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Canadian Nursing: Cultural Competence and Issues Research Paper

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Updated: Nov 25th, 2021


The focal point of the paper is to understand and evaluate the issue in Canadian nursing relating to cultural competence or Issues facing ethnic and minority students in the nursing programs and how they affect the health care system. The major issues confronting the health care system today are nursing shortage and the increase of culturally diverse patient population. Clients today are speaking limited English or no English at all. Racial and ethnic groups are very poorly underrepresented, among registered nurses, yet nursing profession represents the dominant majority (Coffman, 1999). This issue is pinned back to the success of the nursing programs. There are many controversial issues facing ethnic and minority nursing students in today’s nursing programs. These issues gravely affect students as they merge into the heath care system.


When we talk about culture, we mean the values, customs, rituals, behaviours and belief which we share with others in order to create a relation being as a group. On the other hand organisational culture deals with shared values though there also we find assumptions, beliefs and customs but here it creates a relation with the organisational members. Hayward, (1997) while quoting Hofstede (1980) mentioned that culture is the collective programming of the human mind which makes one group different from the other.

Hofstede (1980) identified four cultural dimensions. First, Power Distance refers to social inequality and the amount of authority one person has over others. From a behavioural perspective, a strong Power Distance is observed which manifests in the form of reluctance to challenge the choices and activities of leaders regardless of their appropriateness. Second, Uncertainty Avoidance relates to how a culture deals with conflict, especially the creation of beliefs and institutions to deal with disagreements and aggression. Those cultures which score high in the dimension of Uncertainty Avoidance (Rules and Order) strongly believe that all rules and regulations must at any cost be abided, even in cases when it may be conflicting with a company’s interests or security circumstances. They also hold that well documented procedures should be in place for all circumstances and in addition, stringent time constraints must be applied to all activities. Low Uncertainty Avoidance score indicate that those cultures are more likely to transgress Standard Operation Procedures (SOPs). However, this may be advantageous when dealing with unprecedented circumstances by means of adopting new and innovative means to tackle the same.

Third, concept of Individualism & Collectivism denotes a bipolar construct wherein cultures tend to be towards the individualistic or collectivistic. Cultures which tend to be more individualistic in nature are formed by individuals who are more concerned only about themselves or their closely related associates. On the other hand, in cultures which are more collectivistic, it is observed that people tend to form in-groups or cooperatives wherein caring for others is valued and loyalty is expected in return. Those belonging to individualistic cultures pay more attention to self and individual gains whereas compliance with the group ideals is often observed in people belonging to collectivistic cultures. High Power Distance scores are often observed in collectivistic cultures, indicating disposed approval of unequal status and respect towards leaders. Lastly, Masculinity and Femininity stands for a bipartite construct which signifies two very dissimilar sets of social principles. From the masculine perspective, the most significant ideals are related to accomplishment and wealth. In the feminine standpoint, better quality of life and care and concern for others are looked upon as fundamental values. Culture is also a major factor that affects behaviour. A conceptualization of the total situation is summarized in Lewin’s formula, B=f (PV x C), where B represents behaviour, a function of the interdependence between performance value (PV) and cultural background (C) (Yamamori and Mito, 1993). If a person’s cultural background does not agree with this person’s performance value, then the person’s behaviour will be affected. This is exactly what is happening in this case.


According to CNO (2008) National Competences, upon graduation, new nurses are expected to have a strong base in nursing knowledge and apply their knowledge and skills in provision of safe, competent and ethical care to patients and clients. New nurses are expected to establish and maintain therapeutic caring and culturally safe relationship with clients, and the health care members to ensure continuity of care for clients. CNO (2008) has over one hundred national competences that are geared towards BScN nursing education. These competences are client-centered and futuristic with special attention given to the new development in the health care, nursing knowledge and practice to help new graduates on entry level to function in today’s realities. However, there are many issues that block many ethnic and minority nursing students from achieving and reaching up to this competency requirement. This paper will address some of these issues and recommendations that ethnic and minority nursing students face in the course of their training.

Nursing education is in Canada embraced an “imagined identity” and predominantly Euro-white. This is continuously being challenged by the increase in the numbers of culturally diverse students in the nursing education programs (Paterson, 2004). As an ethnic student myself and in my final year in a bachelor program, I find that we are expected to adapt to professional nursing programs that are grounded in North America’s dominant society which are held in their health beliefs, assumptions and theories. We are blamed for lack of competence. Even conflict occurs as nursing concepts and theories are grounded in the norms and values of the grounded culture (Marian, 2001). Ethnic and minority students are underrepresented and are forced to memorise and practice the nursing theories that are not relevant to their cultures. Marian asserts that educators who teach in multicultural settings, should base education on a diversity model. Teachers should use models that empower students and strategies to assist diverse students to express their views. The five dimensions noted here are content integration, the knowledge construction process prejudice reduction, equality pedagogy, and an empowering school culture and social structure (Yoder, 2001). The limitations are this study is American and only 26 nurse educators and 17 nurses from three population groups were interviewed.


An American study by Gwendolyn, 2004 showed that Black-American students find it hard to reach a level of comfort in predominantly white Universities. Students feel lonely, isolated, and frustrated as there is little representation small number of ethnic minority students are noted in the campus. Within this kind of environment, a black America student has no avenue of sharing feelings and gaining the support he/ she needs in order to progress through the program. Because of the few number in nursing programs, students have very few contacts, and hence they become alienated. This is why some students experience inability to openly discuss their feelings and they opt to leave when confronted with academic problems. Gwendolyn recommends focus in the faculty where cultural biases can significantly impact the racial background different from their own. They can be achieved through sensitivity programs and workshops that will allow faculty to gain some understanding of problems faced by minority students. Faculty should take caution when making assumptions of educational background of minority students as they all vary. The curricula of many nursing programs are based on Eurocentric education models focusing on majority, yet the faculty does not question the effect of the curriculum have on minority students. She suggest a diversified curriculum that will integrate and incorporate cultural hence challenging the students variations of the population improving the quality care and challenging all students to take into consideration the differences people of other racial and ethnic groups, thus improving the quality of care provided to culturally diverse population. Institutions of higher education must commit to the best interest of the population. Historically, institutions address shortage of nurses’ issues but no retention in retention strategies.This article reminds the institutions need to commit to changing face of the population. It represents minority population in the United States.

One feels like an outcast as the white peers separate themselves and it is heard to cross the wring they create around themselves. One Nigerian student angrily stated that, “minority student are expected to work alone, and when people feel alone, they are more likely to quit the program.” (Gardner, 2005) Minority students are different, foreign born students are and respectful as compared to their white peers who are aggressive and assertive even if they are wrong. Students express a great desire for teachers to treat them as individuals with unique needs. Minority students have great needs and difficulties and they want to know if someone understands their situations while in the nursing programs. Gardiner addresses peers’ lack of understanding and knowledge about cultural knowledge which makes the minority students fell ignored, discounted, devalued ad misunderstood. “White students think minority and ethnic student have nothing minority to offer. We make them uncomfortable and they keep sayings they cannot understand what the minority students are trying to say, said Napalese student.” Personally I have been judged and told I have no goals because of my sitting habits. Yet, the teacher said nothing about it, as matter of fact she laughed about it. In my culture I do not need to sit a certain way, as long I am comfortable and respectful. Another student admitted loudly in PBL class that she hates Aboriginal people although they are her neighbours in the reserve make the most population in her local hospital. They are lazy, they don’t finish school, they don’t work, they get a tax break, and yet the government give them money every month. The faculty member reacted like nothing was said. It leaves a lot to be desired as biases and prejudice is directed to the students and the patient population by future nurses and yet the faculty representative proves biased too. This calls for the theme of desiring support from the teachers to promote students success. Students cope with insensitivity and discrimination. They tend to ignore negative behaviour, by choosing not to confront, and choosing their battle wisely. Determinations to build a better future make them strive to improve their quality of life. Minority and ethnic students need to overcome obstacles in their lives that make nursing school a challenge including English proficiency.

Delegation and education strategies

Interpersonal associations, and leadership and administrative approach and overall a supportive congenial work environment is the most important aspect in the issue of nursing workforce retention. Thus, administration should foster a healthy work atmosphere with strong interpersonal connections and through efficient leadership and strategic organizational skills within the hospital.

To be successful, nurse managers must play the role of a leader in addition to that of just a manager. There is a comprehensible link and interrelationship among the aspects of leadership and management, and a successful nurse manager has to be capable of integrating both leadership and management in his or her responsibilities. It is particularly significant that the cohorts are inspired to follow the manager. Effective organizations have influential people who are trusted and revered by the followers. An organizational structure needs to be created where in the followers must have faith in the fact that that the managers are competent enough to guide the team and the institute into the future. Leaders who appreciate and recognize the offerings of the others are more successful. Valuable leadership has a substantial influence on staff authorization and the accomplishment of the objectives in a nursing unit. As each individual and team is distinctive, the exciting and appealing test for the leaders is to adopt the most efficient leadership approach that is to be put into action for each individual, team and condition. However, one leadership method may not be the best option in every situation and with all adherents. The leadership manner of a manager has an impact on all the activities in a nursing facility. It is essential to choose and implement the most suitable leadership approach for every situation uniquely. For example, a transactional leader concentrates on the everyday features and preparation and other leadership activities are primarily task oriented. Nevertheless, when the extent of development i.e., maturity levels of the adherents are singular, the situational leadership model might be a more viable option. In the course of change, transformational leadership is considered to be most fitting approach. Hospitals draw in and retain more competent nurses when the nurses are provided with easily accessible communication channels to nursing managers and in cases where the hospitals ensure that there are enough nurse managers at hand. In response, nurses will carry out their responsibilities more productively and at the same time acquire enhanced job satisfaction.


According to The Diversity Resource Paper of the Honor Society of Nursing (2003), diversity needs to be incorporated and acknowledged within the student’s population and incorporated in the curriculum. In the study on Canadian nursing done by Paterson, Osborne and Gregory (2005), students are bound by unwritten and largely invisible expectations of homogeneity. The authors continue to note that the intuition to focus on cultural diversity in the curriculum fades away and soon the students begin to learn that being different can be difficult and leads to marginalization. Hagey, (1999) found that denial of racism in nursing profession reflected in a curriculum that does not support theory about phenomena or open discussion of issues.


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