By the end of this unit, participants will be able to:

• Define 'Culture' and 'Ethnicity'.
• Discuss how cultural diversity can influence families and parenting.
• Describe ways in which they can become more culturally sensitive.
• List several cultural myths and discuss information needed to dispel these.
• Demonstrate several strategies for culturally sensitive intervention.

3 Hours

A. Overview of Culture and Ethnicity
B. Examples of How Culture and Ethnicity Impact the Families that the PSS will be Visiting
C. Summary and Review

• Friedman, M. (1986). Family Nursing: Theory and Assessment. Connecticut: Appleton-Century-Crofts.
• Holin, A. (1994). Cultural Sensitivity and the African-American Family. (unpublished paper).
• Kavanagh & Kennedy (1992). Promoting Cultural Diversity. Newbury Park: Sage.
• Leahey, M. & Wright, L. (1987). Families and Life Threatening Illness. Pennsylvania: Springer.
• Leahey & Wright (1987). Families and Chronic Illness. Pennsylvania: Springer.
• Leahey & Wright (1987). Families and Psychosocial Problems. Pennsylvania, Springer.
• Lynch, E. & Hanson, M. (1992). Developing Cross-Cultural Competence: A Guide for Working with Young Children and Their Families. Baltimore, MD: Paul Brooks Publishing Co.
• Hoflin (1994). A Cultural Journey. (Handout #1)
• Myths for Discussion (Handout #2)
• Flip Chart
• Role Play Feedback (Overhead #1)
• Post-Unit Evaluation
• Post-Unit Test
• Video Equipment: video camera, tripod, tape, VCR, and television

• Review above references.
• Make sufficient copies of handouts.
• Try out video equipment. Set up camera to videotape role plays.

1. Definitions of Culture and Ethnicity

Ask the participants to tell what culture and ethnicity mean to them.

Be sure to include the following information in your discussion.

• Culture: the shared values, beliefs, behaviors, ideas, practices of a group of people, symbols (ie.clothing, language, decorations).
• Multi-cultural: several different cultures or sub-cultures.
• Cross-cultural/trans-cultural: learning to deal or bridge the gaps across several different cultures.

As an analogy, multi-cultural is like children engaged in parallel play in which there are several different non-interactive activities going on. Cross-cultural is where many children are playing a game in which there is communication and interaction.

Ethnicity: common racial make-up, some similar biological/genetic background, common geographical origin of people, who often share the same culture.

• Recognize that the USA has the largest ethnic diversity of any major country:
• The African-Americans are the largest ethnic group.
• Latinos are the second largest ethnic group in the USA.

2. Understanding How Culture and Ethnicity Influence Families

During the discussion, try to elicit the following information from the group:

• The core concept of ethnicity is that there is a common culture.
• Ethnic groups often have shared ideas about:
• kinship patterns
• religious affiliation
• language
• nationality
• physical features and appearances

Therefore families of certain ethnic groups often have similar idea and practices related to:

• health
• sickness
• parenting
• childrearing practices
• child discipline
• male-female relationships

3. Culture Shock

Discuss with participants what 'culture shock' means to them and how it might impact them. Be sure to include the following information in the discussion:

This occurs when an individual has a series of encounters where personal values, attitudes, beliefs and behaviors are challenged by another person's values, attitudes, beliefs and behaviors. These encounters usually disturb the balance of the individual (Hoflin, 1994).

There is a discomfort in relating to another culture. This discomfort is usually related to not understanding the culture of another group or person.

The PSS may experience the following feelings as they work with their families:

• First enthusiasm, high spirits as you begin to work with the families.
• Next you may find that your problem-solving or help strategies do not work with the families.
• You may find that you disapprove or do not understand the habits or behaviors of the families you are working with, especially if they are different from yours.
• You may realize that your education and background are different from the families and that makes it hard for you to understand the families.

4. Practical Suggestions and Advice for the PSS

Generate ideas from participants about what they can do to be more culturally sensitive. Use a flip chart to record ideas. Include the following in your list:

It will be important to understand the culture, the behavior, habits, knowledge and beliefs of the families.

Consult with colleagues and others who have experience with the families.

You can increase your awareness, sensitivity and appreciation of the culture of the families by:

• Gathering as much information about the culture as possible.
• Identifying lay people who can serve as cultural guides or mentors.
• Finding ways to build trust with the members of the families.
• Trying in a personal way, to experience the culture, learn about the holidays, foods, celebrate or get involved with community activities.
• Learning the language and slang of the culture.

DO NOT MAKE ASSUMPTIONS ABOUT ALL MEMBERS OF THE CULTURAL GROUP BASED ON WHAT YOU LEARN FROM THE PERSONAL EXPERIENCES OF A FEW MEMBERS

Sometimes you may have to be sensitive to other family needs and feelings before you can address the purpose or planned intervention for the home visit.

You may need to earn the trust of the families. You can do this by being sensitive to their needs, concerns and beliefs. Your style of interaction should include warm, empathetic listening and verbalizations. You want to exhibit caring and understanding.

Have the group engage in the following exercises:

Practical Exercise #1 (30 MINUTES)

1. Have PSS sit in groups. Ask them to talk about people they know of different ethnic backgrounds and the practices that they know about related to these families which are different and/or similar from their own family practices.
2. Were they surprised by the practices?
3. What do they think about the similarities?
4. What do they think about the differences?
5. Do the PSS believe these similarities or differences will effect how they might give care to such a family? In what ways could this happen?

Practical Exercise #2 (30 MINUTES)

1. Have the PSS pair up(P1 and P2).
2. Ask one to tell their partner about a negative situation that happened to them related to their ethnicity. Tell how she felt and what she did.
3. Ask the partner P2 to think about what she might tell the P1 about how to make the situation more positive and/or help her handle a similar situation in the future.
4. Role play these situations in the group. Focus on the feelings and behaviors of the P1 and P2.

Present the following information:

Many of the families that the PSS will be visiting will be African-American.

• In African-American families, the extended family is often intact and provides significant support for new mothers and infants. So, when possible and agreed to by the new mom, they should be involved in the interventions for the family.
• In African-American families, it is important to recognize the role and influence of the older woman, i.e., grandmothers, or mother of teen mother. Again, they may be gatekeepers for the family's health habits and practices and should be involved in the intervention if agreed to by the new mom.
• Many African-Americans rely on themselves or friends to care for them when they are sick.
• Many African-American families do not trust health care workers - it is possible that they may not trust you at first. Because they don't trust, they may not come to a doctor or clinic until they can no longer care for themselves. Sometimes they may not do exactly what the nurse or doctor tells them because of fear or mistrust. THIS IS WHERE THE PSS CAN BE VERY HELPFUL TO THE FAMILY BY EMPHASIZING THE IMPORTANCE OF HEALTH CARE.
• African-American families in general value and love their children although they may be strict with them.
• Family ties and kin are very important to African-American families.
• BUT YOU MUST ALWAYS REMEMBER THAT NOT EVERY FAMILY IN AN ETHNIC GROUP IS ALIKE.

Practical Exercise #3 (30 minutes)

MYTHS FOR DISCUSSION (Source: Kavanagh & Kennedy, 1992). HANDOUT #2

1. It is a myth that educated and professional individuals do not have minority status problems or involve themselves in such issues.
2. It is a myth that personal concern with social stratification issues implies immaturity and non-professionalism.
3. It is a myth that institutions must adapt to the needs of minority groups or individuals, rather than minorities adapting to social institutions.
4. It is a myth that you can "get the feel" or "sense" of another culture without having to learn about its social organizations and social processes.
5. It is a myth that health care providers cannot be reasonably prepared to handle cross-cultural and other situations involving diversity because health care personnel in the United States deal with people from more than 100 ethnic, racial, and cultural groups.
   • Have PSS read myths.
   • Lead a discussion with the PSS about their reactions to the myths.
   • Be sure to use the following materials as a guide for the discussion.

POINTS TO EMPHASIZE DURING THE DISCUSSION:

MYTH #1

1. Regardless of educational or professional background or experience, workers of ethnic/minority groups deal with the same issues and prejudices of all members of that group.

MYTH #2

1. Stereotypes still persist related to one's ability to do a job according to: SEX, RACE, ETHNICITY, AGE.
2. It is a mistake to believe that social stratification issues are not relevant for all workers.
3. Even employment situations are stratified and inequitable.

MYTH #3

1. Most health care agencies and providers expect clients to adapt to the system.
2. Health care systems are based upon routines to increase efficiency.
3. Argument is that individualized care takes time and costs money.

MYTH #4

1. People do need to be sensitive and aware of cultural groups.
2. People need to be knowledgeable about patterns among groups of people...this gives/helps to empower health care providers to make valuable interventions.

MYTH #5

1. Complete knowledge of a culture is not the goal.
2. General knowledge about cultural patterns and social organizations is helpful to know what questions to ask...to gather information needed to provide interventions for families.

• The more tolerant you are, the more open you are to learning about others.
• The more you learn, the less you fear.
• The less you fear, the more comfortable you will feel in all types of situations, with all kinds of people.
• The more you get along with other people, the more successful you are ... and the more interesting your life becomes.