Challenge of Cultural Diversity in a Nursing Practice Essay

Challenge of Cultural Diversity in a Nursing Practice Essay

Cultural diversity as a challenge in a nursing practice

1.Introduction/Overview of the Problem:
Thorough and logical overview of the problem, includes a discussion of the problem’s relevancy to nursing
2. Summary of Findings:
Thoughtful, clear, and detailed summary of findings from the current peer-reviewed literature on this issue
3. Recommendations:
Recommendations/implications are stated clearly, includes a discussion about expert views and steps to address the issue
4. Personal Opinion: Challenge of Cultural Diversity in a Nursing Practice Essay
Clearly addresses the nurse’s role in evidence-based healthcare including the following questions: 1) what you feel your role is in applying research to your own practice 2) how your practice has changed as a result of evidence (i.e. is practice now different because of the current evidence?)
5. Formatting:
Consistent use of APA (7ed)guidelines including reference citations within the paper and on reference page; grammar, writing style, and avoiding personal pronouns for “personal opinion” section
6. Use at least 5 peer-reviewed articles for references, scientific journals Challenge of Cultural Diversity in a Nursing Practice Essay


For a nurse to be competent in their nursing practice, there must be adequate communication and efficient care. When the nurse encounters a culturally diverse patient, or a patient from a different culture, there are a variety of obstacles that may impede the nurse with having adequate communication and efficient care with the patient. The purpose of this post is to review the various obstacles that can occur when the nurse and patient come from different cultures. The obstacles to review are cultural baggage, ethnocentrism, cultural imposition, prejudice, and discrimination. Then will proceed to explain what can be done to overcome the obstacles through cultural self-assessment and the five steps in providing culturally congruent nursing care (Andrews & Boyle, 2015). Challenge of Cultural Diversity in a Nursing Practice Essay
Cultural Obstacles
Everyone functions within his or her own culture’s understanding of the world. This includes what is normal and what is the proper way of dealing …show more content…
The nurse must determine what are her or his cultural beliefs and how do they dictate to the nurse what is normal and what should be done to deal with life situations. This includes an honest look at the nurse’s prejudices and acts of discrimination. Once the problem has been realized, the nurse can work on overcoming it. This is accomplished when the nurse leaves his or her own cultural baggage behind and by learning what culture the patient has to provide support. This leads to the concept of culturally congruent nursing care.

Any human community has some basic needs such as food, shelter, safety as well as
health care services. The community thrives when these needs are satisfied as they encourage growth. This is true also for today’s multicultural and diversified modern society. Our modern societies have gone a long way to provide the best of health care services to the community at large. However, the immigrant population is known to have
increased risk for poor physical, psychological and social health outcomes. On a general Challenge of Cultural Diversity in a Nursing Practice Essay
perspective, immigrants vulnerability is linked to financial, socio-economic and environmental factors (Grabovschi, et al., 2013). The vulnerability to health and health care
disparities results from a combination of cultural factors including language barriers,
stigma and marginalization and they occur on a system, provider and patient level
(Derose et al., 2007; Egede, 2006).
Previous findings reveal that ethnic minorities have cultural traits and health profiles
that present complex challenges to health care practitioners in terms of access to equitable care. Thus, many countries especially multicultural societies like Canada, USA,
Australia and the United Kingdom have recognized the need for linguistic and cultural
competence. Health care services need to develop policies and structures to address
health care disparities to provide appropriate access to care to diverse populations
(Szczepura, 2005). In a multicultural society like Australia, health care professionals
have reported difficulties with ethnic minority patients that results in them having inappropriate or diminished access to care, due to cultural differences. Thus, policy makers,
service organizations and health care providers need to understand how people’s cultural backgrounds influence their needs for services and decisions they make concerning
their health and to effectively give care in line with the cultural contexts of the communities served (Yeboah et al., 2013).
The purpose of this study is to investigate challenges that nurses’ encounter when caring
for patients of diverse cultural backgrounds. To examine the effect of these challenges
on nursing care delivery and to exploring ways of overcoming them in order to provide
culturally competent and equitable care to all patients. The writers also got motivation
to write on the subject out of personal experiences at practical training during the study
period. The findings from the study may be used as a reference for additional  Challenge of Cultural Diversity in a Nursing Practice Essay
knowledge for nurses in Finland to providing culturally competent care to patients, as
the society continues to experience a steady increase in its immigrant population.
2.1 Multiculturalism
The concept of multiculturalism has dominated discussions for the past 20-30 years in
many countries of western civilization. It became widespread in the 1970s with the aim
of accepting or tolerating cultural diversity. Multiculturalism is a new concept that is yet
to be distinguished from globalization and liberalism and it is best known in the AngloSaxon world with practical implementation in Canada and Australia. Multiculturalism is
often associated to international migration of people across borders. It is historically
linked to the arrival of migrant workers and colonial immigrants, the arrival of their
family members and the refugee flow in the 1980s and especially of 1989. Multiculturalism in everyday language is also regarded as identical to efforts to promote the integration of immigrants (Berkes, 2010). In addition, multiculturalism is of the view that
cultures, races and ethnicities particularly those of minority groups deserve special
acknowledgement of their differences within a dominant political culture (Eagan, 2015).
Multiculturalism exist in different forms and can be examined from different dimensions. Multiculturalism could refer to a demographic fact, a set of philosophical ideas Challenge of Cultural Diversity in a Nursing Practice Essay
or specific orientation by government or institutions towards a diverse population. Current debates on the value of multiculturalism focus on the policies and laws that are appropriate in dealing with diversity and immigrant integration. In these debates, opinions
differ when it comes to the meaning of multiculturalism, its challenges and benefits.
Proponents of multiculturalism suggest that recognizing and accommodating minority
cultures increases their attachment and engagement in the larger polity. While critics
argue that excessive emphasis on diversity undermines a cohesive collective identity
and hinder common political projects. Research from Canada, Australia and many European countries indicate that many governments are adopting multicultural policies despite the political rhetoric around perceived problems of diversity. Although policy
makers and academics find difficulties in striking a balance between majority preferences against minority interests, evidence suggests that multiculturalism facilitates immigrants’ sociopolitical integration and contribute to their sense of civic inclusion. By
integrating minority groups in main stream society, negative consequences of the feel-
ings of marginalization and exclusion are eliminated. Nevertheless, this view in not
conclusive as the debate on multiculturalism remains an ongoing process (Bloemraad,
2.2 Multicultural Nursing in Finland Challenge of Cultural Diversity in a Nursing Practice Essay
For the past 22 years, Finland has experienced migration in large numbers since becoming a member of the European Union. The recent influx of immigrants is a new phenomenon to the people and the issue of integration and creating social cohesion has become one of the most important challenges for political decision making in Finland and
the whole of European Union. However, the Finnish population is becoming more
aware of the change to a more open and multicultural society whereby immigrants are
given the responsibility to learn Finnish language and customs while preserving their
own culture (Koivukangas, 2002). The population of Finland rose to a new level in
2016. According to Finnish statistics, 34.905 persons migrated to Finland in 2016 which
is a 21% increase more than the earlier year. This increase in migrants exceeded the
2013 records by 3,000 immigrants. Finland has seen an increase in migration that has
grown to 16.823 persons from the previous year of 12.441 (Statistics Finland, 2017). If
external migration remains constant in 2017, the Finnish population will increase by
21.909 as settled permanent residents (Country Meters, 2017).
Just like in other societies, clients with immigrant background in Finland are reported to
be in a poorer state of health and wellbeing than among the general population. Immigrants have difficulties in obtaining social and health care services and information Challenge of Cultural Diversity in a Nursing Practice Essay
about the services despite the employment of professionals with immigrant background
in the health care field (National Institute for Health and Welfare, 2016). There exist
cultural differences visible in language, dress and diet that can be a challenge for patients, employees of different cultural backgrounds and for Finns in general. The health
care system anticipates the need for more skilled and trained health personnel within
and from other countries to manage the increasingly international community in Finland
(Korpela, 2008).
2.3 Multiculturalism and Nursing Care
Recent statistics reveals that about 244 million people or 3.3 percent of the population
of the world reside out of their country of origin. This is a 41 percent increase compared
to the year 2000. Majority are immigrants who cross borders to look for better economic
and social opportunity or maybe because of crisis (United Nations, 2016). The trend in
the immigration of diversified migrant groups means that societies have to come to
terms with a considerable cultural diversity, in terms of linguistic, cultural and socioeconomic specificities that are different from the homogeneous population (Paula &
Mendes, 2013). Other studies on ethnic minorities and health professionals also reveal
structural and psychological factors as barriers to providing care (Parmet et al., 2017).
Cultural diversity poses many challenges to health care systems whereby health professionals have to care for patients with different cultural backgrounds. Some of the challenges include lack of cultural sensitivity and understanding, health literacy and perceptions of expected versus perceived care. There are indications that these challenges are
directly linked to higher levels of psychological distress in migrants (Hyatt et al., 2017).
Nurses on their part feel that providing care to ethnic minority patients affects the flow Challenge of Cultural Diversity in a Nursing Practice Essay
of work, time needed to deliver care and the cost of providing interpreters which is
stressful to both patients and nurses (Taylor et al., 2013). Multiculturalism thus has an
impact in the provision of care in relation to cultural values, health beliefs and practices,
language and health literacy status of immigrant patients.
Culture is a key element in multiculturalism and one of the concepts upon which nursing is based and defined. Culture refers to shared values, norms and codes that collectively shape a group’s beliefs, attitudes and behavior through their interaction in and
with their environment (Iwelunmor et al., 2014). In today’s health care systems, the relationship between culture and health is central to delivering quality care to patients because of the way it influences health beliefs and behaviors (Hussung, 2016). To address
cultural challenges in nursing, Leininger initiated and developed the theory of transcultural or cross-cultural nursing which is the area of nursing that centres on human care,
health and environmental context (Watt & Norton, 2004). Transcultural nursing therefore, is a strategy used to addressing the patient’s cultural needs, equal access to treatment, respect for cultural beliefs and practices including religion, diet, personal care
needs and daily routines, communication needs and cultural safety needs
(Narayanasamy, 2003). Transcultural nursing is now a discipline in nursing and used in
schools of nursing to prepare faculty and educate students to provide cultural and competent nursing care (Murphy, 2006). Cultural competency is a responsibility for all
nurses and must be an integral part of the fabric of organizations as it benefits students,
clients and health care institutions (Douglas et al., 2011). The study uses culture care
theory as one of the models that supports cultural competency in nursing care. Challenge of Cultural Diversity in a Nursing Practice Essay

How do nurses meet the care needs of a diverse group
Diversity is an increasingly important factor in the provision of health care in the UK. As racial and cultural diversity increases, it becomes more likely that nurses will encounter patients from backgrounds other than their own (Davidhizar & Giger, 2004). This paper will present various definitions of diversity and its related terms. Then, the health care needs of a diverse group will be explored, along with the impact of prejudice and some suggestions as to how the multi-professional team can respond the care needs of diverse populations. Addressing diversity is likely to benefit not only patients, but also health care providers and organizations (Bullas, 2003).

Diversity, Culture, Race, and Ethnicity
Diversity usually means a good thing, as in “community” or “equality” (Alexis, 2005). Diversity may include ethnicity, gender, disability, age, or sexuality and is related to social identity or membership in groups whose members share many common experiences and needs (Robb & Douglas, 2004). Diversity also means any difference putting one in a minority (Bullas, 2003). Challenge of Cultural Diversity in a Nursing Practice Essay

The terms race, culture and ethnicity are often used interchangeably, but they define different characteristics of people (Watt & Norton, 2004). Culture is the set of rules, meanings and ideas shared by a group that informs their world view and dictates behavior (Watt & Norton). According to Davidhizar and Giger (2004), culture is “a patterned behavioural response that develops over time as a result of imprinting the mind through social and religious structures and intellectual and artistic manifestations” (pp. 48-49). Culture is both innate and a product of environment, is shaped by values, customs, and beliefs of the shared group, and is significant in influencing behaviors and giving meaning to phenomena (Davidhizar & Giger, 2004). Challenge of Cultural Diversity in a Nursing Practice Essay

Ethnicity refers to cultural attitudes and practices characterizing a given group and distinguishing them from other groups based on a political and historical context (Watt & Norton, 2004). Ethnicity does not imply a biological basis for differences, but is based upon similarities derived from group membership (Robb & Douglas, 2004).
Race refers to the assumed differences in biological backgrounds, and is considered by some to be a contentious term (Watt & Norton, 2004). There are fewer genetic differences between racial groups than within them (Robb & Douglas, 2004). Racial and biological differences are much narrower than cultural differences which include varied values, beliefs, and interpretations of things (Davidhizar & Giger, 2004). For the purposes of this paper, diversity will refer to any difference putting one in a minority.
Factors affecting Health in Immigrants from Diverse Backgrounds Challenge of Cultural Diversity in a Nursing Practice Essay


Health results from a complex combination of economic, political, biological, psychological spiritual and familial factors (Striepe & Coons, 2002). Thus health care providers need to assess all the underlying factors for the presenting health concern, and to respond to the relational or environmental factors that may influence health (Striepe & Coons, 2002).

People from distinct, special population groups are likely to have common cultural beliefs affecting their health including family values, reliance on alternative medicine, and religious or spiritual beliefs (Ramirez, 2003). Health may be low on the priority list of recent immigrants due to numerous other pressing needs (Hepinstall, Kralj & Lee, 2004). Challenge of Cultural Diversity in a Nursing Practice Essay These individuals have often suffered trauma just getting to the UK, and then face major life changes once there—leaving them vulnerable to poor health (Hepinstall, Kralj & Lee, 2004). Furthermore, immigrants often have little control over their lives, live in poverty, and receive hostile, abusive treatment by others. Hepinstall and colleagues (2004) point out that the NHS may not be prepared to deal with the mental and physical sequelae of torture that many asylum seekers bring with them. Refugees and those seeking asylum likely experience various deprivations that can have a severe impact upon their health (Bullas, 2003). They may have certain illnesses based on country of origin, acquired during their flight to the UK, or acquired once they reach the UK (Hepinstall, Kralj & Lee, 2004). Furthermore, many people from different cultures will not have a frame of reference for the western health system, and thus will not know how to even begin to access care (Hepinstall, Kralj & Lee, 2004).  Challenge of Cultural Diversity in a Nursing Practice Essay

Honoring diversity means giving patients equal access to services, based on need, no matter what their differences (Bullas, 2003). Bullas (2003) described several cultural factors which may impact access to care. These include: rituals practiced around major life events; dietary habits; needs during times of cultural festivals or observances; presentation of symptoms and the response to assessment and treatment; language and communication; body language (e.g., eye contact and personal space); and the ability to access and use information (e.g., literacy, vision or hearing impairment, learning ability).
Language barriers can negatively impact access to quality health care (Ramirez, 2003). Challenge of Cultural Diversity in a Nursing Practice Essay

Cultural competence is partially related to the use of language in communication. Bullas (2003) reports that as many as 600,000 people are unable to communicate with health professionals because of inadequate English language skills. Differences in communication styles may become problems when they prevent the patient from asking questions or understanding her care, or when the patient herself is misunderstood (Robb & Douglas, 2004). Patient non-compliance with advised therapy may be an untoward consequence of discordance between health beliefs of the provider and the patient (Harmsen et al., 2003). Challenge of Cultural Diversity in a Nursing Practice Essay

Such discordance may affect the way in which problems are presented and the outcome of the clinical visit (Harmsen et al., 2003). Research has shown that communication in consultation between GP’s and patients who do not speak the native language is less effective than in consultations with persons speaking the same language as the GP (Harmsen et al., 2003). In fact, communication in those with like backgrounds may be insufficient in 25% of cases, while in those with dissimilar backgrounds, it may be as high as 50% (Harmsen et al., 2003).

Better training of health care workers to communicate effectively with diverse individuals—both linguistically and culturally—is an important part of improving their care (Ramirez, 2003). More research and research funding is necessary in order to improve patient-provider communication with diverse populations (Ramirez, 2003). Interpreting services can be a valuable tool to use with non English speaking patients. There is a free, nationally available telephone interpreting service through NHS Direct at every NHS site (Hepinstall, Kralj & Lee, 2004). Use of family members (especially children) is to be avoided except for emergencies (Hepinstall, Kralj & Lee, 2004).Challenge of Cultural Diversity in a Nursing Practice Essay  The gender of the interpreter may be important for women from some cultures. In addition, one should keep in mind that two speakers of Arabic may be from rival cultures (Hepinstall, Kralj & Lee, 2004). When interpreting services are not available, providers should use careful listening, pay attention to body language, and even use mime or drawings to communicate (Hepinstall, Kralj & Lee, 2004). When caring for culturally diverse families, providers should use flexibility in verbal and non-verbal communication, should speak slowly and clearly, avoid the use of slang terms, and be patient yet observant for any misunderstandings created by a language or cultural barrier (Cioffi, 2002, p. 300).

Health care providers may have to seek the services of a bi-lingual health care worker or interpreter (pp. 301-302). In addition, it may be beneficial to learn some basic words in other languages. For example, in the context of midwifery, one should learn words such as “push”, “don’t push”, “breathe”, etc. (p. 303).
It is almost impossible to unravel the effects of social deprivation, racism and social isolation that are so much a part of society today (Hutchinson & Hickling, 1999, p. 165). However, women immigrants have a dual burden of being both culturally diverse, and being female. Power over socioeconomic determinants of health is differentially distributed in women than in men. “Gender determines the differential power and control men and women have over the socioeconomic determinants of their…health and lives, their social position, status and treatment in society, and their susceptibility and exposure to specific mental health risks” (WHO, n.d., no pagination). Many of women’s gender based risks are connected to discrimination, exposure to poverty, and socioeconomic disadvantage (WHO, n.d., p. 3), as well as income and insurance status (WHO, n.d., p. 4), gender-based violence, subordinate social status, and a high level of required care for others. For example, there is a positive relationship between the frequency and severity of such social factors and the frequency and severity of mental disorders in women. Challenge of Cultural Diversity in a Nursing Practice Essay

The traditional gender roles of women, stressing passivity, submission, and dependence, may increase susceptibility to mental illness (WHO, n.d., p. 3). The female gender role suggests “unremitting care of others and unpaid domestic and agricultural labour” (WHO, n.d., p. 3). Desirable feminine characteristics are similar to those of both depression and low social rank (WHO, n.d., p. 12). There is a need for gendered health policy and gender-specific health risk-reduction strategies. Also, there should be accessible, gender sensitive health services (WHO, n.d., p. 10). Accessibility to health care services for women can be increased by having short waiting times, providing evening and weekend hours, and being near public transportation routes (WHO, n.d., p. 10). Challenge of Cultural Diversity in a Nursing Practice Essay

Some have argued that the conventional health system may neglect the values of patients who prefer a non-individualist lifestyle to a more conventional, self-reliance based lifestyle (Leighton, 2005). Examples are those living in a pastoral-communal setting based on retreat, interdependence, and naturalism. Further, it should not be assumed that immigrant women do not share western attitudes about such topics as contraception (Hepinstall, Kralj & Lee, 2004). However, many women will be ambivalent about using contraception—not wanting to use it, but also not wanting to have more children.
Mental health is an especially important topic in immigrants—especially those seeking asylum. Care should be taken not to pathologise normal responses to trauma such as grief (Hepinstall, Kralj & Lee, 2004). “It is important to acknowledge the resilience of individuals and communities and not label people with diagnoses that may add to their stigma and powerlessness” (Hepinstall, Kralj & Lee, 2004, p. 51).  Challenge of Cultural Diversity in a Nursing Practice Essay

Impact of Assumptions, Prejudices, and Stereotyping upon Health Care Delivery

When caring for patients from different cultures, nurses and other care providers may make assumptions about the perspective and needs of these patients (Komaromy, 2004). When diversity is seen as “otherness” it can become seen as the other’s problem that the “non-diverse” individual does not have to deal with (Keys, 2005). The language associated with immigrants is often negative—such as flooding, overrunning, illegal, burden (Hepinstall, Kralj & Lee, 2004). Asylum seekers are often treated poorly and little consideration is given to their skills and potential to make positive contributions to the UK (Hepinstall, Kralj & Lee, 2004).
Individuals often make generalizations based on characteristics such as ethnicity or gender, while ignoring differences within groups and similarities between groups. This may lead to care provided based upon shared assumptions related to group membership (Robb & Douglas, 2004). Such generalizations or stereotypes are usually negative as they are defined by the majority or the group in power (Robb & Douglas, 2004). In addition, immigrants should not be seen as vectors of disease (Hepinstall, Kralj & Lee, 2004). Challenge of Cultural Diversity in a Nursing Practice Essay

Responding to Diverse Health Care Needs
In addition to the above, several suggestions can be given for nurses, the multi-professional team, and health care agencies to improve care for diverse groups including immigrants from abroad. Some suggestions include: appreciation of variations in affective responses to illness; sensitivity to variations in communication styles and in the communication or lack of communication of negative signs and symptoms; having an understanding that the meaning if symptoms may vary between cultures; and having an understanding of common biological variations (Davidhizar & Giger, 2004). Interdisciplinary care will be most effective when team members communicate and synchronize interventions to offer contextual, gender and culture-specific assessment and treatment to help diverse patients make informed decisions about their health (Striepe & Coons, 2002). Challenge of Cultural Diversity in a Nursing Practice Essay

Nurse managers in NHS Trusts should develop strategies emphasizing the importance of race and ethnic composition in relation to health in diverse populations (Chevannes, 1997). Care given should be based on objective assessment, ethnically derived, and not based upon assumptions of the care giver (Chevannes, 1997). Initiatives to improve communication with non-English speaking populations include providing interpreters and publishing literature in other languages (Robb & Douglas, 2004). Challenge of Cultural Diversity in a Nursing Practice Essay

Cultural differences need to be taken into account in nursing education, research and practice (Gerrish, 1998). Some suggestions for how nurses and agencies may respond to diverse care needs include providing immigrants with opportunities to volunteer in health clinics and consulting with community leaders to identify ongoing problems (Gerrish, 1998). According to Gerrish (1998), “For efficient and appropriate care, practitioners need to understand the values and cultural prescriptions operating within the patient’s culture, particularly those that may impinge upon the patient’s conception of health and illness…” (p. 116). Challenge of Cultural Diversity in a Nursing Practice Essay