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Book review: Diversity & Cultural Awareness in Nursing Practice

Posted: October 28 2020

Student & staff projects, Social Work

Interested in Social Work and want to learn more about the subject? The book reviews written by our Social Work students and staff help you identify the best literature to advance your learning.

This week:

Book cover of Diversity and Cultural Awareness in Nursing Practice book


This textbook is published by Learning Matters, a publisher of materials for professional and vocational courses in education, nursing, and social work. As its title indicates and the introductory pages confirm, the textbook is first and foremost for student nurses. The textbook is edited by Beverley Brathwaite, a PhD student with a background in adult nursing who is also a registered teacher with the Nursing and Midwifery Council (NMC), the regulatory body. The other five authors and co-authors of its 8 chapters are teachers in nursing at either Middlesex University or City, University of London.

However, the title of this textbook along with the description of its chapters in the Introduction can, as it has happened to me, attract the attention of education and social work students and their teachers too. They may become curious as to how the issues of diversity and cultural awareness of practitioners in their professions are both similar with and different from those in nursing. After all, one and the same person can be simultaneously a patient of nurses, a learner of teachers, and a service user of social workers.

The first Chapter attempts to outline the notions of ‘diversity’ and culture’ adopted throughout the textbook. It starts with the description of diversity provided by Health Education England instructing the healthcare professionals to appreciate ‘the differences that everyone has’ and to promote ‘the opportunities that different people bring to the work that we do’. Indeed, not only are the patients of nurses diverse, but also the nurses themselves are.

To a rather traditional list of some of such differences constituting diversity Chapter 1 adds the belonging to ‘cultural groups’. As to the concept of culture, it is taken together with those of race and ethnicity since ‘there are overlapping ideas of what race, ethnicity and culture mean’ and ‘an important point to consider is that these are terms that are used to signify difference within society from the biggest ethnic group in Britain, which is white British’.

The concept of cultural awareness, the second component of the textbook’s title, is introduced in Chapter 4 focused on cultural competency the meaning of which is conveyed by the representation of three chosen models. In one of them cultural awareness is described as ‘the conscious recognition that other cultures exist and an appreciation that not everyone comes from the same cultural background’. In all of these models cultural awareness and cultural knowledge are only the preliminary steps towards broader cultural competency. Full cultural competency is topped up by cultural skills (such as the ability to obtain and properly take into account any relevant culturally sensitive information) and attitudes (such as the desire for cultural needs to be met and any obstacles to this addressed).

The other chapters provide more details on individual and organisational cultural awareness.

Chapter 3 starts with emphasising the crucial role of cultural self-awareness of practitioners in effective communication with people with a range of backgrounds different from their own. This includes the communication of non-white non-British nurses with their white British patients and colleagues. The reader’s attention is drawn, in particular, to the old research findings ‘that during a face-to-face interaction, only 7 per cent of a message is made up of words’. Although non-verbal communication is arguably more sensitive to the differences in cultural backgrounds, the verbal aspects of communications can be affected by such differences too. For example, profession-specific jargons and terminology, even if spoken or written in perfect English, can be misunderstood by those who are not familiar with them.

In Chapter 5 culturally sensitive communication in undertaking needs assessments and care planning is presented as the key skill of cultural competency, which can only be constantly developed but never perfected ‘as it is not possible to be knowledgeable about and understand all cultures and diverse groups’.

Chapter 6 demarcates cultural and religious beliefs which can be misconceived as nearly identical, especially in communications around death.

Chapter 8 explores cultural and religious diversities in understanding mental health issues and also touches upon a professional sub-culture, ‘[t]he culture of mental health services’.

Whereas Chapter 2 further expands on health inequalities as such, Chapter 7 focuses on the approaches of British public health authorities to health inequalities in diverse communities.

The textbook has not turned out to be a piece of easy or pleasant reading to me, not least because of its rather patronising style, with the words ‘should’, ‘must’, ‘require(d)’, and ‘will’ applied to the target audience far too often. Nevertheless, the textbook serves its stated purposes and engages numerous and diverse sources.

Also, for many of those belonging to or joining the culture of a caring profession other than nursing it could be interesting and possibly useful to read the textbook to be better aware of the inter-disciplinary diversity of perspectives on diversity and cultural awareness. Nursing, education, and social work, like any other professions, can be anthropologically approached as cultures.

In Chapter 4 there is a reservation about ‘professional nursing culture’. This brief reservation implies strict abidance by the 2015 NMC Code stipulating professional standards of practice and behaviour as the distinctive hallmark of this culture. The NMC Code mandates, amongst other things, to ‘treat people with kindness, respect and compassion’ and ‘consider cultural sensitivities’.

In addition, the textbook multiply refers to a nursing mantra consisting of the words starting with the letter ‘C’ - care, compassion, competence, communication, courage, and commitment - known as ‘the 6 Cs’. It was prescribed in the 2012 NHS Commissioning Board’s publication entitled ‘Compassion in Practice’. The 2014 model of ‘culturally competent compassion’ outlined in Chapter 4 merely appends the words ‘and compassion’ to the previously defined stages of cultural awareness-knowledge-sensitivity-competence. This amendment feels rather artificial.

In comparison, according the Code of Ethics for Social Work in Britain, for example, ‘recognising diversity’, ‘taking into account individual, family, group and community differences’, and ‘treating people with compassion, empathy and care’ are among the professional values that social workers have responsibility to apply to their practice.