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Cultural Diversity in Nursing

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ANA Definition of Cultural Diversity

Cultural diversity in nursing practice derives its conceptual base from nursing, other cross-cultural health disciplines, and the social sciences such as anthropology, sociology and psychology. Culture is conceptualized broadly to encompass the belief systems of a variety of groups. Cultural diversity refers to the differences between people based on a shared ideology and valued set of beliefs, norms, customs, and meanings evidenced in a way of life. Culture consists of patterns of behavior acquired and transmitted symbols, constituting the distinctive achievement of human groups, including their embodiment in artifacts; the essential core of culture consists of historically derived and selected ideas and especially their attached values (Kroeber and Kluckhohn, 1952).

The impact of culture as a causative influence on the perceptions, interpretations and behaviors of persons in specific cultural groups is important. Issues such as cultural differences in defining health and in designing treatments are also important. As knowledge of specific cultures is gained, cross cultural comparison can lead to recognition of possible universal aspects as well. Ideology is comprised of the ideas of a group, their nature and source, and the doctrines, opinions or ways of thinking of a group. These are attached to an agreed upon set of beliefs or a creed. Value(s) refer to the especially favorable way of regarding the ideas, behaviors, customs, and institutions of a group as desirable, useful, estimable, important, or truthful. Ethnocentrism is the belief that one's own culture is superior to all others. This belief is common to all cultural groups, all groups regard their own culture as not only the best but also the correct, moral and only way of life. This belief is pervasive, often unconscious and is imposed on every aspect of day-to-day interaction and practices including health care. It is this attitude which creates problems between nurses and clients of diverse cultural groups. (“...”)


Ethnocentrism :   The tendency to look at the world primarily from the perspective of one's own culture. as the viewpoint that “one’s own group is the center of everything,” against which all other groups are judged. This belief leads to rasicsm and unacceptance in a culture.



Some suggestions to aid health care professionals in providing culturally competent care:


            1. Listen to the patient with openness and with a desire to understand the patient's perspective about the health problem and how it should be treated.


            2. Explain the biomedical point of view about the problem. Educate the patient about why the biomedical way of solving the health problem will help the patient maintain and/or regain health.


            3. Acknowledge the differences and recognize the similarities between the patient's view of the problem and the biomedical view of the problem.


            4. Recommend a treatment plan that tries to meet the patient's health needs and cultural preferences.


            5. Negotiate agreement until a win-win solution is found.


Derosa, Nancy, & Kochurka, Kim. (2006). Implement culturally competent healthcare in          your work place. Nursing Management, 37 (10), 18-26.



A diverse population brings assorted beliefs and membership in many different cultural groups. Such variety can significantly affect healthcare. Health and illness are cultural concepts because how we perceive, experience, and manage health and illness are enculturated into us by our cultural group. When and where to seek help when health is interrupted, how long to remain in care, and how to evaluate treatment are also transmitted to us by our cultural groups. What's perceived as respectful care in one culture may be perceived as disrespectful, insulting, and offensive in another. If clinicians treat their patients as they themselves want to be treated, patients sharing a similar culture as the provider will probably feel satisfied with the care. Patients from very different cultures may feel ill cared for or feel that the care they received was careless, disrespectful, or offensive (Derosa and Kochurka, 2006).

            Unfortunately, situations like these aren't uncommon in healthcare as the population in the United States becomes more diverse. According to the U.S. Census, between the years of 1990 and 2000, minorities accounted for approximately 80% of the largest 10-year U.S. population growth in history. Minorities represented 29% of the total U.S. population during this decade. This recent growth challenges hospitals nationwide to give culturally competent patient care that's respectful of and attentive to different cultural norms and expectations (Derosa and Kochurka, 2006).

            Culturally competent care links professional knowledge with cultural knowledge to address the patient's health needs and cultural preferences. Care that's culturally sensitive avoids the conflicts that end in no-win situations in which the healthcare provider feels frustrated and the patient and/or family feels guilty and alienated. Additional benefits of providing culturally competent healthcare include more effective use of time with patients, increased disclosure of patient information, decreased patient and staff stress, greater trust in the patient-provider relationship, higher patient satisfaction scores, and compliance with increasingly stringent government regulations and medical accreditation requirements (Derosa and Kochurka, 2006).

            Providing culturally competent care requires clinicians to adapt their own ethnic and biomedical cultural beliefs, values, and practices to those of their patients. When clinicians adapt in this way, patients tend to adhere to the care plan, improve faster, and feel more satisfied with their care because it meets their cultural needs.


There are 6 areas to focus on while caring for a patient of another culture: language, eye contact, gender, food, touching, and psychosocial care.

Language is often a barrier to providing quality care to a patient, due to the fact that the healthcare provider doesn’t speak the same language as the patient. This leads to the need for an interpreter, which is often a family member, and much reliance on that person to deliver care to that patient.

Eye contact in the U.S. is seen as a way of showing attention, and giving respect to the person you are talking to. However in other cultures (ex. Asians) it is viewed as disrespectful for someone inferior to make eye contact with a superior. The patient may view the nurse or doctor as superior and avoid eye contact, so as a healthcare professional it is good to know why the person is avoiding eye contact; it may not be that they are trying to hide something.

Gender in other culture plays a bigger role in who is control of the family in other cultures, then it does here in the U.S. With the Muslim culture the men dominate the household, and make the important decisions. As healthcare workers we need to be aware of whom to ask for decisions regarding healthcare decisions, as to not offend that culture.

Touching is important to monitor as well when dealing with different cultures, you don’t want the patient to feel uncomfortable by always invading their personal space.

Food in some cultures can play a role in healing; allowing the family to bring in the patient native dishes into the hospital may assist with the healing process.

In the United States, there is often no one but the nurse to take care of the patient’s psychosocial needs. This aspect of patient care is as important as the medical treatment, since the psychosocial aspect makes the patient feel that they are cared for. We need to be sure to carry that need across the cultures, and provide for their psychosocial needs as well.

Some Helpful Links

Cultural Diversity in Nursing Policies

Transcultural Nursing: Basic Concepts and Case studies

The University of York: Cultural Diversity Resources


Advanced Clinical Practicum
Emily Gausman-Katie Glenn-Brandon Williams-Jennifer Zucal-Benjamin Bickford-Ashley Johnson-Amelia Esch-Frances Yehl-Nichole Nagle-Rebecca Snyder