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A study of cultural diversity and spirituality issues in the nursing profession

Reprinted with Permission by Transcultural C. Associates Cultural Desire Cultural desire is defined as the motivation of the nurse to "want to" engage in the process of becoming culturally aware, culturally knowledgeable, culturally skillful, and seeking cultural encounters. It stands in contrast to the feeling of "having to" participate in this process Campinha-Bacote, 1999.

  1. Without being aware of the influence of one's own cultural values, there is risk that the nurse may engage in cultural imposition. In seeking knowledge about specific cultural groups, Campinha-Bacote 1998 and Purnell 1998 identified four stages that a nurse goes through.
  2. In providing these culturally responsive services, the nurse may want to consider the following question. Transcultural diversity and health care.
  3. However, the nurse must remember that conducting a cultural assessment is more than selecting a tool and asking the patient questions listed on the tool.
  4. The patients' world views will explain how they interpret their illness and how it guides their thinking, doing, and being. How many face-to-face encounters have I had with patients from diverse cultural backgrounds?

Cultural desire is the pivotal and key construct of cultural competence, for it is the nurse's desire that evokes the entire process of cultural competence. This desire must come from one's aspiration, and not out of one's desperation. Cultural desire involves the concept of caring. It has been said that people don't care how much you know, until they first know how much you care Campinha-Bacote, 1998. Cultural desire includes a genuine passion to be open and flexible with others, to accept differences and build on similarities, and to be willing to learn from others as cultural informants.

Cultural desire also involves the commitment of the nurse to care for all clients, regardless of their cultural values, beliefs, customs, or practices Campinha-Bacote, in press, a. This may be difficult when caring for challenging patients or patients who engage in behaviors that may be in direct moral conflict with the nurse e. In this case, too, commitment to the process of cultural desire requires the nurse to be available to care for patients, even when there may be a natural instinct to resign oneself from the nurse- patient interaction.

One suggestion is to see the patient as a unique human being. We all come from the same race - the human race, with similar basic human needs. Our goal in providing culturally responsive care is to find common ground.

The mnemonic LEARN, represents the process of listening, explaining, acknowledging, recommending and negotiating. The nurse must first listen to the patient's perception of the problem. This listening must be done in a non-judgemental manner, using encouraging comments such as, "Tell me more.

Many Faces: Addressing Diversity in Health Care

The next key step is for the nurse to acknowledge not only the differences between the two perceptions of the problem, but to acknowledge the similarities. In developing a culturally responsive approach to care, the nurse must recognize differences, but build upon the similarities. The fourth step is to make recommendations which involve the patient.

Finally, the nurse is to negotiate a treatment plan, considering that it is beneficial to incorporate selected aspects of the patient's culture into the plan. Cultural Awareness Cultural awareness is the self-examination and in-depth exploration of one's own cultural background Campinha-Bacote, 1999. This process involves the recognition of one's biases, prejudices, and assumptions about individuals who are different. Without being aware of the influence of one's own cultural values, there is risk that the nurse may engage in cultural imposition.

Cultural imposition is the tendency to impose one's beliefs, values and patterns of behavior upon another culture Leininger, 1978.

Treloar further states that many health care providers practice from an illness-based model of disability and are unaware of the shift toward looking at disability as a problem that exists within the environment rather than the person. Some nurses haves used the term physically-challenged to capture this contemporary shift. Treloar asserts that effective interactions with people affected by disability begin with a personal awareness of one's thoughts and feelings surrounding disability, and encourages the nurse to ask the following questions: Am I sensitive to cultural differences in response to and support of this population?

Cultural Knowledge Cultural knowledge is the process of seeking and obtaining a sound educational foundation about diverse cultural and ethnic groups Campinha-Bacote 1998. Obtaining cultural knowledge about the patient's health-related beliefs and values involves understanding their world view. The patients' world views will explain how they interpret their illness and how it guides their thinking, doing, and being.

They believe that the most important quality of deafness is not the lack of hearing, but rather participation in the Deaf culture that is based on the American Sign Language and that values pride in this culture.

Knowing the cultural values of the Deaf can help these clients use their usual coping responses in the midst of illness.

Treatment efficacy is another issue to address in the process of obtaining cultural knowledge. This involves obtaining knowledge in such areas as ethnic pharmacology. Ethnic pharmacology is the study of variations in drug metabolism among ethnic groups.

There are several factors that are involved in determining responses to a specific drug in ethnic groups. These factors include genetic, environmental, structural, and cultural variation in ethnic groups. For example, therapeutic ranges of lithium differs among ethnic groups.

Lin, Poland, and Lesser 1986 reported that the therapeutic range of lithium for manic patients in Japan and Taiwan to be 0. In seeking knowledge about specific cultural groups, Campinha-Bacote 1998 and Purnell 1998 identified four stages that a nurse goes through: Unconscious incompetence is not being aware that one is lacking cultural knowledge.

This nurse has no awareness that cultural differences exist between themselves and the patient. Conscious incompetence is the awareness that one is lacking knowledge about another culture. The nurse may have recognized this incompetence by attending workshops on cultural diversity, reading articles or books on the topic, or having direct cross-cultural experiences with patients from culturally diverse backgrounds.

They know that culture plays an important role in nursing, but do not know how to effectively use this knowledge. Conscious competence is the intentional act of learning about the patient's culture, verifying generalizations and providing culturally responsive nursing interventions.

Unconscious competence is the ability of the nurse to spontaneously provide culturally a study of cultural diversity and spirituality issues in the nursing profession care to patients from diverse cultural backgrounds. The timing of an unconsciously competent nurse appears to be "a natural" when observing their interacting with patients from diverse cultures Campinha-Bacote, 1998. In obtaining cultural knowledge, it is critical to remember the concept of intra-cultural variation - there is more variation within cultural groups than across cultural groups.

No individual is a stereotype of one's culture of origin, but rather a unique blend of the diversity found within each culture, a unique accumulation of life experiences, and the process of acculturation to other cultures. Therefore, the nurse must develop the skill to conduct a cultural assessment with each patient.

Cultural Skill Cultural skill is the ability to collect relevant cultural data regarding the patient's presenting problem as well as accurately performing a culturally-based, physical assessment Campinha-Bacote, 1999.

Leininger 1978 defines a cultural assessment as a "systematic appraisal or examination of individuals, groups, and communities as to their cultural beliefs, values and practices to determine explicit needs and intervention practices within the context of the people being served pp.

Cultural skill is also required when performing a physical assessment on ethnically diverse clients. The nurse should know how a patient's physical, biological and physiological variations influence their ability to conduct an accurate and appropriate physical evaluation Purnell, 1998.

However, the nurse must remember that conducting a cultural assessment is more than selecting a tool and asking the patient questions listed on the tool. The nurse's approach must be done in a culturally sensitive manner.

A situation in which the nurse would need to be very culturally sensitive might arise when the nurse is collecting data regarding the sexual orientation of a patient.

The nurse may need to have many encounters with patients from this cultural group in order to formulate questions that are culturally sensitive.

Cultural Encounters Cultural encounter is the process which encourages the nurse to directly engage in face-to-face interactions with patients from culturally diverse backgrounds Campinha-Bacote, 1998.

Interacting with patients from diverse cultural groups will refine or modify one's existing beliefs about a cultural group and will prevent stereotyping.

However, the nurse must be cautious and recognize that interacting with only three or four members from a specific ethnic group does not make one an expert on the cultural group. Cultural encounters also involve an assessment of the patient's linguistic needs. Using a formally trained medical interpreter is necessary to facilitate accurate communication during the encounters.

The use of untrained interpreters, friends, or family members may pose a problem due to their lack of knowledge regarding medical terminology and disease entities. This situation is heightened when children are used as interpreters.

The case involved an obstetrical nurse who needed to communicate to her patient that she was going to deliver a stillbirth. The nurse did not speak Spanish and used the patient's 6 year old daughter to interpret to the mother that the baby was dead. Applying the Model This model is useful in caring for all people, because in reality we all belong to the same race - the human race, with all the same basic needs.

However, it is important to remember that these needs may be expressed differently, and that "quality health care services" may mean something different for each patient. In providing these culturally responsive services, the nurse may want to consider the following question: Am I aware of my personal biases and prejudices towards cultural groups different than mine? Do I have the skill to conduct a cultural assessment and perform a culturally-based physical assessment in a sensitive manner?

Do I have knowledge of the patient's world view and the field of biocultural ecology? How many face-to-face encounters have I had with patients from diverse cultural backgrounds? What is my genuine desire to "want to be" culturally competent? Copyright 2002 by J. Using this Model includes consideration of cultural desire, cultural awareness, cultural knowledge, cultural skill, and cultural encounters.

The need to recognize that this Model is useful for all clients because we are all members of the same human race is emphasized. Associates, a private consultation service which focuses on clinical, administrative, research, and educational issues in transcultural health care and mental health.

She received her B. D from the University of Virginia. Department of Health and Human Services. References BerlinE. A teaching framework for cross-cultural health care. The Western Journal of Medicine, 139 6934-938.

The development of a spiritual construct of cultural competence. Journal of Christian Nursing. The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13 3181-184. Cultural competence in psychiatric nursing: Journal of the American Psychiatric Association, a study of cultural diversity and spirituality issues in the nursing profession 16183-187. A model and instrument for addressing cultural competence in health care.

Journal of Nursing Education, 38 5203-207. The process of cultural competence in the delivery healthcare services: A culturally competentm Model of care 3rd ed.