Analyze prevailing nursing paradigms and nursing theories from a

transcultural nursing perspective

INTRODUCTION TO TRANSCULTURAL NURSING
OVERVIEW

TRANSCULTURAL
NURSING
REFERENCES:
 Transcultural Nursing Assessment and Intervention
 Copyright 2017 Joyce Newman Giger
 Transcultural Concepts In Nursing Care
 6th edition Mosby Inc.
 Margaret M. Andrews PhD RN CTN FAAN
 Joyceen Boyle PhD , RN,MPH ,FAAN
Key terms
 Transcultural nursing : Culture ,cross cultural ,intercultural ,multicultural
 Trans : across Inter : between Multi :many
 Ethnic nursing care referred to caring for people of color
 Pan-ethnic cultural groups Blacks Hispanics Asians/Pacific Islanders , American
Indians/ Alaska Natives
 Culture-specific :particular values ,beliefs ,patterns of behavior , life patterns
that are to be special or unique to a group that do not tend to be shared with
members of other culture
 Culture–universal :commonly shared values , norms of behavior, life patterns
that are similarly held among cultures about human cultures and lifestyle
 Culture :patterned behavioral response that develops overtime as a result of
imprinting the mind through social and religious structures and intellectual
and artistic manifestations.
 Cultural competence/Culturally Competent Care
 Cultural congruence/Culturally Congruent Care
 Cultural diversity
Culturally Diverse Nursing Variability in nursing approaches needed to provide
culturally appropriate and competent nursing care
 Culturally congruent care
 TRANSCULTURAL NURSING
 Goes across cultural boundaries in a search for essence of nursing.
 A blending of anthropology in both theory and practice.
 Anthropology refers to study of humans and humankind , including their
origins ,behavior ,social relationship, physical mental characteristics customs
and development through time and all space in the world.
 Transcultural nursing enables us to view our profession from cultural
perspective.
 Transcultural nursing is a specialty within nursing focused on the
comparative study and analysis of different culture and subcultures .
 Examines with respect to their caring behavior ,nursing care ,health-illness
values , beliefs and pattern of behavior.
 The goal is to develop scientific and humanistic body of knowledge in order to
provide culture specific and culture-universal nursing care.
Leininger’s Sunrise Model Cultural Care
Diversity and Universality

 Concept : cultural care and shows 3 major nursing modalities that guide
nursing judgements and activities to provide Culturally Congruent Care
 Focus
 Describing ,explaining , predicting nursing similarities and
differences focused primarily on human care and caring in human
culture
 Leininger uses worldview , social structure ,language ,
ethnohistory
 Environmental context and the generic(folk) and professional
systems to provide a comprehensive and holistic view of
influences in culture care and well-being
https://www.bing.com/search?q=cultur
e+care+theory+model&cvid=df6
Link:
Three mode of nursing decisions and
action
 Culture care preservation/and or maintenance
 Culture care accommodation and or /negotiations
 Culture care repatterning and or restructuring
 Model of the Client within a culturally unique heritage and cultural
phenomena that have profound effect on nursing care
 HERITAGE CONSISTENCY MODEL
 Client :UNIQUE CULTURAL BEING
 CULTURE
 ETHNICITY
 RELIGION
Transcultural Assessment Model
Giger and Davidhizar Assessment Model
 Spector 2002,2004,2009 Giger 2017
 ENVIRONMENTAL CONTROL the ability of a particular cultural group to plan
activities that control nature or direct environmental factors
Included in this concept are complex systems of traditional healers.
This particular phenomenon plays extremely important role in the way patients respond to
health-related experiences, including ways in which they define health and illness and
seek and use health care resources
BIOLOGICAL VARIATIONS
Several groups of people differ biologically( physically and genetically from members of
other cultural groups constitute their biological variations
Link:
Biological Variations
 Several ways in which people from one culture group differ
biologically(physically and genetically) from members of other cultural groups
 Constitute their biological variations.
 Body build and structure including specific bone and structural differences
between groups , which smaller structure of Asians
 Skin color, including variations in tone ,texture , healing abilities and hair
follicles
 Enzymatic Genetic Variations in tone , including differences in response to
drug ang dietary therapies
 Susceptibility to disease , which can manifest as a high morbidity rate of
certain diseases within groups
 Nutritional variation countless examples which include” hot and cold
preferences found among Hispanics, Yin and Yang preferences among Asians
,rules of Kosher diet , Halal. A relatively common disorder , lactose
intolerance among People groups.
Communication

 Languages differences , verbal and non verbal behaviors and silence

 Language differences are possibly the most obstacle providing multicultural
health because they affect all stages of patient care all stages of patient-
caregiver relationship,
 Clear and effective communication in important when dealing with any
patient , specially if language differences create a cultural barrier.
 When provider is not understood he or she often avoids verbal communication
and does not realize the effect of non verbal communication, which is all too
often painful isolation of patients who do not speak the dominant language
and who are in an unfamiliar environment.
 Patient experience cultural shock and may react by withdrawing , becoming
hostile or belligerent or being uncooperative
Space

 Refers to people’s behavior and attitudes towards the space around

themselves.
 Territoriality term for behaviors and attitude people exhibit about an area
they have claimed and defend or react emotionally when others encroach on
it. Both personal space territoriality are influenced by culture and different
ethnocultural group have varying norms related to use of space.
Social Organization

 People grew up and live plays an essential role in their cultural development
and identification. The social process is inherent part of heritage cultural
,religious and ethnic background.
 Refers to the family unit(nuclear ,single parent or extended family) and the
social group organizations(religious or ethnic)with which patients and families
may identify.
Environmental Control

 Ability of members of a particular group to plan activities that control nature

or direct environmental factors.
 Included is the complex systems of traditional health and illness beliefs ,the
practice of folk medicine and use of traditional healers.
 This plays an extremely important role in the way patients respond to health-
related experiences , including the ways in which they define health and
illness and use health care resources and social support
Time Orientation

 The viewing of present past present and future

 People who are future-oriented are concerned with long ranged goal and
health care measures in the present to prevent the occurrence of illness in
the future.
 The difference in time orientation may become important in health care
measures such as long-term planning and explanations of medication
schedules.
Estes and Zitzow’s
Model of Heritage Consistency
 The degree to which one’s lifestyle reflects his or her respective tribal culture
The values indicating heritage consistency exists in a continuum a person can
possess value characteristics of both a consistent heritage (traditional) and
an inconsistent heritage(acculturated)

Determination of one’s cultural , ethnic, and religious background

link
Culture

 Definition by Fejos (1959)The sum total of socially inherited characteristics

of human group that comprises everything which one generation can tell
convey or hand down to the next ;
 The sum of beliefs, practices, habits ,likes ,dislikes ,norms customs, rituals ,
that are learned from own families during the years of socialization ; in turn
transmit it to own children.
 “Metacommunication system” not only spoken words have meanings , but
everything else as well.
Characteristics of culture

 Medium of personhood
 Only part of culture is conscious
 Extension of biologic capabilities
 Interlinked web of symbols
 Device for creating and limiting human choices
 It can be in two places all at once; found in person’s mind and exists in
environment in such form as the spoken word or an artifact
 Culture depends on social matrix , knowledge, belief, art, law ,morals, and
custom
 Culture and ethnicity are handed down are handed down from one generation
to another
Ethnicity

 Define as ;of pertaining to a social group within a cultural and social system
that claim or is accorded a special status on the basis of complex often
variable traits including religious , linguistic , ancestral or physical
characteristics
 Ethnicity: condition belonging to a particular ethnic group or ethnic pride
 Ethnocentrism :belief in the superiority of one’s own ethnic group ,overriding
concern with a race
 Xenophobe: person unduly fearful or contemptuous of strangers or foreigners
,especially as reflected in political or cultural views
 Xenophobia : morbid fear of strangers
Religion

 The belief in divine or super human power or powers to be obeyed or

worshipped as the creator(s) and ruler(s) of the universe or a system of
beliefs, practices, and ethic values.
 The practice of religion is revealed in numerous cults, sects, denomination,
and churches
 Religious teachings in relation to health help to present meaningful
philosophy and systems of practices within a system of social control having
specific values , norms and ethics.
 Related to health in adherence to religious code
 Illness is sometimes seen as the punishment for the violation od religious
codes and morals
Socialization

 The process of being raised within a culture and acquiring the characteristics
of that group.
 Fundamental to understanding culturally determined health and illness beliefs
 and practices from different heritages requires moving away from linear
 models of process to more complex patterns of cultural beliefs and
 interrelationship.
Acculturation

 Acculturation also refers to cultural or behavioral assimilation or may be

defined as the changes of one’s cultural patterns to those of the host
society.
 In the United States , The assumption of acculturation takes three
generations, hence the adult grandchild of the immigrant is considered fully
Americanized
Assimilation
 Acculturation also may be referred to as assimilation, the process by which an
individual develops a new cultural identity;
 Assimilation means becoming in all ways like the members of the dominant
culture.
 The process of assimilation encompasses various aspects , such as cultural or
behavioral, marital, identification and civic.
 The underlying assumption is that the person from a given cultural group loses
this cultural identity to acquire the new one.
 If this is not always possible , the process may cause stress and anxiety
 This can be described as a collection of subprocesses: process of inclusion
through which a person ceases to conform to any standard of life that differs
from the dominant group standards and , at the same time , a process
through which a person learns to conform to all the dominant group standards
 The process is complete when the foreigner is fully submerged into the
dominant cultural group part of heritage
4 forms of assimilation

 Cultural ;the ability to speak their language in excellent manner

 Marital When member of the group intermarry with members of another
group
 Primary structural and secondary structural determine the extent of social
mingling and friendship occur between groups.
 Primary structural assimilation between people are warm,personal
interaction
 Between group members in the home ,church, and social groups
 Secondary structural assimilation non discriminatory sharing , often cold
impersonal nature, between different groups in settings such as schools and
workplaces.
The dominant society expects that all immigrants are in the process of
acculturation and assimilation and the worldview that we share as health care
practitioner is commonly shared by patients.

 We live in pluralistic society :VARIATION OF HEALTH BELIEFS EXISTS

 The concept of “HERITAGE CONSISTENCY” is one way of exploring whether

people are maintaining their traditional heritage and of determining the
depth of person’s traditional cultural heritage
Decent Workplace
Analyze past present and future trends in the racial and ethnic
composition of the health care workforce
Link:
International Labor Organization
Agenda
 Promoting jobs and enterprise
 Guaranteeing rights at work
 Extending social protection
 Promoting social dialogue
 With gender a cross cutting theme
Types of Nurses In the Philippines
 Types of nurse in Philippines
 The most sought-after nursing jobs:
1. Registered Nurse. ...
2. Licensed Practical Nurse. ...
3. Clinical Nurse Specialist. ...
4. Nurse Practitioner. ...
5. Intensive Care Unit Registered Nurse. ...
6. Emergency Room Registered Nurse. ...
7. Critical Care Registered Nurse. ...
8. Labor & Delivery Registered Nurse.
9. Community Health Nurse
10. Private Duty Nurse
Republic of the Philippines
PD 442 As Amended May1 1974
 Title II
 Training and Employment of Special Workers
 Apprenticeship
 Article 59-64, 71, 72
 Working Conditions and Rest Periods / Weekly Rest Periods
 Article 82-93
 Chapter III
 Holidays Service Incentive leaves and service charges
 Article 94-96
Title II WAGES ;prohibitions
Employee;Wage;
Article 102
Article 112
Article 124,127
Tittle III
Working conditions for special groups of employees
Article 130 133 134,135
 Case study here
HEALTH CARE WORK FORCE

 Objectives:
 Identify Meaning of work and its influence on the corporate culture and
organizational climate
 Examine the manner in which hatred, prejudice ,racism ,discrimination
,ethoviolence , manifest themselves in the health care workforce
 Analyze cultural origins of conflict in the health care workforce
 Evaluate strategies for promoting effective cross-cultural communication and
preventing conflict in a multicultural workplace
 Trace Trends of the migration of Foreign Educated Nurses (FEN)
Sending and Receiving Countries
objective:
Trace migration of foreign educated nurses
 (Sagar)
 Philippines worlds largest exporter of nurses
 350 nursing schools (CHED)
 Annual Philippine graduate 13,000 (PNA)

 Nurse drain Inextricably linked to the larger process of restructuring

 Increase demand for services in the developed countries and export of
manufacturing to developing countries account for higher global mobility
 Outsourcing of industries has become more common in the past years.
 Hidden US colonialism in the Philippines and Americanized training hospital system
that prepared nurses to work in the United States (USA)rather than in the
Philippines ( read handouts)
Ethics of Recruitment

 Nurse drain from developing countries to developed countries create health

care problems, the exodus of nurses is compromising health care in the
Philippines
 Equally alarming are indicators pointing to the decline in the quality of
nursing education , such lower pass rates in the boards exam, decrease in the
quality of quality of nursing instructors and inadequate clinical facilities.
 Globally there are glaring inequities in the distribution of human resources for
health. Comparatively Asia has 3% of the health service
 World Health Organization suggests that underdeveloped countries maintain
1,000 nurses per 100,000 population
 The salaries of nurses un the US are among the highest in the world.
 In comparison nurses in the Philippines earn between 100$-200$ a month
 Working in advanced health care areas in the US enriches nurse clinical and
leadership abilities
 The opportunity to live in another country and be immersed in another
culture is also attractive to some nurses
 The face of Filipino nurses graces the hospitals in the Middle East, In Australia
New Zealand , Canada ,Europe, Canada ,United States and in many parts of
the world.
Philippine Labor code

 Under Article 281 of the Labor Code of the Philippines, probationary employment shall
not exceed six (6) months from the date the employee started working, unless it is
covered by an apprenticeship agreement stipulating a longer period. The services of an
employee who has been engaged on a probationary basis may be terminated for a just
cause or when he fails to qualify as a regular employee in accordance with reasonable
standards made known by the employer to the employee at the time of his
engagement. An employee who is allowed to work after a probationary period shall be
considered a regular employee.
 Article 83
 Enunciates that the number of working hours 8 hours a day
 An employee who performs work exceeding 8 hours is entitled to an
additional compensation equivalent to his regular wage at least 25% there of
 Article 85 meal periods subject to such regulation 60 minutes time off for
regular meals
 Article 90 for the purpose of computing overtime and other additional
renumeration required the regular wage of an employee shall include cash
wage only with out deduction of account of facilities provided by employer
 Emergency overtime work

 Article 95 grants every employee who has rendered at least one year of
service to a yearly service incentive leave for 5days with pay.
 Article 92 when employer require work on rest day , the employer , the
employer may require his employees to work any day
 Article 94 the employee is entitled to at least 100% of his daily wage rate
even if he does not report to work during regular holiday , provided he is
present or is on LOA on the work day immediately preceding the holiday
 Article 95 currently grants every employee who has rendered at least one
year of service incentive leave
Cultural Perspective of Meaning of Work
(Andrews)
 Earliest idea of work refer to as curse , punishment, or necessary evil needed
to sustain life
 People of high status did not work ,whereas slaves indentured servants and
peasants work
 In contemporary society the concept of work must be considered in its
historical and cultural context.
 Cultural views of caring for the sick also must be considered because such
care maybe perceived as divine calling for those with supernatural powers(in
some (African Tribes);
 A religious vocation (some ethnic Catholic groups)
 Or undignified occupation for lower class workers (some Arab groups Kuwaitis
and Saudi Arabians)
Cultural norms influence a staff member’s
consideration of group interest as opposed to
individual interest in multi cultural workplace
 Two major orientation
 Individualism importance is place on individual inputs ,rights and rewards.
Emphasis is on autonomy competitiveness, achievement and self-sufficiency.
e.g Most Europeans/English Speaking countries
Collectivism entails to maintain group harmony above partisan interests of
subgroups and individuals
Values interpersonal harmony and group solidarity prevail.
e.gAsian /South American /Amish /and Mennonite groups
Negative Attitudes and Behaviors In the
Multicultural Workplace (Andrews)
 Hatred According to Henderson HATRED in the workplace is exacerbated
during time of rapid immigration, periods of economic recession or depression
, high unemployment.
 Competition of sexual partners is also cited for hatred
 Tremendous hostility
 PREJUDICE refers to inaccurate perception of others . Result in conclusions
that are drawn without adequate knowledge or evidence.
 BIGOTRY refer to attitudes ,
 DISCRIMINATION refers to behaviors and is defined as act of setting one
individual or group apart from one another.
 RACISM implies superior or inferior traits and behavior are determined by
race
 Continuation;
 1.institutional structures and personal behavior and the relationship between
the two
2.the variation in both degree and form of expression of individual prejudice
3.the fact that racism is merely one form of a larger and more inclusive
pattern of ethnocentrism that may be based on various factors , both racial and
non racial
Factors Cause of Racism
Ignorance
apathy
poverty
historic patterns of discrimination against particular group
social stratification
Part of larger problem of ethnic identification, of power and powerlessness
and exploitation of the weak by the strong.
 In multicultural workplace ,the expressions of negative attitudes and
behaviors by people towards others according to their identification as
members of particular concern.
 The expressions of these attitudes and behavioral patterns is learned as part
of cultural process
 Negative group attitudes and destructive group conflicts are less likely to
arise when employees treat each other as individuals and respond to each
other on the basis of characteristics and behaviors.
 Schwartz and Sullivan(1993) Selective mistreatment, often in the absence of
adequate social support , undermines the work experiences individuals who
are identified with groups that are targets of discriminatory behavior.
 The manifestations of discrimination can be expected to undermine the
functioning of health organization
 Victims of mistreatment may in turn mistreat others.
 People are likely to experience a form of internalized oppression as a result of
low self -esteem
 Violence in the Workplace
 Target of hate crimes ,reported cases of ethnoviolence
 (Herderson ) Blacks ,Hispanics , Asian , Homosexuals Jews, Arabs, Muslims are
primary target of hate crimes
 It is impossible to protect all employees and patients from violence in health
care settings , reasonable steps must be taken to protect those believed to be
at risk.
 Health care a administrators have moral imperative to take reasonable steps
in ensuring the physical safety of the staff , patients/client and visitors
 Safe perimeter so patients and staff may have safe access to the facility.
 Unfortunately some demonstrators may have strong conviction of violated
others’ civil liberties and engaged in violent acts against those who disagree
with their point of view
 Violence may have caused by a complex web of interconnected factors
,including religious, moral , ethical , social political and cultural differences
 FORMATION OF ATTITUDES (Henderson)
 ATTITUDES are learned not innate.
 Researchers found that as the children grow older they tend to forget that
they were instructed in attitudes by their parents and significant other
people.
 Around age of 10,most children regard their attitudes toward people in
different cultural backgrounds as being innate.
 Seldom do they recall being coached.
 SOCIAL AMNESIA develops and elaborate rationalizations are presented to
account for learned attitudes
 Superiority over inferiority of a group (vs an individual) is usually less obvious
than an individual’s behavior.
 Most staff bring their cultural attitude with them , and they are molded and
shaped by peer pressure.
Carl Jung

 We still attribute to other fellow all the evil and inferiors qualities that we
do not like recognize in ourselves , and therefore have to criticize and attack
him, when all that has happened is that an inferior soul has emigrated from
one person to another. The world is still full of ” betes noir” and scapegoats,
just as formerly teemed with witches and werewolves
Changing Attitudes
 Some argue that focus should be on behavior change rather than “attitude
change”

 Others maintain that hatred, prejudice , bigotry ,racism, discrimination

ethnoviolence, begin with individual’s attitudes toward certain groups .


 Staff members attitudes can be changed in several ways , but they require
commitment by all levels of management within the organization.

 They also require a certain degree of openness and receptibility by the

individual


 Efforts to change staff’s member attitudes about people from culturally
diverse groups should center on communication
 Approaches :
 1.Formal attitude change approach; assumption that people are rational ,
information-processing beings who can be motivated to listen to a message ,
hear content , incorporate what they have learned when it is advantageous to
do so
 There is an actual or expected for reward for embracing diversity
 2.Group dynamics approach ;assumes that staff members are social beings
who need culturally diverse coworkers as they adjust to environmental
changes.
 The amount of change depends on people’s attitudes towards diversity ,their
attention to the message and their acceptance of the message.

 CULTURAL VALUES IN THE WORKPLACE
Cultural value frequently lie at the root of cross-cultural differences in the
multicultural workplace
Values form the core of a culture , that exert influences on individuals within the
multi cultural health care settings:
Time orientation
Family obligation
Communication patterns (etiquette, space/distance, touch)
Interpersonal relationships (including long standing historic rivalries)
Gender /sexual orientation
Education
Socio economic status
Moral,religious beliefs ,
Hygiene
Clothing
Meaning of work
Personal traits
 Importance of learning about values of people from diverse cultural groups
 Values exert a powerful influence on how a person behaves, reacts, and feels
 Values affect peoples lives in 4 major ways
 1.Underlie perceived needs
 2.What is defined as a problem
 3.How conflict is resolved
 4.Expectation of behavior
 When values of individual members conflict with organizational values or
those held by coworkers , challenges ,misunderstanding and difficulties in the
workplace become inevitable.
Cultural Perspective on Conflict
latin : confligere ; to strike against
 Action that range from intellectual disagreement to physical violence
 Dominant culture : People should behave assertively and deal with conflict
through direct confrontation
 Other culture (collectivist groups) may promote avoidance of confrontation
and emphasize harmony ;cooperative , conciliatory style of managing conflict
 They learned to internalize conflict and value harmonious relationships
above winning argument and “being right”
 For Asians descent Conflict is not healthy desirable or constructive
 In the Arab world mediation is critical in resolving disputes and confrontation
seldom works, Mediation allows for saving face , all conflicts do not have
simple solutions
Nurses from China and Japan may use covert conflict prevention strategies to
minimize interpersonal conflicts.
Many people from individualist culture view
conflict as healthy , natural , inevitable
component of relationship
 Assertive , confrontational direct style in communicating is characteristics of
people from individualistic culture
Cultural Origins of Conflict
 1.Family obligation
 Both staff and those in administrative positions frequently report difficulty
with requests from nurses of diverse cultural backgrounds that pertains to
family obligation
 May be labeled as uncommitted to their work and or disinterested in their
nursing careers . Family is a priority than job or career,
 Excessive absenteeism is undesirable behavior
 It is generally useful to identify the reasons for excessive absenteeism and
explore culturally appropriate strategies for resolving the problem, such as
use of natural support that is culturally expected of family memebers.The
solution is seldom simple.
 (Tackled in leadership)
2.Cultural Perspective on Personal Hygiene
“Cleanliness is next to godliness”
Highlights the value for cleanliness , including an obsession with eliminating and
minimizing body odors-evidenced by plethora of deodorants , douche body
lotion,mouth washes and the like of different fragrances.
Other cultures are unduly bothered by body odors and see no reason to refrain
from masking nature’s original smells.
Other staff members may be following religious or cultural practices that prohibit
bathing during certain phases of menstrual cycle , delivery of baby , at other
times
Others may come from a country where water is scarce and bathing is restricted.
Nurse managers and other supervisors frequently find sensitive topic of hygiene
difficult to discuss with staff from diverse cultural backgrounds
Communications
 Issues on Effective Cross –cultural communication
 The nurse must exercise must exercise considerable judgment when making
 effective methods of communicating with staff members and patients
/clients from diverse cultural backgrounds considering sense of timing tone
 and pitch of voice choice of location for face-to-face interactions and related
matters.
 Communication difficulties caused by differences in language and accent
 become compounded on the telephone.
Cultural Perspectives on Touch

 Special attention to male-female relationships is warranted in the

multicultural workplace
 It is best to refrain from touching staff members of either sex unless
necessary for the accomplishment job-related task , such as provision of safe
patient care.
 For Nurses who tend to be more tactile , it is important to consciously
refrain from placing one’s hands on another’s armor shoulder as frequently
during ordinary conversation
Cultural Perspective On Etiquette
 Values frequently underlie cultural expectations of behavior ,includes matters
of etiquette

The conventional code of good manners that governs behavior

Cultural Perspectives on Clothing and
accessories
 Most health care institutions have a dress code or policy statement about
clothing accessories worn by staff in various parts of the facility . It is
important to review these documents periodically from a cultural
perspectives.
 Modification of dress code may be necessary to accommodate some attires
from different cultures.
Cultural Perspectives on time
orientation
 Cultural differences in time Orientation create difficulty in the workplace.
May manifest itself when staff members from diverse cultures are tardy, take
excessive time for breaks ,fail to complete assignments within the expected
time frame.
 The differences may be interrelated with the cultural meaning of work,
religious practices , and cross-cultural communication issues
 It is important to be explicit in job-related expectations about punctuality
,schedule for breaks and time allotted assignments
 Follow up discussion should be conducted in a positive, proactive manner
viewed as an opportunity to promote cross-cultural communication, not as a
punitive or disciplinary measure.
Cultural Perspectives on Interpersonal
Relationship
Authority Figures ,Peers ,Subordinates and
Patient/clients
 There are cultural differences in interpersonal relationships involving
authority figures ,peers , subordinates and patients/clients
 Perception of harmony and conflict come into play.
 Direct confrontation with a person in authority would be perceived
negatively
 On the other hand other culture may experience “losing of face”
 Perceived as causing disharmony in the nurse-physician relationship.
 On the other hand the charge nurse perceived the physician as a colleague
whose respect would be earned by assertive direct communication with him.
Long-Standing Historic Rivalries
 1900 Century of war . Any given moment , there was armed conflict between
two or more nations or between two or more nations or between factions
within nations
 Multi cultural workplace becomes a battleground, where long –standing
historic rivalries and more recent geopolitical differences are reenacted in
the form of international conflict between two or more staff members.
 Cues that may signal underlying historic rivalries include
 1.expressions of high levels of emotional energy when a staff member is
interacting with a person from rival group when the topic does not seem to
warrant it.
 2.Sudden uncharacteristic behavior changes 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
 4.Inappropriate attempt to persuade others to adopt the staff member’s
partisan views about the rivalry
Cultural Perspectives On Gender and
Sexual Orientation
 The complex interrelationship between gender and culture has been studied
extensively
 Nurses of both genders may face biases and preconceptions of physicians,
fellow nurses and other health care providers
 It can be complicated by cultural beliefs about relationships with authority
figures and cross-national perspectives on the status of various health care
disciplines.
 Care of the sick is carried out by health care providers who are hired from
abroad for the purpose of caring for bodily needs of the sick-an activity that is
considered unacceptable in its cultural content.
 Men in nursing and other health care disciplines dominated by women
continue to struggle as a minority members of their profession.
 In multicultural health care workplace both men and women face gender
biases that exists in society.

These issues frequently emerge in verbal and nonverbal communication and in

interpersonal relationships.
Our language also betrays covert gender biases and preconceptions.
For example the expression “male nurse” but seldom hear female nurse because
the term is considered redundant and unnecessary.
Extensive analysis of workplace issues concerning gay , lesbian, and bisexual
staff members , must be considered in the workplace
GAD -Gender and Development

 https://zrc.pshs.edu.ph
 A development perspective that recognizes the unequal status situation of
men and women in the society.
 A strategy on Gender mainstreaming or a strategy for making women’s as well
as men’s concern and experiences an integral dimension of design
implementation, monitoring, and evaluation.
 Goal of GAD as a development approach , GAD seeks to equalize the status
and condition of and relations between men by influencing the process and
output of policy making ,planning ,budgeting implementation and evaluation
so that they would deliberately address the gender issues and concerns
affecting full development of women
Promoting Harmony in the Multicultural
Workplace
 There are facilitators and barriers to promoting harmony in the multicultural
workplace
 Facilitators include
 identification of cultural values of the organization, institution or agency
clear articulation of the mission statement and policies about diversity
 Zero tolerance for discrimination;
 Effective cross-cultural communication
 Skill with conflict resolution involving diversity
 Commitment to multiculturalism at all levels of management
 Barriers that must be to overcome :
 Hatred
 Prejudice
 Bigotry
 Racism
 Discrimination
 All employees should be appraised that there will be zero tolerance for those
who engage in negative behaviors ,management staff at all levels should be
given authority to impose sanction when violators occur.