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Diversity occers when a collection of individuals bring together various demographic, cultural, human, intellectual, religious, and philosophical differences to help create a safe and supportive environment that honors and respects those differences (NIGP, 2002-2007). It means understanding that each individual is unique, recognizing our individual differences and exploring these in a safe, positive, and nurturing environment. It is also about understanding each other and moving beyond simple tolerance to embracing and celebrating the rich dimensions of diversity contained within each individual (Gladstone Definition of Diversity).
Cultural competence in the delivery of nursing care is an expectation of both accreditation boards of nursing programs and professional nursing organizations (American Nurses Association (ANA), 1986; American Association of College of Nursing, 1997, as cited in Kardong-Edgren, p. 360).
Campinha-Bacote has defined cultural competence as "the process in which the healthcare provider continuously strives to achieve the ability to effectively work within the cultural context of a client, individual, family or community" (as cited in Kardong-Edgren, 2007 p. 360). Acculturation refers to phenomena that occur when different cultural groups come together, such as when foreign educated nurses emigrate from their homelands to settle and work in the country of choice (Von Zweck & Burnett, 2007). There are five areas of Campinha-Bacote's (2003) cultural model: cultural desire, cultural awareness, cultural knowledge, cultural skill, and cultural encounters (as cited in Kardong-Edgren, 2007, p. 360). Essentially, the healthcare provider should eventually have the ability to recognize ethnocentrism and cultural imposition; the ability to integrate others' worldviews and approaches to health care; the ability to include information about health beliefs and practices on disease incidence and prevalence, and treatment efficacy, and the ability to conduct holistic and culturally relevant physical and psychosocial assessment; and finally, the ability to put into practice all of these cultural skills (Kardong-Edger, 2007, p. 360).
Internationally, the role of nurses differs from country to country as well as their role in patient care. Most foreign educated nurses migrate to larger cities where it is easier to fit into a health care organization with a diverse workforce and clientele (Baumann et al, 2006, p. 25). Large teaching hospitals with multi-ethnic staff led to greater opportunities for education and greater acceptance of differences (Baumann et al, 2006, p.25). Nevertheless, according to Baumann et al (2006) "problems still occurred as a result of cultural misunderstanding or when nurses from particular ethic groups formed cliques" (p. 25).
For most of these nurses, the use of different types of equipment and technical knowledge can also be a challenge especially with the cultural differences and adaptation in the clinical setting (Edwards & Davis, 2006, p. 268).
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