Cultural Diversity

Process Recording Analysis

  • Introduction:
    • Briefly describe the interviewed person.
  • Analysis:
    • Analyze two conversations.
    • Each analysis should consist of three parts:
      1. Determine if the interaction was therapeutic or non-therapeutic.
      2. Identify the technique used.
      3. Suggest a better response when the interaction is non-therapeutic.
  • Concluding Paragraph:
    • Submit a concluding paragraph to Canvas.

Conversation Analysis

  • Format:
    • Nurse (verbal/nonverbal) - Patient (verbal/nonverbal) - Analysis
  • Example 1:
    • Nurse: "Tell me what concerns you have at this time?" (giving eye contact)
      • Therapeutic: Exploring
    • Patient: "I have been so busy at school that I don’t have time for my children" (looking down)
    • Nurse: "I know what you mean, I have a hard time keeping up with school too. (leaning forward) How do you think your children feel about your being gone?"
      • Non-therapeutic: Ignoring/changing subject
      • Better response: "How do you feel about not having enough time for the children?" (exploring)
  • Example 2:
    • Patient: "Well, they don’t understand why I have to go to school every day and cry when I leave home." (looks worried)
    • Nurse: "That must be difficult for you. Have you tried giving them special one on one time each day?"
      • Therapeutic: Accepting
      • Non-therapeutic: Giving advice
      • Better response: "Tell me more." (general lead)

Non-Therapeutic Actions

  • It is not therapeutic to:
    • Focus the conversation on yourself.
    • Lead the conversation.
    • Change the topic:
      • Changing the focus of the topic.
      • Bringing up what you think they should focus on.
    • Take the conversation to a superficial level.
    • Formulate a plan too early.
  • If a non-therapeutic statement is made:
    • You must include a better response.

Helpful Hints

  • Communication Techniques:
    • Refer to Table 6.1 (pp. 100-103) for selecting communication techniques.
    • Review both the example and the rationale to ensure correct usage.
  • Learning Opportunity:
    • Use this as an opportunity to learn the terms.

Concluding Paragraph Content

  • Reflect on the interaction before learning about therapeutic communication techniques.
  • Assess if your PR analysis agreed with your initial assessment.
  • Describe what you learned about your communication with others.
  • Identify your strengths.
  • Identify areas where you could improve.
  • Reflect on whether therapeutic communication came naturally or was difficult.
  • Describe what you learned from your partner’s analysis of your communication and PR.
  • Discuss how you can apply this insight to your practice.

Cultural Diversity

  • Learning Objectives:
    1. Define terms associated with cultural diversity.
    2. Compare Joyce Giger’s Six Factors of Cultural Assessment.
    3. Discuss how nurses should respond to a patient’s cultural health practices.
    4. Identify cultural variables that influence the delivery of healthcare.
    5. Identify significant beliefs, perceptions, and values of specific cultural groups.

Concepts of Culture

  • Definition:
    • Shared system of beliefs, values, and behavioral expectations that provide social structure for daily living.
  • Roles and Interactions:
    • Defines roles and interactions with others, within families, and communities.
  • Manifestation:
    • Apparent in the attitudes and institutions unique to particular groups.
  • Elements:
    • Includes beliefs, habits, likes, dislikes, customs, and rituals learned from one’s family.
  • Behavior Guidance:
    • Guides behavior into acceptable ways for people in a specific group.
  • Origins:
    • Cultural practices arise through the group’s social and physical environment.
  • Belief Systems:
    • Different belief systems affect a patient's expectations of how care should be given.
  • Constancy & Evolution:
    • Cultural practices and beliefs may evolve over time but remain constant while they satisfy a group’s needs.
  • Influence:
    • Influences how people of a group view themselves, their expectations, and how they behave in response to certain situations.
  • American Expectations:
    • Specific expectations of behavior for hospital care, care of children, elderly care, etc.

Ethnicity

  • Definition:
    • Sense of identification with a collective cultural group, largely based on the group’s common heritage.
  • Membership:
    • One belongs to a specific ethnic group either through birth or through adoption of characteristics of that group.
  • Shared Characteristics:
    • People within an ethnic group generally share unique cultural and social beliefs and behavior patterns.
  • Examples:
    • Language and dialect, religious practices, literature, folklore, music, political interest, food preferences, employment patterns.

Concepts of Culture: Stereotypes & Prejudice

  • Stereotypes:
    • Assuming that all members of a culture or ethnic group act alike.
    • Can be either positive or negative.
  • Prejudice:
    • Negative stereotyping that believes a certain race, age group, or gender is inherently superior to others.
    • Leads to discrimination against those considered inferior.
    • Often done by members of the dominant group about the minority group.

Joyce Giger’s 6 Factors of Cultural Assessment

  • Factors:
    • Verbal and Nonverbal Communication
    • The Person’s Need for Personal Space
    • Biological Variations
    • Time Orientation
    • Social Organization
    • The Person’s Perspective on Environmental Control
  • Source:
    • Giger, J., & Davidhizar, R. (1999). Transcultural Nursing: Assessment and Intervention. St. Louis, MO: Mosby.

Important Factors in Cultural Assessment

  • Communication:
    • Verbal (language differences)
    • Nonverbal (eye contact, gestures, etc.)
  • Social Organization:
    • Family structure and organization (importance of family, family members roles, nuclear and extended family)
  • Physical Distance or Space:
    • Personal space (influenced by various settings or circumstances)
  • Time Orientation:
    • Time orientation (past, present, or future) – How important is it to be on time?
  • Environmental Control:
    • Internal or external locus of control
  • Biologic Variations:
    • Biological variations associated with a specific culture

Cultural Variables Influencing Healthcare Delivery

  • Gender Roles:
    • Knowing who is the dominant member of the family is an important consideration when planning nursing care.
  • Language and Communication:
    • Languages and dialects
    • Nonverbal communication (gestures and eye contact)
  • Food and Nutrition:
    • Food preferences and how foods are prepared vary among cultures.
  • Socioeconomic Factors:
    • Income potential
    • Access to social advantages such as healthcare, housing, education, etc.
  • Family Support:
    • Respect and value of family members varies among cultures.
  • Physical and Mental Health:
    • Influenced by ethnicity and cultural values

Possible Effects on Cultural Health Practices

  • Efficacious (Helpful)
  • Neutral (Neither Helpful nor Harmful)
  • Uncertain (Unknown to you)
  • Dysfunctional (Harmful)

Improving Cultural Competence

  • Key Intervention:
    • Routinely ask patients what matters most to them in their illness and treatment.
  • Reference:
    • Wilkinson, J. M., Treas, L. S., Barnett, K. L., Smith, M. H. (20200. Fundamentals of nursing (4th ed.). F.A. Davis.

Presentation Reminders

  • Be respectful and nonjudgmental.
  • Provide a handout with key points related to Giger’s 6 Factors (must include references).

Culture Presentation and Handout Slide Topics:

  • Communication:
    • Language
    • Nonverbal
    • Gestures
  • Space:
    • How much space is ideal
    • Touch
  • Social Organization:
    • Family organization
    • Gender roles
    • Respect for elders
    • Family role in hospitalization
  • Time:
    • Past, present, future
    • Prompt or late
  • Environmental Control:
    • External locus or internal locus
    • Beliefs about disease
    • Herbal supplements
    • Western or eastern medicine
  • Biological Variation:
    • Health problems
    • Diet
    • Mental health stigma
    • Disparity, socioeconomic issues, access

Religion Presentation and Handout Slides

  • Spiritual Beliefs:
    • Belief in God/s or Higher Being
    • Beliefs about health, illness, death
  • Diet and Health Practices:
    • Birth, death, sickness
    • Diet, health code
  • Spiritual Needs:
    • Spiritual advisors
    • Sacrament, baptism, blessings
  • Spiritual Aids (prayer, bible, beads)
  • Daily Schedule and Practice:
    • Daily spiritual needs
    • Religious holidays
    • Folk practices
  • Gender Roles, Family Roles, Social Support
  • Other (language, communication)
  • And whatever the nurse REALLY needs to consider!

References

  • Giger, J. N. & Davidhizar, R. (2002). The Giger and Davidhizar transcultural assessment model. Journal of Transcultural Nursing, 13(3), 185-188.
  • Wilkinson, J. M., Treas, L. S., Barnett, K. L., Smith, M. H. (20200. Fundamentals of nursing (4th ed.). F.A. Davis.