Respecting Client & Staff Diversity Healthcare Core Curriculum Dede Carr, BS, CDA, LDA Pat Reinhart,...

Respecting Client & Staff DiversityHealthcare Core Curriculum

Dede Carr, BS, CDA, LDAPat Reinhart, RN

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Respecting Client & Staff DiversityModule DescriptionThis module provides a framework for dealing with diverse clients/individuals and staff.Belief systems, cultural practices, respect and sensitivity to cultural issues, gender issues and sexuality issues are included. Awareness and use of effective strategies to appropriately deal with client and staff diversity are emphasized.Review on the D2L site theCourse OutlineCompetency Modules and Instructor Notes

Module Outline and Instructor ResourcesThis module consists of 5 competencies for students to master.These competencies are listed on the following slide and will be addressed throughout the remainder of the power point.Each competency is taught through a series of units which include suggested assignments for students to complete to learn the competency. Feel free to use the assignments or develop your own.

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Module Outline and Instructor ResourcesFind these learning activities and resources on the website or create your own.The Course Outline also has documents that the instructor can use in teaching the lesson. These competencies are listed on the following slide and will then be addressed throughout the remainder of the power point.

Module Competencies1. Describe one’s personal belief system.

2. Explain the belief systems and practices of diverse cultures.

3. Explore personal responsibility as a healthcare employee to treat each person as an individual (customer service).

4. Discuss the appropriate workplace expectations to interact with team members and care for clients/individuals from diverse cultures, genders, age groups and/or sexual orientations.

5. Using a problem solving process applied to healthcare situations, describe how healthcare employees can respect client and staff diversity.

Describe one’s personal belief system.

COMPETENCY #1

Competency #1: Describe one’s own personal belief system.

Units included in this competency are:

A. Discuss the role of culture in developing a belief system.

B. Explain what is meant by a belief system.

C. Identify the learner’s personal belief system.

D. Identify extrinsic factors that may influence personal belief systems.

Module Competency #1: Personal Belief System

Unit #1A: Discuss the role of culture in developing a belief system

Recommended ContentFrom the moment we are born, we begin developing a belief system. We all live our lives under a belief system, but not many of us are aware of our belief system. We tend to take things for granted and may just assume everything will work out for the good.

It is critical to understand how a person’s belief system develops for success within this module.

On the following slide, some highlights of a person’s belief system that author R. T. Kelly addresses in the book Cultural and Ethnic Considerations, are noted for background information for you.

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Unit #1A: Discuss the role of culture in developing a belief systemA persons’ belief system is heavily influenced by their culture and values passed from generation to generation.

Culture is learned from significant people in one’s life and as a one grows up, one internalizes the values and beliefs of one’s culture.

So…. one’s culture plays a significant role as one is developing a belief system.

It is our beliefs that guide our behaviors, communication, and lifestyle.

Some of the things included in a person’s belief system are one’s religious beliefs, political beliefs and ethical beliefs.

Beliefs guide the choices that a person makes and the how a person lives with those choices.

(Kelly, p. 125)



The curriculum states that culture is composed of common aspects such as: lifestyle language tradition rules values

This is all true and yet culture is also what is taught to us and passed down from one generation to the next.

The following slides will address the role of language within a culture and lifestyle as it pertains to the family.

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Unit #1A: Discuss the role of culture in developing a belief system.

Language

One of the most apparent communication variation is language. Language variations might involve no understanding of each other’s language, to situations where one can understand the other’s language, but has limited skills in speaking the language. Although both parties may speak English, there may be different meanings for words in the English language.

Communication patterns reflect core cultural values of a society. Some cultures value individualism while others value group harmony.

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Unit #1A: Discuss the role of culture in developing a belief systemDifferences in status and position, age, gender and outsider versus insider determine

the content and process of communication. For example, among Asian cultures, face-saving communication promotes harmony

by indirect communication and avoidance of conflict. In this culture, messages spoken often have little to do with their meanings. Saying “no” to a superior or older adult is not permissible, hence an affirmative response will only mean “I heard you” rather than full agreement. This has important implications in in the healthcare setting because the healthcare provider can be perceived as a person of authority to some Asian, African, or Hispanic clients. Observing a client’s behavior and clarifying messages heard from a trusted insider will prevent misinterpretation. (Potter and Perry, pp. 117-118)

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Lifestyle within the Family◦ The description of family (types/structure) may vary among cultures: nuclear,

extended, single-parent, blended, etc.◦ Some of the family structures are based on biological relationships. Others are based

on meeting basic needs of the family by forming a group of unrelated individuals.◦ Intergenerational support and patterns of living arrangements are related to cultural

background. For example, traditional Chinese, African-American, Japanese, and Hispanic persons are more likely to live in extended family households than are their white counterparts. (Potter and Perry, p. 131)

◦ A common mistake for healthcare workers is to assume that every family is a traditional nuclear family.

◦ It’s more important to know whom the patient depends on for comfort and decision-making and how the patient describes family. (Kelly, p. 130) (see next slide)


Unit #1A: Discuss the role of culture in developing a belief systemValue placed on children and elders within society are culturally derived.

In some cultures children are not disciplined by spanking or other forms of physical punishment. Rather, children are allowed to interact with their environment while caregivers provide subtle directions to prevent harm or injury.

In other cultures, elders are considered the holders of the culture’s wisdom and therefore are highly respected.

Responsibility for care of older relatives is determined by cultural practices. In many cultures, older relative who cannot live independently live with a married son or daughter and family.

(Berman et al., pp. 318-319)

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Tips for presenting the material Students may proudly share some their family make-ups. This can be a sensitive issue for some, especially those students who have no family -- perhaps because of growing up in the foster care system or having cut all ties with their family members.

Students may also share forms of discipline that have been passed down from one generation to the next. Such conversations can be hard to monitor and hard to keep judgment out of the conversation.

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Module Competency #1B and 1C: Personal Belief System

At this point, both Unit #1B: (Explain what is meant by a belief system) and Unit #1C: (Identify the learner’s personal belief system) will be discussed as one unit.

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Units #1B and 1C: Belief System Recommended ContentA person’s belief system is comprised of their cultural values.

A person does not have control over their gender, race, age or which family they were born into, however, these attributes play a critical part in a person’s belief system. For example, a man may believe that he should get paid more than a woman because he

is the head of the household. Another example: The youngest child in the family may have a more lenient curfew

because mom and dad have eased up over the years. Their belief system has shifted.

One’s belief system does, however, determine one’s political affiliation, religious/spiritual practices, and profession, just to name a few.

(New World Encyclopedia)

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Units #1B and 1C: Belief SystemCultural Values Values which support the belief and behaviors that are accepted within each

culture pertain to: Age Gender Family Religion/spirituality Time orientation Politics Behavior and practices

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Units #1B and 1C: Belief SystemThe 7 cultural values listed on the previous slide all play an important role in a person developing their own belief system.

These values influence and guide a person’s behavior and communication.

Many of the values are set such as gender, age, traditional practices.

One value that is so critical in healthcare and throughout life is timeliness.

Time can be culturally learned -- some students understand the value of timeliness and being on time, while others struggle with it daily. Having a better understanding of time within various cultures can help us to better understand our students.

The next 3 slides will introduce to you some ideas that can be discussed with students.

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Units #1B and 1C: Belief System Let’s review the concept of time, and how it can impact the healthcare culture.

Timeliness among healthcare workers varies and conflicts can arise when a healthcare worker is always late for work. It is important to discuss reasons for this, rather than to assume the person does not care about the job. If it is due to a cultural belief, the health care staff involved needs to develop a strategy to solve the problem.

Perception of time (time orientation) can be future-oriented or present-oriented.Many people in the United States are future-oriented; African American, Hispanic, and

American Indian tend to be present-oriented. If a pregnant woman is a member of the present-oriented culture, she may miss an appointment

because of a current family need. For example, if an older child needs a ride home from school, the mother may skip a doctor’s appointment to take care of the older child. She sees the present need as much more urgent than keeping an appointment related to an event that is several months away. (Kelly, p. 129)

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Units #1B and 1C: Belief SystemThe measurement of time can have different meanings in various cultures.The United States and Northern European cultures regard being on time for appointments

as a high priority. Expectations that all individuals will follow this pattern. Japanese Americans are generally prompt and adhere to fixed schedules, especially when meeting someone of high regard.

Many other cultures may feel that other concerns are more important. For example, Eastern cultures including Chinese, East Indian Hindu, Filipino, and Korean view schedules and time as being much more flexible. (Kelly, p. 129)

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Unit #1B and 1C: Belief SystemSome Asians spend time getting to know someone and may view abrupt endings to

conversations as rude.Mexican-Americans may be late for an appointment because they are more

concerned with a current activity than going to a previously planned meeting. This is known as “elasticity” and implies that future-oriented activities can be

recovered but present-orientated activities cannot. When a patient is late for an appointment, fails to come at all, or does not follow a

therapeutic schedule, the healthcare worker who does not understand these cultural differences may be angry. (Kelly, p. 129)

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Units #1B and 1C: Belief SystemFamily may significantly influence one’s personal belief systemFamily was previously described in Unit #1A

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Units #1B and 1C: Belief SystemValue placed on children and elders within society are culturally derived.

In some cultures children are not disciplined by spanking or other forms of physical punishment. Rather, children are allowed to interact with their environment while caregivers provide subtle directions to prevent harm or injury.

In other cultures, elders are considered the holders of the culture’s wisdom and are highly respected. (Berman et al., pp. 318-319)

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Units #1B and 1C: Belief System With the continued appearance of American society changing and traditional cultures blending and assimilating with each generation, all cultures bring to the healthcare arena their own views of what needs to happen to remain healthy or seek healthcare.

As healthcare educators, it is critical to be aware of the three types beliefs hypothesized by Berman:

1. Magico-Religious health belief view2. Scientific or biomedical health belief view3. Holistic health belief view

(Berman et al., p. 318)

The following slides will introduce you to this health belief framework.

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Units #1B and 1C: Belief SystemIn the Magico-religious health belief view, health and illness are controlled by supernatural forces.

The client may believe that illness is the result of “being bad” or opposing God’s will.

Getting well is also viewed as dependent on God’s will. The client may use statements such as, “If it is God’s will, I will recover” or “What did I do wrong to be punished with cancer?”

Some cultures believe that magic can cause illness or that a sorcerer or witch may put a spell or hex on the client.

Some people view illness as possession by an evil spirit. Although these beliefs are not supported by research, clients who believe that such things can cause illness may

in fact become ill as a result. Such illnesses may require magical treatments in addition to scientific treatment.

(Berman et al., pp. 317-318)

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Units #1B and 1C: Belief System Scientific or biomedical health belief is based on the belief that life and life processes are controlled by physical and biochemical processes that can be manipulated by humans.

The client with this view will believe that illness is caused by germs, viruses, bacteria, or a breakdown of the human body. The client will expect a pill, or treatment, or surgery.

(Berman et al., p. 318)

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Units #1B and 1C: Belief System Holistic health belief holds that forces of nature must be maintained in balance or harmony. Human life is one aspect that must be in harmony with the rest of nature and when the natural balance or harmony is disturbed, illness results.

The North and South America Native Americans use the medicine wheel as an ancient symbol to express many concepts for health and wellness, it teaches four aspects of the individual’s nature: physical, mental, emotional and spiritual. The four dimensions must be in balance to be healthy. The medicine wheel can also be used to express the individual’s relationship with the environment as dimension of wellness.

Examples of the holistic health belief view include: the concept of yin and yang in Chinese culture and the hot-cold theory of illness in many Spanish cultures.

In the hot-cold theory, people believe that certain conditions are “cold,” such as a new mother who delivered a baby. To treat the new mother, warm or hot foods and a blanket are provided.

Many cultures believe that the best way to treat a fever is increase an elimination of toxins through sweat baths. (Berman et al., p. 318)

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Units #1B and 1C: Belief SystemRemember that the 3 various health belief views provides the educator a brief understanding of the where our students are coming from and who our students will be caring for:1. Magico-Religious health belief view2. Scientific or biomedical health belief view3. Holistic health belief view

Tips for presenting the material:Many of the students who have had the opportunity to explore these views find that patients do not fall under one specific view, but rather a combination of 2 views or all 3 views.

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Unit #1D: Identify extrinsic factors that may influence personal belief systems.

Recommended Content The curriculum addresses the issue of identifying extrinsic factors and how these factors shape a person’s belief system.

The following slides will be discussed:Culture shockAssimilation Acculturation

As America continues to be a melting pot for many different cultures and as our classrooms represent that melting pot, it is important to address culture shock, talk about what it really is, and how our own cultural shock and that of our patients can influence the therapeutic process.

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Unit #1D: Identify extrinsic factors that may influence personal belief systems

What is culture shock?Culture shock is a disorder that occurs in response to transition from one cultural setting to another so a person’s previous behavior patterns are ineffective in such a setting, and basic cues for social behavior are absent.Expressions of culture shock may range from confusion and anxiety to silence and immobility, to agitation, rage or fury. (Berman et al., p. 315)

Culture shock is used to describe the anxiety and nervousness that occurs when a person leaves some place that is comfortable and familiar. Many changes occur and the person needs to adapt to those changes. Even though the changes can be full of excitement, it can still be overwhelming. (Nemours Foundation)

The important thing to remember is that culture shock is temporary. (Juliar, p. 305)

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Unit #1D: Identify extrinsic factors that may influence personal belief systems

Everyone entering into a new culture will adjust to it differently. For some people, it may mean they are/were excited about their new move. Others may have been forced to move, making the adjustment that much more difficult.

Even though everyone experiences culture shock in a different way, the most common feelings are:

◦ Not wanting to be around people who are different ◦ Loneliness◦ Anxiety◦ Sadness◦ Feeling left out◦ Extreme homesickness (Nemours Foundation) (see next slide)


Unit #1D: Identify extrinsic factors that may influence personal belief systemsThe involuntary process of acculturation occurs when people adapt to or borrow traits from another culture. The members from the non-dominant cultural group is often forced to learn the new culture to survive.

Acculturation can also be defined as the changes of one’ cultural patterns to those of the host society. (Spector, as cited in Berman et al., p. 314)

While becoming participants in the dominant culture, members of the non-dominant cultural group are always identified as members of the culture from which they originated.

People immigrating to the United States from any country will be associated with their native countries for many years, if not all their lives. (Berman et al., p. 314)

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Unit #1D: Identify extrinsic factors that may influence personal belief systemsAssimilation: the process by which an individual develops a new cultural identity.

Assimilation means becoming like the members of the dominant culture.

Assimilation can be described as a collection of sub-processes: a process of inclusion through which a person gradually ceases to conform to any standard of life that differs from the dominant group standards and at the same time, a process through which the person learns to conform to all of the dominant cultural group.

The process of assimilation is when the foreigner is fully merged into the dominant cultural group. (McLemore and Romo, as cited in Berman et al., p. 314)

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Recommended Learning Activities

Assignment Location Notes

Review Vocabulary List On Website and in Module Outline and Instructor Resources Document

Review Vocabulary List with students

Examples of Cultural Misunderstandings in Healthcare

On Website and in Module Outline and Instructor Resources Document

Discuss in Class

RCS Competency 1: Self Assessment: Assignment on website This assignment allows students to assess their cultural competency and reflect on their subcultures.

RCS Competency 1: Cultural Diversity Journal

Assignment on website Students journal on personal beliefs and values.

RCS Competency 1: Family and Cultural Influences:

Assignment on website Students reflect on their parents values and culture and how they relate to those.

Explain the belief systems and practices of diverse cultures.COMPETENCY #2

Competency #2: Explain the belief systems and practices of diverse cultures.


A. List cultures found within a healthcare setting.

B. Describe the belief systems (cultural values, behavior practices, communication patterns, and methods of perceiving, judging, and organizing daily life) of ethnic cultures and subcultures.

C. Describe the “-isms.”

D. Describe the belief systems pertaining to age.

Module Competency #2: Explain the belief systems and practices of diverse cultures

At this point, both Unit #2A (List cultures found within a healthcare setting) and Unit #2B: (Describe the belief systems (cultural values, behavior practices, communication patterns, and methods of perceiving, judging, and organizing daily life) of ethnic cultures and subcultures) will be discussed as one unit.

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Module Competency #2: Belief System and Practices of Diverse Cultures

Units #2A and 2B: Belief System of Various Cultures

Recommended ContentDuring this part of the curriculum of Respecting Client and Staff Diversity, students will be exploring and discussing belief systems of various cultures.The curriculum asks the instructor to address 3 of the following cultures with the students. However, cultures do not need to be limited to this list:

1. African American

2. Native American

3. Asian

4. Hispanic

5. Latino

6. Caucasian (see next slide)



The following 3 slides will briefly introduce the instructor to 3 different cultures:

1. African American

2. Asian

3. Hispanic

Tips for presenting the materials

These slides provide a taste of each culture and yet in class, discussions provide for lively debates. Remind students to be respectful and share from their own experiences. Each experience is valid and unique, as some of us are recent immigrants, and some are several generations removed. Some of us have several ethnic experiences from different sides of the family to draw from.

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Units #2A and 2B: Belief System of Various CulturesAfrican Americans tend to be focused more on people rather than on objects, making family bonding a primary core value.

Within in the African American culture, children are the center of the family and family extends beyond mom, dad and the children. Family includes aunts, uncles, grandparents, cousins, etc.

African Americans have a deep sense of spirituality.

Christianity and Islam are 2 of the primary religions along with a host of others.

Men and women within the African American culture tend to have equal relationships. (Cultural Diversity Organization)

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Religion is valued greatly within the Asian culture. The primary religions of the culture are Buddhism, Confucianism, Hinduism, Islam and Christianity. (Juliar, 2003, p. 308)

Other values of the Asian people are: “group orientation (collectivity); family cohesion and responsibility; self-control and personal discipline; emphasis on educational achievement; respect for authority; reverence for the elderly (filial piety); the use of shame for behavioral control; and interdependence of families and individuals.”

(Juliar, p. 310).

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Units #2A and 2B: Belief System of Various CulturesThe Hispanic culture like many others, value family as the most important social unit. In most Hispanic families, the father is the head of the household and the mother cares for the home.

The Catholic religion is the primary religion for more than 90% of the Spanish-speaking world.

Elders hold a high place within the family structure and are often consulted for advice.

When someone is ill within the Hispanic culture, they expect to be taken well care of. The Hispanic people tend to live in the present and as a result do not typically seek preventive health care. (Juliar, pp. 310-311)


Unit #2C: Describe the “-isms” Recommended Content Students live with –isms everyday and yet may not understand the meaning behind them.

An -ism is a suffix, or something placed at the end of a word.

An -ism can be defined as a “theory, a system or a practice” or “an action, a characteristic or a behavior.” (answers.com,)

Words that end in -ism may portray an “attitude of prejudice against a certain group.” (answers.com)

The –ism suffix tends to be an oppressive and especially discriminatory attitude or belief (Merrian-Webster INC.,)

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Unit #2C: Describe the“-isms”Classism is prejudice, discrimination, mistreatment, neglect of or lack of respect for any human and their rational needs (food, clothing, shelter, education, respect communication, etc.) based on people’s socioeconomic class. (Freire, n.d.)

Criteria for measuring class is usually education, income, occupation and wealth.

Classism is extremely complex. It involves economic exploitation, beliefs, attitudes and prejudices, terrorization, violence, invalidation, etc.

Classism is the belief that people from certain social or economic classes are superior to others. (Freire, n.d.)

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Unit #2C: Describe the“-isms”Racism is a belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race.

Racism is a belief or doctrine that inherent differences among the various human races determine cultural or individual achievement, usually involving the idea that one's own race is superior and has the right to rule others.

Racism is a policy, system of government, etc., based upon or fostering such a doctrine; discrimination. (Random House Dictionary)

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Unit #2C: Describe the“-isms”Ageism is prejudice or discrimination against a particular age-group, especially the elderly (Merriam Webster on-line)

Ageism may also apply to young adults or children

Sexism is prejudice or discrimination based on sex, usually against women. (Merriam Webster on-line)

Sexism may also be defined as behavior, conditions, or attitudes that foster stereotypes of social roles based on sex. (Merriam Webster on-line)

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Unit #2C: Describe the“-isms”Recommended Learning Activities

AssignmentTopic

Resources Notes

Ageism

Ableism

YouTube video “When Do You Think Someone is Old”

Movie: “My Left Foot”

Assignment on website can be used as a class discussion.Class Discussion

Racism A Class Divided RCS Competency 3 Movie a Class Divided:

Students watch the movie and answer reflected questions.

http://www.youtube.com/watch?v=i9z4QCR4qxw

http://www.pbs.org/wgbh/pages/frontline/shows/divided/


Unit #2D: Describe the belief systems pertaining to gender

Recommended ContentThere are more males entering the previously predominant female occupations of nursing and healthcare. This brings another subculture and possibilities for stereotyping, biases, and prejudices.

Even though women and men are more similar than different, some communication patterns are identifiably different.

The key to working effectively with the opposite gender is to recognize communication differences and realize enormous contributions each style brings to the workplace.

While men can be more direct and get right to the point, women often bring valuable interpersonal skills to the workplace. Both men and women are effective problem-solvers. Men usually think of one thing at a time and women tend to consider several things at once. (Juliar, p. 390)


Unit #2D: Describe the belief systems pertaining to age

Recommended ContentIn healthcare, it is important to have some understanding of what different eras were like so that we can better understand our patients/clients.Many of our students fall into the Generation Y category and are unaware of various eras and/or characteristics of them. It is critical for students to have a brief understanding of the various eras because someday they will be caring for patients/clients whose ages span over several decades and generational thinking.The following slides briefly introduce a couple of highlights from each era:

WWII era Baby Boomers era Generation X era Generation Y era (see next slide)



World War II Era

People born during this era valued very highly the work that they did. Men went off to their jobs and the women stayed home to raise the children.

During this time, people had a great respect for leadership. They also had a strong work ethic. A man would tend to “give his life” for the company where he worked. That same man had a drive to reach the top of the corporate ladder, no matter what the cost. As men climbed the corporate ladder, their respect for leadership was constant. (Bosenberg)

Baby Boomer Era

In the work world, the Baby Boomers favor a team approach, however they are driven to be the star of the team. The Boomers are impressed with authority, but tend to have friendly relationships with their bosses.

As Boomers grew into young adulthood, a strong emphasis on personal development came to life. (Bosenberg, 2011) (see next slide)



The 51 million members of Generation X were born between 1965 and 1976.

Divorce and working moms created "latchkey" kids out of many in this generation. As a result, Gen Xers grew up with independence, resilience and adaptability. Generation X feels strongly that "I don't need someone looking over my shoulder."

At the same time, this generation expects immediate and ongoing feedback, and is equally comfortable giving feedback to others. Other traits include working well in multicultural settings, desire for fun in the workplace and a realistic approach to getting things done. (Thielfoldt and Scheef)

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Unit #2D: Describe the belief systems pertaining to ageGeneration Y make up for 70 million of the world’s population and were born in the mid-1980's and later.

Generation Y is the most diverse generation in history. This population of people has been born to teenage mothers as well as mothers in their 40s.

They are tech-savvy, family-centric and achievement-oriented. (Kane, n.d.)

Generation Y grew up with technology and rely on it to perform their jobs better.

Armed with BlackBerrys, laptops, cell phones and other gadgets, Generation Y is plugged-in 24 hours a day, 7 days a week.

This generation prefers to communicate through e-mail and text messaging rather than face-to-face contact and prefers webinars and online technology to traditional lecture-based presentations. (Kane, n.d.)

Module Competency #2: Belief System and Practices of Diverse CulturesRecommended Learning Activities

Assignment Resources Notes

RCS Competency 2-3 Cultural Interaction Interview

Assignment on website Students interview two persons from another culture and reflect on the experience.

Explore personal responsibility as a healthcare employee to treat each person as an individual (customer service).COMPETENCY #3

Competency #3: Explore personal responsibility as a healthcare employee to treat each person as an individual (customer service).


A. Discuss cultural stereotyping.

B. Identify personal cultural prejudices.

C. Identify cultural interactions with team members and clients.

Module Competency #3: Explore personal responsibility as a healthcare worker to treat each person as an individual (customer service)

At this point, both Unit #3A (Discuss cultural stereotyping) and Unit #3B: (Identify personal cultural prejudices) will be discussed as one unit.

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Module Competency #3: Personal Responsibility and Customer Service

Units #3A and 3B: Stereotyping and Prejudices

Recommended ContentThe ancients first formed cultural stereotypes when they came upon a new race or tribe. They quickly had to decide if the people were safe to encounter. Since there wasn’t much time to determine if the group was safe or not, judgments where made towards the race or tribe as a whole, and not on an individual basis.

These assumptions, or stereotypes, were then passed down from generation to generation and still impact our lives today. Books and films have supported the aspect of cultural stereotype. For example, they may depict the black man as a great basketball player or the black woman who is a

servant for a white woman. (Eagle Feather Research Institute)

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Cultural blind spot syndrome is a belief that “just because the client looks and behaves much the way you do, you assume that there are no cultural differences or potential barriers to care.” (Buchwald as cited in Juliar, p. 350)

For example, white American nurses may assume that white American patients believe in the same cultural values as they do. This assumption is false.

◦ White Americans come from many different ethnocultural backgrounds—Irish, Russian, German, Jewish, and English to name but a few. In addition, white nurses and patients may also belong to different subcultures that have different values.

◦ For example, a white male patient of Italian descent who is gay will probably have somewhat different values than a white Irish-American nurse who is married with 3 children. (Juliar, p. 350)

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Units #3A and 3B: Cultural Stereotyping and PrejudicesThrough the discussion of this portion of the module, assumptions of stereotyping will be discussed with the students. This is an area in which many students will have personal experience to share. The discussion can be lively and needs to be controlled with respect and sensitivity.


Units #3A and 3B: Stereotyping and PrejudicesCommunication barriers can lead to a great number of misunderstandings. In the module entitled “Communications in Health Care Settings”, communication is taught at length.

However, as communication relates to stereotyping and prejudices, let’s look at just 2 barriers to communication.

1. Foreign languages and dialects

2. Street talk, slang and idioms.

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Foreign Languages and Dialects

Some facts: Over 6,000 different languages and dialects are spoken today. The number of people in America who speak a language other than English is

growing. 10% of the population speak more than just English. The English language has more than 25,000 different words. The most widely spoken language is Mandarin Chinese. (Juliar, p. 351)

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Definitions of Dialect “A distinctive way a language is spoken or written in a given locality or by a group of individuals.” (Webster’s Dictionary as cited in Juliar, p. 352)

“A regional or social variety of a language distinguished by pronunciation, grammar, or vocabulary, especially a variety of speech differing from the standard literary language or speech pattern of the culture in which it exists.” (Dictionary .com)

“The language peculiar to the members of a group, especially in an occupation; jargon” (thefreedictionary.com)

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Street Talk, Slang, Idioms and Medical Terminology

Street talk, slang, and idioms are expressions that may be used by people that can sometimes create a language barrier. For example, if you are from a white middle class family, you may not understand

that when an African-American person uses the word “hood” they are referring to their neighborhood or that the “Amen Corner” refers to the corner in the church where the older women of the church sit. (Juliar, p. 353)


Unit #3C: Identify cultural interactions with team members and clients

Recommended Content

The curriculum breaks down cultural interactions with team members into 4 parts. They are:

1. Conversations – verbal and non-verbal

2. Thoughts regarding interactions

3. Feelings evoked by the interactions

4. Physical interactions – touch related to the physical care of a client

Tips on presenting the material

These 4 areas of interaction with team members can provide for some interesting stories from the students.


Recommended Learning ActivitiesAssignment Resources Notes

RCS Competency 3 Cultural Prejudice

Assignment on website Reflection on cultural prejudice and how it feels.

RCS Competency 3 Unique Potato Exercise

Assignment on websiteBring a bag of potatoes

Students choose a potato and describe the uniqueness of it.

RCS Competency 3 Website – Keirsey Temperament Sorter II

The Keirsey Inventory Sorter: http://www.keirsey.com/sorter/register.aspx

This is a 70 question personality inventory. Students reflect on how to communicate with others according to their results.

http://www.keirsey.com/sorter/register.aspx

http://www.keirsey.com/sorter/register.aspx

Discuss the appropriate workplace expectations to interact with team members and care for clients/individuals from diverse cultures, genders, age groups and/or sexual orientations.COMPETENCY #4

Competency #4: Discuss the appropriate workplace expectations to interact with team members and care for clients/individuals from diverse cultures, genders, age groups and/or sexual orientations.

Unit included in this competency is:

A. Discuss workplace expectations for team members and clients of divers cultures, genders, ages and sexual orientations.

Module Competency #4: Workplace Expectations

Unit #4A: Discuss workplace expectations for team members and clients of diverse cultures, genders, ages and sexual orientations.

Recommended Content This competency addresses respect in the workplace, from respect with team members to respect with patients/clients of diversity.

Diversity as defined by how the patient/client differs from the healthcare provider. Different age, skin color, class, religion, education level, language, sexuality, etc. can be differing factors.

The curriculum also addresses respectful communication with team members and patients/clients from various cultures.

◦ (see next slide)


Unit #4A: Discuss workplace expectations for team members and clients of diverse cultures, genders, ages and sexual orientations.Respectful communication includes, but not limited to: Verbal and nonverbal communication Written communication Age appropriate and gender appropriate communication Requesting clarification, if needed Validating the feelings of a patient/client

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Recommended Learning Activities

RCS Competency 4 Transcultural Interaction Diary

Assignment on website Students journal after each encounter with someone who is culturally diverse and reflect on the positive and the negative in the encounter.

RCS Competency 4 5 Scenario Cultural Diversity Ethics

Assignment on website Student reflects on a child having marks from “coining” on their skin and whether to report it.

Using a problem solving process, applied to healthcare situations, describe how healthcare employees can respect client and staff diversity.COMPETENCY #5

Competency #5: Using a problem solving process, applied to healthcare situations, describe how healthcare employees can respect client and staff diversity.

Unit included in this competency is:

A. Discuss the problem solving process as applied to respecting client and staff diversity.

Module Competency #5: Problem Solving

Unit #5A: Problem Solving as Applied to Diverse Cultures

Recommended ContentThe problem solving process can be broken down into the following 5 steps:1. Identify the problem2. Gather information3. Create alternative solutions4. Select and act on solution5. Evaluate and revise as needed

Module Competency #5: Problem SolvingRecommended Learning Activities

Assignment Resources Notes

RCS Competency 2, 3, 4, 5. The Spirit Catches You and You Fall Down Learning Activity

Book by: Fadiman, Anne (1997) Students read the book “The Spirit Catches you and you fall down” and answer questions regarding the Hmong people and the cultural problems they had with the healthcare system and doctors in the United States

RCS Competency 5 Scenario Diversity Case Study

Assignment on website An interesting case study of a Moslem woman picking up a Prescription from a pharmacy.

This completes the curriculum for

Respecting Client & Staff Diversity.

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What to do now?You’ve now been introduced to Respecting Client & Staff Diversity.

Presented were key points found on the instructor resource outline and several possible learning activities to use.

You received tips on teaching the material, along with areas to be sensitive to with students.

Now, click on the “Assessments” tab and complete the Respecting Client & Staff Diversity Self Assessment.

You are invited to go to the website to preview additional learning activities, PowerPoints, assessments, etc.

You are encouraged to use the instructor learning resource module outline to make notes on which online resources would benefit you and your teaching style.

Accessing HealthForce Minnesota

To access the HCCC curriculum go to:

1.www.healthforceminnesota.org/Curriculum.htm

2.Click on the Health Care Core Curriculum

3.Choose Curriculum (Password Required)A. Password: HCCC

4.Select desired module to view

http://www.healthforceminnesota.org/Curriculum.htm

“This workforce solution was funded by a grant awarded by the U.S. Department of Labor’s Employment and Training Administration. The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership.”

This work by the Health Professions Pathways (H2P) Consortium, a Department of Labor, TAACCCT funded project is licensed under a Creative Commons Attribution 3.0 Unported License.

This power point created by:Dede Carr, BS, CDA, LDA

Pat Reinhart, RN




References Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).Culture and heritage. In A. Berman, S.J. Snyder, B. Kozier, and G. Erb (Eds.). Kozier and Erb’s Fundamentals of nursing: Concepts, process, and practice (8th ed.) (pp. 311-329). Upper Saddle River, NJ: Prentice Hall

Bosenberg. M.(2011, March 2). The Population Baby Boom of 1946-1964 in the United States Retrieved from http://geography.about.com/od/populationgeography/a/babyboom.htm

Culture Diversity Organization. (1997-2008).Transcultural nursing: Basic concepts and case studies. Retrieved from http://www.culturediversity.org/index.html

Eagle Feather Research Institute http://eaglefeather.org/pages/about.php

Freire,P. (n.d.). The Politics of Education. Retrieved from http://renew.education.ucsb.edu/downloads/overheads_handouts/class.pdf

http://geography.about.com/od/populationgeography/a/babyboom.htm

http://www.culturediversity.org/index.html

http://eaglefeather.org/pages/about.php

http://eaglefeather.org/pages/about.php

http://renew.education.ucsb.edu/downloads/overheads_handouts/class.pdf

ReferencesJuliar, K. (2003) Minnesota Healthcare Core Curriculum (2nd ed.). Clifton Park, NY: Delmar Publishers

Kane, S. (n.d.). Generation Y. Retrieved from http://legalcareers.about.com/od/practicetips/a/GenerationY.htm

Kelly, R.T. (2006). Cultural and ethnic considerations. In B.L. Christensen and E. O. Kockrow (Eds.). Foundations and adult health nursing (5th ed.) (pp. 124-148). St. Louis, MO: Elsevier, Mosby

http://legalcareers.about.com/od/practicetips/a/GenerationY.htm

ReferencesNemours Foundation. (1995-2011). Culture shock. Retrieved from http://kidshealth.org/teen/your_mind/emotions/culture_shock.html#

New World Encyclopedia. (2007). Culture. Retrieved from http://www.newworldencyclopedia.org/entry/Culture

Potter, P.A. and Perry, A.G. (2009). Culture and ethnicity. In P.A. Potter and A.G. Perry (Eds.). Fundamentals of nursing (7th ed.) (pp. 106-120). St. Louis, MO: Elsevier, Mosby

Thielfoldt, D. and Scheef, D. (2004, August). Generation X and the millennial: What you need to know about mentoring the new generations. Retrieved from http://apps.americanbar.org/lpm/lpt/articles/mgt08044.html

http://kidshealth.org/teen/your_mind/emotions/culture_shock.html

http://apps.americanbar.org/lpm/lpt/articles/mgt08044.html

You have completed

Heath Care Core Curriculum

Respecting Client and Staff DiversityCongratulations!!!

Complete the “Self Assessment” tab found

under “Assessments”.

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