Traditionally, nurses have been taught to respect the individuality of patients and to listen to their needs in terms of goals, lifestyles and culture. Nurses have been taught that individuals are psychosocial, cultural beings with their own uniqueness that must be respected. Nurse theorists, such as Leininger, have researched cultural care for decades and instilled the need for nurses to look at diversity from the perspective of the client as they practice culturally competent care. Nursing has evolved to where cultural awareness and diversity are engrained into nursing practice and the nursing consciousness.
What is diversity? There are many definitions of diversity, however, most of the definitions include differences among groups or between individuals. These include, but are not limited to: gender, cultural, spiritual, biological/physical, social, environmental, moral, ethical, economical, educational, political, and ethnical differences. Many definitions include the acknowledgement that not everyone is alike and that it is imperative that differences be acknowledged for understanding and growth to occur between those who are diverse. This diversity can range from slight differences, such as those within family members, to major differences such as those between nations, religions, and geographical locations. All of these diversities affect health care practices and beliefs.
Why is it necessary to study diversity and why is it an important issue in nursing today? The world increasingly is being forced to understand and live with the differences of others. Many nations are faced with not only trying to understand the diversity of others, but are engaged in warfare in an attempt to deal with the diversities. This is very evident in tension areas such as Ireland, Israel, Bosnia, the Middle East and Baltic countries, and most recently, the War on Terrorism. The United States is also trying to accommodate the changes in ethnic/cultural makeup of the population, religious differences, and inequities in entrance into health care based on educational, social, economical, environmental, and cultural factors. As populations change and individuals become more transient, nurses are challenged everyday to incorporate the diverse needs of their clients into the provision of quality nursing care while facing the shortage in qualified staff to meet these needs. Clients are demanding individualized care considerations and research has shown us that without this attention to diversity, health care practices of clients and quality of health care diminish.
This issue of OJIN looks at these many faces of diversity in terms of health care in the United States. The focus of the articles is on cultural and racial diversity. As usual, four articles are presented addressing various aspects of this issue. In the Disparities in Health and Health Care: Focusing Efforts to Eliminate Unequal Burdens, Balwin provides an historical overview of health care in the United States. She then addresses the challenges and solutions to American health care delivery systems, especially in the area of minority health care services. Some of these include the challenge of research, health care providers recruitment, prevention programs, and provision of care to minority populations. Her final focus is on the patient-provider relationship and the importance of focusing on the social, cultural and economic factors of the minority population.
The article, Many Faces: Addressing Diversity In Health Care by Campinha-Bacote examines diversity beyond minority health care and looks at culture and cultural competency. She states that nurses must go beyond just acknowledging differences, we must engage in what she refers to as the "process of becoming culturally competent." This article presents the Process of Cultural Competence in the Delivery of Healthcare Services Model as a model of cultural competence that includes the constructs of: cultural desire, cultural awareness, cultural knowledge, cultural skill, and cultural encounters. This model involves life-long learning, self-examination, skill and knowledge building, and building on similarities while acknowledging differences. The author concludes that although there are many faces to cultural diversity, there is only one voice and one goal, to provide quality health care services responsive to the specific cultural group.
Race Consciousness and the Health of African Americans by Watts integrates the themes of the first two articles of the issue, providing culturally competent health care within the African-American culture. Watts introduces the idea that "race consciousness" must become an integral part of nursing provided to African-Americans. She provides an historical overview of oppression and inferiority toward this group in the United States. The contemporary racial injustice of the American health care system is then examined in terms of the lack of research on African-Americans, lack of preventative health care services, disparities in health care, provider-client issues, and epidemiological issues. Watts focuses on the need to assure culture competency in health care and discusses steps to attain competence and guidelines for beginning the process of incorporating race consciousness as a component of cultural competence.
The final article in this issue is entitled Interweaving Policy and Diversity by Milstead. This article examines the process of policy development as it connects with the concept of diversity. Policy development models are presented with particular focus on the United States political system. Milstead examines the American policy process through the four components of agenda setting, government response, implementation, and evaluation. The impact of policy on nursing and health care is highlighted, as are the values inherent in these policies. Nurses are cautioned to be aware of hidden health items on agendas that reflect values of political candidates. They are also encouraged to be active in the policy process at all stages, become aware of the interconnectedness of issues, and provide data to policy makers concerning diversity issues. Some issues examined in terms of the components of policy process include: racial concerns, human subject concerns, immigration, interstate practice, foreign nurse hiring, cultural competence, diversity in nurses, entry into practice, biological warfare, and nursing shortage.
We hope that you enjoy this issue of OJIN and submit manuscripts concerning the many areas of diversity in nursing that were not addressed in this issue.
