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IMI NATIONAL GUIDELINES:
IMI National Guidelines
A Guide to Good Practice
Cultural Diversity
These guidelines have been developed by the Institute of Medical Illustrators,
in consultation with specialist advisors. They should be considered a guide to good practice, providing a baseline for auditable standards.
If necessary, adaptations may be made to take your local conditions into account.
© Institute of Medical Illustrators 2020. All rights reserved. Unauthorised copying, distribution or commercial exploitation is prohibited and will constitute an infringement of copyright.
Reproduction permission granted for personal and educational use, and for the development of Medical
Illustration departmental guidance, subject to acknowledgement of the source material.
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
2
Contents
Introduction ………………………………………………………………………………………………….3
Section 1. Attitude and understanding...………………...………………………………………………..3
Section 2. Working with others…………………………………………………………………..………...5
2.1 Formal and informal interpreters………………………………………………………………………6
Section 3. Communication ….……………………………………………………………………………..7
3.1 Verbal language……………………………………………..………………………………………….7
3.1.1 Addressing a patient……………………………………………..………………………..……..8
3.2 Body language……………………………………………………………………………………….….9
3.2.1 Eye contact …………..……………. ……………………….………………….………………10
Section 4 - Photographic session ………………………………………….…………………………….11
4.1 Prior to session ………………………………………………………………………………………..12
4.2 During session ………………………………………………………………………………………...13
Summary ……………………………………………………………………………………...……………13
References………………………………………………………………………………………………….15
Acknowledgements…..……………………………………………………………………………………17
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
3
Introduction
Multiculturalism and diversity can affect the practise of clinical photography, in that capturing of a
patient's appearance may involve the patient acting in a way outside their usual habits. The most
common example of this is photographing an area covered for cultural or religious reasons.
However, other sensitive actions could include the act of having their photograph taken at all, or
being alone with someone of the opposite sex. It is important to be aware how patients present
themselves, as clothing and other accessories can potentially make you aware of a person’s
cultural background, which will allow you to adjust your behaviour/language/service appropriately.
It is important to acknowledge that this is a balance; one where the photographer must be aware
of differences and act accordingly, whilst ensuring that actions taken are not discriminatory or
imbalanced. Ultimately the photographer will be required to draw upon their interpersonal skills
and moral values to ensure they act lawfully and respectfully with patients (Hordern, 2016).
This document seeks to help the photographer identify best practice and interaction during a
clinical photography session, this is not an exhaustive list, nor is any completeness implied, given
that nationally thousands of patients are photographed. Therefore, our concern should be to
positively contribute to the patients' journey whilst attending our hospitals.
Section 1. Attitude and understanding These guidelines are primarily the actions to be taken by clinical photographers in the
performance of their duties through positive attitudes and effective communication. The goal is not
merely to obtain good quality images at any cost, but rather to respond to our patients positively
and professionally. In doing so the total experience of the clinical photography session is
enhanced and quality images are produced.
"We do not see things as they are, but as we are"
Immanuel Kant (1724 - 1804)
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
4
Attitude is an important factor when working across cultures and affects how we communicate
verbally and non-verbally. Working effectively across cultures can initially be hard work, because it
can reveal our subconscious prejudices that have developed because of our own background.
Take for instance, your attitude to anyone who supports a rival football team. You may
demonstrate prejudice towards them despite having a mutual appreciation for the same sport. Any
pre-existing attitude can be a barrier to effective communication, which risks any interaction
between a photographer and patient being stilted and awkward and is likely to cause offence.
Therefore, the photographer must first understand their own values and beliefs; only then can an
individual begin to understand and address their potential prejudices against others (Leininger,
2002).
Any treatment within a hospital (including clinical photography) must be impartial, non-
discriminatory and inclusive (General Medical Council, 2013). To achieve this, we must all seek
the virtues of sensitivity, self-awareness, compassion, tolerance and impartiality. We have an
obligation to our patients to improve our attitudes towards those of different racial & cultural
backgrounds, whether this be through self-guided learning (for instance, researching issues
affecting BAME members), hospital appointed Equality & Diversity sessions or through
discussions with your patients.
When engaging with patients, the photographer should ensure the protected characteristics are
considered and respected at all times (age, gender reassignment, being married or in a civil
partnership, being pregnant, disability, race including colour, nationality, ethnic or national origin,
religion or belief, sex or sexual orientation) (Equality Act, 2010). However, the photographer must
also understand intersectionality and how this may affect the beliefs and personal experiences of
individuals’. Intersectionality refers to the overlap of factors in an individual’s life that affect them
simultaneously such as class, income, education, immigration status, indigeneity, and geography
(Collins and Bilge, 2020). These are not mutually exclusive of each other; a patient may
experience prejudice based on any protected characteristics and additional factors. If we are to
positively influence a patient’s experience, it is imperative to acknowledge that health disparities
do exist, and in order to provide the best service to the patient there can no longer be the practice
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
5
to ‘treat everyone the same’ as this simply ignores multiculturalism and the needs of the most
vulnerable in society (Mkandawire-Valhmu, L., 2018).
Wherever face and head coverings are worn they can be signs of modesty, personal preference
(such as the need to cover hair loss) or religious observance. For instance, in Islam, some women
cover their faces; whereas in Orthodox Judaism men cover their heads, and many orthodox
Jewish women keep their heads covered with a scarf, snood or a wig. In Sikhism, Sikh men may
also cover their heads. For strict Muslims a facial photograph is akin to idolatry, the idea similar to
the prohibition of making images of God. However, other anatomical areas must also be included
when considering modesty and the potential cultural background of the patient.
Whilst photographing the head and face may require a sensitive approach from the photographer,
it is important to note that within a particular cultural grouping there are subgroups and this can
result in variations on the approach towards the use of coverings or other customs (Rittle, 2015).
Therefore, clinical photographers must have cultural awareness and interpersonal skills that can
accommodate the range of interactions that occur in multicultural healthcare. This ensures that all
patients are treated with the same respect, dignity and willingness to meet their needs while
obtaining the best quality documentation of the patient’s condition (Hordern, 2016).
Section 2. Working with others
Clinical photography can involve working in partnership with many individuals in order to attain the
required images and provide the best care to the patient. This can include working closely with
clinical and non-clinical members of staff, as well as the patient’s carers, relatives or friends. In
order to acknowledge and accommodate differences in beliefs and customs, photographers
should actively seek to understand them (Rittle, 2015). This is also relevant to the photographer’s
actions when they are not with the individual; for instance respecting their absence due to prayer
or religious events (Whittington Hospital NHS Trust 2009). Clinical photographers must ensure
their behaviour towards both patients and fellow colleagues is free from discrimination or prejudice
(Northumbria Healthcare 2012, Equality Act 2006).
Often a patient is accompanied by someone close to them during photography. It is important to
acknowledge and work alongside these individuals whether staff or relatives, as they often have
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
6
invaluable knowledge of the patient, such as their cultural or religious beliefs (Henley and Schott
2003). The individual can help advise your session or in distressing situations, comfort the patient.
In some cultures, community elders or family members make decisions and may speak on behalf
of the patient being photographed, in this scenario it can be difficult for the photographer to gain
suitable consent from the patient whilst respecting these customs and others attending (Henley
and Schott 2003). Where possible it is advised to discuss consent with both patient and family
member in order to attempt to gain mutual agreement (Ekmekci and Arda, 2017).
2.1 Formal and informal interpreters
Prior to the photographic session, the photographer should ensure that the patient fully
understands and consents (General Medical Council, 2011). It is best practice to use a
professional interpreter for all important conversations where the patient does not speak English
well or at all (Henley & Schott 2003). The photographer should explain to the interpreter what is
going to happen during the session so that they can better explain to the patient and to ensure the
interpreter is prepared. If a professional interpreter is not available or the patient prefers a specific
individual such as a family member (informal interpreter) this must be respected.
In order to make the photographic session as successful as possible, the photographer should:
Pay attention to the informal interpreter and their understanding of English, ask them if they
are able to do as you require, or consider whether it could be better demonstrated by
yourself, directly to the patient
Establish who the interpreter is and their relationship to the patient as this may affect the
patient’s willingness to do or say certain things
Be calm and patient with both the interpreter and the patient
Acknowledge the session is likely to take longer, do not rush
Never accept a child as a suitable interpreter
(General Medical Council, 2008. Henley and Schott 2003)
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
7
Section 3. Communication
Communicating effectively and respectfully with patients is greatly important not only for the
smooth running of the photographic session but also for the patient’s overall experience.
Communication begins from the moment the patient enters the department or you enter their
cubicle. Be aware of your body language and facial expressions as well as your choice of words
and tone of voice.
Photographers should ensure they consider that a patient may have a disability which requires
alternative communication methods and be aware of how and where to request services, such as
British Sign Language interpreters. Refer to the patients Disability Passport (if they have one) as
this will give relevant information of their needs and personal preferences, including
communication requirements. Photographers must consider that not all disabilities are visible, and
each person will have different requirements.
3.1 Verbal Language
In the 2011 England and Wales Census, 92.3% of the population considered English (or Welsh in
Wales) to be their first language, with a much lower proportion in London. 7.7% reported their first
language as ‘Other’ – Polish being highest. The highest proportion of people who responded could
not speak English well or at all were in London and the West Midlands (Office of National
Statistics, 2011).
The clinical photographer should be aware that how they read a patient’s language or behaviour
may be different to how it was intended by the patient. For example, Chinese, Vietnamese and
Thai languages use tone to completely change the meaning of a word, friendliness is shown in
other ways. As British-English speakers are used to hearing tone to portray emotion, they may
consider the tones or volume they hear to be brusque or angry, though the patient is not (Henley &
Schott 2003). Having an understanding of different cultural mannerisms and behaviours will
enable the photographer to read a patient more accurately and adjust their own actions
accordingly.
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
8
To communicate effectively with patients that struggle speaking or understanding English, the
clinical photographer should:
Speak plain English, slowly and clearly, avoiding jargon or slang
Not speak louder than normal
Check the patient understands, by using active listening skills instead of relying on positive
responses only
Avoid using closed questions - do not rely on short or positive responses alone to check the
patient understands. For example, a patient may respond positively to the question "has the
doctor explained what will happen with your photographs?" but their response to the
question "what has the doctor explained to you about these photographs?" may reveal gaps
in their understanding.
Be aware that people can often understand more of a language than they can speak. Do
not say or discuss anything you would not want the patient to hear.
Use positive and encouraging language
Where possible face the patient whilst you are speaking, with your mouth clearly visible
Do not assume that ‘Yes’ means the individual understands
(Rittle, 2015., Henley and Schott 2003)
3.1.1 Addressing a patient
When addressing a patient do not assume that the British or Western naming system is universal,
whereby the last name is the primary identifying point. For some cultures, different naming
systems are used which do not follow the British system and care is required to avoid unintended
offence.
Addressing all patients by their full name is best or it may be acceptable to ask the patient ‘What
would you like me to call you?’ This includes pronouns for those that may be transgender or non-
binary.
Not everyone can be accurately identified by either 'Mr' or 'Mrs' plus their last name, because
names such as Singh, Kaur, Begum or Miah are titles and prefixing the name with either Mr, Mrs
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
9
or Miss is meaningless. In the British naming system the surname is the identifier in health records
followed by first name and middle name. The order of the name indicates its use in the British
system - personal name first and surname last. Middles names are of less significance and a
person can be addressed by their title and surname. However, naming systems in other cultures
can be very different such as; the personal name not always coming first, the title may come after
the name or the surname may come first.
For example: Kushwant Singh and his wife Daljeet Kaur attend the department, he is never
addressed as Mr Kaur nor is his wife addressed as Mrs Singh, though Mrs Kaur may be
acceptable. Further examples illustrate this:
Jahanara Bibi (use full name)
Dilvinder Kaur (use full name)
Lew (Leff) Sapieha (Mr Sapieha)
Mohammed Yunus Miah (use full name, or first two names together)
Cheung-Ng Wai-Yung (use Mrs Ng or full name)
Shahida Begum Ditta (use full name or first two names, not Mrs Ditta)
(Henley & Schott 2003)
3.2 Body language Body language can communicate several messages such as your mood, culture and whether you
are paying attention. This can become more complex where people of different cultures portray
these in alternative ways, as well as differences due to personality. Whilst the clinical
photographer should act with professionalism, it must be acknowledged that each individual
photographer’s personal background will inevitably have a bearing on what behaviour they deem
to be professional and how the patient interprets this behaviour. As mentioned previously, there
are subcultures within all cultures and this will affect the approach each photographer takes with a
patient. It is therefore important to be aware of your personal beliefs and possible prejudices and
how this may translate into your body language and actions that the patient will see and ultimately
be affected by. After identifying these beliefs and behaviours they can be addressed and replaced
with behaviour which is sensitive to potential cultural differences (Lange, 2016).
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
10
Within clinical photography the use of body movements to help demonstrate and give instructions
to the patient can save time and confusion. However, the photographer must ensure they are
doing so in a non-offensive manner. Where there is a verbal language barrier, patients will be
looking to the photographers’ body language even more as a means to understanding what is
being asked of them (de Rezende et al, 2015).
Photographers should be aware of a patient’s reactions when using gesturing. If a patient appears
offended, consider if you may have caused this through specific movements. For instance, curling
the index finger in Europe and American is a gesture used to beckon someone however, in
Chinese, Philippine, Malaysian and Singaporean cultures this is considered extremely impolite
(Virtual Speech 2017). In Thai culture it is considered rude to point the soles of your feet at
another or to touch the head of another person (Virtual Speech 2017, Henley and Schott 2003).
The act of shaking hands with someone of the opposite sex can be considered immodest in some
cultures and in some Islamic culture it is also seen as rude to offer something with the left hand
(ACAS 2011).
Other considerations to make with regard to body language and actions:
Ensure you do not encroach on the patient’s personal space or do this for the shortest
possible time
Do not touch the patient unnecessarily. For example, an overfamiliar tap on the shoulder
Where touching the patient is unavoidable, explain your intentions before doing so
If touching the patient, be conscious of the way you do so
Consider how the patient may interpret or be affected by your actions
Stay alert to the patient’s reactions and stop if they appear offended or upset
(de Rezende et al, 2015., Henley and Schott, 2003., Rittle, 2015)
3.2.1 Eye contact
The degree of acceptable eye contact varies from culture to culture. In some cultures, eye contact
is important and too little can be seen as disrespectful. However, in other cultures such as South
Asian and Indo-Chinese cultures too much eye contact can be seen as aggressive and in Hispanic
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
11
culture lowering the eyes is a form of respect (Henley and Schott 2003). In some cultures, making
eye contact with the opposite sex is seen as flirtatious and men may avoid eye contact with
women as a form of respect (Henley and Schott 2003). Photographers understand that all patients
will act differently to situations but particular behaviours such as eye contact may be overlooked.
Considering a patient’s cultural background will help the photographer recognise why a patient
may make a lot of or no eye contact which may help put both photographer and patient at ease
(Maier-Lorentz. 2008. Understanding Transcultural Nursing 2005).
Section 4: Photographic procedure
During your time with a patient, it is helpful to draw upon your knowledge of different cultures.
However, it is also prudent to neither make assumptions about a patient's culture, nor make
assumptions about the patient based on their culture. Each patient has a unique makeup of
groups with whom they identify, not just ethnic or religious, but also socio-economic, age-based,
gender-based, and with a myriad of sub-cultures therein. The patient cannot be stereotyped
according to any one of these (Nirta and Roh, 2019; Holland and Hogg, 2010). Nor is a patient's
culture fixed, but changes according to the environment or situation (Holland and Hogg, 2010).
The most apparent characteristics which speak of a patient’s culture - gender, attire, skin colour,
language and accent - are open to misinterpretation. The cultural differences to which healthcare
professionals are trained to be most acutely sensitive - ethnicity, religion, sexual orientation - may
not be the most important to the patient during the photography session.
"Patient–provider communication is a vital part of health care regardless of the cultural
backgrounds of those involved. However, culture does add another dimension to an often already
difficult communication situation." (Ulrey and Amason, 2001).
Thus, the best general practice during a session is to draw upon your understanding of different
cultures, to maintain cultural sensitivity, but to use these only to inform a more effective
communication with the patient. Your judgement of a patient's understanding, capacity, comfort
and consent should always derive from your communication with them, and not your cultural
assumptions. These guidelines should therefore apply to any patient the photographer sees.
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
12
4.1 Prior to the session
This is the photographer's opportunity to make sure the patient understands the procedure about
to take place and to establish informed consent. Cultural differences between the patient and
photographer can create barriers to achieving this, as the likelihood of being misunderstood
increases (Crawford, Candlin and Roger, 2015). While both patient and photographer "are
responsible for the communication that takes place", the photographer is "especially responsible
for accurate communication because they are expected to use their training and competence to
develop positive relationships" (Ulrey and Amason, 2001).
The clinical photographer should ensure that their role is made clear to the patient to avoid
confusion. Due to some cultural traditions, assumptions may be made regarding the job role or
level of authority of staff based on age or gender (Henley and Schott 2003). Whilst gaining
consent the photographer must ensure the patient understands as far as possible what will take
place during the photographic session, particularly in the case of removing of clothing so as not to
cause the patient unnecessary stress. Use encouraging and reassuring language with the patient
but be mindful never to coerce the patient into giving consent or undergoing a procedure if they
decline or appear unhappy.
A photographic session can be uncomfortable for all patients, regardless of culture. A major
feature of clinical photography is the need to expose parts of the body. It is rare for any patient to
be entirely comfortable with undressing for photographs. It is advised for all intimate photography
that a chaperone is present (IMI Chaperone Policy 2019, (General Medical Council) (GMC), 2013).
What is considered intimate can be perceived differently by photographer and patient, particularly
for those with strict modesty beliefs such as for Hindu and Muslim women. Therefore, it may be
advisable to offer a chaperone where the removal of any clothing is necessary during photography
(American Medical Association, 2007. IMI, 2019. ACAS, 2011). If at all possible, a patient should
be photographed by a person of the same sex as this may limit the distress and discomfort for the
patient. (Holland and Hogg, 2010)
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
13
4.2 During the session
Effective and culturally sensitive communication must continue throughout the photography
session.
Refer to body parts by their common names but avoid informal terms
When instructing a patient to adopt a posture, demonstrate the posture yourself and use
movement cues
Give instructions one at a time and in the right order
Explain what you are doing
Look out for non-verbal signs - body language and facial expressions - of discomfort. Be
aware that such signs may differ greatly between individuals and be culturally informed.
Check with the patient that they are ok and happy to continue
Be prepared to stop the session if the patient is unhappy.
Where possible use pictures or examples to demonstrate
Allow time, don’t rush or be impatient
Maintain patient modesty wherever possible
(Henley and Schott, 2003. Rittle, 2015)
Summary
The clinical photographer's remit is not merely the production of quality images. The
photographer's interactions with a patient will colour the patient's overall healthcare experience
and may have long-lasting repercussions. It is a legal requirement that all patients and colleagues
are treated without discrimination. Yet it is also a requirement that we are sensitive to a person's
values and beliefs, and make reasonable adjustments to accommodate them.
We achieve this balance by first acknowledging our own values and beliefs. We use these to
inform us of the prejudices and biases we may bring with us, particularly when communicating
across cultural boundaries. These may be as crude as believing members of a certain race,
gender or sexual orientation will think or act in a certain way, or as subtle as assuming a particular
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
14
tone of voice denotes a particular attitude. Following this by better informing ourselves about other
cultures, we can then attempt to bridge the divides.
Armed with this background understanding, we are able to adjust our own behaviour. However, it
is impossible to always strike the perfect balance or be completely informed. Thus also being
mindful of the practical steps highlighted in the sections above, which can be applied to the
photographer's interactions with all patients, which will help mitigate the misunderstandings or
miscommunications that could lead to complaint, or lapse in care, dignity and professional
standards.
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
15
References
ACAS. 2010. Religion or belief and the workplace. A guide for employers and employees (October
2020).
Collins, P.H. and Bilge, S., 2020. Intersectionality. John Wiley & Sons.
Crawford, T., Candlin, S. and Roger, P. (2015). New perspectives on understanding cultural
diversity in nurse-patient communication. Collegian; 24-1; pp. 63-69
de Rezende, R.D.C., de Oliveira, R.M.P., de Araújo, S.T.C., Guimarães, T.C.F., do Espírito Santo,
F.H. and Porto, I.S., 2015. Body language in health care: a contribution to nursing
communication. Revista brasileira de enfermagem, 68(3), pp.430-436.
Ekmekci, P.E. and Arda, B., 2017. Interculturalism and informed consent: Respecting cultural
differences without breaching human rights. Cultura, 14(2), pp.159-172.
Equality Act. 2010.
General Medical Council., 2002. Making and using visual and audio recordings of patients (May
2002). The Journal of audiovisual media in medicine, 25(4), p.165.
General Medical Council., 2008. Making decisions about investigations and treatments (June
2008). Consent. Part 2: Consent: patients and doctors making decisions together.
General Medical Council., 2013. Good Medical Practice (April 2013). Working with doctors
Working with patients. Available from: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-
for-doctors/good-medical-practice [Accessed August 2020]
Henley, A. and Schott, J., 2003. Culture, religion and patient care in a multi-ethnic society: A
handbook for professionals.
Holland, K. and Hogg, C. (2010). Cultural Awareness in Nursing and Health Care. 2nd ed. Great
Britain: Edward Arnold, pp. 4, 51
Hordern, J., 2016. Religion and culture. Medicine, 44(10), pp.589-592.
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
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Institute of Medical Illustrators. Confidentiality and consent. 2020. Available from:
www.imi.org.uk/account/national-guidelines [Accessed August 2020].
Institute of Medical Illustrators. Chaperone Guidelines. 2019. Available from:
www.imi.org.uk/account/national-guidelines [Accessed August 2020].
Lange, C., 2016. Nursing and the importance of body language. Nursing2019, 46(4), pp.48-49.
Leininger, M., 2002. Culture care theory: A major contribution to advance transcultural nursing
knowledge and practices. Journal of transcultural nursing, 13(3), pp.189-192.
Maier-Lorentz, M.M., 2008. Transcultural nursing: Its importance in nursing practice. Journal of
cultural diversity, 15(1), pp.37-43.
Mkandawire-Valhmu, L., 2018. Cultural safety, healthcare and vulnerable populations: A critical
theoretical perspective. Routledge.
Nirta, L. and Roh, H. (2019). Cultural diversity should be taught: a reply to UK medical students’
view on interacting with multicultural patients. Korean J Med Educ 2019 Jun; 31(2): pp. 173-176.
Northumbria Healthcare NHS Foundation Trust., Religious Observance. 2012. Available from:
[https://madeinheene.hee.nhs.uk/Portals/14/Religious%20Observance%20%20v4.pdf[Accessed
August 2020]
Office for National Statistics. 2011 Census: English Language Skills (England and Wales).
(February 2018) Available from: https://www.ethnicity-facts-figures.service.gov.uk/uk-population-
by-ethnicity/demographics/english-language-skills/latest#data-sources [Accessed July 2020]
Rittle, C., 2015. Multicultural nursing: providing better employee care. Workplace health &
safety, 63(12), pp.532-538.
Understanding Transcultural Nursing., Nursing2005: January 2005 - Volume 35 - Issue – pp.14-
23.
Ulrey, K. L. and Amason, P. Intercultural Communication Between Patients and Health Care
Providers: An Exploration of Intercultural Communication Effectiveness, Cultural Sensitivity,
Stress, and Anxiety. Health Communication, 13(4), pp. 449–463
IMI National Guideline – Cultural Diversity Lead Author – Pip Stiff
Date Created – November 2004 Last Review Date – November 2020
Review Due – November 2023 Version – V2
17
Acknowledgements
Thanks to Oyebanji Adewumi, Associate Director Inclusion at the Barts Health Inclusion Team for
advice and guidance.
Acknowledgement to Ian Berle for his work on the first version of these guidelines.
Lead author
Pip Stiff, Senior Medical Photographer, Barts Health NHS Trust, Royal London Hospital, London.
Working group
Arezoo Alford, Specialist Senior Medical Photographer, Guy’s and St Thomas’ NHS Foundation
Trust, London.
Nicholas Gray, Medical Photographer, University Hospital of North Durham, Durham.