Respecting Culture and Honoring Diversity in Community Practice
Racher, Frances E., Annis, Robert C., Research and Theory for Nursing Practice
Nurses work with individuals, families, groups, and communities where lives are enriched and challenged by cultural diversity. The purpose of this article is to discuss challenges and strategies for respecting culture and honoring diversity. This article diverges from the traditional nursing practice of working with individuals to working with collectives, to community practice beyond individuals and families, beyond community as context, to community as client. Culture and ethnicity are defined to set the stage for discussion of theory and its application to practice. Acculturation theory is explored through comparisons of the Canadian mosaic and American melting pot. Cultural competence, cultural attunement, and cultural humility are examined, and recommendations for effective community practice in working with groups and organizations are shared.
Keywords: culture; cultural diversity; community health; community practice; acculturation
Nurses work with individuals, families, groups, and communities where lives are enriched and challenged by cultural diversity. This article diverges from the traditional nursing practice of working with individuals to discussions related to working with collectives and to community practice beyond individuals and families, beyond community as context. Nurses are more frequently turning their attention and contributing their knowledge and skills to the focus of population health and the community as the client.
Culture is identified as one of the 12 determinants of health, which include income, social support networks, education, employment, social environments, physical environments, personal health practices and coping skills, healthy child development, genetic endowment, health services, gender, and culture (Public Health Agency of Canada, 2006). These determinants do not act in isolation but are known to be complex and interrelated, creating intricate webs.
The purpose of this article is to discuss strategies for respecting culture and honoring diversity when working with the community as the client. Key concepts related to culture and ethnicity are defined to set the stage for discussions of theory and the application of theory to practice. Theory on acculturation is explored through comparisons of the Canadian mosaic and American melting pot. Given the paucity of nursing literature on matters of racism, marginalization, and inequities in health and health care (Kirkham, 2003), these challenges are discussed. Cultural competence, cultural attunement, and cultural humility are examined, and recommendations for community practice in working with groups and organizations are shared.
KEY CONCEPTS RELATED TO CULTURE AND ETHNICITY
Culture refers to the integrated lifestyle, the learned and shared beliefs, values, worldviews, knowledge, artifacts, rules, and symbols that guide behavior of a particular group of people. Culture is transmitted intergenerationally, it explains patterns of thought and action, and it contributes to the group's social and physical survival. Culture is continuous, cumulative, and progressive (Fleras & Elliott, 2002; Leininger, 2002).
Individuals are the primary building blocks upon which cultural groups are based. Individuals bring with them their past experiences based on socialization and knowledge that have been reinforced by influential others such as coworkers, peers, social groups, and family members (Goto & Chan, 2003). When commonalities along these lines exist in an aggregate of people, it is often identified as a culture. Although most commonly related to ethnicity, a culture may develop within an organization, a workplace, a profession, a group, or a community.
Ethnicity involves cultural, organizational, and ideational values, attitudes, and behaviors. In its broadest sense, ethnicity refers to groups whose members share a common social and cultural heritage passed on to successive generations. …