192 unit 3 | Professional Issues
Cultural Diversity
Ms. V. is beginning orientation as a new staff nurse.
She has been told that part of her orientation will be
a morning class on cultural diversity. She says to the
Human Resources person in charge of orientation,
“I don’t think I need to attend that class. I treat all
people as equal. Besides, anyone living in the United
States has an obligation to learn the language and
ways of those of us who were born here, not the other
way around.”
Mr. M. is a staff nurse on a medical-surgical
unit. A young man with HIV infection has been
admitted. He is scheduled for surgery in the morn-
ing and has requested that his signif icant other be
present for the preoperative teaching. Mr. M. reluc-
tantly agrees but mumbles under his breath to a
coworker, “It wouldn’t be so bad if they didn’t throw
their homosexuality around and act like an old
married couple. Why can’t he act like a man and get
his own preop instructions?”Diversity in health-care organizations includes
ethnicity, race, culture, gender, lifestyle, primary
language, age, physical capabilities, and career
stages of employees. The composition of nurses in
health care is changing to include more older
workers, minorities, and men. Working with people
who have different customs, traditions, communi-
cation styles, and beliefs can be exciting as well as
challenging. An organization that fosters diversity
encourages respect and understanding of human
characteristics and acceptance of the similarities
and differences that make us human.
Often, when stressful situations arise, gender, age,
and culture can contribute to misunderstandings.
Davidhizer, Dowd, and Giger (1999) identified six
important factors in their model for understanding
cultural diversity:
1.Communication.Communication and culture
are closely bound. Culture is transmitted
through communication, and culture influences
how verbal and nonverbal communication is
expressed. Vocabulary, voice qualities, intona-
tion, rhythm, speed, silence, touch, body pos-
tures, eye movements, and pronunciation differ
among cultural groups and vary among persons
from similar cultures. Using respect as a central
core to a relationship, everyone needs to assess
personal beliefs and communication variables of
others in the workplace.
2.Space.Personal space is the area that surrounds
a person’s body. The amount of personal space
individuals prefer varies from person to person
and from situation to situation. Cultural beliefs
also influence a person’s personal space comfort
zone. In the workplace, an understanding of
coworkers’ comfort related to personal space is
important. Often, this comfort is relayed in
nonverbal rather than verbal communication.
3.Social organization.In most cultures, the
family is the most important social organiza-
tion. For some people, the importance of family
supersedes that of other personal, work, or
national causes; for example, caring for a sick
child overrides the importance of being on time
or even coming to work, regardless of staffing
needs or policies. Because the health-care
industry employs a large number of women, the
value of the family becomes an important issue
in the workplace.- Time.Time orientation is often related to cul-
ture, environment, and family experiences.
Some cultures are more past-oriented and focus
on maintaining traditions, with little interest in
goals. People from cultures with more of a pres-
ent and future orientation may be more likely
to engage in activities, such as returning to
school or receiving certifications that will
enhance the future. Working with people who
have different time orientations may cause
difficulty in planning schedules and setting
deadlines for the group.
5.Environment control.Environmental control
consists of those activities that an individual
plans for controlling nature. Environmental
control is best understood through the psycho-
logical terms internaland external locus of
control.Individuals with an external locus of
control believe in fate or chance. People with an
internal locus of control believe in developing
plans and directing their environment. In the
workplace, nurses are expected to operate from
an internal locus of control. This approach may
be different from what a person has grown up
with or how a patient deals with illness. - Biological variations.More and more infor-
mation is available to health-care workers about
the variations among races in aspects such as
body structure, skin color, genetic variations,
susceptibility to disease, and psychological
differences. The Joint Commission states that