concepts and principles important in healthcare diversity.important in healthcare diversity.

Describe common characteristics of any culture.Describe common characteristics of any culture.


Objectives Objectives (cont’d)(cont’d)

Evaluate individual and societal factors Evaluate individual and societal factors involved in cultural diversity.involved in cultural diversity.

Compare values and beliefs about illness that Compare values and beliefs about illness that affect management of nursing care affect management of nursing care interventions involving patients from specific interventions involving patients from specific cultures.cultures.


Case Study Case Study

Muslims are one of the fastest growing Muslims are one of the fastest growing populations in the United States. El Gindy (2004) populations in the United States. El Gindy (2004) describes Muslim nurses’ dress requirements describes Muslim nurses’ dress requirements and the role of Islamic beliefs in their lives. A and the role of Islamic beliefs in their lives. A Muslim nurse wore her Hijab in the workplace Muslim nurse wore her Hijab in the workplace while providing nursing care to her patients.while providing nursing care to her patients.


Case Study Case Study (cont’d)(cont’d)

This nurse became frustrated because the This nurse became frustrated because the Infection Control staff consistently asked her to Infection Control staff consistently asked her to wear short sleeves or roll up her sleeves. The wear short sleeves or roll up her sleeves. The Islamic dress code of wearing a Hijab is Islamic dress code of wearing a Hijab is considered mandatory; it is a way of life to obey considered mandatory; it is a way of life to obey Allah.Allah.


Case Study Case Study (cont’d)(cont’d)

Consider the impact of hospital policy on Consider the impact of hospital policy on nursing staff dress codes. nursing staff dress codes.

Consider sensitive or controversial issues Consider sensitive or controversial issues that are often addressed by behaviors that that are often addressed by behaviors that represent coercion. represent coercion.

Consider what role concepts about culture Consider what role concepts about culture have in this case situation.have in this case situation.


Concepts and PrinciplesConcepts and Principles

Culture:Culture: Develops over timeDevelops over time Is responsive to its members and their familial Is responsive to its members and their familial

and social environmentsand social environments Is learned and shared by membersIs learned and shared by members Is essential for survival and acceptanceIs essential for survival and acceptance Changes with difficultyChanges with difficulty


Concepts and Principles Concepts and Principles (cont’d)(cont’d)

Cultural diversity:Cultural diversity: Comprises a vast range of cultural Comprises a vast range of cultural

differences among individuals or groupsdifferences among individuals or groups



Cultural background:Cultural background: Is a fundamental component of one’s external Is a fundamental component of one’s external

and internal distinctionsand internal distinctions



Cultural sensitivity:Cultural sensitivity: Involves affective behaviors in individualsInvolves affective behaviors in individuals Involves the capacity to feel, convey, or react Involves the capacity to feel, convey, or react

to ideas, habits, customs, or traditions unique to ideas, habits, customs, or traditions unique to a group of peopleto a group of people


Muslims and the Role of Islamic Muslims and the Role of Islamic Beliefs in the Healthcare Beliefs in the Healthcare

WorkplaceWorkplace For class, bring an annotated reference from For class, bring an annotated reference from

the literature that describes persons of the the literature that describes persons of the Muslim faith and the role of Islamic beliefs in Muslim faith and the role of Islamic beliefs in their lives.their lives.

Based on the following slides, consider how Based on the following slides, consider how coercive behaviors might occur with the coercive behaviors might occur with the Muslim nurse’s attire.Muslim nurse’s attire.


Coercion in the Healthcare Coercion in the Healthcare WorkplaceWorkplace

Coercion:Coercion: Involves the use of power or statusInvolves the use of power or status Is persuasion of a person to act in a specific Is persuasion of a person to act in a specific

way or to make a changeway or to make a change Limits choicesLimits choices May lead to negative consequences (inequity May lead to negative consequences (inequity

of power or powerlessness)of power or powerlessness) Can take many formsCan take many forms


Coercion in the Healthcare Coercion in the Healthcare Workplace Workplace (cont’d)(cont’d)

Cite some examples that might occur in the Cite some examples that might occur in the workplace.workplace.

Consider the following factors:Consider the following factors:

Coercion: direct or indirect?Coercion: direct or indirect?

Responses to coercionResponses to coercion


External, Indirect Coercion in External, Indirect Coercion in Relationship to Cultural DiversityRelationship to Cultural Diversity

Negative biases toward a minority nurseNegative biases toward a minority nurse Negative attitudes and their impact on nurses’ Negative attitudes and their impact on nurses’

delivery of patient care delivery of patient care


External, Direct Coercion in External, Direct Coercion in Relationship to Cultural DiversityRelationship to Cultural Diversity

Behaviors, either subtle or overtBehaviors, either subtle or overt Actual occurrence or a perceptionActual occurrence or a perception Intentional or accidental Intentional or accidental


Behavioral Responses to Behavioral Responses to CoercionCoercion

What forms of coercive control or power are What forms of coercive control or power are being exercised by whom in what role being exercised by whom in what role context?context?


Negative Responses to CoercionNegative Responses to Coercion

FrustrationFrustration AngerAnger Passive-aggressivenessPassive-aggressiveness AvoidanceAvoidance ManipulationManipulation DefensivenessDefensiveness DominationDomination


Negative Responses to Coercion Negative Responses to Coercion (cont’d)(cont’d)

Verbal retaliationVerbal retaliation InflexibilityInflexibility IntoleranceIntolerance Uncooperativeness Uncooperativeness UnassertivenessUnassertiveness Backlash effectBacklash effect


Positive Behaviors to Effect Positive Behaviors to Effect Change in Use of CoercionChange in Use of Coercion

Cultural sensitivityCultural sensitivity Self-examination of one’s personal and Self-examination of one’s personal and

workplace values, beliefs, and prejudicesworkplace values, beliefs, and prejudices Mutual communicationMutual communication

Respect for differencesRespect for differences HonestyHonesty Integrative solutions (win-win)Integrative solutions (win-win)


Positive Behaviors to Effect Positive Behaviors to Effect Change in Use of Coercion Change in Use of Coercion

(cont’d)(cont’d) Richness of cultural differences requires Richness of cultural differences requires

deliberate effort.deliberate effort. Cultural diversity is valued and celebrated Cultural diversity is valued and celebrated

within the nursing unit.within the nursing unit.


DiscussionDiscussion

What might be some potential negative and What might be some potential negative and positive behaviors occurring with the issue of positive behaviors occurring with the issue of the Muslim nurse’s wearing of the Hijab?the Muslim nurse’s wearing of the Hijab?

What specific strategies might be used to What specific strategies might be used to address cultural attire within the nursing unit address cultural attire within the nursing unit and with other departments?and with other departments?


EvaluationEvaluation

Write a brief evaluation about what you learned from Write a brief evaluation about what you learned from this case study of a Muslim nurse to enhance this case study of a Muslim nurse to enhance knowledge about the following:knowledge about the following:

Cultural diversity in the healthcare workplaceCultural diversity in the healthcare workplace Coercive behaviors and affecting changeCoercive behaviors and affecting change

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Chapter 09