3/17/2015
Diversity in the Workplace: Delivering
Culturally Competent Care
Robert Pope
PhD, MSN, RN
Assistant Professor
San Francisco State University
March 18, 2015
Diversity in the Workplace: Delivering Culturally
Competent Care
After attending, you will be able to:
• Discuss the changing demographics and the significance of
culturally competent care
• Identify the intersection of the Nursing Code of Ethics and
cultural sensitivity
• Apply strategies to enhance diversity and cultural awareness in
your nursing practice
2
Polling Question
• How would you identify your primary role in nursing?
–
–
–
–
–
Beside Clinical Nurse
Nurse Leader (Supervisor, Manager, Director)
CNO
Educator
Other
3
1
3/17/2015
Changing Demographics:
The Significance of Culturally Competent Care
Changing Demographics (From 2000 to 2009; numbers higher
today)
307 million inhabitants of the United States. Today, minorities
outnumber whites in some communities in the United States
For centuries, the United States has incorporated diverse
immigrant and cultural groups and continues to attract people
from around the globe.
From 2000 to 2009, there was a:
32% increase in the Asian population,
37% increase in individuals of Hispanic origin
18% increase in American Indians and Alaskan Natives
13% increase in the African American population
2% increase in non-Hispanic population
Overall
non-Hispanic whites represented 65.1%
Hispanics (of any race) represented 15.8%
African Americans represented 13.6%
Asians represented 4.6%
American Indians, Alaskan Natives, Native Hawaiians, and other
Pacific Islanders represented 1.2% of the total.
4
Polling Question
• I work with a diverse patient population
– True
– False
Polling Question
• Our staff is culturally diverse
– True
– False
2
3/17/2015
Changing Demographics:
The Importance of Culturally Competent Care
As healthcare workers we strive to provide the best care possible to
all patients. An integral part of providing that high level of care is
meeting the patient where they are, connecting with them in a way
that is comfortable and familiar.
There are many ways to communicate like this - some are
surprisingly simple, like enjoying the same movies or TV shows or
foods; others are more recognized, like connecting through
language, ethnic or racial identity, or traditions.
There will be times when you share few of these
characteristics with your patients/clients. However, it is
still possible to build connections by becoming familiar
with different peoples and cultures. This is called
building Cultural Competence.
We are often confronted with many terms used to describe culture.
• cultural awareness
• cultural competency
• Cultural knowledge
A host of
• Cultural sensitivity
others
• cultural skill
• Cultural encounters
• cultural desire
• cultural barrier
• cultural conditioning
We hear the word culture so often that it’s true meaning becomes lost
and so the word loses its power and becomes a cliche´.
THE CLICHE´ OF CULTURE
Culture - Definition
What is your definition?
Culture:
– A set of beliefs, attitudes, behaviors, and policies to
which people identify and adhere.
– Is the sum total of ways of living including:
• Behavioral norms
• Language
• Communication style
• Patterns of thinking
• Beliefs and Values
3
3/17/2015
Many Determinants of “Culture”
Can be defined by:
1. Group or Setting
ethnic, racial, religious,
corporate, professional,
age, socioeconomic
status, sexual
orientation
2. Self-identification
3. Stereotyping by others
“Culture”
• Even though we may share
a general culture with other
people, each of us has a
special set of experiences
and influences that makes
us unique.
• Similar to the meaning of
race, which is socially
unpredictable and politically
unstable. Culture is fluid – it
changes with time,
experience, and
circumstances.
Intersection of Culture and
Health:
“NO TABULA RASA”
• Personal view of provider
• Personal view (well developed) of
older adult patient
• Family view
• Interdisciplinary team view
• Organizational setting perspective:
acute, primary, homecare, long-term
care, hospice
don’tdon’t
wantlike
that
“I“Ireally
Nurse,
sheofcan’t
taking
care
speak
English.”
old
people.”
4
3/17/2015
Culture Influences
Components of Health Care
• Attitudes and behaviors about
health and illness
• Beliefs about causes of
disease
• Possible Treatments
• Communication among all
participants
• Expectations that older adults
have about care provider
• Expectations that providers
have about older adults and
their cultural identification
Polling Question
• The Code of Ethics is an integral part of my nursing practice
or
• I use the Code of Ethics frequently in my nursing practice
– True
– False
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Diversity in the Workplace: Delivering Culturally Competent Care
In order to most effectively meet the needs of a culturally diverse patient
population, nurses must address many of the healthcare challenges that face
the populations they serve. Healthcare workers strive to provide the best care
possible to every patient that walks through their doors. An integral part of
providing that high level of care is meeting the patient where they are,
connecting with them in a way that is comfortable and familiar.
5
3/17/2015
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Diversity in the Workplace: Delivering Culturally Competent Care
Our social contract and our Code of Ethics delineate our responsibilities – to
be aware of our own attitudes, beliefs, thoughts and priorities in providing care
to our patients, their families and communities and to populations. According
to the American Association of Colleges of Nursing, nursing leaders recognize
a strong connection between a culturally diverse nursing workforce and the
ability to provide quality, culturally competent patient care. Make a
commitment to increasing your understanding of diversity issues by attending
this webinar and apply what you learn to caring for your patients.
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Provision 1:
The nurse, in all professional relationships, practices with compassion
and respect for the inherent dignity, worth and uniqueness of every
individual, unrestricted by considerations of social or economic status,
personal attributes, or the nature of health problems.
The message summarized in Provision 1 is at the core of the Nursing
profession: As nurses we must treat all human beings with respect and dignity,
regardless of who they are, what they need, how they conduct themselves, or
what their world view may be. Because the provision of safe, quality care
requires the interdisciplinary collaboration of all, respect for all is the hallmark
of this provision. This is important to nursing because individual prejudice and
bias regarding race, religious beliefs, lifestyle, illness, disability and age must
not be allowed to affect patient care.
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Provision 2:
The nurse’s primary commitment is to the patient, whether an individual,
family, group, or community.
While this provision, which underlines the nurse's need to place the patient above all
else seems straightforward, it can be difficult to put into practice. Even the most selfassured nurse will inevitably be faced with conflicts of interest, between their employers'
or peers' opinions and what they believe is right or appropriate. This is important to
nursing because families, other practitioners, institutions, etc. may compete for the
nurse’s loyalty or persuasion and the nurse must remember their primary responsibility is
to be an advocate to and for their patient not these competing influences. In doing so the
nurse prevents other factors or people from influencing their decisions, actions, and care
for their patient. It focuses the nurse’s perspective to that of the patient not competing
issues.
6
3/17/2015
Polling Question
• I feel adequately prepared to care for the cultural needs of all the
patients in my care.
– Yes
– No
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Provision 3:
The nurse promotes, advocates for, and strives to protect the health,
safety and rights of the patients.
Advocacy is what we do. Provision 3 serves to remind us, as nurses that the
patient has rights that must be respected and at times defended when the
patient is unable to do so. The Code is designed to provide guidance to the
nurse, not absolutes. The nurse thus must balance the patient’s right to privacy
with protection of the patient from harm. This is important to nursing because it
focuses the nurse’s actions and encounters with the patient specifically. Such
principals are used to drive protocols and promote the well-being, protection,
and autonomy of all patients and improves all patient care.
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Provision 4:
The nurse is responsible and accountable for individual nursing practice
and determines the appropriate delegation of tasks consistent with the
nurse’s obligation to provide optimum patient care.
Beyond the fundamental requirements of safe and compassionate care, Provision 4
goes further, holding nurses responsible for their own competence in performing the
duties required for their jobs. The recognition of accountability for actions is the
cornerstone for a profession because of the implied social contract with the public. This
is important to nursing practice because it makes nurses accountable for the care they
give and responsible for providing appropriate care.
7
3/17/2015
Polling Slide
• My facility provides adequate education on cultural diversity and
sensitivity.
– True
– False
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Provision 5:
The nurse owes the same duties to self as to others, including the
responsibility to preserve integrity and safety, to maintain competence,
and to continue personal and professional growth.
This section of the Code provides learning in the aspect of: How does one remain ethical
toward others, while remaining ethical towards one’s own self? Nurses are obligated to
themselves in their personal morals and ethics. A nurse is expected to have individual
integrity. Continuation of both personal and professional growth is part of this
commitment. This provision is important to nursing because nurses neglect their own
personal care, the care they give also diminishes. It is a reminder that nurses must take
care of themselves in order to be able to take care of others and neglecting to do so puts
patient care at risk.
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Provision 6:
The nurse participates in establishing, maintaining and improving health
care environments and conditions of employment conducive to the
provision of quality health care and consistent with the values of the
profession through individual and collective action.
This means that nurses must accept responsibility in regard to the care given
by the medical facility where they are employed. If unethical practices are
being observed, the nurse is obligated to address the situation. This is
important to nursing because it helps establish a standard for workplace
ethics.
8
3/17/2015
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Provision 7:
The nurse participates in the advancement of the profession through
contributions to practice, education, administration and knowledge
development.
This provision is important to nursing because actively participating in the
advancement of the nursing profession is a requirement for all nurses.
Additionally, it is important to nursing because it connects individual nurses to
their practice.
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Provision 8:
The nurse collaborates with other health professionals and the public in
promoting community, national and international efforts to meet health
needs.
Nurses must work with the public, and other health care professionals to meet
the health care needs. This includes need on a local, national and international
level. For example, nurses need to be aware of the health of the entire
community and health issues that affect the community. Additionally, while a
nurse may have individual cultural values, respect must be shown for differing
cultures in the community.
The Intersection of the Nursing Code of
Ethics and Cultural Sensitivity
Provision 9:
The profession of nursing, as represented by associations and their
members, is responsible for articulating nursing values, for maintaining
the integrity of the profession and its practice, and for shaping social
policy.
This provision is important to nursing because it focuses on the profession as a
whole rather than the individual nurse like the eight preceding provisions. Provision
nine is a collective provision regarding the social ethics of the profession of
nursing. It places the largest burden of collective responsibility to associations
within nursing and its main focus is social conditions and policy. The nursing
profession as a whole must maintain professional practice and nursing values.
Nurses are expected to participate in the advancement in public education and
nursing care and. Involvement in groups that raise awareness of social issues
including human rights violations, violence and homeless are part of social
awareness.
9
3/17/2015
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
There are many resources that are useful in developing Cultural Competency
in the workplace:
The CLAS Standards (National Standards for Culturally and Linguistically
Appropriate Services) in health care
“Bafa Bafa” and “BARNGA” Cultural Simulations
Culturally Competent Nursing Modules
Cultural Competency Curriculum Modules (designed for physicians, but also
carries accreditation for APNs).
“Coming together” (2008) DVD
“Dignity and Respect: Showing our patients cultural sensitivity”
(2006)DVD
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
However, a task force of the Expert Panel for Global Nursing and Health of the
American Academy of Nursing, along with members of the Transcultural
Nursing Society, developed a set of standards for cultural competence
in nursing practice. The aim of the project was to define standards that
can be universally applied by nurses around the world in the areas of
clinical practice, research, education, and administration, especially by
nurses involved in direct patient care. It serves as the basis for the
suggestions offered today.
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
The document includes 12 Standards:
Standard
Standard
Standard
Standard
Standard
Standard
Standard
Standard
Standard
Standard
Standard
Standard
1 Social Justice
2 Critical Reflection
3 Knowledge of Cultures
4 Culturally Competent Practice
5 Cultural Competence in HealthCare Systems and Organizations
6 Patient Advocacy and Empowerment
7 Multicultural Workforce
8 Education and Training in Culturally Competent Care
9 Cross Cultural Communication
10 Cross Cultural Leadership
11 Policy Development
12 Evidence Based Practice and Research
10
3/17/2015
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 1: SOCIAL JUSTICE
Professional nurses shall promote social justice for all. The applied principles
of social justice guide decisions of nurses related to the patient, family,
community, and other health care professionals. Nurses will develop
leadership skills to advocate for socially just policies.
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 2: CRITICAL REFLECTION
Nurses shall engage in critical reflection of their own values, beliefs, and
cultural heritage in order to have an awareness of how these qualities and
issues can impact culturally congruent nursing care. Understanding one’s own
cultural values and beliefs as well as the culture of others is essential if nursing
care is to be not only appropriate but deemed effective by the patient, family,
community and population. Self-awareness, as the initial step, is the personal
process of identifying one’s own values and beliefs. This awareness enables
each individual to analyze personal feelings as a component of reflection.
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 3: KNOWLEDGE of CULTURES
Nurses shall gain an understanding of the perspectives, traditions, values,
practices, and family systems of culturally diverse individuals, families,
communities and populations for whom they care, as well as a knowledge
of the complex variables that affect the achievement of health and well-being.
11
3/17/2015
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 4: CULTURALLY COMPETENT PRACTICE
Nurses shall use cross cultural knowledge and culturally sensitive skills in
implementing culturally congruent nursing care.
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 5: CULTURAL COMPETENCE IN HEALTHCARE SYSTEMS
AND ORGANIZATIONS
Healthcare organizations should provide the structure and resources
necessary to evaluate and meet the cultural and language needs of their
diverse clients.
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 6: PATIENT ADVOCACY AND EMPOWERMENT
Nurses shall recognize the effect of healthcare policies, delivery systems and
resources on their patient populations, and shall empower and advocate for
their patients as indicated. Nurses shall advocate for the inclusion of their
patient’s cultural beliefs and practices in all dimensions of their health care
when possible.
12
3/17/2015
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 7: MULTICULTURAL WORKFORCE
Nurses shall actively engage in the effort to ensure a multicultural workforce in
health care settings. One measure to achieve a multicultural workforce is
through strengthening of recruitment and retention effort in the hospital and
academic setting.
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 8: EDUCATION AND TRAINING IN CULTURALLY
COMPETENT CARE
Nurses shall be educationally prepared to promote and provide culturally
congruent health care. Knowledge and skills necessary for assuring that
nursing care is culturally congruent shall be included in global health care
agendas that mandate formal education and clinical training, as well as
required ongoing, continuing education for all practicing nurses.
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 9: CROSS CULTURAL COMMUNICATION
Nurses shall use culturally competent verbal and nonverbal communication
skills to identify client’s values, beliefs, practices, perceptions, and unique
healthcare needs.
13
3/17/2015
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 10: CROSS CULTURAL LEADERSHIP
Nurses shall have the ability to influence individuals, groups and systems to
achieve positive outcomes of culturally competent care for diverse populations.
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 11: POLICY DEVELOPMENT
Nurses shall have the knowledge and skills to work with public and private
organizations, professional associations and communities to establish policies
and standards for comprehensive implementation and evaluation of culturally
competent care.
Strategies that Enhance Diversity and Cultural
Awareness in Your Nursing Practice
STANDARD 12: EVIDENCE-BASED PRACTICE AND RESEARCH
Nurses shall base their practice on interventions that have been systematically
tested and shown to be the most effective for the culturally diverse populations
that they serve. In areas where there is a lack of evidence of efficacy, nurse
researchers shall investigate and test interventions that may be the most
effective in reducing the disparities in health outcomes.
14
3/17/2015
Diversity in the Workplace: Delivering
Culturally Competent Care
Summary
1.
Because of the changing demographics in the United States there is a
need to maximize patient trust in the clinical encounter of an
increasingly diverse population.
2.
Our social contract and our Code of Ethics mandate our responsibility to
be aware of our own attitudes, beliefs, thoughts and priorities in
providing culturally competent care to our patients, their families and
communities and to populations.
3.
Nursing leaders recognize a strong connection between a culturally
diverse nursing workforce and the ability to provide quality, culturally
competent patient care.
Diversity in the Workplace: Delivering
Culturally Competent Care
Thank You!
15