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HEALTHCARE CORE CURRICULUM
RESPECTING CLIENT & STAFF
DIVERSITY
LESSON #2 CULTURAL BELIEF SYSTEMS
Dede Carr, BS, LDA
Karen Neu, MSN, CNE, CNP
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
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Cultural Belief Systems
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Competency #2
Explain the belief systems and practices of diverse
culture
 List cultures found within a healthcare setting
 Describe the belief systems cultural values,
behavior and practices, communication patterns,
& methods of perceiving, judging & organizing
daily life of the ethnic cultures and subcultures
 Describe the “isms”
 Describe belief systems related to gender
 Describe belief systems related to age.
Culture Defined
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“Culture is a set of learned values, beliefs, customs, &
practices that are shared by a group & are passed from one
generation to another.”
(Kelly, p. 124)
Culture can be defined in many different ways.
Culture is:
 Patterns of human activity
 Attitudes, values and beliefs
 An characteristic of society
 People with shared beliefs & practice
 Knowledge & sophistication
 The arts
 Growing of biological material (New World Encyclopedia)
Culture
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Culture can also be defined as:
 Common lifestyles which include language,
beliefs, traditions.
 Something that is passed on from
generation to generation.
 The lens in which we view the world.
 Something that is learned & then shared.
(New World Encyclopedia)
Culture
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Culture is a complex whole in which each part is
related to every other part.
Culture is learned, and the capacity to learn
culture is genetic, but the subject matter is not
genetic and must be learned by each in his/her
family & social community.
Culture depends on an underlying social matrix,
including knowledge, belief, art, law, morals, &
custom.
(Berman et al., p. 315)
What does culture do?
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Culture helps to determine a person’s world
view or philosophy of life.
Culture influences how each of us views our
relationship with the surrounding environment,
religion, time, and each other.
Culture provides each person with specific rules
for dealing with the universal events of life:
birth, mating, childrearing, illness, pain, & death.
(Juliar, p. 304)
Culture
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Culture provides strength & stability, but is everchanging.
Cultural groups continually face challenges from
powerful forces of environmental upheavals, wars,
natural disasters, influx of immigrants, and growth of
new technologies. As a result, cultures change &
evolve over time.
Culture is learned & then shared. Many contribute to
the teachings of culture to include parents, teachers,
religious & political leaders, & respected peers.
As people mature & grow up they internalize the
values & beliefs of their culture, & in turn share these
values & beliefs with their children.
(Juliar, p. 304)
Culture-Name Systems
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
One way the cultural beliefs and values are passed on to
the next generation is through the naming system, of
which many cultures differ from those in North
America.
In some cultures (Japanese & Vietnamese), the family name
comes first & the given name comes second. One or two
names may be added between the family and given names.
 Other nomenclature may be used to delineate gender, child,
or adult status. For example in the traditional Japanese
culture, adults address other adults by their surname
followed by san, meaning Mr., Mrs., or Miss. (Example:
Maurakami san.) the children are referred to by their first
names followed by kun for boys and chan for girls.

(Berman et al., p. 319)
Cultural Naming Systems
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
Shikhs & Hindus traditionally have three names.
 Hindus have a personal name, a complimentary name, &
then the family name.
 Shikhs have a personal name, the title Singh for men and
Kaur for women, and lastly the family last name.
Names by marriage vary also.
In Central America, a woman who marries retains her
father’s name & takes her husband’s.
 For example:, if Louisa Viccario marries Carlos Gonzales she
becomes Louisa Viccario de Gonzales. The connecting de
means “belonging to.” Their son is Pedro Gonzales Viccario.

(Berman et al., p. 319)
Culture-Name System
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It would be interesting to learn how a bicultural family
would select names as they marry and/or have children.
 Bicultural is used to describe a person who has dual
patterns of identification & crosses two cultures, lifestyles, &
sets of values (Spector, as cited in Berman et al., p. 314)
 Example: a young man with whose father is Cherokee &
whose mother is European American may honor his
Cherokee heritage while also being influences by his
mother’s cultural values.
 Another example exists in large areas of Canada where both
British & French influences are strong. (Berman et al., p. 314)
Many times culture is reflected in names & the names have
specific meanings. What does your name mean?

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Cultural Belief System
Subcultures
Subcultures
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Not only do people belong to a major culture, i.e. African
American, Medicine, Dentistry, people also belong to
subcultures.
 Subcultures are subgroups or subsystems with a large
cultural group (Berman et al., p. 314)
 Subcultures share many of the characteristics with the
primary culture but have characteristic patterns of
behaviors & ideals that distinguish it from the rest of the
cultural group. (Kelly, p. 124)
A subculture is a culture within a culture. A smaller group
with it’s own belief system and practices. (Juliar, p. 305)
Subcultures
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A sub-cultural group generally shares ethnic origin or
physical characteristics with the larger cultural group,
but may have differences too.
Examples of cultural subgroups include
Occupational groups (i.e., nurses)
 Societal groups (i.e., feminists)
 Socioeconomic groups (lower class, middle class, upper
class)
 Age groups (teens, senior citizens)
 Ethnic groups (i.e., Cajuns who are descendants of French
Acadian-17th century settlers in Canadian Nova Scotia, New
Brunswick, & Prince Edward Island)

(Berman et al., p. 314)
Diversity
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Diversity refers to the fact or state of being
different. Many factors account for diversity:
race, gender, sexual orientation, culture,
ethnicity, socioeconomic status, educational
attainment, religious affiliation, etc.
Diversity therefore occurs not only between
cultural groups but also within a cultural group.
(Berman et al., p. 314)
Culture Shock
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As America continues to be a melting pot for many
different cultures it is important to address
culture shock and talk about what it really is.
In the next few slides the following questions will
be addressed.
 What is culture shock?
 What causes culture shock?
 How does it feel?
Culture Shock
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What is culture shock?
 Culture shock is a disorder that occurs in response to
transition from one cultural setting to another so a person’s
previous behavior patterns are ineffective in such a setting,
& basic cues for social behavior are absent.
 This may happen when one moves from one geographic
location to another or when an individual immigrates to a
new country.
 It may occur when a person is admitted into a hospital & has
to adapt to a foreign or different situation.
 Expressions of culture shock may range from confusion &
anxiety to silence & immobility, to agitation, rage, or fury.
(Berman et al., p. 315)
What is culture shock?
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Culture shock is used to describe the anxiety&
nervousness that occurs when a person leaves some
place that is comfortable & familiar. Many changes
occur & the person needs to adapt to those changes.
Even though the changes can be full of excitement, it
can still be overwhelming. (Nemours Foundation)
 Example: A person has moved to a different country &
the values & beliefs that he grew up with may be
challenged. What was once normal for him may be
looked upon as being strange & different by someone
else.
(Nemours Foundation)
The important thing to remember is that culture shock
is temporary.
(Juliar, p. 305)
What causes culture shock?
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Culture shock occurs when what was once
common to someone is no longer.
 The person enters into a new and different
culture from the one they left behind. Sometimes
the cultures are similar and sometimes not.
Clothes, food, music, smells, vegetation, & the
weather are different. All of these things and
more may have changed for the person entering
into a new culture. (Nemours Foundation)
It is the differences between the cultures that make
it difficult to adjust to the changes. (Juliar)

How does culture shock feel?
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Everyone entering into a new culture will adjust to it
differently. For some people they may have been excited
about their new move. Others may have been forced to
move making the adjustment that much more difficult.
Even though everyone experiences culture shock in a
different way, the most common feelings are:
 Not wanting to be around people
who are different
 Loneliness
 Anxiety
 Sadness
 Feeling left out
 Extreme homesickness
(Nemours Foundation)
Acculturation
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The involuntary process of acculturation occurs when
people adapt to or borrow traits from another culture. The
members from the non-dominant cultural group is often
forced to learn the new culture to survive.
Acculturation can also be defined as the changes of one’
cultural patterns to those of the host society.
(Spector, as cited in Berman et al., p. 314)
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While becoming participants in the dominant culture,
members of the non-dominant cultural group are always
identified as members of the culture from which they
originated.
People immigrating to the United States from any country
will be associated with their native countries for many
years, if not all their lives.
(Berman et al., p. 314)
Assimilation
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Assimilation: the process by which an individual develops a
new cultural identity.
Assimilation means becoming like the members of the
dominant culture.
The process of assimilation encompasses various aspects,
such as behavioral, marital, identification, & civic.
Assimilation is can be described as a collection of subprocesses: a process of inclusion through which a person
gradually ceases to conform to any standard of life that
differs from the dominant group standards & at the same
time, a process through which the person learns to conform
to all of the dominant cultural group.
The process of assimilation is when the foreigner is fully
merged into the dominant cultural group (McLemore & Romo,
2005, as cited in Berman et al., p. 314)
Extrinsic Factors
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As a person adjusts and adapts to the new or
dominant culture, there are extrinsic (external)
factors that influence the individual’s personal
belief system.
Some of these factors include the processes of
adjustment or adaptation to the dominant
culture. (Juliar)
Extrinsic Factors
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Country of birth
Culture shock
Degree of acculturation
Length of residence in US
 Use of English language
 Rural or urban residence
 Occupation
 Education level
 Personality characteristics
 Previous experiences
 Socioeconomic class
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(Juliar)
Cultural Values
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A culture’s values are its ideas of what is right and
wrong, fair and just, possible and impossible.
There maybe varying values within a given
culture but none the less there are values.
The smallest arena for culture is an individual.
Someone’s personal set of decisions can
determine what is acceptable and what is not.
Cultural values differ dramatically from one
culture to another.
(Juliar, p. 306)
American Culture
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There are a large number of values that the
American culture possesses.
For learning purposes, only three (3) values will
be addressed. They are:
1. Individual Freedom
2. Family
3. Equality
(Kohls, n.d.)
American Culture-Whites
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Values that are dominate with white Americans,
especially the middle-class, include individuality,
independence, wealth, comfort, cleanliness,
achievement, punctuality, hard work, aggression,
assertiveness, rationality, an orientation to the
future, and mastery of one’s own fate.
(Andrews & Boyle; Edmission, as cited in Juliar, p. 307)
These values involve individual freedom as described in the
following slide.
American-Individual Freedom
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As individuals, we have the freedom to make our
own choices. We are free to choose where we
want to live, shop and worship.
We can vote for whomever we want and we can
go to school wherever we want.
Our freedom is expressed in how we dress and
through the tattoos that decorate our bodies.
We are free to choose who we love and whether
or not to have children.
(Kohls, n.d.)
American Culture-Family
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Another value that Americans cherish is family.
Americans define family in a variety of ways, i.e.
husband/wife, same sex couples, significant
others, couples with children, couples without,
single parent households, etc.
The purpose of the family is to provide security
and structure, happiness and accountability,
recreation and education.
“Blood is thicker than water” is a phrase that
many people use to define family. (Kohls, n.d.)
American Culture-Equality
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Americans have been raised with the saying “all men
are created equal.”
Equality is valued so strongly in America that it has
almost become a religion. Children learn equality early
in life. Just go to a child’s birthday party and see how
very important it is that everyone receives the same
size piece of cake. But equality goes beyond birthday
cakes.
Equality is desired in the workforce through equal pay
for all.
Equality is desired in the healthcare arena through
assess to care. Some people even desire that all people
receive medical insurance regardless of their
employment status. (Kohls, n.d.)
African American Culture
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African Americans tend to be focused more on people rather
than on objects making family bonding a primary core
value.
Within in the African American culture, children are the
center of the family and family extends beyond mom, dad
and the children. Family includes aunts, uncles,
grandparents, cousins, etc.
African Americans have a deep sense of spirituality.
 Christianity and Islam are 2 of the primary religions along
with a host of others.
Men and women within the African American culture tend
to have equal relationships. (Cultural Diversity Organization)
Asian Culture
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Religion is valued greatly within the Asian culture.
The primary religions of the culture are:
Buddhism, Confucianism, Hinduism, Islam, and
Christianity. (Juliar, p. 308)
Other values of the Asian people are: “group
orientation (collectivity); family cohesion and
responsibility; self-control and personal discipline;
emphasis on educational achievement; respect for
authority; reverence for the elderly (filial piety);
the use of shame for behavioral control; and
interdependence of families and individuals.” (Juliar, p.
310).
Hispanic Culture
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The Hispanic culture like many others value family as the most
important social unit. In most Hispanic families, the father is
the head of the household and the mother cares for the home.
The Catholic religion is the primary religion to more than 90% of
the Spanish-speaking world.
Elders have a hold a high place within the family structure and
are often consulted for advice.
When someone is ill within the Hispanic culture, they expect to
be taken well care of. The Hispanic people tend to live in the
present and as a result do not typically seek preventive health
care. (Juliar, pp. 310-311)
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Belief Systems
“-Isms”
“ISM”
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-ism is a suffix. Something that is placed at the
end of a word.
-ism can be defined as a “theory, a system or a
practice”, “an action, a characteristic or a
behavior.” (answers.com)
-ism is also an “attitude of prejudice against a
certain group.” (answers.com)
-ism is an oppressive & especially discriminatory
attitude or belief (Merrian-Webster INC.)
“ISMS”
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Throughout the next few slides, “isms” will be
discussed:
1.
Classism
2.
Racism
3.
Ageism
4.
Sexism
Classism
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Classism is prejudice, discrimination, mistreatment,
neglect of or lack of respect for any human and their
rational needs (food, clothing, shelter, education, respect
communication, etc.) based on people’s socioeconomic
class. (Freire, n.d.)
Criteria for measuring class is usually education,
income, occupation and wealth
Classism is extremely complex. It involves economic
exploitation, beliefs, attitudes and prejudices,
terrorization, violence, invalidation, etc.
Classism is the belief that people from certain social or
economic classes are superior to others. (Freire, n.d.)
Classism
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Simply put, classism occurs when there is
discrimination against a person, or group, because
of their economic class.
The following 4-5 minute YouTube video entitled,
Classism Stats, provides a look into classism and
some startling statistics about it.
Classism Stats
View this video and then proceed to the next slide.
Racism
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Racism is a belief that race is the primary determinant
of human traits and capacities and that racial
differences produce an inherent superiority of a
particular race. (Random House Dictionary)
Racism is a belief or doctrine that inherent differences
among the various human races determine cultural or
individual achievement, usually involving the idea that
one's own race is superior and has the right to rule
others.
(Random House Dictionary)
Racism a policy, system of government, etc., based
upon or fostering such a doctrine; discrimination.
(Random House Dictionary)
Racism
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Racism is a belief that one race is superior to another.
Racism occurs when one person hates another
because of the color of their skin, the language that
they speak, or the traditions that they uphold.
Slavery began as a result of racism because Black
African were viewed as being less than the white
Europeans.
(Global Village)
Racism exists in most countries and effects their
economic, political and cultural life.
The following (3:35 minute)YouTube video entitled,
“Racism,” is thought-provoking and poignant.
Racism
View this video and then proceed to the next slide.
Ageism
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Ageism is discrimination of a certain group based on
age: for example, seniors, young adults, and children.
Discrimination towards seniors takes on thoughts and
actions that an older person is unworthy,
unintelligent, and a burden to society. Seniors are too
old to work and are incapable of making decisions.
Young adults can be looked at as people whose hair is
too long, have too many tattoos, and expect
everything to be handed to them on a silver platter.
Children, like seniors, are often times viewed as unable
to make their own decisions and “children are to be
seen and not heard.” (Woolfe)
Ageism
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
Ageism is an attitude that discriminates, separates,
stigmatizes, or otherwise disadvantages older
adults on the basis of chronologic age. (Mosby's Medical
Dictionary)
(Woolfe)
Ageism
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“The number of Americans 65 and older is
projected to double over the next three decades
from 35.9 million to nearly 70 million,
comprising 20 percent of the population in 2030
compared to less than 13 percent now.”
(The Associated Press; Global Village)
The following video from YouTube addresses the
question, “When Do You Think Someone is Old”.
View this video
Possible Activity
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
How Old is too old…
Sexism
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Sexism is a term that began in the 20th century and
is used to define the beliefs and attitudes that
one sex or gender is inferior to the other.
Sexism is also defined as prejudice or hatred
towards one sex.
The belief that one sex is superior to the other
leads to sexual stereotyping and sexual
discrimination.
Sexual discrimination is not reserved only for the
heterosexual population but is also aimed at the
homosexual and transgender populations as
well.
(Global Village)
Sexism
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
Sexism is both discrimination based on gender
and the attitudes, stereotypes, and the cultural
elements that promote this discrimination. Given
the historical and continued imbalance of power,
where men as a class are privileged over women
as a class an important, but often overlooked, part
of the term is that sexism is prejudice plus power.
(Tekanji)
Stop & Think Activity
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Possible Activity:
“-Isms” Discussion Activity.
Cultural Belief System of Age
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
In healthcare, it is important to have some
understanding of what different eras were
like so that we can better understand our
patients.
The next few slides will address the cultural
belief system as it pertains to the era in
which the person was born.
World War II Era
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World War II lasted from 1939 – 1945. It was a war
that involved most of the world’s nations and over100
million troops.
People who were born during this era, valued very highly
the work that they did. Men went off to their jobs and the
women stayed home to raise the children.
During this time, people had a great respect for
leadership. They also had a strong work ethic. A man
would tend to “give his life” for the company where he
worked. That same man had a drive to reach the top of
the corporate ladder no matter what the cost. As men
climbed the corporate ladder, their respect for leadership
was constant. (Bosenberg)
Baby Boomers
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In 1946, after WWII ended and the troops started to
return home, babies were born. 79 million babies were
born and they are referred to as the Baby Boomers. Baby
Boomers were born between 1946 – 1964.
In the work world, the Baby Boomers favor a team
approach, however they are driven to be the star of the
team. The Boomers are impressed with authority but tend
to have friendly relationships with their bosses.
As the Boomers grew into young adulthood, a strong
emphasis on personal development came to life. (Bosenberg)
Generation X Era
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The 51 million members of Generation X, born between
1965 and 1976. Divorce and working moms created
"latchkey" kids out of many in this generation. As a
result the members of this gen X era grew up with
independence, resilience and adaptability. Generation X
feels strongly that "I don't need someone looking over
my shoulder."
At the same time, this generation expects immediate
and ongoing feedback, and is equally comfortable
giving feedback to others. Other traits include working
well in multicultural settings, desire for some fun in the
workplace and a realistic approach to getting things
done.
(Thielfoldt & Scheef)
Generation X
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Generation X saw their parents get laid off or face job
insecurity. Many of them also entered the workplace in
the early '80s, when the economy was in a downturn.
Because of these factors, they've redefined loyalty.
Instead of remaining loyal to their company, they have a
commitment to their work, to the team they work with,
and the boss they work for.

For example, a Baby Boomer complains about his
dissatisfaction with management, but figures its part of the
job. A Gen Xer doesn't waste time complaining-she sends
her resume out and accepts the best offer she can find at
another organization. (Thielfoldt & Scheef)
Generation X
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
At the same time that Generation X takes
employability seriously, there isn't a career
ladder for this generation. It’s a career lattice in
which they move laterally and stop and start.
Their career is more fluid. (Thielfoldt & Scheef)
Generation Y: The Millennial
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People who are apart of Generation Y were born in
the mid-1980's and later.
Generation Y make up for 70 million of the world’s
population.
Generation Y is the most diverse generation in
history. This population of people have been born
to teenage mothers as well as mothers who are
their 40s.
They are tech-savvy, family-centric & achievementoriented. (Kane, n.d.)
Generation Y
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Tech-Savvy: Generation Y grew up with technology
and rely on it to perform their jobs better.
 Armed with BlackBerrys, laptops, cell phones and
other gadgets, Generation Y is plugged-in 24
hours a day, 7 days a week.
 This generation prefers to communicate through
e-mail and text messaging rather than face-to-face
contact and prefers webinars and online
technology to traditional lecture-based
presentations. (Kane, n.d.)
Generation Y
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Family-Centric: The fast-track has lost much of its
appeal for Generation Y who is willing to trade
high pay for fewer billable hours, flexible
schedules and a better work/life balance.
While older generations may view this attitude as
narcissistic or lacking commitment, discipline, and
drive, Generation Y legal professionals have a
different vision of workplace expectations and
prioritize family over work. (Kane, n.d.)
Generation Y
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Achievement-oriented: Generation Y is confident,
ambitious and achievement-oriented.
 They have high expectations of their employers, seek
out new challenges and are not afraid to question
authority. Generation Y wants meaningful work and
a solid learning curve.
 Generation Y craves attention in the forms of
feedback and guidance.
 Generation Y combines the “can-do” attitude of
Veterans, the teamwork ethic of Boomers, and the
technological savvy of Generation X. (Kane, n.d.)
Cultural Belief System of Age
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Now that you learned some generalizations about
various age groups, remember that individuals in
these age ranges may be unique & not have the
characteristics described: World War II Era, Baby
Boomers, Generations X and Generations Y.
However, some of these may apply especially in
the workplace. In healthcare this may be your
coworkers as well as patients you are providing
care for.
Cultural Belief System of Age
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There are several reasons why there is a greater mix of
coworkers in the labor force than has been in the past. The
changes reflect a change in demographics, societal, and
legislative changes.
People are living longer. Since many older workers want to
continue working or can’t afford to retire, their number in
the labor force is increasing. With the elimination of the
mandatory retirement age, workers can remain in the work
force as long as they are productive.
With a change in legislative law, the older worker can be
laid off because of their higher salary (many years of
service) and be replaced with younger, less experienced
employees at a lower salary level. This allows companies
and businesses the chance to reduce costs. (Juliar, p. 372)
References
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Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008).Culture and heritage. In A.
Berman, S.J. Snyder, B. Kozier, & G. Erb (Eds.). Kozier & Erb’s Fundamentals of
nursing: Concepts, process, and practice (8th ed.) (pp. 311-329). Upper Saddle
River, NJ: Prentice Hall

Bosenberg. M.(2011, March 2). The Population Baby Boom of 19461964 in the United States Retrieved from
http://geography.about.com/od/populationgeography/a/babyboom.htm
Culture Diversity Organization. (1997-2008).Transcultural nursing: Basic
concepts and case studies. Retrieved from
http://www.culturediversity.org/index.html
Freire,P. (n.d.). The Politics of Education. Retrieved from
http://renew.education.ucsb.edu/downloads/overheads_handouts/class.pdf
Global Village. (2006). Prejudice: Ageism. Retrieved from
http://www.globalvillage2006.org/en/find_out_about/prejudice/ageism
References
61
Juliar, K. (2003) Minnesota Healthcare Core Curriculum (2nd ed.). Clifton
Park, NY: Delmar Publishers
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