Clinical Nurse Specialists as Cultural Brokers, Change Agents, and Partners in Meeting the Needs of Culturally Diverse Populations

Journal of Multicultural Nursing & Health, Summer 2005 by Jeffreys, Marianne R

ADVERSE EFFECTS OF CULTURALLY INCOMPETENT CARE

The avoidance, lack of commitment, cultural misperceptions, lack of adequate preparation, and culturally inappropriate actions (or inactions) of nurses cannot be dismissed as merely a "misunderstanding" but is, in reality - culturally incompetent care (care that is incongruent with the values, beliefs, and practices of others). Culturally incompetent care may stem from cultural blindness or ethnocentrism and result in cultural imposition, stereotyping, prejudice, bias and discrimination, and cultural pain. Cultural blindness refers to the inability of an individual to recognize one's own life-style, thoughts, values, and behavior and those of another individual because of strong ethnocentric tendencies (Leininger, 1991b; 2002). Such an individual is "blind" to cultural similarities and differences and may pride oneself in "treating everyone the same". This sameness does not account for the need to provide culturally specific care nor use culturally acceptable interactions in the workplace setting.

Ethnocentrism is the tendency of an individual (or group) to hold the feelings and beliefs that one's own values, beliefs, and practices are the most desirable, acceptable, or best, and to act in a superior manner to another culture's values, beliefs, and practice (Leininger, 1991b; 2002). At times, the USA subculture of nursing has been ethnocentric in feeling that the values, beliefs, and practices of modern Western medicine is superior to health care values, beliefs, and practices within other traditional cultures or subcultures despite documented support for such practices (Leininger, 1994b). The tendency of imposing values, beliefs, behaviors, and practices upon another culture is termed cultural imposition (Leininger, 1991b; 2002). For example, in the United States, the health beliefs, values, and practices of western medicine predominate within a health care institution, nursing subculture, and other health care professional cultures. Discounting folk medicine practices without adequate knowledge of such practices and imposing western practices on clients would be considered a cultural imposition. Cultural misperceptions may also arise from the tendency to label all individuals of a common background based on gender, age, ethnic group, socioeconomic class, religion, race, sexual orientation, and/or lifestyle with the same values, beliefs, behaviors, and practices, resulting in stereotypes. The danger of stereotyping is that variations within and between groups (based on other variables) are not acknowledged. Furthermore, the individual's values, beliefs, behaviors, and practices are not considered. Thus stereotyping can result in prejudice or "pre-judging" individuals based on perceived group identification. Prejudice and stereotyping can result in bias and discrimination, that is, treating individuals differently based on perceived group identification. Views and actions of stereotyping, prejudice, bias, and discrimination can and does adversely affect the nurse-patient-family relationship (Zoucha, 2000). Additionally, stereotyping, prejudice, bias and discrimination adversely affect nursing personnel relationships, interdisciplinary professional relationships, and organizational relationships. Consequently workplace harmony may be disrupted and result in multicultural workplace conflict.