Cultural sensibility: Personal and professional

By Sally N. Ellis Fletcher | 07/01/2015

In this chapter from Cultural Sensibility in Healthcare, author Sally N. Ellis Fletcher provides an introspective look at our behaviors and examines the impact of our cultural influences on healthcare interactions.


Consider the following conversation between a young college student (YCS) and the academic dean of a church-related liberal arts college (based on a true experience, but altered here slightly to maintain anonymity):

YCS:

Dean, why did you devote your entire life to the church?

Dean:

That’s a very good question, YCS. I wanted to serve God full time as a minister.

YCS:

Oh. Did you always want to be a full-time minister?

Dean:

No, I wanted to become an actor and go into the theater like my family.

YCS:

Wow, an actor?

Dean:

In our family, we were always playing different characters from theater, musicals, television programs, or books. We were constantly acting. We even held our own “Tony Awards.”

YCS:

An actor. Isn’t that an extreme leap from the ministry?

Dean:

Perhaps, but for me, life is an enormous opportunity to act. So, I minister full time and act when I’m confronted with the situations of life that are opposite my personal desires. I do what I have to do as a character, like from a play.

YCS:

The YCS said nothing else but simply thought, “Gee, that’s strange.”

I am not a thespian, my family is not theatrical, and as of this writing, I have yet to see a Broadway production. Even so, I am completely fascinated with live theater. However, it is not an essential element of who I am. It is not my cultural experience. In the conversation you just read, theater is the cultural experience of the academic dean. The world of theater is intricately woven into the dean’s responses and view of the world. We could even surmise that it influences his values, beliefs, communications, and so much more about how he navigates through daily activities.

Book cover of Cultural SensibilityUnlike the dean, though, many of us are unaware of how cultural influences impact our own actions. This guidebook serves as an antidote to our tendency toward cultural myopia. The focus here is on cultural sensibility in healthcare delivery, and so we’ll explore culture from both a pragmatic and a personal perspective. Let’s start with the personal.

Seeing the world from our own perspective
Because much of my work involves examining cultural influences, I often hear, “I don’t have a culture.” I also hear, “I’m not Jewish,” “I’m not Latino,” and “I’m not African American.” However, these refutations represent a narrow view of what culture is. Remember that culture is more than one’s ethnic group (individuals who self-identify membership with or belong to a group with shared values, ancestry, and experiences [Leininger & McFarland, 2002]).
 
So, the first step in our cultural sensibility journey is to visit points in our personal history from which we derive meaning, insight, encouragement, and inspiration.
 
Culture influences how we see the world. It guides and shapes how we think politically, socially, and personally. If we fail to know or recognize our cultural history, we may be disconnected from the reality of why we do the things we do. Cultural sensibility (a deliberate proactive behavior by healthcare providers who examine cultural situations through thoughtful reasoning responsiveness and discreet interactions) allows us to recognize that we all have a personal history that has been woven together from various experiences and events that guide our life today and that will influence our future. Often, we recall only the positive events that influence our life. In reality, though, both positive and negative experiences build our personal history. As you work through this guidebook, always reference your personal history, especially those events that steered you toward a healthcare career and that may still influence how you respond to cultural issues in healthcare today.
 
Have you heard of Michael Crichton? The award-winning novelist was perhaps best known for writing Jurassic Park. He also wrote The Andromeda Strain, in 1969, and created the television series ER. His works famously incorporate detailed scientific research that captivates readers. However, few probably know that Mr. Crichton earned a medical degree from Harvard Medical School. Mr. Crichton was actually Dr. Crichton. If you didn’t know this about him, you, too, might have wondered how he could incorporate superb scientific detail into his novels. Most likely, the answer is that his personal experiences as a medical student and physician and his passion for science and computers led to that particular skill (Goodreads, 2013; “Michael Crichton: The official site,” 2013).
 
Although few of us will ever gain the recognition and prominence achieved by Michael Crichton, we each have a personal history that influences how we embrace and respond to our healthcare professional role. Our initial desire to pursue a healthcare career, influenced by different motivations/catalysts for each of us, inspired our individual goal/vision to become a healthcare provider. That vision resulted in emotional, mental, and spiritual idealism regarding healthcare. Our idealism allowed us to dream and develop hopes about our future as a healthcare worker.
 
Because cultural sensibility begins with self-examination, as mentioned earlier, it is time for a few questions:
  1. Have you become less open to colleagues and consumers of healthcare services (patients) than when you began your journey toward becoming a healthcare professional?
    Yes ____ No ____

  2. Do any of the following issues negatively affect your view of your career as a healthcare provider?
    Use Y for yes and N for no.

    ____ Sociocultural dynamics that diminish trust and your dreams
    ____ Family dynamics (births, marriages, financial challenges, aging parents)
    ____ Powerlessness to reshape your personal vision to fit the needs of today’s world
    ____ World events that cause you to become introspective and nostalgic for the safety of the past, with a focus on me and mine

  3. Do you feel overwhelmed by the rapid amount of change and information overload that occurs in your personal and professional life?
    Yes ____ No ____

Let’s discuss these questions from a general perspective. Our idealism and initial vision of our future in healthcare may no longer guide us today (question 1). If that’s so, it certainly cannot provide inspiration for tomorrow. If this describes you, how did that happen? Perhaps you have lost the drive that initially led you to a healthcare career. Again, why?

Our lives change over the years based on any number of factors, including those listed in question 2. Perhaps you’ve been a healthcare provider for only a relatively short time, though, and none of the factors listed in that question apply to you. Even so, maybe you’re experiencing 21st century rapid change and information overload (question 3). After all, our email inboxes are chock-full of information daily (sometimes hourly), and you might find such a rapid pace of information overload overwhelming. Maybe you create task lists that you end up continually adding to as more information (instructions/orders) becomes available (and therefore you can never quite complete the task list).


AUTHOR’S NOTE
Farrell (2013) holds that email is an outdated communication method. It is too slow and too singular in its reach. So, we turn to Facebook, Twitter, and other social media. Those other platforms enable us to share (both send and receive) information with wider audiences more rapidly. Within 5 to 10 years, though, the popular social media of today will likely be replaced by newer technologies that more appropriately meet our future requirements.

Maybe our past, present, and imagined future come into conflict today, diminishing the once wide-eyed idealism of a new healthcare professional. Think carefully about these issues; they have a profound impact both personally and professionally. After all, when we lose our idealism and career goals/vision, we risk being physically present at work but professionally absent in our career as a healthcare provider.


Becoming a healthcare provider: A timeline of influences
To recapture a bit of our idealism and the vision we had for our healthcare career, let’s use a timeline technique to explore what led us to healthcare when we were still “starry-eyed” and the vision for our career in healthcare was vibrant.
 
Author’s Note: If factors that led you into healthcare involve traumatic experiences, you might want to just glance through this section, especially if you have not fully emotionally healed from those events. You are also encouraged to seek professional assistance through an employee assistance program or personal counselor if you find this timeline activity emotionally disturbing.
 
Let’s begin by examining the life event timelines of two nurses. The information presented in the timelines was collected by asking each person to share why she selected nursing as a career and what kept her interested in nursing throughout the years.
 
Welcome’s Timeline

1919

Welcome is born to Bill and Arizona.

She was raised in a close-knit community in a Midwestern town in the United States.

Her father was a World War I veteran who worked odd jobs after the war and became a fireman, working the required 24-hour shifts at the town fire station.

Her mother worked odd jobs and was a housewife.

1925

Arizona (Welcome’s mother) dies after a ruptured appendix. Welcome is 6 years old at the time.

Bill cherishes Welcome and teaches her self-reliance and respect for others.

1929

Bill marries Nila, a schoolteacher, who rules with firmness and a loving heart. Besides teaching, Nila is very involved in the community. Welcome is 10 years old.

1931

Almost every year, after the snow melts, a fire breaks out at the paper mill (as do other fires in other places throughout the year). Whenever disasters strike in the community, Nila and Welcome cook food to take to the disaster site for workers, families, and the injured.

1933

Bill is injured in a paper mill fire and hospitalized. Mr. Jaspers, a fellow fireman and family friend, also is injured. Welcome describes him as being very swollen and puffy when she arrives at the hospital to visit. Welcome is in the hospital room visiting both men when Mr. Jaspers dies. She is distraught and fears that her father will swell and die (a common occurrence with injured firefighters). Welcome is comforted and supported by the Catholic nuns who are nurses. Welcome is 14 years old. Her father recovers.

1936

Welcome graduates from high school at 17 years old. She wants to go to New York and design clothes, but Bill and Nila encourage her to seek a career that will provide greater independence and stability.

1938

Welcome remembers how much she enjoyed helping out after disasters, her fascination with hospitals, and how impressed she was with the nuns who were nurses. She knew of several nurses in the community who graduated nursing school from General Hospital #2 in the state of Missouri.

Welcome applies and is accepted to begin nurse training at General Hospital #2 in Kansas City, Missouri. Welcome is 19 years old.

1941

Welcome completes nurse training and becomes an RN.

1946

Now married to a physician, Welcome and her husband work at the city hospital. She also teaches student nurses and, serving as a supervisor, responds to a large number of the emergencies in the hospital.

1955

Welcome completes her bachelor’s degree in nursing from the local Catholic college.

She enjoys teaching students, has a deep sense of compassion for people, and is still fascinated with hospitals.

Nursing provides the independence and flexibility Welcome seeks as she raises their children.

 

Though often encouraged to stop working and be financially supported by her husband, Welcome enjoys the economic security nursing provides.

1960

She begins working as a school nurse.

1962

She earns a master’s degree in teaching.

1970

Welcome continues working as a public school nurse and part-time at the local pediatric hospital.

1981

She retires from full-time nursing.

2013

Though retired for 32 years, Welcome continues to use public health nursing principles daily, regardless of the setting.

She states that she is still fascinated with aspects of healthcare and has a deep compassion for people.

Discussion question: Can you identify where Welcome was idealistic/vulnerable in her nursing life? What situations would have caused her to exhibit empathy and open up emotionally as a caregiver?

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Discussion question: List five influences on Welcome’s life that might inform her cultural sensibility.

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Discussion question: Is it important that we do not know Welcome’s race or cultural background?

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The following facts and experiences (among others) might affect how Welcome perceives different cultures:

  • Being born in the United States (specifically in the Midwest)
  • Having the parents she had
  • Seeing someone suffer fatal burns
  • Losing her mother young
  • Being helped by Catholic nuns
  • Being married to a doctor
  • Completing higher education

As Welcome reminisced about why she went into nursing (and stayed), she identified several themes that were interwoven throughout her life. These themes were independence, experience, and involvement with disasters. Another theme was the inspiration from the Catholic nuns as they responded to healthcare issues in the community. Welcome is quick to tell you that she experienced some difficult periods as a nurse. In retrospect, though, she reflects on the positive influences and states that she loves nursing and healthcare. (Yes, if you did your math, Welcome was 94 years old when I interviewed her.)

Let’s explore a second timeline, this time for Mary.

Mary’s Timeline

1955

Mary is born in the northern Midwest part of the United States to loving parents.

She recalls a deep fascination with human behaviors.

1968

Throughout her childhood, an aunt suffered with mental illness, and other family members exhibited behavioral issues.

As a child, she enjoys playing school, with her always in the role of the teacher. She creates classrooms with boxes and teaches her toys and sometimes her playmates.

1972

As a member of church and youth groups, Mary visits nursing homes and assists members in the community. This experience provides an exposure to community healthcare for Mary.

1973

Mary is the first generation in her family to attend college.

While visiting with the high school career counselor, she notices a brochure on mental healthcare providers. A program is being offered through the community college. She decides to enroll in the program.

1975

Mary earns an associate of science degree with an emphasis in mental healthcare.

She begins working as a mental healthcare technician (MHT) in a hospital.

Mary’s fascination with human behavior continues as she enjoys her job as an MHT.

Mary is surrounded by RNs and decides she could do what they do as mental healthcare nurses.

Mary makes plans to return to school.

Mary marries her longtime boyfriend.

1982

She earns a bachelor of science degree in nursing.

She dislikes the rigidity of hospital structure.

1983

Mary’s first child is born.

She enjoys working on the eating disorder unit.

1985

She seeks nursing positions that allow teamwork, autonomy, and working with human behavior.

Mary is recruited to begin teaching in the associate degree nursing program at a community college.

1987

She begins work toward a master’s degree in mental health nursing.

She enjoys teaching because it provides autonomy, teamwork, and the joy of seeing nursing through the eyes of students entering the profession.

1991

Mary completes her master’s degree in mental health nursing.

1993

She begins working at a 4-year college in a baccalaureate nursing program.

2006

Mary becomes department director of the nursing program.

She continues to enjoy autonomy, teamwork, and seeing nursing through the eyes of students entering the profession.

2012

Mary retires from the position of department director of the nursing program.

She takes on a consultant role to schools of nursing.

Discussion question: Where was Mary idealistic/vulnerable in her nursing life? What situations would have caused her to exhibit empathy and open up emotionally as a caregiver?

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Discussion question: List five influences on Mary’s life that might inform her cultural sensibility.

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Discussion question: Is it important that we do not know Mary’s race or cultural background?

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The following facts and experiences, as well as others, might affect how Mary perceives different cultures:

  • Having mental illness in her family
  • Being a church member
  • Being attracted to teaching and human behavior
  • Being the first in her family to attend college
  • Having children

During our conversation, Mary emphasized multiple times that there was no grand plan to her becoming a nurse and a nurse educator; it just evolved. The following themes were interwoven throughout her life: fascination with the behavior of people, her love for teaching, and a need for autonomy and flexibility.

The power of one (or two, in this case)
According to the Bureau of Labor Statistics (2012), there were 2,737,400 registered nurses employed in the United States in 2010. The American Nurses Association (2011) identifies 3.1 million licensed registered nurses in the United States. That’s a lot of nurses! Yet, I believe in the power of one. Welcome and Mary represent the power of one. They have touched countless lives throughout their careers. I’m sure that there were moments when they had bad days or forgot their reasons for entering healthcare. However, they were still able to draw on their original motivations/catalysts for becoming a healthcare provider. Even Welcome, whose RN license is no longer active, can be heard saying to staff in her independent senior living center, “Would you mind checking on George; he might be dehydrated,” or, “His shirt is on wrong, and he is not responding as quickly to questions,” or, “It’s about flu season, and so it’s time to have our hand- washing reminders.” Generally, her assessments are accurate, and one might say that for Welcome, “Once a nurse, always a nurse.”

Welcome’s and Mary’s timelines allowed us to explore the motivations/catalysts and themes that were interwoven throughout their lives. Similarly, we each have these ourselves (as you’ll explore in the following section), and they represent the essence of our decision to enter into and remain in a healthcare career.

Activity: Build your own timeline
Now it’s your turn. Reflect on the experiences in your life that led you to a career in healthcare. Use pen and paper, your word processor, or your tablet to respond to the following questions. It’s okay to write your responses in incomplete sentences. Content is important here, not form.
 
1. Why did you select nursing as a career? Try to recall the earliest motivations possible. Don’t hesitate to call your parents or siblings and ask them what they recall as your earliest interest in healthcare.

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2. What has kept you interested in nursing throughout the years?

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3. Create your personal timeline of influences. Refer to Welcome’s and Mary’s timelines for help.

  • Enter your name above the blank timeline.
  • Review the information you recorded in steps 1 and 2. If you recall additional events that are important, great. Include them.
  • Organize the information according to year.

Timeline of influences: (Your name goes here)
 
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4. Review your timeline.

  • What themes are interwoven throughout your life?
  • What additional information should you add?

Discussion question: At what periods were you idealistic/vulnerable in your nursing life? What situations would have caused you to exhibit empathy and open up emotionally as a caregiver?

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Discussion question: List five influences from your timeline that might inform your cultural sensibility.

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The themes identified from your personal timeline should provide you with encouragement, pride, and an overall “positive energy deposit” into your professional healthcare career today. Your timeline is a reminder of the milestones that have shaped your views and how you respond to patients in your daily practice of healthcare. Likewise, the patients we serve have experienced milestones that influence how they respond to wellness, illness, healthcare providers, and the healthcare system. The milestones on their timelines, just like ours, make them who they are. If we look at each other through the lens of one’s timeline, we might better understand the actions, reactions, and viewpoints of others.

Keeping control of distractors
Now that we’ve explored personal timelines and why we selected healthcare as a profession, let’s discuss challenges in healthcare that may interfere with or even block our cultural sensibility. Consider the conversion from paper charts to electronic health records (EHRs), text messaging, and mobile phones that place direct-care providers in constant communication with all members of the healthcare system while trying to provide direct patient care. Can you think of other challenges?

The constant nature of change
The demands and changes prompted by technology like converting to EHR can be a steep learning curve with major financial implications for most U.S. healthcare systems. Yet some organizations have made or are making the transition with fewer “hiccups” than others. How can that be? One answer may be in how an organization views change. In 1970, Alvin Toffler, a futurist, published a controversial book, Future Shock. In it, he described a future where technology controlled our lives and we were bombarded with so much information we experienced the phenomenon he termed information overload. Though countless disagreed with many of the futuristic predictions outlined in the book, Toffler’s basic premise regarding an overloaded feeling from excessive information generated by technology was correct. In most of our daily routines, we stop to view Facebook, tweets, emails, instant messaging, and various other posts on our portable technological devices. Many of us review work-related electronic communications during weekends, holidays, and even vacations (all so that we’re not behind when we return to work). However, if an organization embodies the primary premise from Toffler’s book, “Change is not merely necessary to life—it is life” (Goodreads, 2013), that organization may be more nimble, open, and responsive to change. An organization like that has learned from history and creates processes allowing its workforce to not only adapt to rapid change but also remain idealistic and visionary about opportunities change affords. Likewise in our personal lives, if we embrace the idea that change will continuously happen, we may be empowered to become more nimble and creatively responsive to change.

Earlier in this chapter, in the section “Seeing the World From Our Own Perspective,” you answered three questions about yourself. As you continue to ask yourself these questions, new thoughts and insights should be revealed. A yes or no response is not diagnostic. The goal is to expand our self-awareness. Remember that if you are weighed down by social dynamics and family demands, feel powerless toward influencing change, and are overloaded with information, you will not be able to be idealistic, open, energized, or present to provide culturally sensible healthcare.

You can regain or create a vision for today and tomorrow as a healthcare provider by recalling and embracing your personal history, your timeline. Reflecting on the original desire that guided you into healthcare, you can gently begin to embrace yesterday’s desire as an energizer for today’s needs as a healthcare provider. But this can be scary because it requires us to be open, idealistic/vulnerable and dare to consider someone else’s timeline (an empathetic view) and its impact on that person’s actions and reactions.

At the core of cultural sensibility is the willingness and empathetic temperament to consider the other person’s perspective. I was once told that the Cherokee tribe, as part of a life lesson, taught that it is not good to judge until you walk a mile in the other person’s shoes. Seeing life from the perspective of another is a lesson we can never outgrow. It requires us to leave our introspective world and become a risk-taker. As a risk-taker, you must approach in a nonjudgmental way anyone who may appear different from the way you look, think, believe, and act. I don’t know about you, but sometimes this is difficult (and downright scary) for me to do. However, I realize it is vital for healthcare providers to recall the Cherokee life lesson and to consider the footsteps that each patient and colleague has taken to arrive at his or her personal viewpoints.

The power of many
Number-wise, nursing is a powerful workforce with a large power base that can set the tone for a compassionate, culturally sensitive, and culturally sensible healthcare delivery system. A base this large means that nurses can also set a healthcare tone that is apathetic, disillusioned, and alienated from the essence of good healthcare delivery. When our interactions with patients/colleagues lack cultural sensibility, we become less effective and less able to bring hope, healing, and inspiration to those who seek our services as healthcare providers. Therefore, let’s reexamine our primary motivations for selecting healthcare as a career.

I will go out on a limb and say that most healthcare providers experienced no lightning strikes, angels with harps, or dreams or visions that told us to make healthcare our career. For some, it was a deliberate and calculated career choice, minus the theatrics or cinematography. Most of us were guided by circumstances, life events and desires, opportunities, and our belief that a career in healthcare would provide (at least some) personal enjoyment. But when was the last time we revisited the catalysts that launched us on our professional healthcare journey? Our motivations/catalysts differ for each of us, but we can all benefit from revisiting the events that led us into healthcare.

Before finishing this section, let’s explore the number of nurses in the U.S. Based on national employment projections, registered nurses rank number 5 among the largest employment occupations in the United States (CareerOneStop, 2013). If you’re curious (as I was), you may wonder what other occupations were identified. So, I’ve listed CareerOneStop’s top 10 occupations.

Click here for CareerOneStop's top 10 occupations.

The next healthcare occupation after nursing in 2012 is listed at number 17 (nursing assistants); physicians didn’t make it into the top 50. Additional healthcare provider occupations are listed in the following table.

Click here for additional healthcare provider occupations.
 

Categorical knowledge limitations
Part of what prompted my journey to cultural sensibility was my personal frustration with healthcare providers wanting lists for each ethnic or racial group that presents to their respective agency. Essentially, providers were requesting categorical lists for every group: an impossible task.

Categorical knowledge as it relates to culture describes information about particular racial or ethnic groups that is clustered under headings such as language, food preferences, homeland of origin, religion, and so on. The information provided by categorical knowledge of culture in healthcare is useful and important, but can be misleading. It is impossible to be familiar with all cultures, subcultures, and groups one may encounter, regardless of the way in which the categorical knowledge is presented and learned. If we are not careful, categorical knowledge can limit our perspective and approach toward cultural issues and can increase the risk of stereotyping during consumer/patient interactions. If stereotyping is increased from categorical knowledge, we magnify provider-bias healthcare encounters. If we equip ourselves and other healthcare providers only with categorical knowledge, we may create unnecessary stress, demands, and expectations on healthcare providers when unanticipated cultural groups present to their healthcare practice.

As a healthcare provider, you might recall situations where you scrambled and searched for information that described a cultural group an individual represented, only to then fumble with cultural errors. Confusion and frustration from such attempts to provide culturally appropriate healthcare may restrain future efforts or produce a lackadaisical attitude toward the subject of cultural diversity in healthcare. Consequently, approaching culture in healthcare primarily from the level of categorical knowledge perpetuates culture in healthcare at the intellectual level and may inhibit opportunities to genuinely care for, treat, and respect individuals seeking healthcare based on their culturally unique attributes.
 

Cultural sensibility benefits
Cultural sensibility describes a proactive response, which implies that one is energetic, enthusiastic, and in a state of readiness and openness for some event, occurrence, or phenomenon. It is a deliberate behavior that incorporates systematic and thoughtful reasoning and responsiveness to an event, occurrence, or phenomenon. Sometimes when we are proactive and deliberate, we become overzealous. However, cultural sensibility is not overbearing or bullish. In contrast, it embraces a discreet (attentive, considerate, and observant) behavior during interactions. To move toward a behavioral level of addressing the needs of culture in healthcare, a new process is needed. Cultural sensibility is proposed as one process to move healthcare providers to the level of behavioral cultural sensitivity.

Cultural sensibility offers healthcare providers a process that encourages examination of their attitudes, biases, beliefs, and prejudices through self-reflection. The process of self-reflection allows us the opportunity to accept or change our biases, beliefs, and prejudices. Most important, though, it allows us to recognize that these areas have the potential to interfere with effective healthcare interactions.

Kathryn Stockett wrote in the historical novel The Help (2009), “All my life I’d been told what to believe about politics, coloreds, being a girl. But with Constantine’s thumb pressed in my hand, I realized I actually had a choice in what I could believe.” As healthcare providers, we have a choice in what we believe about patients who seek our healing care. We can incorporate the stereotypes and labels of noncompliant, frequent flyer, drug seeker, and so forth, or we can exhale and examine our attitudes, biases, and beliefs and reflect on what the patients are saying they need from us as healthcare providers. 


REALITY CHECK MOMENT

For emergency responders, critical care providers, and other emergency situations, I am not advocating that emergency care be paused for a self-reflection cultural sensibility assessment. As you engage in more and more cultural sensibility interactions, though, they will become second nature, as your previous interactions inform your future ones.



Activity: Consider whether healthcare is a right or a privilege

Don’t panic, you’re not about to read a philosophical, political, sociocultural discussion or debate on the topic of whether healthcare is a right or privilege. If you are a healthcare provider or student enrolled in a healthcare program, you’ve more than likely already answered this question. If you’ve recited the Florence Nightingale Pledge or reviewed the Code of Ethics for Nurses or oaths and codes of ethics for your respective healthcare profession, you have considered this question already.

1. If you are a registered nurse, review the Code of Ethics for Nurses and the Nightingale Pledge. If you are a member of another healthcare profession, review your professional code of ethics and any oath that members of your profession recite.
 


THE NIGHTINGALE PLEDGE
The Florence Nightingale Pledge was modified from the Hippocratic Oath by Lystra E. Gretter in 1893. Since 1893, the pledge has been updated and modified several times. The original version reflects nursing in 1893 and reads as follows:
 
“I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care” (American Nurses Association, 2013).


CODE OF ETHICS FOR NURSES

The Code of Ethics for Nurses (American Nurses Association, 2015) has nine provisions that guide the profession of nursing in its professional responsibilities and conduct: 
  1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

  2. The nurse’s primary commitment is to the patient, whether an individual, family, group or community, or population.

  3. The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.

  4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.

  5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

  6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality healthcare.

  7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.

  8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.

  9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

 

2. Describe how the Code of Ethics and the Nightingale Pledge, or similar documents that represent your profession, answer the question of whether healthcare is a right or a privilege.

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3. Analyze how your personal beliefs impact your practice.

If you wrote that healthcare is a privilege, describe how that concept might motivate your state of readiness and openness with patients you encounter.

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If you wrote that healthcare is a right, describe how that concept might motivate your state of readiness and openness with patients you encounter.

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Activity: Consider your own cultural sensibility
On any given day, healthcare workers face a number of tasks, responsibilities, unexpected changes, and life-and-death situations. Providing culturally appropriate care may seem low on the priority list of urgent tasks to accomplish, especially if one’s perspective is “we’re all the same.”

Read the following scenario.

Two healthcare workers from different ethnic and cultural backgrounds are friends at work and sometimes socialize outside the work environment. On break, Donna tells Maria, “I don’t understand this culture stuff. We’re all people! Why do we have to make a big deal of everything?”

1. Describe your initial, unfiltered response to Donna.

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2. Have you ever felt like Donna?

If yes, write why you felt like the comment Donna expressed.

If no, can you imagine why Donna might feel this way?

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Summary
Cultural sensibility was introduced in this chapter, but the focus was on the healthcare provider. As healthcare providers, we’re confronted with so many issues that it’s easy to forget that we are the essence of healthcare. We are powerful and important and limited only by our belief in that fact. We need energy deposits into our energy accounts to effectively provide healthcare, and one way to renew our enthusiasm/energy is to revisit the motivations/catalysts that directed us toward a career in healthcare. Whether we personally believe healthcare is a right or a privilege, as healthcare providers, we are bound by our professional codes of ethics. The Code of Ethics for Nurses, with its interpretive statements, can provide meaning, direction, encouragement, and motivation when we lose direction, or even that extra boost of emotional energy.

Sally N. Ellis Fletcher, PhD, RN, FNAP, created the NxSTEP (Nurses Sharing Tremendous and Extraordinary Possibilities) program, designed to assist students with socialization, career planning, and cultural inclusiveness in nursing.

Information on purchasing Cultural Sensibility in Healthcare. 


References
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American Nurses Association. (2013). Florence Nightingale Pledge. Retrieved from http ://nursingworld.org/FunctionalMenuCategories/
AboutANA/WhereWeComeFrom/FlorenceNightingalePledge.aspx

American Nurses Association. (2015). Code of Ethics for Nurses: With interpretive statements. Silver Spring, MD: Author.

Bureau of Labor Statistics, U.S. Department of Labor. Occupational outlook handbook, 2012-13 edition, registered nurses. Retrieved from http://www.bls.gov/ooh/healthcare/registered-nurses.htm

CareerOneStop (2013). Occupations with the largest employment. Retrieved from http://www.careerinfonet.org/oview3.next=oview3 &level=overall&optstatus=101000000&id=1&nodeid=
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Farrell, M. (2013, March 30). E-mail a thing of past for business, young. The Boston Globe. Retrieved from http://www.bostonglobe.com/business/2013/03/29/mail-gets-cold- shoulder/xWOVx0s9h8EXVs8t6MxrmO/story.html

Michael Crichton: The official site (2013). Retrieved from http://www.michaelcrichton.net/aboutmichaelcrichton-biography.html

Toffler, A. (1970). Future Shock. New York, NY: Bantam Books.

Wall, B. M. (2002). The pin-striped habit: Balancing charity and business in Catholic hospitals 1865–1915. Nursing Research, 51(1), 50–58.

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