Running Head: ETHNOCENTRISM IN COSTA RICA

Ethnocentrism in Costa Rica: Repercussions on Nursing Major Students Carlos Ernesto Mora Sandí LM-1482 English Rhetoric IV University of Costa Rica June 25, 2009

Ethnocentrism in Costa Rica 1

Abstract Ethnocentrism is the ultimate obstacle for successful mutual understanding among human beings. It is crucial to recognize levels of ethnocentrism in society in order to eliminate and soften prejudices and negative conducts between individuals in the current multicultural civilization. As every study on human behavior and culture, this subject matter represents a fascinating and complex challenge for researchers and the results will have powerful educational applications. This study focuses on a very important Costa Rican population which is required to be especially aware towards this issue: Nursing students. It was found that in Costa Rica ethnocentrism is present in a high level, and it will deteriorate those future professionals’ quality of service.

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Introduction Ethnocentrism in Costa Rica is noticeable throughout its history and its culture. In this country, the identity of the inhabitants relies on the differences that they supposedly have with other countries. Although comparison with others is a common distinctiveness structure instituted in all nations’ self-conception, Costa Rican case is special in terms of the insinuated yet not totally explicit “superiority” among its neighbors. The height of its people’s own-declared uniqueness leads Ticos think themselves as spaced out from their geographic location as Central Americans. Costa Rican history focused studies are numerous and they provide very important information about how its ethnocentrism is manifested. For instance, Hiltunen Biesanz, Biesanz, & Zubris Biesanz declared in their study that, Most Ticos are aware of, and often overestimate, the cultural and physical differences between themselves and the most conspicuous minorities – Indians, blacks of the West Indian ancestry, Nicaraguans, and Chinese. Although they give lip service to tolerance, many consider members of these groups not only different but also inferior. (1999, p. 110) This information gives a broader description of ethnocentrism characteristics on Costa Ricans. Many of them believe that they belong to a different “race” apart from those “minorities” inside and outside the country. According to other studies further mentioned in the next section, this “superiority” feeling commonly found on many Costa Ricans is related to a distort image they have of themselves as different to the “others.” Molina (2003) illustrates this issue with a journal article found in “La Nacion” on February 21st of 1999. The article is under the title “Ticos hacia el 2000” and it has a photograph showing four models used to portrait Costa Rican population. The interesting fact about this picture

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is that those four models were white, and even two of them have blond hair (p. 1). The observation that the author made on this article is that it did not showed people from other ethnic background such as Indigenous or Black to represent Costa Rican population. As a result, it is clear that many people see themselves as “white” people and how it is reflected and usually reinforced on popular media. This imaginary “whiteness” is strongly related to characteristics given exclusively to Costa Ricans, such as peaceful people, hard workers, democrats, etc. Nonetheless, it is impossible for a society to be free of ethnocentrism because it is found in all cultures of the world but if it is taken to the extreme, it becomes a very dangerous feature. Dodd (1991) stated, “On thousands of occasions throughout history, ethnocentrism has led to wars, takeovers, and host of negative behaviors” (p.51). Therefore, it is clearly confirmed that high levels of ethnocentrism affect intercultural personal relationships and it has raised violent behaviors among human beings. Proper human interaction is crucial for all those professionals in the heath field, in order to reach the required commitment to all peoples’ well being. Nursing professionals in Costa Rica are facing the difficult task of giving health assistance to users on a full-time job basis. Thus, these specialists are spending more time with people from the mainstream than other medical professionals. Moreover, Nursing professionals, as human beings that belong to a given society within a specific culture, possess a certain level of ethnocentrism even if their profession requires them to be particularly sensitive towards different culture people. Consequently, it is assumed that if high levels of ethnocentrism are found on these licensees, the service that they give will be negatively affected. This critical situation puts hypothetically in danger many patients in a vital moment of their lives. In other words, ethnocentrism to a certain point harms significantly the capacity of this population to

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interact with people of other cultures and ethnic backgrounds that are necessitating fundamental health support. Despite the significant contribution that history researchers provide on the discussed culture; on-field and updated studies on this matter were not found. In addition, a very highly intercultural contact exposed part of Costa Rican population, such as Nursing professionals, have not being a subject of study proposed by previous investigators. Furthermore, due to the cruelty, intolerance, and discrimination towards several ethnic groups and “different” people in general, this study will serve to measure and enumerate the characteristics of Costa Rican ethnocentrism in a group of senior Nursing Major students of the University of Costa Rica (UCR). It is worthy to mention also that the considered population is the biggest in the Nursing School history and they are all Costa Ricans. In the present research paper, the following questions are to be answered: • • • How ethnocentric are the Nursing students? What characteristics of Ethnocentrism are present in Nursing Students? How Ethnocentrism can affect negatively in the quality of service that Nursing professionals give? Their level of ethnocentrism and most common characteristics will be described, and it will be explained if these characteristic affect negatively the quality of service that this critical population is being trained to provide. The next segment is devoted to locate ethnocentrism traits in all the found data prepared by researchers in Costa Rican history. Review of Literature Ethnocentrism is a difficult topic to analyze due to the complexity of human behavior. This concept is usually confused with terms like racism and xenophobia and they

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may be connected with several aspects or negative symptoms of a given culture. To explain briefly, Racism is based in the physical differences due to heredity, like the color of the skin; on the other hand, Xenophobia is a generalized hate to foreigners (Perrot & Preiswerk, 1979). Nonetheless, ethnocentrism is defined by Perrot and Preiswerk as an attitude of a group of attributing themselves a central position in terms of superiority, judging negatively other groups that are different (1979, p. 54). Moreover, in the case of ethnocentrism this comparison with other groups is strictly in terms of culture; that is, a given group may have different colors and nationalities but they share a culture that is overestimated above other cultures. Human beings from any culture, have their own whimsical biased values to judge other cultures even if they try to be objective. Thus, it is believed that every human being is ethnocentric to a certain level. In fact, Dodd (1991) describes this issue as a universal tendency that is “part of the attitude system sometimes lurking in intercultural communication climates” (p. 22). Ethnocentrism becomes, hence, harmful only if it is present in higher levels. Conversely, in the case of the present qualitative research, in which a test (See Appendix) designed by Dodd (1998) was utilized for measuring that specific level, it is very important to take into account that certain variables alter the expected results. The participants of quantitative studies will fake some of the evaluation statements to fit into their own social desirability scale, even if they know that the responses are anonymous. According to Edwards, “a subject’s responses may be ‘falsified’ in such a way that he obtains either a higher or a lower score on a particular variable than he would if his responses were completely accurate.” The phenomenon described by Edwards is known as “Social Desirability Variable.” The author makes a distinction between “faking good” and “faking bad” in his further explanation on the Social Desirability Variable: “Faking good refers to the tendency to create a more favorable impression (…) to give socially desirable

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responses to items in self-description;” on the other hand, an individual may alter his responses in order to create an adverse image of him or herself (1957, pp. 53-54). The Social Desirability Variable is, at this time, one of factors to be considered into the complexity of ethnocentrism analysis. The study on ethnocentrism made by Perrot and Preiswerk (1979) describes the degrees of ethnocentrism and it has also a wide explanation on this topic; therefore, their work is going to be the basic source for the analysis of the studies on Costa Rican ethnocentrism in this research. According to the authors, First Degree Ethnocentrism occurs when it becomes evident on people’s behavior and beliefs; in fact, it is explicitly expressed by the group in numerous ways. Second Degree Ethnocentrism takes place when it appears to be innocent and implicit in society. For instance, a group of people feel honored because other cultures are devoid of their “privileges”, which usually are merely culture differences like technology, religion, etc. Therefore, Second Degree Ethnocentrism appears to be harmless but it could be taken as offensive. Third Degree Ethnocentrism is, on the other hand, an apparent admiration for the target culture, in which praises it basically because of the similarities that both cultures share. In other words, Third Degree Ethnocentrism behavior never flatters other cultures instead of the own, even if it seems otherwise. Finally, Verbal Rejection is an element shared with racism and is considered by psychologist G.W. Allport as one of the initial stages of prejudice. Verbal Rejection consists of negative language against people from other cultures in their absence (Perrot & Preiswerk, 1979, pp. 55-56, 60). According to the Intercultural Communication Course Anthology, Costa Rican culture is a “face-saving culture” in which confrontation is avoided, and it has lead to “indirect ways of communication such as talking behind somebody’s back, gossiping…” (2009). This cultural trait suggests that Verbal Rejection is also a conventional attribute in

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the subject population. Studies on Costa Rican history, in relation to ethnocentrism, are critical and well documented with historical facts and they are arranged in chronological order according to the development of this country’s culture. Ethnocentrism trends are found in Costa Rica before independence and it begins from the local elite nationalism; however, it is uncertain if that ethnocentrism is still present in our culture. Nationalism is in this case the beginning of Costa Rican ethnocentrism; in fact, both terms are linked to a certain point especially if we refer to ethnocentrism within a given nation. In this aspect, Acuña (2002) hit the mark when he stated that ethnocentrism has its roots in the ninetieth century when Costa Rican elites wanted to have an independent nation and, in order to achieve it, they portrayed Costa Rica as a better state than all other Central American states in particular than Nicaragua (pp. 191-228). Putnam (1999) agreed with the theory and added that it served also to perpetuate economic hierarchy and politic exclusion inside the country in exchange of a “white European race” image for all Costa Ricans. (pp. 139-186) The criticism presented in both researches is demonstrated by the use of words like “imaginary” and “ideal” to refer to these statements made by elites. Hiltunen Biesanz, Biesanz, and Zubris Biesanz (1999) explained that few Spanish hidalgos went to colonize this land, in addition, “Despite colonial hidalgos’ pride in their noble status and pure Spanish blood (…) interracial mixing was ‘impressively rapid’ (…) informal unions between Spanish men and Indian and Black woman were common” (p. 97). Consequently, it is valid to criticize such statements because of the evident diversity and mixing of cultures that this country hosted since that earlier era. Moreover, Putnam (1999) as well as Acuña (2002) did not revise the current situation of Costa Rican ethnocentrism but they limited their research in the ninetieth century. Both studies are also well documented with

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articles published and pronouncements made in that period. The presence of high ethnocentrism is evident in the past but studies cannot prove if it is present in our day. Another two researches on Costa Rican culture confirm a strong local ethnocentrism despite the great changes in the twentieth century. According to the book “Identidad nacional y cambio cultural en Costa Rica durante la segunda mitad del siglo XX”, ethnocentrism has been fought with certain movements that have been successful but not effective enough against the invented “white” identity of Costa Ricans (Molina Jiménez, 2003). Furthermore, Costa Rican people had to deal with an excessive change in a very short time, in terms of an implementation and imposition of the United States’ culture, along with the proliferation of capitalism and individualism. Such changes triggered a different conception of Costa Rica by their own citizens. Therefore, nationalism –that was the first detected trigger of ethnocentrism– has decreased because of an arisen mistrustful population of the political, economic, and social order of the country. Molina (2003) suggests that Costa Rican culture and identity lived a traumatic transformation that has not being digested yet by the inhabitants. Even though policies support and advocate for cultural diversity, in the year 2000, the highest indexes of poverty are located in immigrants’ communities, (especially Nicaraguans) Guanacaste, Puntarenas, and Limón were the residents are considered different in terms of culture and race (p. 35). With these statistics, the writer implies that generally ethnic variety is somewhat rejected in the country. On the other hand, Hiltunen Biesanz, Biesanz, and Zubris Biesanz (1999), affirm more directly, the existence of a generalized high level of ethnocentrism in the present. To illustrate this point, the authors offer a revealing example, Many other Cental Americans accuse the Ticos of (…) feeling superior in part because their skin is lighter. Indeed, Costa Rican soccer fans often taunt

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their Central American opponents as indios. And many Ticos refer to Centroamérica as if it did not include Costa Rica, usually comparing the region unfavorably to their own country. (pp. 109-110) It is demonstrated, as a result, that because of profound changes on society, the imaginary “whiteness” and not the Nationalism of the discussed culture is the cause of the current high level of ethnocentrism. Studies have demonstrated that there is actually a commonly spread high ethnocentrism with deep roots in the past; nevertheless, no official study focused in ethnocentrism levels was found. Reporters focused strictly in Costa Rican history rather than an actual revision on people’s ethnocentrism. Clearly, it is crucial to have background information about how this culture has developed from the beginning in the ninetieth century but the level in which ethnocentrism has been assumed by Costa Ricans was not determined by a quantitative investigation. However, Molina’s and Hiltunen Biesanz, Biesanz, and Zubris Biesanz’s researches on local culture of the twentieth century, are a very important reference of what it could be found in an eventual quantitative research. Furthermore, no investigation of this nature was traced in the past that could have helped the present study. No researchers, in fact, have yet focused in such a critical population as Nursing students. The most important aspect of the chosen population is their future responsibility in Costa Rican society. Unlike Medical Doctors, Nursing specialists are required to spend large amount of time giving personalized assistance to every user health necessities. On the professional profile published by the official homepage of Nursing School of University of Costa Rica (2008), nurses must have high-quality skills on human inter-dealings, a broad service giver character, respect for The Universal Human Rights, and analyze and recognize heath care priorities in their labor. Costa Rica, as many other

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countries, is formed with people from several cultural contexts and nationalities. According to the official homepage of Nursing School of University of Costa Rica (2008), professionals must contribute to health care of people in diverse cultural contexts. To sum up, all literature analyzed contributed greatly in the examination of ethnocentrism; in addition, the authors also recommended further study in the subject. According to the qualities and descriptions that authors uncovered about the discussed culture and its evolution, ethnocentrism is present but it is not known in what level has been embraced by the subject population. Methodology The following is a quantitative study with the objective of describing the level of ethnocentrism that Nursing students have and what common characteristics are prominent. Moreover, statistic evaluation was applied to achieve all the desired data accurately. Analyzing the sample, it is expected to determine a generalized trend of the population. Population The population is a group of one hundred and eight students of which twenty eight are male and the remaining, female undergraduates. The age range is established from twenty one to twenty eight years old, with an average age of twenty three years old. This population belongs to the last year generation (fifth year) of the study program of Nursing License Major at the University of Costa Rica, Rodrigo Facio Campus of San Pedro, San José. Sample Due to availability, a group of 27 students have been chosen to represent the subject population of this research. These classmates were randomly picked both women and men and they are all Costa Rican.

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Instrument According to the correct data gathering and the question of the study, an ethnocentrism test designed by Kregg Hood, located on Carley Dodd’s book: The Dynamics of Intercultural Communication (1998, p. 266), was employed in this investigation (See Appendix). The utilized test consists on a Likert scale that measures the level of agreement of seventeen given statements. All statements have five options with its corresponding score arranged as follows: “Strongly Agree”= 5 points, “Agree”= 4 points, “Neutral”= 3 Points, “Disagree”= 2 points, and “Strongly Disagree”= 1 point. If the total score amounts to 35 points and below, the result is “Low Ethnocentrism” and if it adds to 45 points and above, the result is: “High Ethnocentrism”. Procedures The procedures that were followed with the collected data were finding typical patterns of behavior, determine whether the sample shows High or Low Ethnocentrism, obtaining percentages, and comparing patterns with the literature reviewed. The instrument also consists of two sections: first personal information (age, sex, ethnic background) and the second part, the ethnocentrism test. Results and Discussion The results of the employed instrument were in entire agreement with the purpose of answering the main questions of this study. Despite of Social Desirability Variable, which in several cases played an important role on sample participants’ dishonest responses, the instrument provided the expected effect on determining accurate trends and characteristics of ethnocentrism among the studied population. Moreover, the percentages on quantity of women and men on the sample remained identical to the one on the population. To be precise, twenty five point nine percent (25.9%) of Nursing Major students are men, which

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is exactly the same percentage of men that belong to the population. The most common factor of age (mode) in the sample is also identical to the age average of the population, which is twenty-three years old. Furthermore, the instrument employed offered the possibility of a deeper examination on ethnocentrism in the studied sample such as the identification of crucial traits. As a result, the findings gathered matched the projected precision of this study. These facts, along with the conscious design of the selected instrument, contributed to achieve a satisfactory reply to the main inquiry of this investigation. According to Perrot and Preiswerk, ethnocentrism consists on praising one’s own culture above “others” by the arbitrary use of negative judgment against dissimilar cultures (1979, p. 54). According to this study, Nursing Major population showed mid ethnocentrism level, which was an unexpected result (See Figure 1). Figure 1. Results on Levels of Ethnocentrism. Total scores in the Likert scale that are 35 points and below indicate “Low Ethnocentrism,” if they are from 35 to 45 points, the result is “Mid Ethnocentrism,” and if they are 45 points and above, the answer is “High Ethnocentrism”
Level of Ethnocentrism High Ethnocentrism Mid Ethnocentrism Low Ethnocentrism 28 Lowest Mode Highest Mode 46 41,15 Total Average

Source: Likert scale administered to 27 participants.

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The highest and the lowest mode on figure 1 were obtained in two instances each; that is, two people the exact rate in either “High” (46pts) or “Low Ethnocentrism” (28pts). Low Ethnocentrism ethnocentrism level was expected for these participants because of their education and their professional profile (Escuela de Enfermería, 2008); however, in accordance with the total 2008); average (41.15%) of sample’s rates, the reality is that they actually are considerably rates, ethnocentric with an “Intermediate” level of ethnocentrism. Nonetheless, from a more ethnocentrism. general point view, in terms of quantities, twelve people showed “Intermediate Ethnocentrism” while other eight people scored a “High Ethnocentrism” level and only seven participants out of twenty seven achieved “Low Ethnocentrism” level (See Figure 2). Figure 2. Percentages on Levels of Ethnocentrism. Percentages on ethnocentrism levels according to the results and quantity of participants. Percentages of Participants' Level of Ethnocentrism
26%
High Ethnocentrism: 8 participants Mid Ethnocentrism: 12 participants Low Ethnocentrism: 7 participants

30%

44%

Source: Likert scale administered to 27 participants. As seen on Figure 2, the fact that only the minority of Nursing Major students (seven people) are low-ethnocentric, demonstrates that Costa Rican high ethnocentrism has indeed entric, influenced this critical population. Moreover, in order to analyze this matter deeply, the n different manifestations of ethnocentrism were identified and measured organizing the questions of the instrument into four categories, based on Perrot and Preiswerk’s Degrees of Ethnocentrism (1979, pp. 55 55-56,60): Verbal Rejection, First Degree Et : Ethnocentrism,

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Second Degree Ethnocentrism, and Third Degree Ethnocentrism. The lowest traits found in Nursing Major students were Verbal Rejection and Third Degree Ethnocentrism. However, according to the Intercultural Communication Course Anthology, since Costa Rican culture is characterized by confrontation avoidance or “face saving culture” (2009, p. 21) in many people, there is no guarantee that the sample was completely honest with the question. Thus, it is inferred that Social Desirability Variable has altered the results in this case. The statement used to determine Verbal Rejection level was: “…3- I usually make negative comments on other people’s culture preferably if they are not present or cannot hear me;” clearly, it was too direct and obvious, encouraging people to discard it (see Appendix). On the other hand, since the Nursing Major students are socially sensitive about the elderly people, Third Degree Ethnocentrism had the lowest value because most students chose “strongly disagree” to the statement: “…11-The Asian practice of honoring the elderly is interesting but not very practical” (see Appendix). Courses on social awareness and the proper care of senior people have been, in this case, incorporated successfully in the conduct and attitude of the sample. First Degree Ethnocentrism, which is the most evident, is slightly present in participants as they mostly selected “disagree” under this category. Finally, the strongest trait found was Second Degree Ethnocentrism since they opted for either “neutral” or “disagree,” with similar incidence on the scale provided. Therefore, the results indicate that the implicit and innocent-looking-ethnocentrism is the most popular among the sample; it is inferred, that the influence of Costa Rican “face saving” culture have been demonstrated with these results (See Figure 3).

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Figure 3. Traits of Perrot & Preiswerk’s “Degrees of Ethnocentrism” in Nursing Major students. The higher values on mean and median determine the strongest “degree” or characteristic of ethnocentrism
Perrot & Preiswerk’s Degrees of Ethnocentrism

Parameters Valid Missing Mean Median Mode Std. Deviation N
a.

1 Degree 27 0 2,34 2,33 2. (Disagree) 0.51

st

2nd Degree 27 0 2,71 2,50 2. (Disagree) a 0.59

3rd Degree 27 0 1,59 1,00 1. (Strongly Disagree) 0.75

Verbal Rejection 27 0 2,22 2,00 2. (Disagree) 0.97

Multiple modes exist (Neutral and Disagree). The lowest rate is shown. N: Number of Participants. Source: Likert scale administered to 27 participants. Furthermore, the question on ethnic background revealed that the majority of participants considered themselves either as “white” or “mestizo” and it revealed an interesting fact. In terms of proportion, only one person belonged to “other” ethnic background (unspecified), fifty nine point three percent (59.3%) admitted being “mestizo” while thirty seven percent (37%) assured being “white.” In Costa Rica, it is difficult to conclude that a person can actually be identified as “white” because of the vast history of immigration and culture mixture since the beginning of colonization. On this subject, Hiltunen Biesanz, Biesanz, & Zubris Biesanz (1999), reported that, …University of Costa Rica geneticists Bernal Morera and Ramiro Barrantes declared in 1995 that almost all Costa Ricans are mestizos with varying combinations of the general population’s mix of genes: 40-60 percent white, 15-35 percent Indian, and 10-20 percent black. (p. 98)

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Thus, the “white” conception of Costa Ricans has a very different implication than the traditional conception of “race” or biological heritage. The idea of being “white” is limited to a description of an individual complexion that can be called more accurately as “pale.” Commonly, “white” people may have African-American or Indigenous ancestors. Perrot and Preiswerk (1979) stated that it seemed that there are no nations in this world which population is perfectly homogenous from the cultural point of view (p. 43); likewise, it is inferred that the subject of “race” is also included in this statement. On the other hand, Wagner and Sherzer described Costa Ricans as primarily “white” Spanish population in 1853, adding that Costa Rica was also superior to many other Hispanic countries (Acuña Ortega, 2002, p. 212). Such assumption of “to be white is equivalent to be superior” and vice versa is, according to Perrot and Preiswerk (1979), strongly related to western macro ethnocentrism (p. 61); evidently, Wagner and Sherzer drew their pseudo-scientific conclusions on racism and hasty generalization. Moreover, Costa Rican ethnocentrism was reinforced by this self conception; according to Putnam (1999), peace, hard work, virtue, sacrifice, and honesty were characteristics only found on Costa Ricans that were automatically understood as “white” (p. 151). From this point of view, ethnocentrism is strongly related to racism. The results on this issue are alarming: those Nursing Major students who considered themselves as “white” are less in quantity but have higher average rate of ethnocentrism than those who accepted being “mestizo” (See Figure 4).

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Figure 4. Results on Ethnocentrism level of Nursing Major students according to their ethnical background.

44 43 42 41 40 39 38 37

Rating of ethnocentrism

43,6

42,5 39,81

White

Other

Mestizo

Ethnical background of the sample

Source: Likert scale administered to 27 participants. Conclusions Finally, the desirable professional profile of licensed Nursing Professionals is affected by the previous results in terms of professional performance. Evidently, as an especially educated population, Nursing Major students were expected to show low ethnocentrism but this was not the case because, according to the results, their average resu ethnocentrism level is intermediate. Thus, the problem detected in this study deserves close attention by the mentioned population and authorities. Ethnocentrism levels change according to the individual awareness and experience but in Costa Rican population the average level has been proven to be high and osta consequently, very dangerous. In the case of Nursing professionals, intermediate ethnocentrism differs from what was expected because of their exceptional responsibility towards human health safeguarding. In a hypothetical case, some patients that are ealth considered culturally different may be mistreated, ignored and eventually harmed

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unconsciously by a high ethnocentristic person that is supposed to take care of them in their most vulnerable condition. For this reason the chosen population is considered as critical and decisive. However, the situation can be prevented by education and by exercising tolerance. The present study will be open for future revision to the participants because of their enormous interest on the results information to raise awareness and open a discussion on the topic. It is important to recognize that the average did not reached the dangerous higher level of ethnocentrism due to their education; on the other hand, as previously stated, Social Desirability Variable and the Costa Rican “face saving culture” may have made an impact on specific aspects of the results. For this reason, in future investigations, more subtle questions are suggested in order to measure the ethnocentrism degrees more accurately. It is also highly recommended to follow this population in their future carrier in order to verify if the facts discovered in this study are actually damaging negatively their professional performance in the future. In fact, in order to fight high ethnocentrism in Costa Rica, it is necessary to confront public opinion with what can be found with future and more specialized ethnocentrism studies, not only limited to Nursing students and professionals.

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References Acuña Ortega, V. H. (2002). La Invención de la Diferencia Costarricense, 1810-1870. Revista de Historia (45), 191-228. Dodd, C. H. (1991). Dynamics of Intercultural Communication (Third ed.). Dubuque, United States of America: Wm. C. Brown Publishers. Dodd, C. H. (1998). Dynamics of Intercultural Communication (Fifth ed.). Boston, Boston, United States of America: McGraw-Hill. Edwards, A. L. (1957). The Social Desirability Variable in Personality Assesment and Research. New York, United States: Holt, Rinehart and Winston, Inc. Escuela de Enfermería, Universidad de Costa Rica. (2008). Escuela de Enfermería. (A. Solano G, Editor, E. d. Enfermería, Producer, & Universidad de Costa Rica) Retrieved April 29, 2009, from <http://www.enfermeria.ucr.ac.cr/index.html> Hiltunen Biesanz, M., Biesanz, R., & Zubris Biesanz, K. (1999). The Ticos: Cultural and Social Change in Costa Rica. Colorado, United States: Lynne Rienner Publishers, Inc. Intercultural Communication Course Anthology. (2009). San Pedro, Costa Rica. Molina Jiménez, I. (2003). Identidad nacional y cambio cultural en Costa Rica durante la segunda mitad del siglo XX. San Pedro, San José, Costa Rica: Editorial de la Universidad de Costa Rica. Perrot, D., & Preiswerk, R. (1979). Etnocentrismo e Historia. America indígena, Africa y Asia en la Visión Distorsionada de la Cultura Occidental (Primera Edición ed.). (E. G. Lerner, Trans.) Sacramento, México DF, México: Editorial Nueva Imagen. Putnam, L. E. (1999). Ideología Racial, Práctica Social y Estado Liberal en Costa Rica. Revista de Historia (39), 139-186.

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Appendix