Theoretical and Scientific Foundations of Nursing

Chapter 13 Theories From the Sociologic Sciences 281

Cultural Diversity Culture refer~ to the ~lured bclid~ .rnJ \'Jlui.:~ tlut underlie .rnd gcncr,lte \ll(i,11 bi.:- h.1\'ior. It is how peopk m.1kc mcJning of their c::xpcricn..:c~, opcr.uc in dai1'· lifr . • rnd dcn~lop so..:i.11 org.111iz.1tion. The intcrc~t in and the ~tudy of culnm: \\ ithin the

282 Unit 111 Shored Theories Used by Nurses

l lnited St.1ks h.1s been sceadily pushing its \\'J.Y w the so..:ial fordront si1w: the mid- I980s I Akx.mdcr & Smith, 2009 ). It w.1~ .ilso during thi~ ti me that a ~hiti: on:urred in U.S. popubtion dcmographio .111d the corresponding in..:n:ase in diH-rs..: ethnic group~ bec.1me more pronounced. Indeed, ..:ulrun.: is \'ery rdcLmt to nursing prac- ti~·e br..:.1use it is .1 signific:1.11t detcrmin.mt of hc.1lth-n.:L1ted behaviors and .1 n1.1jor factor in hc.tlth c.m: dclin·ry.

Overview Dc~pite some , ·ariacions, ~u..:ial s..:ientist~ agree n n the e~senria,( principles o f culture. These principles .He that ( 1) culrnre consists of t.111gibk ( m.1tcri.1I ) .111d im.rngibk ( nonmateri.1l I components; ( 2) people inhcric Jnd le;trn .1 culture; ( 3 ) biologic, endronmental, .md hisrori..:.1I fon:cs .,h;1pc .rnd d1ange n 1lturc; .md { 4) cultu re i~ .1 tool tlur pcople use to e,·.1lu.nc other ~o..:iet ie~ .rnd ad,1,pt t0 problems of li\'ing I fcrr.1nte, 201;; I. ;\lost people arc so .1..:..:mtomed to the!>c bdids, pcrspt:ai,·..:s, .md pr.Ktice~ th1.·,· are often un.l\\ .ire of them until they 1.· 11..:o untcr another ..:ul- ture. Equating ethni..: perspe.:tiy,:., t,r resc,uch only on ethnic o r minority groups is .1 Ycry limited ,·ic\\' .1s e\·cryone .111d n ·cry group h~,s its own ..:ultur.1I bel iefs .md practices. Tht.: \\'ord bins rcti:r~ ro .111 i11din .1tion for o r .1g.1inst some pheno menon tl1.1t inhibit\ i111p,1rti.1l and objecti,-e jlldgmcnt .md thJt .:an, in th,: extreme, con- stitute prejudice. C11ltuml bins, intt"rpreting and judging phenomcna in relation to one's 0\\"11 culture, i.', .:0111111on ,1mnng ~m:i.11 and human societies .111d nccds to be re..:ognized. A multitude ofhi.'.toric,11 .111d contemporary ,:xample~ of cultural bi,1~es dc;1I \\'ith the "isms": ra.:ism, ~ex ism, cl.tssism, .md ,1gcism. ,'\n alternJte perspec- tin: \'iews .:ultur.11 bias as a norm.ui,·c respome to s,1tegu,1rJ th,lt whid1 i~ knm\'n and familiar to th.: individual-cr/mocrntrism. Am· normatin· belief about hu111 ;111 bt·ings c.rn be rcason.ibly isol,lted .1s .1 cultural bdicf .rnd consequently lead to .1 bia.'.ed pc-r.'.pecti,·e.

C11/t11rnl cu111pt'tmCf lus become ,·cry impmt.111t in din i1.··,1I pra.:ticc .1s ethni.: di- ,·cr.'.ity and .rn·.1rcness htl\"c challenged dinici,111,. Indc-ed, culturJI co mpetenc,: has bc-c-n linked w scnsiri,·iry tlJ culture, r.1cc, ethnicity, gcnJer. ,llld scxu,11 oricnt.1t io n in pro,·ision of patient-centered lwal th c.1rc .md imprm·emcnt in h..:nlth ourco111<:~ ( Engt:bretson, 2011 ). Prm·iding culturally scmitin· he.11th c,u,: is expected , o r ...-,·en 111,rnd.1ted .1~ ( 'ultur.11 .rnd Linguistic Scn·i.:I."~ ( CL\S ) st.rnd:.uds ,,·1.-rc e~tablis hed b~· the Office 011 1\linority H1.·.ilrh ( 01\lH I in 2001 .md nr'l' incorpor.1tcJ inro The Joint Commis.'.ion\ .1ccrcdit.1tion (The Joinr Commi~sinn, 20101.

To be cffcctin:, hcJlth profcssion.1ls should considl'r culru r:1II~· cmbcddni per- spcctin:s, hut remember that one size docs nor tit all. .\I though promoting cultur.11 competence .rnd re.:ognition of culrur.11 ditfrrenc,:~ or \',lria tions is welcome, .'.ollle concerns with thcsc emph.1ses .ire esscntializing thi.'. information into stereotyp- ing indi,·id u,1l s with group identities. To .1ddre.s.'. su..:h con..:errn, .111d incorporJte paticnt ,·a lues .rnd circumst.111..:cs into CHl' Jcli,·cry, nursing theorists dcycJopcd the Clini.:.11 Model of Culrnral Competence (Engebretson, 2 0 11~ Engebretson, Mahoney, & Carlson, 2008 ). Thi l'- mode l in..:orporateJ ,l ..:ultural competency continuum . .\tone end of the ...-onrin uum \\ne cultur.11 "dc.structiYeness" .rnd "i11...-.1p,1.:ity"-\\'hcre dcsrru.:ti,·e hchaYior was directed ,lt specifk gro ups. Toward the middle of the continuum .ire "culrnral blindnes~" ,rnd "prc..:ompetence"; here, dinici.ms .'ieck to tre.lt .111 g roups "·ith equalit~·, .rnJ there arc efforts ro nwYc tow.1rd understanding of the g;roup. C ultur.11 "cnrnpetem:y" and. "proficiency" are the highest k,·cl~ of the model. Here, the ...-lini...-i.rn demonstr.Hes .Ill u111.krstanding of th1.· ..:ulturJI issucs, and progresses tcm·ard provision of cul turally competent, indi,·idual-b.1scd c.1re.

Chapter 13 Theories From the Sociolog1c Sciences 283

Application to Nursing In the ~cKial ~ci1:nces, significant r1:~1:arch i~ b.1sni on how ml'.'mber~ of .1 \oci.11 group .mend to their en:ryd.1y li\'es ( Holstein & Gubrium, 2008 ). Ethnography rd<:r~ to both rhe product nf an Jnthropologic study .is well as a research .1ppro.1ch .md i~ c ,li:n1 ,1pplied in nursing studies. In the litt:rarure, there .ire many n.1mplc~ pf nursing ~tud- ies th.1t re~e.m.:h cultur,11 bclicb .rnd practin:s, often using ethnographic techniques. For ex.1mplc, Hig.ginbottnm. Ri\'a~, .rnd Story ( 201-1) conducted .1 focused ethnog- r.1phy look :.lt the health .rnd ~ocial needs of Somali rdi.1gcc~ \Yitl, l"i~u.11 impJirmcnt, concluding; there is .1 significant need for social ~upport ;,nd awarcnc~~ of community outre.tch scn·iccs for these imfo·idu.11'. Also researching rcti.1gel'.'s, D.i,·enport i 2017) perforn1l'.'d .1 grounded theory study to examine issues faced b,· Iraqi refugen \\"hen they settle in the United St.Hes. In other ex.1111plcs, J\kCulbgh, Sanon, .rnd Foky l 2015 l u~ni qualitati,·I'.' mcthnds to ex.1mine he.11th practices of migrJnt ~e.1.~011.1! farm\\"orkers .md Opalinski, Dyess, Jnd Groopc:r ( 2015) w,cd ctlrnogr,1phic method_., to research strJtegics that r.::.111 be usl'.'d by multio1ltural faith communities to .1ddrcss the problems of childhood obesity.

In se,·..:ral examples from the literature, "culture" did not neces~Jrily reter to r.1ci.1I or ethnic groups. In lllle \\"ork, Christemen I 101-1) described how ,nur_~es "·ho work in correction.-il facilitie~ should consider the "culture of incarceration" in proYiding culturally sensitive care for i11carccr.1t1:d women. Then, Rkhardson ( 201-1) di..,cusscd the impnn.mce of considering the spl'.'cific need~ of rhe "De.1f ntlture" ro prcwidc culrurall~- competent care to those \\ith he.1ring impairments.

Fin.1lly, infor111.1tion, st1".1tegies, .rnd models tu promote cultu1-.1l competence .ire easily itkntitil:d in the nursing literature. Elminowski ( 20 IS) repor,ted on dnelop- mcnt of a ,nirkshop to prommc cultural aw.m:ne~s for nurs..: practitioner~, .rnd Lon~ ( 2016 l dei,crihcd the implcmcm.Hion of imenuti011JI scn·ice learning experiences to promote culmral compctl'.'nce in nursing ~tudcnt~. Fin,111~·, Shen ( 2015) performed J systemati..: literature re\'iew and reported on her ,uulysis of the m.1m· cultural compe- tence models .md cultural competency .1~scssm..:m instruments that h.n·e been pub- lished o,·er the past 35 years.

Current methods of research, practice, .md training. .u-c dulleng,ed by multiculrur.il- ism. Results from these .md other cultur.1lly b.1~ed ~tudies h.,n: implic.ltions for he.11th c.m: proti:ssion.,1~ to pro\'ide culture-specific .111ll e\"idcnce-based care. Box 13-3 giws guide- lines on hm,· to .1\"oid cultu1-;1l bi,1s in research .rnd thereby impnl\'e he.11th c.1re for .111.

Box 13-3 Recommendations for Avoidance of Cultural Biases in Research

Acknowledge your own cultural beliefs and values through ongoing selkissessmenls. Question the value, purpose, cultural origins, and relevance of cur,re11t practices wherever they ore found. Critically examine any cross<ulturol research in literature reviews for potential bias and pretension and be prepared for anti-intuitive findings and rejection of ,assumptions. Engage persons culturally similar to the study sample at each step of the research process.

• Promote cultural diversity in scientific nursing communities jlocol, stole, notional, and international) to provide checks and balances for individual biose.s, Create environments for egalitarian and pluralistic dialogue. Collaborate jar consult) with o multicultural interdisciplinary research group. Consider o qualitative ethnographic study for exploring differences.