This thesis examines the meanings that nurses attach to the concept of “cultural sensitivity”. The findings are drawn from an extensive review of nursing's formal discourse (the nursing literature) and nurses' informal discourse (indepth interviews with 31 nurses practising in Southern Ontario). An analysis of this discourse shows that there are different emphases in the formal and informal discourse, and considerable variability between nurses in how cultural sensitivity is understood. The two general orientations identified are control and humanism. A control orientation regards cultural sensitivity as a tool for increasing the efficiency of nursing care. A humanist orientation involves viewing cultural sensitivity as a process of personal growth that occurs between the nurse and client. The formal discourse in nursing tends to emphasize the control orientation while the informal discourse tends to give the humanist perspective more prominence. The thesis concludes by suggesting that efforts to promote cultural sensitivity will continue to be problematic so long as these differences in how the concept is understood are overlooked. / Thesis / Master of Arts (MA)

The Latino population is not accessing community mediation centers throughout Oregon. Mediation provides a safe space to resolve conflicts outside of the adjudicative processes and at a lower cost. Through interviews with program coordinators/directors of community mediation centers around Oregon, mediators with experience in bilingual mediation and Latino stakeholders, I explore the barriers that exist and methods to increase the participation of the Latino population in community mediation centers. The research asserts that mediation program practitioners have a desire to reach out to the Latino population but face enormous difficulty due to a lack of trust and, frequently, a lack of resources. The findings illustrate that energy and time focused on outreach and community building with the Latino population is necessary to increase trust, knowledge and willingness to participate in mediation. There is a need to train new mediators and to design programs to bring conflict resolution into diverse communities.

The purpose of this study was to explore how social workers identify elder abuse, factors they find contribute to or protect from elder abuse, and cultural considerations they identify as important. The qualitative research approach was utilized, and an interview instrument was created to explore participants’ perceptions and generate recommendations for developing cultural sensitivity in practice. The study sample consisted of 10 social workers with experience working with the elderly population recruited by snowball sampling. Face-to-face interviews were conducted, audio-recorded, and transcribed for analysis. This study found that social workers are particularly knowledgeable about risk factors for elder abuse and cultural considerations, such as client perception of seeking help and accepting services as taboo, and the greater effectiveness of a social worker who shares the same cultural background. A key finding was social workers’ perceived need for education in developing cultural sensitivity, including formal trainings, consultation with client families, and self-awareness. Implications for social work practice include the development of new and more comprehensive training programs, such that specifically incorporates cultural sensitivity. Greater opportunities for education call for increased funding, and mandatory cultural sensitivity trainings call for changes in policy. Future research is needed to understand client perceptions of elder abuse and of service providers. Finally, future research on elder abuse and cultural factors beyond race and ethnicity, such as sexual orientation and religion, is also needed.

The primary purpose of this study was to assess Spanish-speaking patients’ satisfaction with their clinical pharmacists’ communication skills and demonstration of cultural sensitivity and to determine their association with Spanish-speaking patients’ socio-demographic, clinical, and communication factors, as well as pharmacists’ Spanish proficiency, cultural rapport, knowledge of complementary and alternative medicines, and race/ethnicity. A self-administered survey was designed to assess the study objectives, and a convenience sample of 93 adult (≥18 years) Spanish speakers with limited English proficiency was obtained from five CommUnityCare Health Centers in Austin, Texas. Satisfaction with communication skills and satisfaction with cultural sensitivity were measured as a 6-item construct and a 4-item construct, respectively, where Spanish-speaking patients rated their satisfaction using a 4-point Likert scale (1=extremely dissatisfied, 2=dissatisfied, 3=satisfied, 4=extremely satisfied). The participants’ mean age was 52.0±14.3 years, where respondents primarily were female (65.9%), utilized publicly-funded insurance (100%), received less than a high school education (86.9%), and reported a “fair” health status (64.8%). Spanish-speaking participants reported overall satisfaction with their clinical pharmacists’ communication skills (3.6±0.5) and demonstration of cultural sensitivity (3.6±0.5). Study participants also indicated items within the cultural rapport subscale were generally important characteristics to Spanish speakers (3.5±0.5). The cultural rapport subscale instructed participants to rate the importance of pharmacists’ specific characteristics (i.e., speaks Spanish, is Latino, provides written information in Spanish, is respectful, is kind, is friendly, and understandings the importance of family opinion in healthcare decisions) on a 4-point Likert scale, where 1=not at all important, 2=somewhat important, 3=important, 4=very important. Multiple linear regression analyses showed that cultural rapport was the only significant predictor of Spanish speakers’ satisfaction with their clinical pharmacists’ communication skills (p<0.01) and demonstration of cultural sensitivity (p<0.001). The results of this study may be instrumental in understanding the communication-related and cultural sensitivity-related needs of Spanish speakers in relation to pharmacists’ cultural rapport and may help initiate future initiatives and interventions involving pharmacists and Spanish-speaking patients with limited English proficiency. / text

This thesis examines the role of language and culture in international business. Through a theoretical framework, it investigates how these are integrated and argues that an understanding of the complexity of the relationship between language and culture in cross-cultural communication is crucial in international business, as essentially it provides an explanation as to what effective communication means. The premise that language and cultural barriers might be preventing New Zealand businesses from enhanced engagement in Asia was investigated using quantitative data obtained from an online survey of New Zealand exporters supported by qualitative data from case studies. The results revealed that New Zealand companies were expressing much apprehension regarding language and cultural barriers prior to entry into Asia but upon entry, they had found that the experience had not been as difficult as anticipated. English alone was sufficient for the most part, particularly during the early phases. However, if businesses wanted to commit fully on a long term engagement with Asia, then English alone was not enough because without the knowledge of the local language and culture, they could not communicate effectively to build long-term relationships. Faced with a rapidly changing, increasingly competitive multilingual global environment, this study suggests that New Zealand businesses will need to find practical solutions to best enhance their opportunities in Asia.

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Specifically oriented towards Russian culture, this study addresses the need in diplomacy for deeper cultural understanding. As research suggests a link between the inclusion of religious perspectives in second language acquisition (SLA) and student motivation and cultural empathy, this study examines how Russian language classrooms could leverage an understanding of Russian religious themes to foster cultural sensitivity. The study invited 24 second-year university students of Russian to complete a previously-validated assessment of cultural sensitivity: the Global Perspectives Inventory (GPI). Divided into a control and a treatment group, the participants also watched a short video depicting a story from Russian history on the interactive video platform, Ayamel. The control group viewed a set of 10 extra-textual annotations containing Russian cultural material highlighting secular themes from Russian culture, while the treatment group reviewed 10 that were more spiritually-themed. After viewing the respective annotations, participants completed a short, open-ended, Video Response Questionnaire (VRQ), and completed a GPI post-test. The findings from the VRQ suggested that the video intervention tended to challenge participants' previous perceptions of Russia, noted a general increase in positive, self-reported perspectives of Russian culture, and revealed a tendency in the treatment group to more often portray Russia as a multi-faceted, rather than monolithic, cultural entity. The comparison of the GPI pre-test and post-test scores revealed an inverse interaction between the collective scores of the control and treatment groups on two questions gauging affective responses to culture. For each of these questions on the post-test, the treatment group's collective score slightly increased and the control group's collective score slightly fell.The findings suggest that interaction with religious themes in SLA may promote feelings of commonality and empathy with a foreign culture. As the relative, religious homogeneity of the sample constitutes a threat to the external validity of this study, the researchers invite similar tests to be conducted in SLA among different population types.

Type 2 diabetes mellitus (T2DM) continues to be a national challenge for Canadians. African and Caribbean Immigrants are among the most affected groups and those at risk of developing comorbidities and related complications. It continues to prove challenging to treat T2DM for the affected individuals. Effectively treating the disease can help mitigate risk factors for related comorbidities and complications while improving the quality of life for those affected. There is increasing research, outside of Canada, showing the evidence for the effectiveness of culturally sensitive and adapted interventions to immigrant patients affected with T2DM. In light of the effectiveness of such interventions in many industrialized nations, a systematic review (SR) can offer the best evidence for the scope and consideration of such treatment approaches in Canada. This SR aimed to determine whether community-based diabetic interventions in Canada, are culturally sensitive to African and Caribbean minorities living with type II diabetes. A narrative synthesis was employed to report the effect of interventions seeking to affect outcomes of T2DM patients in Canada. Of the 63 articles included for full review, 60 were excluded for not meeting the criteria of having the target population explicitly identified and also not having any mention of cultural sensitivity. Three articles were included for the final review because the target population was explicitly identified. The final results showed that all interventions were found not to be culturally sensitive to African and Caribbean T2DM patients in Canada. Our results suggest a lack in Canadian literature. To the best of our knowledge, this is the very first systematic review on this subject matter in Canada. This review provides dependable information and recommendations to researchers, educators, clinicians, and policy makers for future research with T2DM African and Caribbean patients in Canada. RÉSUMÉ Le diabète de type 2 demeure un défi national pour les Canadiens. Les immigrants d’origine d’Afrique et des Caraïbes sont parmi les groupes les plus frappés et l'un des plus à risque de développer des troubles comorbides et de complications liées au diabète. Traiter le diabète continue à poser un défi chez les personnes affectées. Traiter efficacement cette maladie peut contribuer à réduire des principaux facteurs de risque quant aux troubles comorbides et complications, tout en améliorant la qualité de vie chez les personnes affectées. Un nombre grandissant de recherche, hors du Canada, démontrent avec des preuves concluantes que les interventions sensibles et culturellement adaptées aux immigrants affectés par le diabète sont efficaces. Étant donné l'efficacité de ces interventions dans nombreux pays industrialisés, une revue systématique peut nous offrir la meilleure preuve pour l'envergure relative à ce genre de traitement au Canada. La présente étude méthodique vise à déterminer si les interventions contre le diabète, en milieu communautaires au Canada, sont culturellement adaptées aux minorités ethniques d’origines d’Afrique et des Caraïbes souffrant de diabète de type II. Une synthèse narrative a été utilisée afin de signaler les effets des interventions par rapport aux résultats des patients souffrant du diabète de type 2. Parmi les 63 articles considérés pour une évaluation complète, 60 ont été exclus car ni la population cible ou la mention de la sensibilité culturelle n’a été explicitement identifiée. Trois articles ont été inclus pour l’évaluation finale car la population cible fut explicitement identifiée. Aucune des interventions n’est culturellement sensible aux patients Africains et Caribéen affecté par le diabète de type 2. Nos résultats démontrent un écart dans la littérature Canadienne. A ce que nous sachons, cette revue systématique est la première qui touche à cette question au Canada. Cette revue fournie des données fiables et recommandations qui permettront aux chercheurs, enseignants, cliniciens, et aux décideurs en matière de politiques de santé pour des recherches futures auprès des patients Africains et Caribéen souffrants du diabète de type 2 au Canada.

Background: Death is a common occurrence in the Intensive Care Unit (ICU), and the circumstances surrounding a patient’s death can have a lasting influence on the wellbeing of families and nursing staff alike. Culture is an important influence on an individual’s perspective of end-of-life (EOL) care and a ‘good death’, and, as such, cultural sensitivity is an essential element of high quality EOL care in the ICU. Nurses are well situated to facilitate culturally sensitive EOL care within the ICU; however, there is a significant paucity of knowledge regarding ICU nurses’ perceptions of a culturally sensitive EOL nursing practice and their experiences delivering this within an adult ICU. Aims: The purpose of this study was to explore ICU nurses’ perceptions of delivering culturally sensitive care within their current EOL practice, and thus better understand how culturally sensitive EOL care can be supported within adult ICUs. Design and Methods: An Interpretive Description methodology was utilized to explore the perceptions of seven (n=7) Canadian ICU nurses regarding culturally sensitive EOL care. Maximum variation and theoretical sampling were used to recruit registered nurses from ICUs in two hospitals in Southern Ontario, Canada. Data were generated using semi-structured interviews and field notes and was concurrently analyzed using a constant comparative and reflexive approach. Study rigour was supported through the use of reflexive journaling/memoing, data triangulation, and peer debriefing. Results: Analysis of the data led to the construction of three themes which described nurses’ perceptions of providing EOL care within the ICU: 1) culturally sensitive EOL care is truly person-centered care, 2) dissonance between culturally sensitive EOL care and the biomedical model of care in the ICU, and 3) needing support to adopt a more relational approach to care in the ICU. Conclusion and Implications: Study findings highlight that ICU nurses perceive that culturally sensitive EOL care primarily involves building a strong therapeutic relationship and being truly person-centered when delivering care. However, the context surrounding nursing practice in the ICU creates many barriers to adopting this relational approach to care; thus, multifaceted support is needed for culturally sensitive EOL nursing practice to be bolstered and sustained. / Thesis / Master of Science in Nursing (MSN) / Patients in the Intensive Care Unit frequently die and the circumstances surrounding these deaths affects both family members’ and nurses’ wellbeing. Culture is an important influence on an individual’s needs during the end-of-life period and on their views about a ‘good death’. As such, when caring for dying patients, healthcare professionals need to be sensitive to the culture of each patient and family. In the Intensive Care Unit, nurses play an important role in making sure end-of-life care is culturally sensitive. The goal of this study was to learn more about nurses’ perceptions and experiences of providing culturally sensitive end-of-life care within adult Intensive Care Units. This study found that nurses working in Intensive Care Units feel culturally sensitive end-of-life care mainly involves being truly person-centered and this requires staying open-minded and building strong relationships with patients and their families. Nurses in this study also indicated that they face many obstacles when trying to be culturally sensitivity during end-of-life care and some of these were created by their practice environment. This research shows that if nurses are to deliver culturally sensitive end-of-life care within critical care settings they need significant support in various forms, which likely includes a change in the unit culture.

Background: Women across many ethnicities and backgrounds experience a lower quality of care compared to men, and have reported lower levels of patient satisfaction, and negative health outcomes. Women of various ethnic backgrounds often have health, cultural and religious needs during pregnancy that are not met by their care providers. While addressing patient needs is a priority, providers also face challenges in understanding, accommodating, and addressing women’s needs due to limited understanding of their cultures and available resources in caring for diverse populations. Objective: The purpose of this study is to describe and synthesize information from the literature regarding the perceptions and experiences of healthcare providers in delivering maternity care to ethnically diverse women. Methods: A scoping review was conducted, and database searching occurred in Ovid Medline, Ovid Embase, Ovid Emcare and Web of Science. Primary studies and literature reviews in English were included if they discussed the perspectives of healthcare providers in delivering maternity care to either ethnically diverse women, immigrant women, or a specific ethnic group of women. No time restrictions were placed on articles. Thematic analysis was applied to analyze the data, and results were reported in tabular format. Results: A total of 11 themes were generated across findings, namely, provider-patient communication difficulties, family involvement, lack of health and health system awareness, delays in care, limited time and resources, cultural conflicts, preference for a female provider, creation of stereotypes, prejudice and superior thinking, motivation to help ethnically diverse women, and cultural sensitivity training. Conclusion: Healthcare providers face challenges in addressing the needs of ethnically diverse women, due to resource and time limitations, lack of awareness of cultural norms, and lack of adequate cultural sensitivity training and education. Therefore, there is a need to increase the number of supports for providers as well as improve cultural sensitivity training in medical education. / Thesis / Master of Science (MSc) / Women of different backgrounds who are pregnant or who have given birth sometimes like to practice certain cultural traditions during pregnancy and birth such as eating cultural foods, fasting, and having family involved. When healthcare providers do not know about these practices or do not have the time or resources to help women practice their cultural traditions, this can cause them and the women they care for to have conflicts. This can cause other problems which can lead to poor mental and physical health. While there is a great amount of research on women’s experiences with their health providers, there is not much research on healthcare providers’ experiences with women. To address this, a scoping review was conducted to summarize research on healthcare providers’ experiences in caring for women of diverse cultures, during and after pregnancy. This review can help bridge the gap between women’s needs and healthcare providers’ abilities in meeting them.