why she hesitates to return to the room and feels
tense around her roommate. As she examines the sit-
uation, she realizes that they view the use of per-
sonal space differently (choosing). Next she discusses
her conflict and choices with her adviser and friends
(prizing). Finally she decides to negotiate with her
roommate for a compromise (acting).
Beliefsare ideas that one holds to be true: for ex-
ample, “All old people are hard of hearing,” “If the sun
is shining, it will be a good day,” or “Peas should be
planted on St. Patrick’s Day.” Some beliefs have ob-
jective evidence to substantiate them. For example,
people who believe in evolution have accepted the ev-
idence that supports this explanation for the origins
of life. Other beliefs are irrational and may persist,
despite these beliefs having no supportive evidence or
the existence of contradictory empirical evidence. For
example, many people harbor irrational beliefs about
cultures different from their own that they developed
simply from others’ comments or fear of the unknown,
not from any evidence to support such beliefs.
Attitudesare general feelings or a frame of ref-
erence around which a person organizes knowledge
about the world. Attitudes, such as hopeful, optimistic,
pessimistic, positive, and negative, color how we look
at the world and people. A positive mental attitude
occurs when a person chooses to put a positive spin
on an experience, comment, or judgment. For exam-
ple, in a crowded grocery line, the person at the front
pays with change, slowly counting it out. The person
waiting in line who has a positive attitude would be
thankful for the extra minutes and would begin to
use them to do deep-breathing exercises and to relax.
A negative attitude also colors how one views the world
and other people. For example, a person who has had
an unpleasant experience with a rude waiter may
develop a negative attitude toward all waiters. Such
a negative attitude might cause the person to behave
impolitely and unpleasantly with every waiter he or
she encounters.
The nurse should re-evaluate and readjust beliefs
and attitudes periodically as he or she gains experi-
ence and wisdom. Ongoing self-awareness allows the
nurse to accept values, attitudes, and beliefs of others
that may differ from his or her own. Box 5-2 lists ques-
tions designed to increase the nurse’s cultural aware-
ness. A person who does not assess personal attitudes
and beliefs may hold a prejudice (hostile attitude) to-
ward a group of people because of preconceived ideas
or stereotypical images of that group. For example,
a nursing student comes from a white, Protestant,
middle-class environment; until beginning nursing
school in a multicultural urban environment, she had
little experience with cultures other than her own.
She came with an ethnocentric attitude of believing
that her culture was superior to all others. Once she
94 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP
became friends with students from Mexico and Kenya,
she began to realize that each culture has its own
beauty and style and each is as important as the other
is. By letting her new experiences and friends become
part of her view of the world, the student has revised
her beliefs and attitudes and expanded her under-
standing of people and the world. Box 5-3 provides an
example of a values clarification exercise that can as-
sist nurses to become aware of their own beliefs and
thoughts about other cultures.THERAPEUTIC USE OF SELF
By developing self-awareness and beginning to under-
stand his or her attitudes, the nurse can begin to use
aspects of his or her personality, experiences, values,
feelings, intelligence, needs, coping skills, and per-
ceptions to establish relationships with clients. This
is called therapeutic use of self.Nurses use them-
selves as a therapeutic tool to establish the therapeu-
tic relationship with clients and to help clients grow,
change, and heal. Peplau (1952), who described this
therapeutic use of self in the nurse–client relationship,
believed that nurses must clearly understand them-
selves to promote their clients’ growth and to avoid
limiting clients’ choices to those that nurses value.
The nurse’s personal actions arise from conscious
and unconscious responses that are formed by life
experiences and educational, spiritual, and cultural
values. Nurses (and all people) tend to use many auto-Box 5-2
➤ CULTURALAWARENESSQUESTIONS
ACKNOWLEDGING YOUR CULTURAL HERITAGE- To what ethnic group, socioeconomic class, reli-
gion, age group, and community do you belong? - What experiences have you had with people from
ethnic groups, socioeconomic classes, religions, age
groups, or communities different from your own? - What were those experiences like? How did you
feel about them? - When you were growing up what did your parents
and significant others say about people who were
different from your family? - What about your ethnic group, socioeconomic class,
religion, age, or community do you find embarrass-
ing or wish you could change? Why? - What sociocultural factors in your background
might contribute to being rejected by members of
other cultures? - What personal qualities do you have that will help
you establish interpersonal relationships with people
from other cultural groups? What personal qualities
may be detrimental?