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Fundamentals · chapter 5 · Cultural Competence

Diversity, Equity, and Inclusion

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 5 practice questions with the reasoning.

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Key points

  1. DEI and patient outcomes

    Diversity, equality, and inclusion foster a culture of mutual respect, understanding, and support which can lead to improved patient outcomes.

  2. Disparities from exclusion

    There are numerous factors that can prevent diversity, inclusion, and justice. These can in turn create health disparities that limit access to care and decrease outcomes for certain groups.

  3. Nurses and racism impact

    As healthcare providers, nurses have an obligation to recognize the impact of racism on their patients and the communities they serve.

  4. Race-related implicit bias

    Implicit bias related to race and ethnicity has been repeatedly shown in research to negatively affect patient care and outcomes.

  5. Religious preferences in care

    Healthcare providers must be prepared to take patients’ religious and spiritual preferences into account as an important part of the treatment plan (Swihart et al., 2022). A thorough cultural assessment should include information on a patient’s religious or spiritual beliefs that might affect their care.

  6. Age bias in treatment

    Studies have shown that healthcare providers are more likely to assume that older patients’ conditions, such as cognitive decline, are due to their age and to deny them certain treatments as compared to younger patients (Hughes et al., 2020). Older patients also tend to be undertreated for pain and depression.

  7. Pronouns in assessment

    Sharing pronouns as part of a basic introduction to a patient can assist a transgender patient to feel secure sharing their pronouns in a healthcare setting. Asking a patient for their pronoun (he, she, they, ze) is considered part of a nursing assessment.

  8. Gender bias in complaints

    Providers are more likely to believe that the health complaints of women result from emotional instead of physical causes compared to men. There is also a demonstrated history of underdiagnosis and undertreatment of cardiovascular disease in women when compared to men.

  9. LGBTQIA+ health disparities

    Historically, individuals within the LGBTQIA+ community have experienced discrimination and prejudice from healthcare providers and avoided or delayed health care due to these negative experiences. Despite increased recognition of this group of people in recent years, members of the LGBTQIA+ community continue to experience significant health disparities.

  10. Disability barriers to care

    Adults with disabilities also cite common stereotypes, bias, and beliefs among providers as barriers to care (VanPuymbrouck et al., 2020). Examples include lack of appropriate equipment to transfer patients with disabilities, or a healthcare provider’s assumption that the patient is unhealthy or fragile simply because they have disabilities.

  11. Education and health decisions

    Differences in educational levels can affect how people access healthcare services and understand health information to make informed decisions.

  12. Homelessness and treatment plans

    This is attributed to their limited opportunities for early prevention and a lack of resources to adhere to standard treatment plans (Baggett et al., 2013; Fazel et al., 2014; National Academies of Sciences, Engineering, and Medicine, 2017b). For instance, someone experiencing homelessness is unable to perform clean dressing changes daily without adequate access to water.

  13. Overcoming diversity barriers

    Overcoming these barriers requires ongoing education, open-mindedness, and a willingness to learn about and appreciate different cultures and backgrounds. It also requires actively challenging one’s biases and seeking out opportunities for exposure to diversity.

  14. Medical interpreter use

    Use of a trained medical interpreter is linked to fewer communication errors, shorter hospital stays, reduced thirty-day readmission rates, and improved patient satisfaction. Refrain from asking a family member to act as an interpreter.

Terms to know

health equality
The principle of ensuring that all individuals, regardless of their background or socioeconomic status, have equal access to healthcare resources and opportunities is called health equality (CDC, 2022b).
health equity
When everyone has a fair opportunity to obtain optimal health, health equity is achieved (CDC, 2022a).
diversity
Diversity refers to the existence of societies, communities, or subcultures that differ substantially from one another.
inclusion
Inclusion is the practice of creating an environment in which individuals of all backgrounds feel respected, valued, and supported (CDC, 2022b).
stereotyping
The assumption that a person has the attributes, traits, beliefs, and values of a cultural group because they are a member of that group is termed stereotyping.
cultural imposition
The imposition of one’s own values, beliefs, and practices upon another person or group is cultural imposition.
cultural blindness
The belief that all cultural groups are the same and share identical experiences is cultural blindness (Bhattacharya et al., 2019).
linguistic competence
The AHRQ defines linguistic competence as “providing readily available, culturally appropriate oral and written language services to limited English proficiency members through such means as bilingual/bicultural staff, trained medical interpreters, and qualified translators” (AHRQ, 2019).

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A nurse is preparing discharge teaching for a patient who has limited English proficiency. The patient’s adult daughter offers to interpret because she speaks English well. What is the best nursing action?

    1. Ask the daughter to interpret because she knows the patient best.
    2. Speak more slowly in English and ask the daughter if the patient understands.
    3. Request a trained medical interpreter before providing teaching.
    4. Give the patient English-language written instructions using simple language.

    Answer: Request a trained medical interpreter before providing teaching.

    A trained medical interpreter should be used when a patient has limited ability to speak, read, write, or understand English. Family members should not be used because the patient may withhold sensitive information, family members may change information, and unfamiliarity with medical terminology can cause errors.

  2. A nurse is caring for a patient with a hearing barrier and wants to improve communication during discharge teaching. Which actions are appropriate? Select all that apply.

    1. Use videos with captioning.
    2. Offer text telephones (TTYs).
    3. Provide print materials.
    4. Silence the television and reduce distracting noise.
    5. Provide Braille consent forms as the primary communication method.

    Answer: Use videos with captioning., Offer text telephones (TTYs)., Provide print materials., Silence the television and reduce distracting noise.

    For hearing barriers, the section recommends print materials, TTYs, captioned videos, and reducing background noise during conversations. Braille materials are helpful for patients with sight barriers, not as the primary accommodation for a hearing barrier.

  3. During admission, a nurse is caring for a patient who may be transgender. Which nursing action best supports inclusive care?

    1. Introduce themself with pronouns and ask the patient what pronouns they use.
    2. Avoid asking about pronouns unless the patient brings up gender identity first.
    3. Ask a family member which pronouns the patient uses.
    4. Use only the sex assigned at birth documented in the chart.

    Answer: Introduce themself with pronouns and ask the patient what pronouns they use.

    Sharing pronouns during a basic introduction can help a transgender patient feel secure sharing their pronouns. Asking for a patient’s pronoun is identified as part of a nursing assessment.

  4. An older adult reports new symptoms, but a staff member says the patient is probably just forgetful because of age. What is the nurse’s best response?

    1. Document the symptoms as expected aging and continue routine care.
    2. Focus only on memory testing because older patients often have cognitive decline.
    3. Ask the family to confirm the symptoms before listening to the patient’s report.
    4. Assess the patient’s concerns individually instead of attributing them to age.

    Answer: Assess the patient’s concerns individually instead of attributing them to age.

    Assuming an older patient’s concerns are due to age is stereotyping and can cause legitimate symptoms to be overlooked. The nurse should assess the patient as an individual rather than dismissing concerns as age-related.

  5. A nurse works in a hospital that has consent forms only in English and Spanish, although there is a significant local Vietnamese population. The nurse repeatedly has difficulty locating Vietnamese consent forms for patients. What is the best action?

    1. Ask Vietnamese-speaking patients to sign after a brief verbal summary.
    2. Escalate the issue so adequate Vietnamese-language consent forms are available.
    3. Continue using English or Spanish forms because those are the hospital’s standard options.
    4. Assume current treatment services are adequate for all patients unless a patient complains.

    Answer: Escalate the issue so adequate Vietnamese-language consent forms are available.

    The scenario reflects system-wide cultural blindness when services fail to meet the language needs of the patient population. The nurse should identify and escalate the issue so appropriate Vietnamese-language consent forms are available.

Where every quote comes from

Section 5.4 Diversity, Equity, and Inclusion of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.