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Code No. 397 - Set 1

FINAL TERM WEEK 15

Learning Content

Formerly, we discussed cultural concepts as they relate to the community at large that helps nurses plan care for diverse individuals, families, and communities. We
also talked over cultural assessment which is an integral component of a community nursing assessment. Somehow, we were able to go through the cultural competence
on nursing interventions which are an integral part of the nurse’s role and ensure health maintenance and health promotion at a community level.
 
This module examines diversity in the nursing workforce, including the advantages of diversity, demographic and societal trends, legal perspectives, barriers, and
strategies to increase diversity in health care organizations and agencies. Cultural differences in workplace perspectives, values, and behaviors are analyzed. And a
cultural self-assessment of health care organizations, institutions, and agencies is outlined.
 

DIVERSITY IN THE WORKFORCE

Workplace diversity refers to differences between individuals in the work setting in any attribute that may evoke the perception that another person is different from
oneself (Dijk & van Engan, 2013; Guillaume, Dawson, Woods, Sacramento, & West, 2013).
 
Workplace diversity is the collective, all-inclusive mixture of human differences and similarities that provides an organization with a large pool of people with the
knowledge, skills, and abilities required for the accomplishment of organizational goals and objectives (Ewoh, 2013; Sabharwal, 2014).
 

A. Advantages
Diversity in the workplace is important because:
1. It contributes to the organization’s collective decision-making, effectiveness, and responsiveness to societal health care needs.
2. Enhances the organization’s ability to evaluate the intended and unintended consequences of decisions by examining them through the lens of multiple perspectives.
3. enhances rational decision-making and organizational efficiency and effectiveness (Ewoh, 2013; Singh, Winkel, & Selvarajan, 2013).

 
Concordance, matching the demographics of employees to the community served, is tied to better patient outcomes (Flores & Combs, 2013; Georges, 2012; Mittman &
Sullivan, 2012; Sabharwal, 2014).
 

B. Demographic and Societal Trends

During the past three decades, the registered nurse workforce has undergone gradual changes in its composition. What was once a demographically homogeneous
workforce dominated by young, white women prepared primarily in diploma schools of nursing has now become increasingly diverse in age, gender, race, ethnicity,
national origin, and educational preparation.
 
Nursing is in the midst of a period of substantive transformation that is influenced by the following three trends:
(1) an aging population of baby boomers (those born between 1946 and 1964) who are now experiencing manifestations of the aging process such as chronic
illnesses and retirement from the health care and other workforces;

 
2) the passage of the Affordable Care Act (ACA) of 2010 provides health insurance to millions of people in the United States who previously were uninsured; and
 

(3) increased educational preparation for nurses, including greater emphasis on the bachelor of science in nursing (BSN) degree for entry into professional nursing
practice, the Doctor of Nursing Practice (DNP) degree for RNs who seek preparation in advanced practice nursing (midwifery, nurse anesthesia, and nurse
practitioner), and specialty credentialing (American Association of Colleges of Nursing, 2014; American Nurses Credentialing Center, 2015; Fineberg & Lavizzio,
2013).
 
Diversity is a requirement for many national nursing organizations, hospital associations, the U.S. Department of Health and Human Services Division of Nursing,
philanthropic organizations, and other stakeholders within the health care community whose leaders agree that the recruitment of people from underrepresented groups
into nursing is a priority for the nursing profession in the United States (American Association of Colleges of Nursing, 2014).
1. racial and ethnic minority groups
2. gender
3. Age

 
The majority of health care administrators and leaders in health professions education currently acknowledge that increasing the diversity of the workforce will improve
the quality of care, decrease racial disparities in health, and result in the delivery of more culturally congruent and competent care (Flores & Combs, 2013; Hedlund,

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Esparza, Calhoun, & Yates, 2012; Kirch & Nivet, 2013; Mittman & Sullivan, 2012; Mixer, Lasater, Jenkins, et al., 2013). There is widespread belief among the majority of
hospital administrators and members of accrediting bodies that the nursing workforce should reflect the diversity found in the population it serves (Gates & Mark, 2012;
Joint Commission, 2010).
 
C. Legal Perspective

Affirmative action is designed to (1) eliminate existing and continuing discrimination, (2) remedy the effects of past discrimination, and (3) create systems and procedures
to prevent future discrimination
 
Similar initiatives are known as employment equity in Canada, reservation in Inland Nepal, and positive action in the United Kingdom.
 
Title V of the Affordable Care Act (ACA) of 2010
funds scholarships and loan repayment programs to increase the number of primary care physicians, nurses, physician assistants, mental health providers, and
dentists in the areas of the country that need them most.
Combats critical nursing shortage by increasing the supply of public health professionals so that the United States is prepared for health emergencies
provides state and local governments flexibility and resources to develop health workforce recruitment strategies.
helps to expand critical and timely access to care by funding the expansion, construction, and operation of community health centers throughout the United States
(U.S. Department of Health and Human Services, 2014).
D. Barriers to Diversity
There are numerous barriers to diversity in nursing and other health professions, beginning with
road blocks in the education pipeline that prevent students from traditionally underrepresented and minority groups from gaining admission to nursing,
medical, pharmacy, and other health professions schools
keeping racial and ethnic minorities, men, and other groups from entering nursing include educational deficiencies that are complex and interconnected with
inadequate K-12 education systems for students from minority and economically disadvantaged populations who frequently attend poorly funded schools, often
in neighborhoods characterized by crime and drugs.
failure of colleges and universities to reach out to students from diverse backgrounds with recruitment and retention services that promote academic, clinical,
and career success, as well as their failure to provide application assistance to students who are the first in their family to apply to college (Flores & Combs,
2013; Harris, Lewis, & Calloway, 2012; Mittman & Sullivan, 2012).
insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.
Negative attitudes and behaviors in the workplace (ex: hatred, prejudice, bigotry, discrimination, racism, and ethnoviolence)
F. Strategies to Increase Diversity
Corporate Culture and Organizational Climate

Corporate culture is a process of reality construction that allows staff to see and understand particular events, actions, objects, communications, or situations
in distinctive ways. The corporate culture metaphor is useful because it directs attention to the symbolic significance of almost every aspect of organizational life.
Structures, hierarchies, rules, and organizational routines reveal underlying meanings that are crucial for understanding how organizations function.
 
Corporate or organizational culture, on the other hand, is what its members share—their beliefs, values, assumptions, and rituals—often unconsciously.
Culture provides the community, the sameness, and the consensus that makes those people unique and special.
 
Organizational climate usually measures perceptions or feelings about the organization or work environment.
 
Diversity Management and Organizational Inclusion
Roosevelt Thomas, Jr., President of the American Institute for Managing Diversity, first introduced diversity management as a way of creating an
environment that enables employees to reach their full potential in pursuit of organizational goals and objectives (Thomas, 1990).
 
A complex, multifaceted concept, diversity management refers to the systematic and planned commitment by organizations to recruit, retain, reward, and
promote a heterogeneous mix of employees. Diversity management requires that there is senior-level support for ongoing educational development programs
that increase cultural awareness and competence (Lowe, 2013).
 
For maximum productivity and job satisfaction, employees in health care and other organizations need to feel that the groups they belong to are a source of self-
esteem and make them feel that they are accepted, fit in, belong, and feel secure. At the same time, the employee needs to feel unique.
 
Organizational inclusion is defined as the degree to which individuals feel that they are part of critical organizational processes as indicated by workgroup
involvement, ability to express ideas and opinions, access to information and resources, ability to influence decision making, and a sense of psychological safety
and job security (Gates & Mark, 2012; Sabharwal, 2014; Singh & Winkel, 2012; Singh, Winkel, & Selvarajan, 2013).
 
 

THE CHALLENGES AND OPPORTUNITIES OF A MULTICULTURAL HEALTH CARE WORKFORCE

 

A. Cultural Perspective on the Meaning of Work

The earliest recorded ideas about work refer to it as a curse, a punishment, or a necessary evil needed to sustain life. People of high status did not work; slaves, indentured
servants, and peasants worked. Cultural views about caring for the sick also must be considered, because such care may be perceived as a divine calling for those with
supernatural powers (some African tribes), a religious vocation (some ethnic Catholic groups), or an undignified occupation for lower-class workers (some Arab groups
such as Kuwaitis and Saudi Arabians).

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B. Cultural Values in the Multicultural Workplace

Cultural values frequently lie at the root of cross-cultural differences in the multicultural workplace. Values Cultural values exert an influence on (or inform)
workplace factors, which in turn influence each other: time orientation, family obligations, etiquette, communication patterns, space/distance, touch, the meaning
of work, and work ethic.
 
Values exert a powerful influence on how each person behaves, reacts, and feels. In the multicultural workplace, values affect people’s lives in four major ways: values
underlie perceived needs, what is defined as a problem, how conflict is resolved, and expectations of behavior.
 

C. Cultural Perspective on Conflict

The term conflict is derived from Latin roots (confligere, “to strike against”) and refers to actions that range from intellectual disagreement to physical violence.
Frequently, the action that precipitates the conflict is based on different cultural perceptions of the situation. According to some social scientists, when participants in a
conflict are from the same culture, they are more likely to perceive the situation in the same way and to organize their perceptions in similar ways.

By examining proverbs used by members of various cultural groups, it is possible to better understand differences in the way conflict is viewed.
 

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The US culture’s proverbs emphasize assertive behavior and dealing with conflict through direct confrontation. Other cultures—particularly collectivist groups—may
promote avoidance of confrontation and emphasize harmony (e.g., Native North Americans, Alaskan Natives, Amish, and Asians). The culture-based choices that lead
people in these opposite directions are a major source of conflict in the workplace. 

         
 

D. Conflicting Values that Underlie Problems

  Family Obligations
Independence from the family is highly valued by many from the dominant cultural groups in the United States and Canada, but it ranks very low in the
hierarchy of people from most Middle Eastern and Asian cultures. In the latter groups, the family is highly valued, and the individual’s lifelong duties toward the
family are explicit. Thus, absence from work for family-related reasons may be considered legitimate and important by workers from some cultures, but may be
perceived as an unnecessary inconvenience to the supervisor.
Personal Hygiene
Personal hygiene can be a sensitive topic, and views on personal hygiene can vary greatly among cultures.
 Communication
Underlying the majority of conflicts in the multicultural health care setting are issues related to verbal and nonverbal cross-cultural communication.
 Nurses must exercise considerable judgment when making decisions about effective methods for communicating with staff members and patients from diverse
cultural backgrounds.
 Touch
 In general, it is best to refrain from touching staff members of either gender unless necessary for the accomplishment of a job-related task, such as the provision
of safe patient care.
 Etiquette
Values frequently underlie cultural expectations of behavior, including matters of etiquette, the conventional code of good manners that governs behavior.
 Clothing and Accessories
Most health care institutions have a dress code or policy statement about clothing and accessories worn by staff in various parts of the facility (e.g., delivery room,
operating room, specialty units).
 Intergenerational Relationship
The nursing workforce is composed of a mixture of generational cohorts. A generation is defined as an identifiable group of people who share birth years, age,
location, and experience the same significant events within a given period of time. The term generation is sometimes used interchangeably with the term
generational cohort (Hendricks & Cope, 2013). Scholars agree that there are four major generational cohorts in the United States, Canada, and Australia that go
by the following names: veterans, baby boomers, generation X, and millennials.

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Interpersonal Relationship
There are cultural differences in interpersonal relationships involving authority figures, peers,
subordinates, and patients.
 
National and Ethnic Rivalries
Cues that may signal underlying historic rivalries include
1. the expression of high levels of emotional energy when a staff member is interacting with a person from a rival group and the topic does not seem to
warrant it
2. sudden, uncharacteristic behavior changes when the staff member is in the presence of a person from the rival group
3. the repeated expression of strong opinions about historical, political, and current events involving rival nations or factions; and
4. inappropriate attempts to persuade others to adopt the staff member’s partisan views about the rivalry.

Gender and Sexual Orientation

In the healthcare setting, nurses of both genders may face the biases and preconceptions of physicians, fellow nurses, and other healthcare providers. The issue is
further complicated by cultural beliefs about relationships with authority figures and cross-national perspectives on the status of various health care disciplines.
 
Moral and Religious Beliefs
Consider the following dilemmas:
A nurse who believes that it is morally wrong to drink alcohol refuses to carry out a physician’s order for the therapeutic administration of alcohol as a
sedative–hypnotic or to administer medicines with an alcohol base (e.g., cough syrup).
A nurse who philosophically believes that humankind should not unleash the power
of nuclear energy refuses to care for cancer patients undergoing irradiation.
A Roman Catholic nurse working in the operating room refuses to scrub for abortions, tubal ligations, vasectomies, and similar procedures because of
religious prohibitions.
A Jehovah’s Witness nurse refuses to hang blood or counsel patients concerning blood or blood products.
A Seventh-Day Adventist nurse who cites biblical reasons for following a vegetarian diet is unwilling to conduct patient education involving diets that
contain meat.
Muslim and Jewish staff members express concern that the hospital cafeteria fails to
serve foods that meet their religious dietary requirements
These philosophical, moral, and religious issues reflect the diversity that characterizes staff members in the health care workplace. The challenge is to balance the
health care needs and rights of patients with the moral and religious beliefs of healthcare providers.
 
National Origin
Another form of diversity in the workplace is the national origin of nurses and the country in which nurses are educated. Nurses entering the United States or
Canada from a similar culture and with English as the primary language, for example, nurses from Australia or the United Kingdom, are likely to experience less
difficulty with cultural adjustment than do nurses from the Near and the Middle East, Asia, or Africa, where language, religion, dress, and many other
components of culture may be markedly different.
 

CULTURAL SELF-ASSESSMENT OF HEALTH CARE ORGANIZATIONS, INSTITUTIONS, AND AGENCIES

Organizational cultural self-assessment should be part of the strategic planning process for medical centers, hospitals, public and community health organizations,
home health care agencies, psychiatric/mental health institutions, and related facilities. Organizational cultural self-assessment may focus on the entire health care
organization, institution, agency, or a particular unit or division of the organization. A variety of tools may be used to assess organizational culture.

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Given the demographic composition of the contemporary healthcare workforce, nurses will continue to find both challenges and opportunities as they practice nursing in
multicultural healthcare settings. Microcosms of society at large, health care organizations, institutions, and agencies consist of staff members from increasingly diverse
backgrounds. It is important to remember that culture influences the manner in which people perceive, identify, define, and solve problems in the workplace.
 

References:
Textbook:

1. Andrews, M. (2016). Transcultural Concepts in Nursing Care 7th Edition. Wolters Kluwer.

2. Giger, J. (2016). Transcultural Nursing 7th Edition. Mosby
3. Deger, V. (2018). Transcultural Nursing. Intech Open

E-Book:

1. How to Develop Your Healthcare Career - A Guide to employability and Professional Development. http://onlinelibrary.wiley.com/book/10.1002/9781119103202

Online Reference:

1. https://medical-dictionary.thefreedictionary.com/sunrise+model 
2. https://books.google.com.ph/books?
id=rdEnV1HWrvgC&pg=PA85&lpg=PA85&dq=%E2%80%A2%09Transcultural+Perspectives+in+Childbearing&source=bl&ots=GCR0T03g0K&sig=ACfU3U28xjWrb4gjG1UHybCCrakWQCR5vg&hl=en&
3. https://everynurse.org/7-steps-culturally-sensitive-nurse/ 
4. https://www.scu.edu/ethics/ethics-resources/ethical-decision-making/
5. https://www.coursera.org/lecture/international-travel/cultural-competency-e69Ne 

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