Nurse leaders and managers are concerned with cultural diversity from two perspectives: (1) the care of a diverse patient population and (2) positive work experiences in a culturally diverse workforce.
The NACNEP solicited, through the Division of Nursing, an Expert Workgroup on Diversity to advise them on the development of the National Agenda. They developed these goals.
Effective leaders can shape the culture of their organization to be accepting of persons from all races, ethnicities, religions, ages, and genders.
This provision helps the nurse recognize that health care must be provided to culturally diverse populations in the United States and on all continents of the world.
This challenges nurse leaders, managers, and followers who strive for worth, recognition, and individuality for patients and staff regardless of their ascribed economic and social standing.
Multicultural recognition is addressed in these competencies.
Competency 1 – Facilitate Learning – nurse educators are held responsible for creating an environment in classroom, laboratory, and clinical settings. To facilitate this learning, the nurse educator: “recognizes multicultural, gender, and experiential influences on teaching and learning.”
Competency 2 –Facilitate Learner Development and Socialization, the nurse educator: “identifies individual learning styles and unique learning needs of international, adult, multicultural, educationally disadvantaged, physically challenged, at-risk, and second-degree learners.”
Competency 4 – Participate in Curriculum Design and Evaluation of Program Outcomes, the nurse educator: “ensures that the curriculum reflects institutional philosophy and mission, current nursing and health care trends, and community and societal needs so as to prepare graduates for practice in a complex, dynamic, multicultural health care environment.”
Causes of disparities in health care include poor education, health behaviors of the minority group, inadequate financial resources, and environmental factors.
Disparities in healthcare that relate to quality of care include provider/patient relationships, actual access to care, treatment regimens that necessarily reflect current evidence, provider bias and discrimination, and mistrust of the healthcare system and refusal of treatment (Baldwin, 2003).
Health disparities in ethnic and racial groups are observed in cardiovascular disease, which has a 40% higher incidence in U.S. blacks than in U.S. whites; cancer, which has a 30% higher death rate for all cancers in U.S. blacks than in U.S. whites; and Hispanics with diabetes, who are twice as likely to die from this disease than non-Hispanic whites.
Consider how these disparities in disease and in healthcare services might affect the healthcare providers in the workplace in relationship to their ethnic or racial group. It is necessary to increase healthcare providers’ knowledge of such disparities so that they can more effectively manage and treat diseases related to ethnic and racial minorities, which increasingly might include themselves.
Staff who know what is valuable to patients and to themselves can act accordingly and derive satisfaction from work. Having a clear mission, goals, rewards, and acknowledgement of efforts leads to greater productivity from a culturally diverse staff who aspire to unity and uniqueness.
Cultural background stems from one’s ethnic background, socioeconomic status, and family rituals, to name three key factors. Ethnicity, according to The Merriam Webster Dictionary (Merriam-Webster Inc., 2013), is defined as related to groups of people who are “classified” according to common racial, tribal, national, religious, linguistic, or cultural backgrounds. This description differs from what is commonly used to identify racial groups. This broader definition encourages people to think about how diverse the populations in the United States are.
Inherent characteristics of culture are often identified with the following four factors:
1. It develops over time and is responsive to its members and their familial and social environments.
2. Its members learn it and share it.
3. It is essential for survival and acceptance.
4. It changes with difficulty.
For the nurse leader or manager, the characteristics of ethnicity and culture are important to keep in mind because the underlying thread in all of them is that staff's and patients’ culture and ethnicity have been with them their entire lives.
Cultural diversity is the term currently used to describe a vast range of cultural differences among individuals or groups.
Cultural sensitivity describes the affective behaviors in individuals—the capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people.
Acculturation: socialization refers to growing up within a culture and taking on the characteristics of that group. All of us are socialized to some culture. Acculturation refers to adapting to a particular culture.
The overall process of acculturation into a new society is extremely difficult.
Assimilation refers to the change that occurs when nurses move from another country to the United States or from one part of the country to another part. They face different social and nursing practices. Individuals now define themselves as members of the dominant culture.
An example of this might be when nurses no longer say they are from their country of origin. They say they are from where they live and practice.
Nurse leaders and managers who ascribe to a positive view of culture and its characteristics effectively acknowledge cultural diversity among patients and staff. This includes providing culturally sensitive care to patients while simultaneously balancing a culturally diverse staff.
For example, cultural diversity might mean being sensitive to or being able to embrace the emotions of a large multicultural group comprising staff and patients. Unless we understand the differences, we cannot come together and make decisions that are in the best interest of the patient.
Failure to address cultural diversity leads to negative effects on performance and staff interactions. Nurse managers can find many ways to address this issue.
For example, in relation to performance, a nurse manager can make sure messages about patient care are received. This might be accomplished by sitting down with a nurse and analyzing a situation to ensure that understanding has occurred. In addition, the nurse manager might use a communication notebook that allows the nurse to slowly “digest” information by writing down communication areas that may be unclear.
Nurse managers must work with staff to foster respect of different lifestyles.
To do this, nurse managers need to accept three key principles: multiculturalism, which refers to maintaining several different cultures;
cross-culturalism, which means mediating between/among cultures;
and transculturalism, which denotes bridging significant differences in cultural practices.
Cultural differences among groups should not be taken in the context that all members of a certain group or subgroup are indistinguishable.
The first individuals in most organizational structure who have to address cultural diversity are the leaders and managers. They have to give “unwavering” support to embracing diversity in the workplace rather than using a standard “cookie cutter” approach.
Creating a culturally sensitive work environment involves a long-term vision and financial and healthcare-provider commitment.
Leaders and managers need to make the strategic decision to design services and programs especially to meet the needs of diverse cultural, ethnic, and racial differences of staff and patients.
Mentoring programs can help staff expand their knowledge of cultural diversity and recognize their own biases while integrating them with diverse colleagues.
Continuing education programs can help nurses learn about caring for different ethnic groups in ways that honor their beliefs.
Internet Websites can help nurses quickly and effectively obtain information on cultural topics.
Understanding and valuing cultural differences benefits both patients and colleagues. Culture is a broad term encompassing many diversities. This broadness both enriches our perspective of diversity and provides a complex challenge.
All nurses, regardless of their titles or positions, have a role in improving the workplace and patient care by attending to the implications of culture in health care.
Make it a goal to appreciate the cultural richness found among staff and patients.
