![]()
Chapter 1
Culture, race and ethnicity: Exploring the concepts
Karen Holland
Introduction
This chapter aims to explore and discuss the concepts of culture, race and ethnicity. These three concepts are found being discussed in various ways in the media, government and health policies and in the literature generally. Consideration of their individual meaning as well as their application and interpretation within nursing and healthcare practice will then enable the reader to understand some of the underpinning issues throughout the book.
This chapter will focus on the following issues:
•Cultural care in context
•The meaning of culture
•The meaning of race
•The meaning of ethnicity
•Culture, race and ethnicity in nursing and health care
Cultural care in context
Nurses have been advised in the past that the needs of different cultural groups were not being catered to (Chevannes, 1997; La Var, 1998), and that there was a need to ensure that healthcare practitioners are suitably prepared to cater to these needs (Gerrish et al., 1996). However, as noted in the first edition of this book in 2000, there remains very little specific guidance offered by the statutory and professional bodies on how to make these recommendations a reality within healthcare practice and nurse education. The publication of the English National Board research report (Iganski et al., 1998) on the recruitment of minority ethnic groups into nursing, midwifery, and health visiting was an example of the evidence clearly indicating a need for a national policy. The Department of Health in the United Kingdom began this cultural change in health care by ensuring that National Health Service (NHS) Trusts adhered to Patients’ Charter standards with regard to privacy, dignity, and religious and cultural beliefs (Department of Health, 1992), and in 2009 published guidance for NHS organizations on how to manage the issue of belief and religion in order ‘to implement and comply with the requirements of legislation on religion or belief enacted recently’, and also provided general practical guidance around the issues that fall out of that for the NHS (Department of Health, 2009).
However, despite the increase in information and research concerned with ensuring that the culture and religious beliefs of patients and clients are considered in health care and nursing, there remains a distinct lack of evidence on what is available to help us to achieve this. The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) 1992 Code of Professional Practice set out for nurses, midwives and health visitors how they were expected to relate to the general public in the course of their work. It stated the need to:
The updated Nursing and Midwifery Council (NMC) professional code (The Code – Standards of Conduct, Performance and Ethics for Nurses and Midwives, 2008), however, no longer made this an explicit issue as in 1992 but an implied one, where ensuring that the specific needs of individuals is met is an accepted part of ensuring that nurses ‘make the care of people your first concern, treating them as individuals and respecting their dignity’. For example, it states that as nurses we ‘must not discriminate in any way against those in your care’.
The new Code (NMC, 2015) can be downloaded at (https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf). Here is an example from the revised Code, which can be seen to reflect the need for understanding cultural diversity and equality of care:
Section: Practice effectively
This remains a holistic approach that ensures that nurses care for people as individuals irrespective of their culture, which is essential in today’s multicultural UK society. However, to ensure that student nurses become not only culturally aware but demonstrate knowledge about different cultural groups so as not to discriminate requires a much more focused Standard as per the UKCC (1992) one.
The new NMC (2010) Standards for Pre-Registration Nursing also offer a broad approach for student nurses to achieve in practice:
It is left up to curriculum development teams including practitioners, students and service users to interpret this competence statement, which as can be seen includes understanding culture and how it impacts on health and illness.
Reflective exercise
Consider the NMC (2010) statement above and plan at least two Learning Outcomes or Goals for your next practice placement on how you are going to ensure that you can identify how culture (as well as the other concepts defined) impacts on health and illness and how you intend to demonstrate this for your mentor in clinical practice.
The Australian Code of Professional Conduct (2008), unlike its UK counterpart, has retained a more explicit Conduct statement: ‘Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues’ (4) and offers four explanatory statements as to how this is visualized (see Box 1.1).
Box 1.1Conduct statement 4: Nurses respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment, and of their colleagues
Explanation
1.In planning and providing effective nursing care, nurses uphold the standards of culturally informed and competent care. This includes according due respect and consideration to the cultural knowledge, values, beliefs, personal wishes and decisions of the persons being cared for as well as those of their partners, family members and other members of their nominated social network. Nurses acknowledge the changing nature of families and recognize families can be constituted in a variety of ways.
2.Nurses promote and protect the interests of people receiving treatment and care. This includes taking appropriate action to ensure that the safety and quality of their care is not compromised because of harmful prejudicial attitudes about race, culture, ethnicity, gender, sexuality, age, religion, spirituality, political, social or health status, lifestyle or other human factors.
3.Nurses refrain from expressing racist, sexist, homophobic, ageist and other prejudicial and discriminatory attitudes and behaviours toward colleagues, co-workers, persons in their care and their partners, family and friends. Nurses take appropriate action when observing any such prejudicial and discriminatory attitudes and behaviours, whether by staff, people receiving treatment and care or visitors, in nursing and related areas of health and aged care.
4.In making professional judgements in relation to a person’s interests and rights, nurses do not contravene the law or breach the human rights of any person, including those deemed stateless such as refugees, asylum seekers and detainees.
From Code of Professional Conduct for Nurses in Australia (Australian Nursing & Midwifery Council 2008: Rebranded in 2013 but Code is unchanged)
From this we can see very clearly what those involved in the education of student nurses would be able to promote...
