Care of Mother, Child and Adolescent (Well-

Clients)
INSTRUCTOR’S GUIDE BS NURSING / SECOND YEAR
Session # 5

LESSON TITLE: DIVERSITY AND MATERNAL AND

CHILD NURSING Materials:
Book, paper, pen, notebook, and LCD projector

LEARNING OUTCOME:
At the end of the lesson, the student nurse can:
1. Identify nursing considerations related to cultural
diversity, sexual orientation and gender identity
Reference
2. Assess a client for aspects of cultural diversity that
might affect how a family responds to childbearing and
Pilliteri, Adele and Silbert-Flagg, JoAnne (2018)
childrearing th
Maternal and Child Health Nursing, 8 Edition.
3. Define terms related to sexual orientation and sexual USA: Lippincott Williams and Wilkins
identity

LESSON REVIEW/PREVIEW (10 minutes)

1. The instructor will start the session by greeting the class, checking attendance and responding to clarifications on
the previous topic
2. The instructor will introduce the topic by asking the class about cultural and superstitious beliefs they know
regarding pregnancy, childbirth and also on sexuality.

MAIN LESSON (50 minutes)

The instructor should discuss the following topics. Instruct the students to tak e down notes and read their book about this
lesson (Chapter 2: Diversity and Maternal Child Nursing p.23).
Definitions Related to Providing Culturally Sensitive Nursing Care

A. Culture: a view of the world and a set of traditions a specific social group uses and transmits to the next
generation
B. Diversity in a population means there is a mixture or variety of sociodemographic groups, experiences and
beliefs in the population.
C. Transcultural nursing = is care guided by cultural aspects and respects individual differences
D. Culture-specific values = are norms and patterns of behavior unique to one particular culture.
E. Ethnicity =refers to the cultural group into which the person was born, although the term is sometimes used in
a narrower context to mean only race
F. Race = a social construct, refers to a category of people who share a socially recognized physical
characteristic, often skin color or facial features. It can also refer to a group of people who share the same
ancestry.
Nursing Process Overview for care That Respects Cultural Diversity
A. Assessment:
 Assessment of cultural diversity factors is important so care can be planned based on the actual
preferences of a family (please refer to table 2.1)
 Assess patients as individuals, not as a group

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 CONTINUUM OF CULTURAL COMPETENCY

Stereotype-a widely held but fixed and oversimplified image or idea of a particular type of person or thing.

Prejudice-preconceived opinion that is not based on reason or actual experience.

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Discrimination-the unjust or prejudicial treatment of different categories of people or things, especially on the grounds
of race, age, or sex.

B. Nursing Diagnosis, Outcome Identification and Planning

Several nursing diagnoses speak to the consequences of ignoring cultural preferences in care, including:
 Powerlessness related to expectations of care not being respected
 Impaired verbal communication related to limited English proficiency
 Anxiety related to a cultural preference for not wanting to bathe while ill
 Imbalanced nutrition, less than daily requirements, related to unmet cultural food preferences.
 Fear related to possible ethnic discrimination

Examples of Nursing Diagnoses and Outcomes Related to Cultural Diversity

Nursing Diagnosis Outcome

Impaired verbal communication related to limited English Family will be able to communicate their needs
proficiency accurately to their health care provider.
Anxiety related to a cultural preference for not wanting to Anxiety related to woman’s cultural preference will be
bathe while ill decreased.
Powerlessness related to expectations of care not being Feelings of powerlessness will be decreased.
respected
C. Outcome Identification and Planning
 Planning needs to be very specific for individual families because cultural diversity preferences tend to be
very personal.
 Begin with in-service education for team members who are unfamiliar with a particular cultural practice and its
importance to a specific family involved.
 This type of planning can be beneficial not only because it makes health care more acceptable to families but
also because it can motivate providers to examine policies and initiate more diverse care.

D. Implementation
 Do NOT impose your cultural values on others

Interventions Related to Rendering Culturally Sensitive Maternal and Child Nursing Care

Nursing Diagnosis Possible Nursing and Therapeutic Interventions

Impaired verbal communication related to limited English Assure that a translator is readily available when
proficiency communicating with the family.
Anxiety related to a cultural preference for not wanting to Respectfully discuss the woman’s belief about not bathing
bathe while ill while ill.
Powerlessness related to expectations of care not being Respectfully explore the family’s expectations of their
respected health care.

E. Outcome Evaluation
 Evaluation should reveal that a family’s diversity preferences have been considered and respected during
care.

Evaluating Outcomes Related to Rendering Culturally Sensitive Maternal and Child Nursing Care
Nursing Diagnosis Outcome Evaluation
Impaired verbal communication related to limited English Family expresses that they feel that their needs were
proficiency accurately expressed to their healthcare provider.
Anxiety related to a cultural preference for not wanting to ?
bathe while ill
Powerlessness related to expectations of care not being ?
respected

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 Understanding Sexual Orientation in Maternal and Child Health Nursing
Sexual Orientation and Gender Identity Terminology Intersex- or hermaphrodite; a person who is born with a
for Nurses: reproductive or sexual anatomy that doesn’t fit the typical
female or male definitions.
Sex- biological, based on reproductive organs; may be
male, female or intersex Queer- An umbrella term for those who wish to not
categorize sex, sexuality or gender
Sex Role- biological, function or role which a male or
female assumes because of the basic physiological or Cross-dressing (Transvestism)- act of wearing items of
anatomical differences between the sexes clothing commonly associated with the opposite sex within
a particular society
Gender- MASCULINITY or FEMININITY; refers to the
social attributes and opportunities associated with being MSM- men who have sex with men
male and female
WSW- women who have sex with women
Gender Identity- Gender identity refers to a person’ s
deeply felt internal and individual experience of Bisexual- an individual attracted to both men and women.
gender, which may or may not correspond with the sex
assigned at birth Cisgender- when individuals feel that their gender and
their sex match
Perception of self; lesbian, gay, bisexual, transgender,
queer, intersex, asexual Transgender- when individuals feel that their gender and
their sex do not match
Heterosexual- a person who finds sexual fulfillment with a
member of the opposite sex. Gender expression- way in which a person acts to
communicate gender within a given culture; for example,
Homosexual- someone who finds sexual fulfillment with a in terms of clothing, communication patterns and interests
member of his or her own sex
Stereotypes- a widely held but fixed and oversimplified
Gay- male-identified individuals who are sexually attracted image or idea of a particular type of person or thing
to male partners
Sexuality- totality of being; the sum of a person's sexual
Lesbian- female-identified individuals who are sexually behaviors and tendencies, and the strength of such
attracted to female partners. tendencies; It begins at birth and last a life time

Asexual- Someone who does not experience or feel

sexual attraction
SEX vs. GENDER
SEX GENDER
 Same in all societies  May differ from society to society
 Never change with history  Can change with history
 Can be performed by only one of the sexes  Can be performed by both sexes
 Biologically determined  Socially, culturally determined

SEX ROLE STEREOTYPES

MASCULINE FEMININE
 Unemotional  Emotional
 Very aggressive  Not aggressive
 Very good at making decisions  Not good at making decisions
 Independent  Dependent
 Rough  Gentle
 Blunt  Tactful

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CHECK FOR UNDERSTANDI NG (25 minutes)
The instructor will prepare 10-15 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.

Multiple Choice

(For 1-10 items, please refer to the questions in the Rationalization Activity)

RATIONALIZATION ACTIVITY
The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss
among their classmates.

1. Which is an example of a culture -specific value or norm?

A. The expectation that communication between the woman and the healthcare provider will be understood by both
parties
B. The expectation to have only the spouse present during the delivery
C. The desire to have healthy family communication
D. The desire for the family to have enough basic necessities in life
ANSWER: B
RATIONALE: The expectation of having only the spouse in the delivery room is only one of many cultural values
related to expectations about labor and delivery and thus is not a universal one. In contrast, the expectations of clear
communication with healthcare providers, having good family communication, and striving for enough resources for
the family to flourish are almost universally embraced by all cultures

2. In performing a family assessment, what is the best way to handle the situation of an English -speaking
healthcare provider and parents who do not speak English?
A. Assure that a translator from the healthcare organization is present
B. Enlist the help of a neighbor visiting the home who speaks English
C. Ask the oldest child in the family who has learned English to translate
D. Ask the family to bring a friend who speaks English with them for the next visit.
ANSWER: C
RATIONALE: It is the healthcare organization’s responsibility to provide translation resources when the healthcare
provider and the clients do not speak the same language. Ask ing a child in the family, a friend, or a neighbor is not
appropriate (except in case of extreme emergency) because this could lead to the child needing to mak e age -
inappropriate judgments or could easily result in a “third-party” health history from nonfamily members.
3. The nurse is assessing a laboring woman for pain. Which is most important for the nurse to remember?
A. Pain threshold sensation can vary widely from one culture to another
B. Communication of pain is acceptable in all cultures, so she will readily tell you if she is in pain.
C. Ways of expressing pain is fairly universal
D. Use of a 0 (no pain) to 10 (the most pain) scale is an objective way of assessing pain.
ANSWER: D
RATIONALE: Use of a numeric pain rating scale is an evidence-based method of objectively assessing pain for most
cultures. Although pain threshold and pain tolerance can vary widely across cultures, pain threshold sensation is fairly
stable. Ways of expressing pain and the acceptability of expressing pain can also vary wi dely across cultures

4. Which of the following phrases best describes assimilation as related to sociocultural differences?
A. An adoption of the most dominant culture’s values and influences
B. A loss of cultural expression as the customs of a dominant culture are taken on
C. A family tradition practiced in future generations
D. Placement of “labels” placed on groups of people according to their ethnic backgrounds
ANSWER: B

RATIONALE: Assimilation refers to the process through which individuals and groups of differing heritages
acquire the basic habits, attitudes, and mode of life of an embracing culture. Option A refers to acculturation. Option C
refers to familial culture. Option D refers to stereotypes

5. You overhear a group of nurses talking. One of the group states, “Men are never any good at diapering
babies.” You interpret this as an example of
A. Discrimination
B. Stereotyping
C. Acculturation
D. Ethnocentrism

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 ANSWER: B
RATIONALE: Stereotyping is classifying based on a widely held but fixed and oversimplified image or idea of a
particular type of person or thing; Discrimination is the unjust or prejudicial treatment of different categories of people or
things, especially on the grounds of race, age, or sex; Acculturation is cultural modification of an individual, group, or
people by adapting to or borrowing traits from another culture. Ethnocentrism is the attitude that one's own group,
ethnicity, or nationality is superior to others

6. In the 1800’s, large numbers of immigrants came to the U.S. from many different countries and gave up their
native country’s traditions and values. Which of the following is the common explanation for the actions of these
immigrants?
A. The immigrants found the American culture and beliefs to be equal or superior to their own
B. The immigrants feared the Americans and participated in the American culture to avoid cruelty and punishment
C. The immigrants joined the giant American “melting pot.”
D. Immigrants who did not take on the American culture were placed in lower socioeconomic groups.
ANSWER: C
RATIONALE: Large numbers of immigrants from different countries joined the American melting pot, gave up their
native culture and traditions and imbibed the American way.

7. It is the care of patients that is guided by cultural aspects and respects individual differences.
A. Ethnocentrism
B. Transcultural Nursing
C. Ethnicity
D. Stereotyping.
ANSWER: B
RATIONALE: Transcultural nursing is care guided by cultural aspects and respects individual differences.
Ethnocentrism is seeing one's culture as superior. Ethnicity refers to the cultural group into which the person was born,
although the term is sometimes used in a narrower context to mean only race. Stereotyping is classifying based on a
widely held but fixed and oversimplified image or idea of a particular type of person or thing.

8. It is the Individual perception that one’s own culture is superior to all others
A. Ethnocentrism
B. Transcultural Nursing
C. Ethnicity
D. Stereotyping
ANSWER: A
RATIONALE: Ethnocentrism is seeing one's culture as superior. Ethnicity refers to the cultural group into which the
person was born, although the term is sometimes used in a narrower context to mean only race. Stereotyping is
classifying based on a widely held but fixed and oversimplified image or idea of a particular type of person or thing.
Transcultural nursing is care guided by cultural aspects and respects individual differences .

9. Sarah, a 14-year-old female, openly declares that she is attracted to Jenna, a 17-year old female. Sarah can be
classified as:
A. Heterosexual
B. Asexual
C. Lesbian
D. Gay
ANSWER: C
RATIONALE: Lesbian is a female-identified individual who is sexually attracted to female partners. Asexual is
someone who does not experience or feel sexual attraction. A Gay is a male-identified individual who is sexually
attracted to male partners

10. This refers to a person’ s deeply felt internal and individual experience of gender, which may or may not
correspond with the sex assigned at birth
A. Sex
B. Sex role
C. Gender identity
D. Gender expression

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 ANSWER: C
RATIONALE: Gender identity refers to a person’ s deeply felt internal and individual experience of gender, which may
or may not correspond with the sex assigned at birth; Perception of self; lesbian, gay, bisexual, transgender, queer,
intersex, asexual. Sex is biological, based on reproductive organs; may be male, female or intersex. Sex Role is a
biological, function or role which a male or female assumes because of the basic physiological or anatomical differences
between the sexes. Gender expression is the way in which a person acts to communicate gender within a given culture;
for example, in terms of clothing, communication patterns and interests

LESSON WRAP-UP (5 minutes)

Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students trac k
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.

You are done with the session! Let’s track your progress.
Period 1 Period 2 Period 3
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

AL Strategy: Minute Paper

1. Towards the end of the class, students are asked to use index cards or half-sheets of paper to provide written
feedback to the following questions:
a. What was the most useful or the most meaningful thing you have learned this session?
b. What question(s) do you have as we end this session?
2. Collect the responses as or before the students leave. One way is to station yourself at the door and collecting
“minute papers” as student file out.
3. Respond to students’ feedback during the next class meeting or as soon as possible

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