Culturally Sensitive Care

Culture is defined as the learned beliefs, values, and attitudes that influence an

individuals thinking, decisions, and actions and allows them to be accepted by a community of

individuals (College of Nurses of Ontario, 2009).

Culturally sensitive care is refers to providing patient and family-centered care in the

context of recognizing the patients culture and the nurses culture, and how this affects the

nurse-patient relationship. All the attributes of the nurse, including age, gender, past

experiences, strengths and weaknesses, have an impact on the interaction with the client.

Through reflection, learning and support, nurses will be better able to strengthen the quality of

care they provide to the diverse communities they serve (College of Nurses of Ontario, 2009).

Nurses should understand that everyone has a culture, and while culture can be

influenced by many things, ultimately, ones culture refers to the learned values, beliefs, norms

and way of life that influence an individuals thinking, decisions and actions in certain ways

(College of Nurses of Ontario, 2009).

Culturally-sensitive care needs to be a core clinical skill taught in an undergraduate

nursing program because nurses have the opportunity to interact with families of varying cultures

on a daily basis. They must be culturally competent, or knowledgeable of elements of others

culture, and be able to effectively assess, manage, and teach patients in a way that incorporates

and is respectful of their patients culture (AACN, 2008). Being aware of ones own culture and

knowing how this affects the nurse-patient relationship is essential to providing the best patient

care.

CONCEPT: Culturally Sensitive Care
Educational Program: Four Year BSN Program Two Year ADN Program
Competency
Level 1 Competency
Blooms Level: 2
A practitioner who
understands the meaning of
culturally-sensitive care.
Level 2 Competency
Blooms Level:3
A practitioner who applies the
knowledge of culturally-
sensitive care to ones patient providing culturally-sensitive
and family.
Level 3 Competency
Blooms Level: 4
A practitioner who is able to
deconstruct their personal
values and beliefs related to
culture.
Level 4 Competency
Blooms Level: 5
A practitioner who constructs
a nursing plan of care
centered on a patients
culture.
Core Concept Teaching Strategies
Learner Objective(s) Teaching Strategies
1. Recognize factors that 1. Cultural Reflection and self-
contribute to ones own assessment activity
culture.
2. Family history assignment
2. Identify factors that make up a
patients culture.
1. Demonstrate a 1. Cultural Fair
comprehensive
understanding of various
cultures.
2. Apply knowledge of cultures to 2. Culturally-themed nursing
skills day
care.
1. Examine ones own cultural 1. Animal Activity Game
beliefs and biases.
2. Analyze how ones culture may 2. Watch a movie
affect the care of a patient of a
different culture.
1. Assess a patients cultural 1. Simulation
needs and recommend changes to
teaching strategies.
2. Explain why certain cultural 2. Case Study
interventions are implemented
for a patient.
 NAME OF LEARNING Cultural Reflection and Self-assessment
ACTIVITY
Learning Activity Students are asked to explore their own cultural backgrounds including:
Summary family origin, advantages and disadvantages of belonging to own
ethnic/racial group, own biases about own and other cultural groups,
similarities and differences between own group and others groups. They
will share this information in class first in small groups, and then as a class
discussion.

Cognitive: apply (3), analyze (4), evaluate (5)

Domain of Learning Affective: receive (1), respond (2), value (3)

(Blooms Taxonomy Revised)
Psychomotor: articulate (4)

Student-Centered Learning At the completion of this learning activity, the learner will:
Objective(s)
1. Recognize factors that contribute to ones own culture.

2. Identify factors that make up a patients culture.

Preparation Required by Teacher will need to instruct group to do some investigation and
Teacher/Facilitator and preparatory work prior to class to facilitate deep discussion. Questions to
Materials Needed help facilitate discussion should also be prepared ahead of time.

Time Allotted 30-40 minutes (including reflection)

Learning Styles Addressed Information presentation: _sight Xsound _text
by Activity
Modality: _visual Xverbal

Approach: Xactive Xreflective

Understanding: _sequential Xholistic

How is content connected to Students will spend time on their own researching their culture and
prior learning? reflecting on what their own beliefs are prior to coming to class and
discussing with others.
Reflective Debriefing with Debriefing will take place within the group discussion and then on a larger
Learners (post-learning scale with the class as a whole. Debriefing will focus on what similarities
activity) How will it be and differences came up in the discussion of culture, and what stereotypes
accomplished? were common.
Evaluation of Learning Students will spend time at the end of class reflecting on one thing they
(How will it be accomplished?) learned from this activity as a part of the debriefing. Everyone is the class
will be asked to share.
Teacher Reflection As one of the early activities within the curriculum, students have an
opportunity to learn about their own culture and do some reflection on this
(justify choice of learning culture as it relates to other cultures, before applying it to nursing and
activity and good fit for the patient care/care planning. It meets to objective of recognizing what
identified learning objectives) contributes to their own culture.
 NAME OF LEARNING
ACTIVITY
Family history assignment
Learning Activity Students will construct their family history including creating a genogram
Summary (pictorial display of a family and their relationships) and an ecomap (a
diagram that shows the social and personal relationships of an individual
with his or her environment) of resources.

Cognitive: understand (2), evaluate (5)

Domain of Learning Affective: value (3), organize (4)

(Blooms Taxonomy Revised)
Psychomotor: articulate (4)

Student-Centered Learning At the completion of this learning activity, the learner will:
Objective(s)
1. Recognize factors that contribute to ones own culture.

2. Identify factors that make up a patients culture.

Preparation Required by The teacher will have to spend some class time going through how to
Teacher/Facilitator and create a genogram and an ecomap so that students are aware of what the
Materials Needed assignment entails. In addition, a sample of both displays should be made
available to students.
Time Allotted 2-3 hours, completed outside of class
Learning Styles Addressed by Information presentation: _sight _sound Xtext
Activity
Modality: _visual Xverbal

Approach: Xactive _reflective

Understanding: Xsequential _holistic

How is content connected to Students will have an introduction to the material, have a sample made
prior learning? available as most of this activity will be new material. Students will most
likely have a prior understanding of their familys history.
Reflective Debriefing with Reflection will take place in the following class where students will
Learners (post-learning complete a one minute paper describing what they learned from creating
activity) How will it be these 2 displays of their familys history.
accomplished?
Evaluation of Learning A grading rubric will be used to evaluate if all parts of the assignment were
(How will it be completed.
accomplished?)
Teacher Reflection Students will have an opportunity to do a deeper reflection into their
family history and culture. This will allow them to recognize factors that
(justify choice of learning they maybe did not realize made up their culture, and it will allow them to
activity and good fit for the better identify what factors are considered when others refer to their
identified learning objectives) culture.
 NAME OF LEARNING Cultural Fair
ACTIVITY
Learning Activity Students will choose groups of 4-5 people and pick a culture to provide a
Summary poster presentation on. Topics to include on poster would be: How the
culture defines family, how success is defined in that culture, religion that
is most prevalent in the culture, roles of men and women within the
culture, prominent language within the culture, important holidays and
their meaning, how physical contact is viewed in the culture, foods that
are common, any specific values or traditions.

Cognitive (identify level): remember (1), apply (3), create (6)

Domain of Learning Affective: receive (1), respond (2), value (3)

(Blooms Taxonomy Revised)
Psychomotor: imitate (1) ,manipulate (2), articulate (4)

Student-Centered Learning At the completion of this learning activity, the learner will:
Objective(s)
1. Demonstrate a comprehensive understanding of various cultures.

2. Apply knowledge of cultures to providing culturally-sensitive care.

Preparation Required by The teacher will need to supply poster boards needed for the presentation.
Teacher/Facilitator and In addition, she will have to secure a space large enough for many
Materials Needed students to set up posters and for students to migrate through
presentations.
Time Allotted 50 minutes
Learning Styles Addressed Information presentation: Xsight _sound Xtext
by Activity
Modality: Xvisual Xverbal

Approach: Xactive _reflective

Understanding: Xsequential _holistic

How is content connected to Students will have the opportunity to learn in great detail about a specific
prior learning? culture on their own, then throughout the fair, learn about other cultures
and compare and contrast this culture with the one they learned about,
and their own culture.
Reflective Debriefing with Students will complete a brief, online debriefing following the cultural fair.
Learners (post-learning The teacher will be present in the online debriefing as well, to facilitate
activity) How will it be discussion points.
accomplished?
Evaluation of Learning There will be a participation grade for participation in the online
(How will it be debriefing. The teacher will use the debriefing as a formative evaluation of
accomplished?) learning based on student responses.
Teacher Reflection This meets the objectives because students gain an understanding of a
variety of cultures within a short time period. It is student centered
(justify choice of learning because students acquire knowledge at their own pace during this activity,
activity and good fit for the but should know what information they are looking for from their own
identified learning objectives) poster.
 NAME OF LEARNING Culturally Themed Nursing Skills Day
ACTIVITY

Learning Activity Nursing students rotate from one skills station to another. Students
Summary complete physical skills at each station, and each station has its own
cultural scenario to go with specific nursing skills.

Cognitive (identify level): create (6)

Domain of Learning Affective: receive (1), respond (2), value (3)

(Blooms Taxonomy Revised)
Psychomotor: articulate (4)

Student-Centered Learning At the completion of this learning activity, the learner will:
Objective(s)
1. Describe how cultural diversity affects working relationships and
the nurse-patient relationship
2. Identify one way to incorporate culturally-sensitive care into
practice for each of the cultures represented.

Preparation Required by This requires significant preparation by the teacher as many different
Teacher/Facilitator and scenarios will have to be created. Finding additional instructors to
Materials Needed facilitate the skills stations needs to be completed ahead of time. The
skills stations must also be set up ahead of time.
Time Allotted 50 minutes
Learning Styles Addressed Information presentation: Xsight Xsound _text
by Activity
Modality: Xvisual Xverbal

Approach: Xactive _reflective

Understanding: _sequential Xholistic

How is content connected to Students must have knowledge of many cultures and their implications
prior learning? such as with the cultural fair before being able to implement these cultural
principles to patient care. If students do not have a foundation from other
classes or the cultural fair, pre-learning must be assigned prior to this
activity.
Reflective Debriefing with Group debriefing should take place at the end of the skills stations as a
Learners (post-learning group. The teacher should facilitate questions and answers related to the
activity) How will it be working relationship between the nurse and patient and how this changed
accomplished? based on the skills station.
Evaluation of Learning A questionnaire was given to each student at the end of the skills stations
(How will it be to evaluate if learning occurred. In addition, observation was used by the
accomplished?) nursing instructor to see if students were properly assessing and
implementing care based on the cultural implications.
Teacher Reflection Although this activity requires a lot of planning prior to implementation,
it allows students to complete psychomotor as well as cognitive and
(justify choice of learning affective skills, to create a holistic, student-centered activity. It also allows
activity and good fit for the them to identify their professional role in working with patients with
identified learning objectives) diverse backgrounds.
 NAME OF LEARNING Animal Assignment Activity
ACTIVITY
Learning Activity Assign a different area of the room to each of three different animals:
Summary lions, turtles, cats. Ask the group to think about the qualities of each
animal and then decide which animal they are most like; remind them
that its important they go with their heart rather than their head on this.
Ask them to go the part of the room for their animal. Once everyone has
found their appropriate place, ask the groups to spend a minutes
discussing among themselves what is good about being the animal they
chose and what they can learn from the other three animals.

Cognitive: apply (3), analyze (4), evaluate (5)

Domain of Learning Affective: receive (1), respond (2), value (3)

(Blooms Taxonomy Revised)
Psychomotor: manipulate (2)
Student-Centered Learning At the completion of this learning activity, the learner will:
Objective(s)
1. Articulate what culture is and discuss the implications for a nurse
2. Recognize cultural biases in oneself and identify ways to reduce
these biases

Preparation Required by Preparation for this activity should be minimal. The teacher should have
Teacher/Facilitator and discussion points for the activity prepared ahead of time to help facilitate a
Materials Needed good flow to the activity. Reflection questions for the end of the activity
should also be prepared.
Time Allotted 15 minutes
Learning Styles Addressed Information presentation: _sight Xsound _text
by Activity
Modality: _visual Xverbal

Approach: Xactive Xreflective

Understanding: Xsequential Xholistic

How is content connected to Prior learning in other courses includes reflecting on their own cultures.
prior learning? This is then tied into the debriefing segment.
Reflective Debriefing with Debriefing should be built into the game itself, questions include:
Learners (post-learning
activity) How will it be 1. Are there times when you have made a judgement a patient
accomplished? whose culture is different than yours?

2. How can we as nurses ensure that we do not let our own culture
affect our interactions with our patients?

Evaluation of Learning Learning will be accomplished through a reflection following the activity.
(How will it be Students will talk about how if what they learned in the activity changes
accomplished?) their practice.
Teacher Reflection This is a fun, interactive, student-centered activity that engages students
and makes them reflect on culture and biases from a non-threatening
(justify choice of learning perspective of animals. Students can freely talk about opinions and beliefs
activity and good fit for the and how stereotypes are formed in a safe context.
identified learning objectives)
 Watch a movie

NAME OF LEARNING
ACTIVITY
Learning Activity Students will view the movie Zootopia and complete a reflection on the
Summary movie and how this relates to providing culturally sensitive care to
patients. Students will also reflect on a situation where they made a
judgement before grasping the full details of a situation.

Cognitive : Understand (2), apply (3), analyze (4), evaluate (5)

Domain of Learning Affective: value (3), organize (4)

(Blooms Taxonomy Revised)
Psychomotor: articulate (4)

Student-Centered Learning At the completion of this learning activity, the learner will:
Objective(s)
1. Examine ones own cultural beliefs and biases.

2. Analyze how ones culture may affect the care of a patient of a

different culture.

Preparation Required by Teacher will need to make sure that movie is accessible to all students
Teacher/Facilitator and either through a group viewing, or making it available to students for
Materials Needed borrowing. Teacher will also need to have viewed the video to be able to
provide additional insight to students reflection.
Time Allotted 2 hours for the movie, 2 hours to complete reflection assignment
Learning Styles Addressed Information presentation: Xsight Xsound Xtext
by Activity
Modality: Xvisual _verbal

Approach: Xactive Xreflective

Understanding: _sequential Xholistic

How is content connected to Students will complete active learning during viewing of the movie and
prior learning? reflective learning during their reflection.
Reflective Debriefing with Debriefing will take place within the assignment itself, as students reflect
Learners (post-learning on what they learned and how it relates to the care they provide as nurses.
activity) How will it be
accomplished?
Evaluation of Learning A rubric will be used to ensure students responded to and met all the
(How will it be learning points for this activity.
accomplished?)
Teacher Reflection This assignment is fun and different from most others. It gives students
the opportunity to gain context from a situation that is not as
(justify choice of learning straightforward as a patient scenario. It also allows students to reflect on
activity and good fit for the personal beliefs and biases and how these may have created a challenge in
identified learning objectives) a real life situation.
 Simulation

NAME OF LEARNING
ACTIVITY
Learning Activity Students will work through a scenario where a patient in a critical
Summary situation has folk explanations for his illness and symptoms, rather than
biomedical explanations. The student will have to provide the best
medical care while being culturally sensitive.

Cognitive (identify level): remember (1), apply (3), create (6)

Domain of Learning Affective: receive (1), respond (2), value (3), organize (4), internalize (5)
(Blooms Taxonomy Revised)
Psychomotor: imitate (1), perfect (3), articulate (4), embody (5)

Student-Centered Learning
Objective(s)
At the completion of this learning activity, the learner will:
1. Assess a patients cultural needs and recommend changes to
teaching strategies.
2. Explain why certain cultural interventions are implemented for a
patient.

Preparation Required by The physical environment including mannequin and supplies must be
Teacher/Facilitator and prepared ahead of time. Equipment should be tested for functionality.
Materials Needed The scenario in its entirety will need to be prepared ahead of time as well.
Time Allotted 50 minutes
Learning Styles Addressed Information presentation: Xsight Xsound _text
by Activity
Modality: Xvisual Xverbal

Approach: Xactive Xreflective

Understanding: Xsequential Xholistic

How is content connected to At this point, students should have a strong foundation in cultural
prior learning? awareness and sensitivity. This activity allows them to apply what theyve
learned into a patient scenario.
Reflective Debriefing with After the simulated activity, as reflective debriefing will take place as a
Learners (post-learning group. Students will talk about what went well and what some challenges
activity) How will it be were during the simulation, and reflect on the challenges of providing
accomplished? culturally-sensitive care during a critical situation.
Evaluation of Learning Learning will be evaluated during students reflections in the debriefing,
(How will it be when they share their thoughts on how the simulation went.
accomplished?)
Teacher Reflection The simulated scenario meets the objectives because it allows students to
assess and implement, as well as use critical thinking to explain certain
(justify choice of learning interventions should be utilized. In addition, it meets many levels and
activity and good fit for the domains of learning as a level 4 competency should.
identified learning objectives)
 Case Study

NAME OF LEARNING
ACTIVITY
Learning Activity Students are assigned to groups and given a variety of case studies of
Summary patients from many cultures and their responses to medical interventions
that may seem abnormal for a nurse that is not well-versed in providing
culturally-sensitive care. Students will work through the case scenario in
groups, and then share findings with the class.

Cognitive: understand (2), apply (3), analyze (4), evaluate (5)

Domain of Learning Affective: respond (2), value (3), organize (4)

(Blooms Taxonomy Revised)
Psychomotor: articulate (4)

Student-Centered Learning At the completion of this learning activity, the learner will:
Objective(s)
1. Assess a patients cultural needs and recommend changes to
teaching strategies.
2. Explain why certain cultural interventions are implemented for a
patient.

Preparation Required by The teacher will need to prepare several individual case studies and
Teacher/Facilitator and questions for the groups to discuss. In addition, questions for reflection
Materials Needed may need to be prepared in case the students are struggling to come up
with talking points.
Time Allotted 20 minutes
Learning Styles Addressed Information presentation: Xsight _sound Xtext
by Activity
Modality: _visual Xverbal

Approach: Xactive Xreflective

Understanding: Xsequential Xholistic

How is content connected to At this point, students should have a strong foundation in cultural
prior learning? awareness and sensitivity. This activity allows them to apply what theyve
learned into a patient scenario.
Reflective Debriefing with Debriefing will take place through class discussion when findings from
Learners (post-learning individual case studies are shared with the class.
activity) How will it be
accomplished?
Evaluation of Learning At the end of the class, students will be asked to list a nursing intervention
(How will it be made in another groups scenario and describe why it was implemented.
accomplished?)
Teacher Reflection This meets the objectives because it allows students to make cultural
assessments and recommendations, and reflects a deeper level of
(justify choice of learning understanding for students at a higher level of competency. It allows the
activity and good fit for the students to put to use all the skills theyve learned thus far.
identified learning objectives)
 References

American Association of Colleges of Nursing. (2008). Tool Kit of Resources for Cultural
Competent Education for Baccalaureate Nurses. Retrieved from:
http://www.aacn.nche.edu/education-resources/toolkit.pdf

College of Nurses of Ontario. (2009). Culturally sensitive care: Practice Guideline. Retrieved
from: http://www.cno.org/globalassets/docs/prac/41040_culturallysens.pdf

Gears, M. & Andes, J. (2013). Improving cultural knowledge through a culturally themed
nursing skills day. The Journal of Continuing Education in Nursing, 44 (5), 201-202.

Hermann, J.W. (2016). Creative teaching strategies for the nurse educator (2nd ed). Philadelphia,
PA: F.A. Davis Company.