1. Chapter 8
Gender, Socioeconomic, and
Cultural Attributes of the Learner

2. Gender Characteristics
• Interaction of genetics and environment
• Brain structure in males and females
• Brain functioning in males and females
– Affective responses
– Cognitive processing

3. Gender Characteristics (cont’d)
• Gender-related cognitive abilities
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General intelligence
Verbal ability
Mathematical ability
Spatial ability
Problem solving
School achievement

4. Gender Characteristics (cont’d)
• Gender-related personality traits
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Aggression
Conformity and dependence
Emotional adjustment
Values and life goals
Achievement orientation

5. Sexual Orientation and Gender
Identity
• LGBT population
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Over 8 million people in the United States
Not represented in U.S. Census
Underrepresented in health research
Institute of Medicine is writing first federal
report on LGBT health issues.

6. Sexual Orientation and Gender
Identity (cont’d)
• Problems contributing to LGBT health
disparities
– Social stigma contributes to negative health
behavior (e.g., alcohol, drug use) and high
incidence of depression, anxiety.
– Structural barriers decrease access to
healthcare (e.g., no insurance for same-sex
domestic partners).

7. Sexual Orientation and Gender
Identity (cont’d)
• Problems contributing to LGBT health
disparities (cont’d)
– Lack of culturally appropriate care results in
limited or ineffective use of healthcare
services.
• In recent years there has been greater
awareness and acceptance of LGBT
lifestyle.

8. Sexual Orientation and Gender
Identity (cont’d)
• Teaching Strategies
– Create an environment welcoming to all men
and women
– Avoid making assumptions about family
structure, sexual preference, lifestyle
– Adjust admission or intake forms to be more
inclusive

9. Socioeconomic Characteristics
• Variables affecting health status and
health behaviors
– Educational level
– Family income
– Family structure
• All three variables affect health beliefs,
health practices, and readiness to learn.

10. Socioeconomic Characteristics (cont’d)
• Social Class
– Types of indices for measurement
– Occupation of parents
– Income of family
– Location of residence
– Educational level of parents

11. Socioeconomic Characteristics (cont’d)
• Social Class (cont’d)
– Poverty circle, low education level results in
occupations with lower levels of pay,
prestige, and intellectual demand; families
living at this level become part of the cycle
that does not allow one to easily change a
pattern of life.

12. Socioeconomic Characteristics (cont’d)
• Impact of socioeconomics on health
– Lack of financial resources has a negative impact on
prevention of illness, compliance with treatment,
and motivation to learn; focus is on
day-to-day survival.
• Impact of illness on socioeconomics
– The cost of medical care and supplies can negatively
impact a person’s/family’s financial well-being,
especially if socioeconomic level is already low.

13. Socioeconomic Characteristics (cont’d)
• Teaching Strategies
– Directed toward attaining and maintaining
health
– Focus on
– Avoiding health risks
– Reducing illness episodes
– Establishing healthful environmental
conditions
– How to access healthcare services

14. Cultural Characteristics
Definitions of Terms
• Acculturation
• Assimilation
• Cultural awareness
• Cultural competence
• Cultural diversity
• Cultural relativism
• Culture

15. Definitions of Terms
• Ethnic group
• Ethnocentrism
• Ideology
• Subculture
• Transcultural
• Worldview

16. Purnell Model for Cultural Competence
Macro level of the paradigm:
1.
2.
3.
4.
Global society (outermost sphere)
Community (second sphere)
Family (third sphere)
Individual (innermost sphere)

17. Giger & Davidhizar’s Model
Six cultural phenomena:
1.
2.
3.
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6.
Communication
Personal space
Social organization
Time
Environmental control
Biological variations

18. Price & Cordell’s Nurse-Client Negotiations
Model
Four steps:
1. Examine personal culture
2. Familiarity with client culture
3. Identify adaptations made by client
4. Modify client teaching based on data
from earlier steps.

19. General Assessment and Teaching
Interventions
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Identify client’s primary language
Observe interactions between client
and family members.
Listen to the client.
Consider communication abilities and
patterns.

20. General Assessment and Teaching
Interventions (cont’d)
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Explore customs or taboos.
Determine the notion of time.
Be aware of cues for interaction
Assess client’s religious practices.

21. Four Major Subcultural Ethnic Groups
– Hispanic/Latino culture
– Black/African American culture
– Asian/Pacific Islander culture
– American Indian/Alaskan Native culture

22. Hispanic/Latino Culture
• Characteristics
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Economically disadvantaged
Strong family ties
Much information obtained from mass media
Spanish or English may be primary language
Categorize disease into “hot” and “cold,”
magical origin, emotional origin, folkdefined, or “standard scientific”

23. Hispanic/Latino Culture (cont’d)
• Teaching Strategies
– Identify subgroup (e.g., Mexican, Cuban,
Puerto Rican)
– Encourage involvement in teaching/learning
– Provide space for extended family
– Incorporate religious beliefs into plan
– Respect cultural values

24. Hispanic/Latino Culture (cont’d)
• Teaching Strategies (cont’d)
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Be considerate of feelings of modesty
Determine primary language
Avoid slang
Do not assume understanding
Use an interpreter
Provide written materials in Spanish

25. Black/African American Culture
• Characteristics
– Many acculturated into American “way of
life”
– Disadvantaged due to poverty and lack of
education
– Extended family important and elders hold
highest respect
– Strong religious values

26. Black/African American Culture
(cont’d)
• Characteristics (cont’d)
– Some believe in voodoo, witchcraft
– Some believe all animate and inanimate
objects have good or evil spirits
– Some use folk remedies

27. Black/African American Culture
(cont’d)
• Teaching Strategies
– Any folk practices or religious beliefs should
be respected and allowed (if not harmful)
and incorporated into the recommended
treatment.

28. Asian/Pacific Islander Culture
• Characteristics
– Blend of four philosophies
– Buddhism
– Confucianism
– Taoism
– Phi
– Male authority

29. Asian/Pacific Islander Culture (cont’d)
• Characteristics (cont’d)
– “Saving face” (conduct as a result of a sense
of pride)
– Strong family ties
– Respect for parents, elders, teachers, and
authority figures

30. Asian/Pacific Islander Culture (cont’d)
• Teaching Strategies
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Friendly, nonthreatening approach
Give permission to ask questions
Consider language barriers
Learning style is passive
Learning by repetition and rote
memorization

31. Asian/Pacific Islander Culture (cont’d)
• Teaching Strategies (cont’d)
– Need reassurance
– Ask questions in different ways to assure
understanding

32. Native American Culture
• Characteristics
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Spiritual attachment to the land
Intimacy of religion and medicine
Strong ties to family/tribe
View children as an asset, not a liability
Believe supernatural powers exist in
animate and inanimate objects
– Avoid acculturation

33. Native American Culture (cont’d)
• Characteristics (cont’d)
– Lack materialism, time consciousness, and
desire to share with others
– Believe witchcraft is cause of illness
– Not very future oriented
– Do not feel they have control over their
destiny
– Believe that looking into another’s eyes
reveals and may steal someone’s soul

34. Native American Culture (cont’d)
• Teaching Strategies
– Focus on giving information about diseases
and risk factors
– Emphasize teaching of skills related to
changes in diet and exercise
– Consider each tribe’s unique customs and
language

35. Preparing Nurses for Diversity Care
• Increase minority representation in
nursing.
• Strengthen multicultural perspective in
nursing curricula.
• Improve relationship between nurses
and clients from different cultural
backgrounds.

36. Stereotyping
• Nurse educators must relate to each
person as an individual.
• Use neutral language when teaching
• Confront bias by other healthcare
professionals
• Request information equally from clients
regardless of gender, socioeconomic
status, age, culture

37. Stereotyping (cont’d)
• Keep instructional materials free of
stereotypical terminology and
expressions
• Be a role model of equality
• Treat all clients with fairness, respect,
and dignity

38. Stereotyping (cont’d)
• Do not let appearance influence
expectations of quality of care
• Assess educational backgrounds,
attributes, and economic resources to
ensure appropriate teaching
• Be knowledgeable of the cultural
traditions of various groups

39. Summary
There is much more for nurses to know
about how gender, socioeconomics and
culture affect the teaching-learning
process before we can competently,
confidently, and sensitively deliver care
to satisfy the needs of our socially,
intellectually, and culturally diverse
clientele.