CULTURAL DIVERSITY IN THE

HEALTH CARE WORKFORCE

By. Ns. WULAN PURNAMA
General Overview
 The 3 most common employment settings for RN in the USA are
hospitals, public or community health centers, and ambulatory
care.
 In many health care settings there is diversity in race, ethnicity,
religion, age, sexual orientation, and national origin.
 Recent strides in the women movement have called attention to
important gender differences and the manner in which
changing societal roles of both men and women influence
relationships in the multicultural workplace.
 The interrelationship between culture and the physical, mental,
and emotional handicaps and disabilities of some health care
workers must also be considered in the complex web called the
multicultural workforce.
 The Challenges and Opportunities
of a Growing Multicultural Population
and Health Care Workforce

 Because the health care workplace is a microcosm of

the changing demographic patterns in society at
large, the growing diversity among nurses and other
members of the health care team frequently poses
challenges and opportunities in the multicultural
work setting.
Transcultural Nursing Administration
 It refers to a creative and knowledgeable process of assessing,
planning, and making decisions and policies that will facilitate
the provision of educational and clinical services that take into
account the cultural caring values, beliefs, symbols, references,
and life ways of people of diverse and similar cultures for
beneficial or satisfying outcomes (Leininger, 1996).
 Contemporary, it focuses on cost-benefit outcomes, downsizing,
territorial struggles with members of other disciplines,
appropriate use of technology, and other important topics.
 With the increasing diversity among members of the health
care workforce, nurses are challenged to develop and practice
a new kind of administration known as transcultural nursing
administration that positively influence cost-benefit and quality
outcomes.
 Cultural Perspectives on the
Meaning of Work
 Cultural norms influence a staff member’s consideration of
group interest as opposed to individual interest in the
multicultural workplace.
 2 major orientations embraced by people: INDIVIDUALISM &
COLLECTIVISM.
 Individualism: importance is placed on individual inputs, rights,
and rewards. Individualists emphasize values such as autonomy,
competitiveness, achievement, and self-sufficiency.
 Collectivism: it entails the need to maintain group harmony
above the partisan interests of subgroups and individuals.
Collectivists emphasize values such as interpersonal harmony
and group solidarity prevail.
Individualists
 They work to earn a living.
 They don’t need to enjoy working.
 They tend to dichotomize work and leisure.
 Their concepts of work reflect an orientation toward
the future.
 They are typically achievement oriented.
 They want to do better, accomplish more, and take
responsibility for their actions.
 They tend to develop personality traits such as
assertiveness and competitiveness that facilitate these
goals.
Collectivists
 They value qualities such as commitment to
relationships, gentleness, cooperativeness, and
indirectness are valued.
 They have sense of loyalty, commitment, and group
orientation, whereas the motivation of the managers
must appeal to the worker’s sense of contract, rules,
and individuality.
Corporate Cultures and Subcultures
 Health care organizations are mini societies that have
their own distinctive patterns of culture and subculture.
 Certain organization may have a high degree of
cohesiveness, with staff working together like
members of a single family toward the achievement
of common goals. Others may be highly fragmented,
divided into groups that think about the world in very
different ways or that have different aspirations
about what their organization should be. This
phenomenon is referred to as corporate culture.
Corporate Cultures…..
 Corporate culture is a process of reality construction that allows
staff to see and understand particular events, actions, objects,
communications, or situations in distinctive ways.
 It helps people cope with the situations they encounter and
provide a basis for making behavior sensible and meaningful.
 The components: shared values, beliefs, meaning, and
understanding.
 Social system is useful to distinguish between the organizational
climate of the work environment and the corporate culture.
 Negative Attitudes and Behaviors in the
Multicultural Workplace
 E.g. hatred, prejudice, bigotry, discrimination, racism, and violence.
 Hatred is exacerbated during times of rapid immigration, periods of economic
recession or depression, and high unemployment (Henderson, 1994).
 Prejudice refers to inaccurate perceptions of others. It results in conclusions that are
drawn without adequate knowledge or evidence.
 Bigotry connotes narrow-mindedness and an obstinate or blind attachment to a
particular opinion or view-point.
 Discrimination refers to behaviors and is defined as the act of setting one individual
or group apart from another, thereby showing a difference or favoritism.
 Racism implies that superior or inferior traits and behavior are determined by race.
Race relations should be properly understood in the larger context of human
relations (Henderson, 1994).
 Ethnoviolence is increasing by time, verbal threats and/or assaults by or against staff
members should not be tolerated.
Formation of Attitudes
 When social amnesia develops, the individual tends to
create elaborate rationalizations in an effort to
account for learned attitudes toward certain groups
of people in a society.
 The superiority or inferiority of a group (versus an
individual) is usually less obvious than an individual’s
behavior.
 The values, behaviors, and customs of those in the
outgroup are labeled as “strange” or “unusual”.
Changing Attitudes
 All the negative behaviors begin with an individual’s attitudes toward
certain groups.
 Efforts to change staff member’s attitudes about people from culturally
diverse groups should center on communication.
 Firstly, formal attitude change approach is based on learning theories on
the assumption that people are rational, information processing beings who
can be motivated to listen to a message, hear its content, and incorporate
what they have learned when it is advantageous to do so.
 Secondly, groups dynamics approach assumes that staff members are social
beings who need culturally diverse coworkers as they adjust to
environmental changes.
 Cultural Values in the
Multicultural Workplace
 Values form the core of a culture.
 Cultural values frequently lie at the root of cross-cultural differences in the
multicultural workplace.
 Values affect people’s lives in 4 major ways: perceived needs, what is
defined as a problem, how conflict is resolved, and expectations of
behavior.
 Time orientation, family obligations, communication patterns (including
etiquette, space/distance, touch), interpersonal relationships (including long-
standing historic rivalries), gender/sexual orientation, education,
socioeconomic status, moral/religious beliefs, hygiene, clothing, meaning of
work, and personal traits exert influences on individuals within the
multicultural health care setting.
Cultural Perspectives on Conflict
 Conflict refers to actions that range from intellectual disagreement to
physical violence.
 The actions that precipitates the conflict is based on different cultural
perceptions of the situation.
 The dominant culture’s proverbs emphasize that people should behave
assertively and deal with conflict through direct confrontation.
 Individualists view conflict as a healthy, natural, and inevitable components
of all relationships. Characteristic: assertiveness, confrontational, and direct
style of communicating.
 Collectivists view conflict is not healthy, desirable, or constructive.
 Mediation allows for saving face and is rooted in the realization that all
conflicts do not have simple solutions.
 Cultural Origins of Conflict
Conflicting values that underlie problems:
1. Cultural perspectives on family obligations.
2. Personal hygiene.
3. Cross-cultural communication (etiquette and touch).
4. Clothing and accessories.
5. Time orientation.
6. Interpersonal relationships (long-standing historic rivalries
between groups; authority figures, peers, subordinates, and
patients).
7. Gender/sexual orientation.
8. Moral and religious beliefs.
 Conflicting Role Expectations:
Staff Educated Abroad
 Role is defined as the set of expectations and behaviors associated with a
specific position.
 People from similar cultures are more readily able to relate to one another,
health care providers must be able to transcend cultural differences and to
recognize that there are differences in role expectations. Discrepancies in it
tend to create intrapersonal and interpersonal conflict.
 Nurses have considerably expanded roles, and their scope of practices is
correspondingly broader.
 Because of the shortage of qualified health care providers in many less
developed countries, there usually are fewer interdisciplinary differences
about the nature and scope of practice for various health care disciplines.
 Cultural Assessment in the
Multicultural Workplace

1. Individual cultural self-assessment.

2. Cultural self-assessment of health care
organizations, institutions, and agencies.
Individual Cultural Self-Assessment
1. It focuses on staff members and their beliefs about multiculturalism in the
workplace.
2. It is important for nurses to be aware of their own ethnocentric tendencies.
This is best accomplished when individuals review their cultural attitudes, values,
beliefs, and practices.
3. By gathering responses to the individual cultural assessment instrument, nurse
managers can identify staff perceptions about diversity issues and determine
what management strategies might be useful.
4. A culturally diverse workforce should be a strength in meeting the needs of
culturally diverse patients and should be viewed as an asset.
5. Nurse managers need to release the cultural talents of this workforce.
Organizational Cultural Self-Assessment

 Content and process are considered as important in

organizational self-assessment.
 It is needed because of changing demographics in populations
served or concerns with quality of care for diverse patients.
 The instrument may be used to assess an entire organization,
such as hospital, a long-term care facility, a home health
agency, or another organization, institution, or agency, or it
may be modified for the assessment of a particular unit or
division.
The Process…..
 After identifying key staff members to lead the institutional cultural self-
assessment process, the leaders should communicate the purpose of the
cultural self-assessment to those who will be participating in it.
 It is important to involve grassroots members of the staff and to solicit input
from the patient population served through interviews, focus groups, written
surveys, or other methods.
 It involves collecting demographic and descriptive data, identifying
strengths and limitations, assessing the need and readiness for change,
identifying community resources, evaluating the effectiveness of changes,
and implementing any necessary revisions.