Inclusivity in My Nursing Practice

4/20/2008

Inclusivity in My Nursing Practice

Synthesis
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I have had to re-examine all the information I learned

in this class to come up with my definition of inclusivity.

Some of the concepts I already knew and understood before

the class, others were completely new to me, yet others I

had heard used before but not understood. In this paper, I

will try to piece together my knowledge to arrive at what I

think the term means and how I would include it in my future

practice.

This class is about race, but according to Tatum race

is nothing but a social construction (2003). It is used to

classify groups of people based on their cultural heritage

and ancestry (Krieger, 2003). Classifying people is an

intentional social action involving: the establishment of

boundaries, the description of attributing qualities and the

application of preexisting criteria (Gee, 1999).

Race in itself means nothing. It is society that gives

it the weight and power that it has. Melvin Oliver a

sociologist on episode 3 of Race: the power of an illusion

expressed this opinion by stating that all the markers of

race mean absolutely nothing unless they were given social

meaning and there is public policy as well as private

actions that act upon those kinds of specific

characteristics. That is what creates race (2003).

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The concept of race is divisive. It is not just for

classification but also for social and economic purposes. "…

description is the creation of difference; difference

entails classification and classification involves power

(Allen, 2006). It allows one group to lay claim to

superiority. It was manufactured by societal systems based

on an ideology of domination and oppression wherein one

group benefits from and defines itself by its domination of

others (Krieger, 2003).

Here was a concept I had never heard before; Others.

"In the United States, those perceived as Other consciously

remind members of the dominant European-American majority

that as Other, they are different. It is this perceived

differentness that constructs their social identity as

Other" (Canales, 2000). This "othering" system, based on

fear has been used to exclude and police the others (Karis,

2006). Another name for this othering, a term that I was

more familiar with is racism.

Racism is an expression of privilege and power as part

of the very structure of society and can be defined as any

type of exploitation or process of exclusion that

Institutionalizes and privileges the dominant group at the

expense of others (Racher & Annis, 2007). There are three

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levels of racism. Jones listed them as institutionalized,

personally mediated and internalized (2000).

Institutionalized racism is also known as systemic

racism. It is the differences in how different races access

the goods, services and opportunities of society (Jones,

2000). It could be access to education, or housing, or

employment, or health care, or other things such as

information, or having a voice in decision-making. "It is

structural, having been codified in our institutions of

custom, practice and law, so there need not be an

identifiable perpetrator" (Jones, 2000).

Personally mediated racism is characterized by

prejudice and discrimination. It includes acts of omission

and commission. This type of racism presents in healthcare

as a lack of respect for patient population, poor service,

inattention, difficulty communicating or suspicion (Jones,

2000).

Internalized racism is when members of a culture begin

to believe the messages that are being said about them. "It

is characterized by their not believing in others who look

like them, and not believing in themselves. It involves

accepting limitations to one's own full humanity …it

manifests as an embracing of whiteness…" (Jones, 2000).

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Definition

The above quote from Jones made me think about the

United States motto, "e pluribus unum" which means one from

many. This indicates that our society is formed from many

cultures that become one culture. However, Racher & Annis

explain that assimilation of cultural groups to create the

familiar metaphor of a “melting pot” is sought; maintaining

the culture and heritage of diverse groups is not desired

(2007).

In light of this, I decided that the definition for

inclusivity that I would use in my practice would be

respecting all people, and allowing them the opportunity,

irrespective of their race, culture or socioeconomic

background, to participate and have an opinion about their

care. The national standards for culturally and

linguistically appropriate services (CLAS) in health care

states that all health care organizations ensure that

patients receive from all staff effective understandable and

respectful care that is compatible with their cultural

health beliefs and practices and preferred language (2000).

Actions

I would admit my own personal biases, stereotypes and

prejudices, to rid myself of any ethnocentric tendencies. .

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The preferred cultural lens of ethnocentrism reinforces a

faith in the superiority of a person's ethnic or cultural

group and a privileging of its values, views, beliefs, and

behaviors (Racher & Annis, 2007). However, as Dean notes, "…

it is difficult to separate ourselves from our cultural

baggage. Becoming aware of it and keeping this awareness in

the forefront of consciousness, makes it more likely, that

we will limit its impact on our work" (2001).

I would now be ready to connect with my patients by

getting to know the population I would be serving. If in a

residential community, I would go to the library or other

community settings: introduce myself, and mingle with the

families in a neutral environment. Another way to meet my

patients would be for the clinic/practice to organize an

open house and invite members of the community. This would

include sitting down with the leaders of the different

ethnic communities and political leaders in the area.

Martino-Maze wrote stated that the difference between the

providers' belief and that of the patient can lead to

failure and frustration for both (2004). This is true

because people of diverse cultures have different beliefs

about cause, diagnosis and healthcare treatments. Getting to

know my population would prepare me to acknowledge their

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cultural beliefs and incorporate their beliefs into their

plan of care.

My next action would be to improve communication with

my patients. Communication is an important aspect of care.

How well we communicate depends on how we behave (Burnard,

2005). It is only about talking, it is also about listening

and understanding non-verbal cues. A good way to do this

would be to encourage the use of professional interpreters

in conjunction with the family. This way, the patient

receives all pertinent information and the family is

satisfied that they have been able to add to or refute

whatever the interpreter said.

Another way to utilize my definition in my practice

would be to adapt treatment options to suit my patients'

culture and no the other way around. This would also help to

alleviate some of the feelings of mistrust on the part of

the patient. It would also make it easy for the patient to

adhere to and comply with treatment regimen (Unequal

treatment, 2002).

The final way that I would practice inclusivity within

my practice would be to encourage my employers to hire

people of different ethnic backgrounds. The composition of

the United States is changing because of immigration

patterns and significant increases among racially,

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ethnically, culturally and linguistically diverse

populations living here (Servonsky, 2005). Though, according

to Allen, this is just primarily adding color to the

mainstream and stirring (2006), Frusti, Niesen and Campion

contend that the fiscal health of hospitals now depends on

having a nursing workforce that reflects the racial and

ethnic diversity of its patient population (Frusti, Niesen &

Campion, 2003). CLAS acknowledges the need for this also by

requiring that all health care organizations recruit retain

and promote at all levels individuals that are

representative of the population they serve (2000).

Conclusion

The most important thing that resonates through this

whole class is that we are all connected in our differences.

Karis puts it eloquently that in spite of our fears, we need

our differences because they show us new ways of being and

help us to reclaim a sense of security in a global community

(2006).

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REFERENCES

Allen, D.G. (2006). Whiteness and difference in nursing.

Nursing Philosophy, 7, 65-78

Burnard, P. (2005). Cultural sensitivity in community

nursing. JCN, 19(10)

Canales, M.K.(2000). Othering: Toward an understanding of

difference. Adv Nurs Sci, 22(4), 16-31

Dean, R. (2001). The myth of cross-cultural competence.

Families in Society, 82(6), 623-630.

Frusi, D., Niesen, K., & Campion, J. (2003). Creating a

culturally competent organization. Journal of Nursing
Administration, 33(1), 31-38.

IOM: Unequal Treatment: Confronting racial and ethnic

disparities in healthcare (2002). Washington D.C: NAP

Jones, C. (2000). Levels of racism: A theoretical framework

and a gardener’s tale. American Journal of Public
Health, 90(8), 1212-1215.

Karis, T.A.(2006). The psychology of whiteness: moving

beyond separation to connection. Oxford, England

Krieger, N. (2003). Does racism harm health? Did child

abuse exist before 1962? On explicit questions, critical
science, and current controversies: An ecosocial
perspective. AJPH, 93(2), 194-9

Martino-Maze, C.D.(2004). Registered nurses' personal

rights vs. professional responsibility in caring for
members of underserved and disenfranchised populations.
Journal of Clinical Nursing, 14, 546-554

Office of Minority Health, U.S. Department of Health and

Human Services. (2000). National Standards for
Culturally and Linguistically Appropriate Services
(CLAS) in Health Care. Retrieved April 20, 2008 from
https://ccnm.thinkculturalhealth.org/PDFs/CLAS_Standards
.pdf.

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Racher, F.E & Annis, R. (2007). Respecting Culture and

Honoring Diversity in Community Practice Research &
Theory for Nursing Practice: An International journal,
21(4), 255-70
Structural Racism and Health Film: Race: The Power of an
Illusion Part III The House that Race Built

Tatum, B. (2003). Defining racism: Can we talk?” In Why

are All the Black Kids Sitting Together in the Cafeteria?
(pp.3-17). New York: Basic Books.

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