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Inclusivity in My Nursing Practice Synthesis
2 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).
3 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
4 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).
5 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. . 5
6 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
7 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,
8 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).
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, rights vs. members of Journal of C.D.(2004). Registered nurses' personal professional responsibility in caring for underserved and disenfranchised populations. 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. 9
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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