Respecting Client & Staff Diversity
Healthcare Core Curriculum
Respecting Client & Staff Diversity
Module Description
This module provides a framework for dealing with diverse clients/individuals and
staff.
Belief systems, cultural practices, respect and sensitivity to cultural issues, gender
issues and sexuality issues are included.
Awareness and use of effective strategies to appropriately deal with client and staff
diversity are emphasized.
Module Outline and Instructor Resources
This module consists of 5 competencies for students to master.
These competencies are listed on the following slide and will be addressed
throughout the remainder of the power point.
Each competency is taught through a series of units which include suggested
assignments for students to complete to learn the competency. Feel free to use the
assignments or develop your own.
Module Outline and Instructor Resources
Find these learning activities and resources on the website or create your own.
The Course Outline also has documents that the instructor can use in teaching the
lesson.
These competencies are listed on the following slide and will then be addressed
throughout the remainder of the Power Point.
Module Competencies
Describe one’s personal belief system.
1. Explain the belief systems and practices of diverse cultures.
2. Explore personal responsibility as a healthcare employee to treat each person as
an individual (customer service).
3. Discuss the appropriate workplace expectations to interact with team members
and care for clients/individuals from diverse cultures, genders, age groups and/or
sexual orientations.
4. Using a problem solving process applied to healthcare situations, describe how
healthcare employees can respect client and staff diversity.
Competency 1
Competency 1
Describe one’s own personal belief system.
Units included in this competency are:
• Discuss the role of culture in developing a belief system.
• Explain what is meant by a belief system.
• Identify the learner’s personal belief system.
• Identify extrinsic factors that may influence personal belief systems.
Discuss the role of culture in developing a
belief system
Recommended Content
From the moment of birth, we begin developing a belief system. We all live our lives
under a belief system, but not many of us are aware of our belief system. We tend
to take things for granted and may just assume everything will work out for the good.
On the following slide, some highlights of a person’s belief system that author R. T.
Kelly addresses in the book Cultural and Ethnic Considerations, are noted for
background information for you.
Discuss the role of culture in developing a
belief system
• A persons’ belief system is heavily influenced by their culture and values passed
from generation to generation.
• Culture is learned from significant people in one’s life and as a one grows up, one
internalizes the values and beliefs of one’s culture.
• So…. one’s culture plays a significant role as one is developing a belief system.
• It is our beliefs that guide our behaviors, communication, and lifestyle.
• Some of the things included in a person’s belief system are one’s religious beliefs,
political beliefs and ethical beliefs.
• Beliefs guide the choices that a person makes and the how a person lives with
those choices.
Kelly, R.T. (2006).
Discuss the role of culture in developing a
belief system
The curriculum states that culture is composed of common aspects such as
lifestyle, language, tradition, rules, and values.
This is all true and yet culture is also what is taught to us and passed down from
one generation to the next.
The following slides will address the role of language within a culture and lifestyle
as it pertains to the family.
Discuss the role of culture in developing a
belief system
Language
One of the most apparent communication variation is language. Language variations might
involve no understanding of each other’s language, to situations where one can understand
the other’s language, but has limited skills in speaking the language. Although both parties
may speak English, there may be different meanings for words in the English language.
Communication patterns reflect core cultural values of a society. Some cultures value
individualism while others value group harmony.
Discuss the role of culture in developing a
belief system
Differences in status and position, age, gender and outsider versus insider
determine the content and process of communication.
For example, among Asian cultures, face-saving communication promotes harmony
by indirect communication and avoidance of conflict. In this culture, messages
spoken often have little to do with their meanings. Saying “no” to a superior or older
adult is not permissible, hence an affirmative response will only mean “I heard you”
rather than full agreement. This has important implications in in the healthcare
setting because the healthcare provider can be perceived as a person of authority to
some Asian, African, or Hispanic clients. Observing a client’s behavior and clarifying
messages heard from a trusted insider will prevent misinterpretation. Potter, P.A. and Perry, A.G. (2009).
Discuss the role of culture in developing a
belief system
Lifestyle within the Family
The description of family (types/structure) may vary among cultures: nuclear,
extended, single-parent, blended, etc.
Some of the family structures are based on biological relationships. Others are
based on meeting basic needs of the family by forming a group of unrelated
individuals.
Potter, P.A. and Perry, A.G. (2009).
Discuss the role of culture in developing a
belief system
Lifestyle within the Family
Intergenerational support and patterns of living arrangements are related to cultural
background. For example, traditional Chinese, African-American, Japanese, and
Hispanic persons are more likely to live in extended family households than are their
white counterparts. A common mistake for healthcare workers is to assume that
every family is a traditional nuclear family.
It’s more important to know whom the patient depends on for comfort and decisionmaking and how the patient describes family.
Kelly, R.T. (2006).
Discuss the role of culture in developing a
belief system
Value placed on children and elders within society are culturally derived.
In some cultures children are not disciplined by spanking or other forms of physical
punishment. Rather, children are allowed to interact with their environment while caregivers
provide subtle directions to prevent harm or injury.
In other cultures, elders are considered the holders of the culture’s wisdom and therefore are
highly respected.
Responsibility for care of older relatives is determined by cultural practices. In many cultures,
older relative who cannot live independently live with a married son or daughter and family.
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Discuss the role of culture in developing a
belief system
Tips for presenting the material
Students may proudly share some their family make-ups. This can be a sensitive
issue for some, especially those students who have no family -- perhaps because of
growing up in the foster care system or having cut all ties with their family members.
Students may also share forms of discipline that have been passed down from one
generation to the next. Such conversations can be hard to monitor and hard to
keep judgment out of the conversation.
Personal Belief System
Recommended Content
A person’s belief system is comprised of their cultural values.
A person does not have control over their gender, race, age or which family they
were born into, however, these attributes play a critical part in a person’s belief
system.
For example, a man may believe that he should get paid more than a woman
because he is the head of the household.
Another example: The youngest child in the family may have a more lenient
curfew because mom and dad have eased up over the years. Their belief system
has shifted.
One’s belief system does, however, determine one’s political affiliation,
religious/spiritual practices, and profession.
New World Encyclopedia. (2007)
Personal Belief System
Cultural Values
Values which support the belief and behaviors that are accepted within each culture pertain
to:
Age
Gender
Family
Religion/spirituality
Time orientation
Politics
Behavior and practices
Personal Belief System
The 7 cultural values listed on the previous slide all play an important role in a
person developing their own belief system.
These values influence and guide a person’s behavior and communication.
Many of the values are set such as gender, age, traditional practices.
One value that is so critical in healthcare and throughout life is timeliness.
Time can be culturally learned -- some students understand the value of timeliness
and being on time, while others struggle with it daily. Having a better understanding
of time within various cultures can help us to better understand our students.
Personal Belief System
Timeliness among healthcare workers varies and conflicts can arise when a
healthcare worker is always late for work. It is important to discuss reasons for this,
rather than to assume the person does not care about the job. If it is due to a
cultural belief, the health care staff involved needs to develop a strategy to solve the
problem.
Perception of time (time orientation) can be future-oriented or present-oriented.
Kelly, R.T. (2006).
Personal Belief System
Perception of time (time orientation) can be future-oriented or present-oriented.
Many people in the United States are future-oriented; African American, Hispanic,
and American Indian tend to be present-oriented.
If a pregnant woman is a member of the present-oriented culture, she may miss an
appointment because of a current family need. She sees the present need as much
more urgent than keeping an appointment related to an event that is several months
away.
Kelly, R.T. (2006).
Personal Belief System
The measurement of time can have different meanings in various cultures.
The United States and Northern European cultures regard being on time for
appointments as a high priority. Expectations that all individuals will follow this
pattern. Japanese Americans are generally prompt and adhere to fixed schedules,
especially when meeting someone of high regard.
Many other cultures may feel that other concerns are more important.
Kelly, R.T. (2006).
Personal Belief System
Some Asians spend time getting to know someone and may view abrupt endings to
conversations as rude.
Mexican-Americans may be late for an appointment because they are more concerned with a
current activity than going to a previously planned meeting.
This is known as “elasticity” and implies that future-oriented activities can be recovered but
present-orientated activities cannot.
When a patient is late for an appointment, fails to come at all, or does not follow a therapeutic
schedule, the healthcare worker who does not understand these cultural differences may be
angry.
Kelly, R.T. (2006).
Personal Belief System
Value placed on children and elders within society are culturally derived.
In some cultures children are not disciplined by spanking or other forms of physical
punishment. Rather, children are allowed to interact with their environment while
caregivers provide subtle directions to prevent harm or injury.
In other cultures, elders are considered the holders of the culture’s wisdom and are
highly respected.
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Personal Belief System
With the continued appearance of American society changing and traditional
cultures blending and assimilating with each generation, all cultures bring to the
healthcare arena their own views of what needs to happen to remain healthy or seek
healthcare.
As healthcare educators, it is critical to be aware of the three types beliefs
hypothesized by Berman:
1. Magico-Religious health belief view
2. Scientific or biomedical health belief view
3. Holistic health belief view
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Personal Belief System
In the Magico-religious health belief view,
health and illness are controlled by supernatural forces.
The client may believe that illness is the result of “being bad” or opposing God’s will.
Getting well is also viewed as dependent on God’s will. The client may use
statements such as, “If it is God’s will, I will recover” or “What did I do wrong to be
punished with cancer?”
Some cultures believe that magic can cause illness or that a sorcerer or witch may
put a spell or hex on the client. Some people view illness as possession by an evil
spirit.
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Personal Belief System
Scientific or biomedical health belief is based on the belief that life and life
processes are controlled by physical and biochemical processes that can be
manipulated by humans.
The client with this view will believe that illness is caused by germs, viruses,
bacteria, or a breakdown of the human body. The client will expect a pill, or
treatment, or surgery.
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Personal Belief System
Holistic health belief holds that forces of nature must be maintained in balance or
harmony. Human life is one aspect that must be in harmony with the rest of nature
and when the natural balance or harmony is disturbed, illness results.
The North and South America Native Americans use the medicine wheel as an
ancient symbol to express many concepts for health and wellness, it teaches four
aspects of the individual’s nature: physical, mental, emotional and spiritual. The four
dimensions must be in balance to be healthy. The medicine wheel can also be used
to express the individual’s relationship with the environment as dimension of
wellness.
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Personal Belief System
Examples of the holistic health belief view include: the concept of yin and yang in
Chinese culture and the hot-cold theory of illness in many Spanish cultures.
In the hot-cold theory, people believe that certain conditions are “cold,” such as a
new mother who delivered a baby. To treat the new mother, warm or hot foods and a
blanket are provided.
Many cultures believe that the best way to treat a fever is increase an elimination of
toxins through sweat baths.
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Personal Belief System
Remember that the 3 various health belief views provides the educator a brief
understanding of the where our students are coming from and who our students will
be caring for:
1. Magico-Religious health belief view
2. Scientific or biomedical health belief view
3. Holistic health belief view
Extrinsic factors that influence personal
belief systems.
Recommended Content
The curriculum addresses the issue of identifying extrinsic factors and how these
factors shape a person’s belief system.
The following slides will be discussed:
• Culture shock
• Assimilation
• Acculturation
As America continues to be a melting pot for many different cultures and as our
classrooms represent that melting pot, it is important to address culture shock, talk
about what it really is, and how our own cultural shock and that of our patients can
influence the therapeutic process.
Extrinsic factors that influence personal
belief systems.
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, and basic cues for social behavior are absent.
Expressions of culture shock may range from confusion and anxiety to silence and
immobility, to agitation, rage or fury.
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Extrinsic factors that influence personal
belief systems.
Culture shock is used to describe the anxiety and nervousness that occurs when a
person leaves some place that is comfortable and familiar. Many changes occur
and the person needs to adapt to those changes. Even though the changes can be
full of excitement, it can still be overwhelming.
The important thing to remember is that culture shock is temporary.
Juliar, K. (2003); Nemours Foundation. (1995-2011).
Extrinsic factors that influence personal
belief systems.
Everyone entering into a new
culture will adjust to it differently.
For some people, it may mean they
are/were 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. (1995-2011).
Extrinsic factors that influence personal
belief systems.
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. 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, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Extrinsic factors that influence personal
belief systems.
Assimilation: the process by which an individual develops a new cultural identity.
Assimilation means becoming like the members of the dominant culture.
Assimilation can be described as a collection of sub-processes: a process of
inclusion through which a person gradually ceases to conform to any standard of life
that differs from the dominant group standards and 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.
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).
Competency 1: Personal Belief System
Recommended Learning Activities
Assignment
Location
Notes
Review Vocabulary List
On Website and in Module Outline
and Instructor Resources Document
Review Vocabulary List with students
Examples of Cultural
Misunderstandings in Healthcare
On Website and in Module Outline
and Instructor Resources Document
Discuss in Class
RCS Competency 1: Self
Assessment:
Assignment on website
This assignment allows students to assess
their cultural competency and reflect on their
subcultures.
RCS Competency 1: Cultural
Diversity Journal
Assignment on website
Students journal on personal beliefs and
values.
RCS Competency 1: Family and
Cultural Influences:
Assignment on website
Students reflect on their parents values and
culture and how they relate to those.
Competency 2
Competency 2
Explain the belief systems and practices of diverse cultures.
• List cultures found within a healthcare setting.
• Describe the belief systems (cultural values, behavior practices, communication
patterns, and methods of perceiving, judging, and organizing daily life) of ethnic
cultures and subcultures.
• Describe the “-isms.”
• Describe the belief systems pertaining to age.
Belief System of Various Cultures
Recommended Content
During this part of the curriculum of Respecting Client and Staff Diversity, students
will be exploring and discussing belief systems of various cultures.
The curriculum asks the instructor to address 3 of the following cultures with the
students. However, cultures do not need to be limited to this list:
• African American
• Native American
• Asian
• Hispanic
• Latino
• Caucasian
Belief System of Various Cultures
The following 3 slides will briefly introduce the instructor to 3 different cultures:
• African American
• Asian
• Hispanic
Tips for presenting the materials
These slides provide a taste of each culture and yet in class, discussions provide for
lively debates. Remind students to be respectful and share from their own
experiences. Each experience is valid and unique, as some of us are recent
immigrants, and some are several generations removed. Some of us have several
ethnic experiences from different sides of the family to draw from.
Belief System of Various Cultures
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.
Culture Diversity Organization. (1997-2008).
Belief System of Various Cultures
Religion is valued greatly within the Asian culture. The primary religions of the
culture are Buddhism, Confucianism, Hinduism, Islam and Christianity.
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, K. (2003).
Belief System of Various Cultures
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 for more than 90% of the Spanish-speaking
world.
Elders 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, K. (2003).
Describe the “-isms”
Recommended Content
Students live with –isms everyday and yet may not understand the meaning behind them.
An -ism is a suffix, or something placed at the end of a word.
An -ism can be defined as a “theory, a system or a practice” or “an action, a characteristic
or a behavior.”
Words that end in -ism may portray an “attitude of prejudice against a certain group.”
The –ism suffix tends to be an oppressive and especially discriminatory attitude or belief.
Describe the“-isms”
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. 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,P. (n.d.).
Describe the“-isms”
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.
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.
Racism is a policy, system of government, etc., based upon or fostering such a
doctrine; discrimination.
Describe the“-isms”
Ageism is prejudice or discrimination against a particular age-group, especially the
elderly. Ageism may also apply to young adults or children
Sexism is prejudice or discrimination based on sex, usually against women. Sexism
may also be defined as behavior, conditions, or attitudes that foster stereotypes of
social roles based on sex
Describe the“-isms”
Recommended Learning Activities
Assignment
Topic
Resources
Notes
Ageism
YouTube video “When Do You Think
Someone is Old”
Assignment on website can be used as a class
discussion.
Class Discussion
Ableism
Movie: “My Left Foot”
Racism
A Class Divided
RCS Competency 3 Movie a Class
Divided:
Students watch the movie and answer reflected
questions.
Describe the belief systems pertaining to
gender
Recommended Content
There are more males entering the previously predominant female occupations of nursing and healthcare.
This brings another subculture and possibilities for stereotyping, biases, and prejudices.
Even though women and men are more similar than different, some communication patterns are identifiably
different.
The key to working effectively with the opposite gender is to recognize communication differences and
realize enormous contributions each style brings to the workplace.
While men can be more direct and get right to the point, women often bring valuable interpersonal skills to
the workplace. Both men and women are effective problem-solvers. Men usually think of one thing at a time
and women tend to consider several things at once.
Juliar, K. (2003).
Describe the belief systems pertaining to age
Recommended Content
In healthcare, it is important to have some understanding of what different eras were
like so that we can better understand our patients/clients.
Many of our students fall into the Generation Y category and are unaware of
various eras and/or characteristics of them. It is critical for students to have a brief
understanding of the various eras because someday they will be caring for
patients/clients whose ages span over several decades and generational thinking.
Describe the belief systems pertaining to age
World War II Era
People 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. M.(2011, March 2).
Describe the belief systems pertaining to age
Baby Boomer Era
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 Boomers grew into young adulthood, a strong emphasis on personal development
came to life.
Bosenberg. M.(2011, March 2).
Describe the belief systems pertaining to age
The 51 million members of Generation X were born between 1965 and 1976.
Divorce and working moms created "latchkey" kids out of many in this generation.
As a result, Gen Xers 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 fun in the workplace and a realistic approach to
getting things done.
Thielfoldt, D. and Scheef, D. (2004, August).
Describe the belief systems pertaining to age
Generation Y make up for 70 million of the world’s population and were born in the mid1980's and later.
They are tech-savvy, family-centric and achievement-oriented. 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, S. (n.d.).
Competency 2: Belief System and
Practices of Diverse Cultures
Recommended Learning Activities
Assignment
Resources
Notes
RCS Competency 2-3
Cultural Interaction
Interview
Assignment on website
Students interview two persons from another culture
and reflect on the experience.
References
Berman, A., Snyder, S.J., Kozier, B., and Erb, G. (2008).Culture and heritage. In A. Berman, S.J. Snyder, B.
Kozier, and G. Erb (Eds.). Kozier and 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 1946-1964 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
Eagle Feather Research Institute
http://eaglefeather.org/pages/about.php
References
Freire,P. (n.d.). The Politics of Education. Retrieved from
http://renew.education.ucsb.edu/downloads/overheads_handouts/class.pdf
Juliar, K. (2003). Minnesota Healthcare Core Curriculum (2nd ed.). Clifton Park, NY: Delmar Publishers
Kane, S. (n.d.). Generation Y. Retrieved from http://legalcareers.about.com/od/practicetips/a/GenerationY.htm
Kelly, R.T. (2006). Cultural and ethnic considerations. In B.L. Christensen and E. O. Kockrow (Eds.). Foundations
and adult health nursing (5th ed.) (pp. 124-148). St. Louis, MO: Elsevier, Mosby
References
Nemours Foundation. (1995-2011). Culture shock. Retrieved from
http://kidshealth.org/teen/your_mind/emotions/culture_shock.html#
New World Encyclopedia. (2007). Culture. Retrieved from http://www.newworldencyclopedia.org/entry/Culture
Potter, P.A. and Perry, A.G. (2009). Culture and ethnicity. In P.A. Potter and A.G. Perry (Eds.). Fundamentals of
nursing (7th ed.) (pp. 106-120). St. Louis, MO: Elsevier, Mosby
Thielfoldt, D. and Scheef, D. (2004, August). Generation X and the millennial: What you need to know about
mentoring the new generations. Retrieved from http://apps.americanbar.org/lpm/lpt/articles/mgt08044.html
Author: Dede Carr, BS, CDA, LDA; Pat Reinhart, RN
“This workforce solution was funded by a grant awarded by the U.S. Department of Labor’s Employment and Training Administration.
The solution was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The
Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information,
including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness,
usefulness, adequacy, continued availability, or ownership.”
This work is licensed under a Creative Commons Attribution 4.0 International License.
60