18Jones Leadership(F)-ch 18 1/14/07 3:50 PM Page 313 Maximizing Employee Performance NCLEX Questions In most organizations, a current, valid job des- cription should all of the following except: A Outline the duties, skills, and knowledge required for the job B Describe how the person is to carry out basic responsibilities C Be used as the baseline for a performance appraisal D Identify the department or unit for the work assignment Performance appraisals are primarily done for which purpose? A Comparing the performance of employees on the unit B Identifying employees with personal problems C Recruiting new employees into the organization D Improving the performance of individual employees A peer review may be done as part of the per- formance appraisal to: A Compare the employee’s past and present performance B Document a single outstanding observation C Assess the level of a colleague’s performance D Make a list of desirable employee behaviors The following statements about management by objectives are all true except: A Employees have an opportunity to appraise their own performance B The employee’s supervisor establishes the performance standards C Performance is compared with goals established by the employee D The end result is usually a more realistic appraisal of performance Which of the following methods is likely to be most effective in motivating a new employee with poor performance? A Coaching B Counseling C Disciplining D Supervisor praise E Additional training In preparing for the yearly performance appraisal meetings, Ellen Jones’ new supervisor noted that Ellen had an unusual increase in the number of 313 absences and reported late to work on at least six occasions during the previous year Up until this point, Ellen, an employee at the organization for years, had received good, but not outstanding, evaluations What should the supervisor do? A Talk to Ellen as soon as possible and determine if this was due to some temporary problem or one that is likely to continue B Talk with Ellen’s previous supervisor and/or her peers see if they are aware of any problems C Talk with Ellen about this when she comes in for her performance appraisal next month D Talk to Ellen about seeing a counselor as her attitude toward work seems to have taken a turn for the worse Janet Smith is a new employee at the hospital She graduated from nursing school years ago, passed the NCLEX, and worked part time in a skilled care facility for a year Janet since married and had twin girls years ago As her supervisor, you have noticed some knowledge and skill deficiencies For example, she has not started an IV recently and is unfamiliar with many of the medications being given to patients on her unit Which of the following are most likely to be helpful? 1) Give her a book on pharmacology 2) Tell her to contact the local nursing program and sign up for a pharmacology course 3) Have her spend time in the hospital pharmacy 4) Make arrangements for her to spend additional time with one of the preceptors 5) Arrange practice time for her in the hospital skills laboratory A and B and C 2, 4, and D 1, 2, and E only During a performance appraisal report, the super- visor should focus on all of the following except: A The employee’s current level of performance B The employee’s career development plans C Determining why the employee may be performing poorly D Discussing the employee’s contributions to the organization 18Jones Leadership(F)-ch 18 314 1/14/07 3:50 PM Page 314 Skills for Being an Effective Manager It is difficult for most supervisors to avoid bias when evaluating their subordinates, mainly because many of the tools lead to rater errors like the halo effect, which can best be defined as: A Rating someone based on her education or position B Giving someone an average rating because the supervisor is unsure of the actual performance C Rating someone based on his most recent positive behavior, not his overall performance D Giving someone a high rating because she is popular with her peers 10 Which of the following is the last step in a pro- gressive disciplinary procedure? A Reprimand B Counseling C Transfer D Termination REFERENCES American Nurses Association (2004) Nursing: Scope and standards of practice Washington, D.C.: ANA Ash, M.K (1984) Mary Kay on people management NY: Warner Barnum, B.S., & Kerfoot, K.M (1995) The nurse as executive (4th ed.) Gaithersburg, MD: Aspen Brykczynski, K.A (1998) Clinical exemplars describing expert staff nursing practices Journal of Nursing Management, 6(6):351–360 Creasia, J.L., & Parker, B (2001) Conceptual foundations: The bridge to professional nursing practice (3rd ed.) St Louis: Mosby Donner, G.J., Wheeler, M.M., & Waddell, J (1997) The nurse manager as a career coach Journal of Nursing Administration, 21(12), 14–18 Ellis, J.R., & Hartley, C.L (2000) Managing and coordinating nursing care (3rd ed.) Philadelphia: Lippincott Ellis, J.R., & Hartley, C.L (2004) Nursing in today’s world: Trends, issues, and management (8th ed.) Philadelphia: Lippincott, Williams & Wilkins Gillies, D.A (1994) Nursing management: A systems approach (3rd ed.) Philadelphia: Saunders Hecht, I.W.D., et al (1999) The department chair as academic leader Phoenix, AZ: Oryx Press Houston, R (1995) Integrating CQI into performance appraisals Nursing Management, 26(3):48A-C Huber, D (2000) Leadership and nursing care (2nd ed.) Philadelphia: Saunders Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2005) 2005 Hospitals’ national patient safety goals Retrieved May 16, 2005, from http://www.jcaho.org/ accreditedϩorganizations/patientϩsafety/05ϩnpsg/05_npsg_ hap.htm Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2005) National patient safety goals for 2005 Retrieved May 16, 2005, from http://www.jcaho.org/ accreditedϩorganizations/patientϩsafety/npsg.htm Kelly-Heidenthal, P (2003) Nursing leadership & management Clifton Park, NY: Delmar Lancaster, J (1999) Nursing issues in leading and managing change St Louis: Mosby Leaming, D.R (1998) Academic leadership: A practical guide to chairing the department Bolton, MA: Anker Loveridge, C.E., & Cummings, S.H (1996) Nursing management in the new paradigm Gaithersburg, MD: Aspen Marquis, B.L., & Huston, C.J (2000) Leadership roles and management functions in nursing: Theory & application (3rd ed.) Philadelphia: Lippincott Merriam-Webster’s desk dictionary (1995) Springfield, MA: Merriam-Webster Metcalf, C (2001) The importance of performance appraisal and staff development: A graduating nurse’s perspective International Journal of Nursing Practice, 7(1): 54–57 Nauright, L (1987) Toward a comprehensive personnel system: Performance appraisal part IV Nursing Management, 18(8), 67–77 Parks, J., & Lindstrom, C.W (1995) Taking the fear out of peer review Nursing Management, 26(3), 48–49 Peterson, J.V., & Nisenholz, B (1995) Orientation to counseling (3rd ed.) Boston: Allyn & Bacon Rondeau, K.V (1992) Constructive performance appraisal feedback for healthcare employees Hospital Topics, 70(2): 27-33 Smith, M.H (2003) Empower staff with praiseworthy appraisals Nursing Management, 34(1): 16–18 Swansburg, R.C., & Swansburg, R.J (2002) Introduction to management and leadership for nurse managers (3rd ed.) Boston: Jones & Bartlett Tappen, R.M (2001) Nursing leadership and management: Concepts and practice (4th ed.) Philadelphia: Davis Yoder-Wise, P.S (1999) Leading and managing in nursing (2nd ed.) St Louis: Mosby 19Jones Leadership(F)-ch 19 1/14/07 3:51 PM Page 315 chapter 19 Nursing Celebrates Cultural Diversity JOSEPHINE A KAHLER, EDD, RN, CS CHAPTER MOTIVATION “Cultural diversity is not an obstacle, it’s a gift.” Anonymous CHAPTER MOTIVES ■ ■ ■ ■ ■ ■ Define and explain the concept of culture Explain the foundational impact of culture on nursing practice Discuss models describing cultural competence Describe the characteristics of some prominent cultures Analyze transcultural nursing perspectives as they pertain to the work environment Evaluate the challenges of managing a culturally diverse workforce 315 19Jones Leadership(F)-ch 19 316 1/14/07 3:51 PM Page 316 Skills for Being an Effective Manager T he minority population in the United States is expected to make up more than 40% of the total population by 2035 (Giger & Davidhizer, 1995) Addressing the needs of an increasingly diverse population has become a major challenge to all health-care providers, especially nurse leaders and managers Cultural diversity concerns can be viewed from two perspectives: caring both physically and spiritually for a diverse client population and providing a culturally diverse workforce with positive work experiences (Dreher, 1996) With the present-day nursing shortage, recruitment of foreign nurses will result in a new workforce of individuals who bring with them an understanding of other cultures but also different values and beliefs This chapter explores the concept of cultural diversity, along with the theories used to explain cultural differences It offers guidance to nurses who are providing leadership and care in an increasingly more diverse health-care system, with increasing diversity of team members See Box 19-1 on terms commonly used when discussing cultural diversity Foundations of Cultural Study The swell in the ethnic diversity of the United States has put new demands on health-care systems Box 19-1 Cultural Terms To ensure that there is an understanding of terms commonly used to describe culture, some definitions follow: Culture: Shared values, beliefs, and practices of a particular group of people that are transmitted from one generation to the next and are identified as patterns that guide thinking and action Cultural competence: Providing effective nursing care to patients from many cultures in a respectful and knowing way Cultural diversity: Differences in race, ethnicity, religion, national origin, gender, and economic status Stereotyping: Assigning certain beliefs and behaviors to groups without recognizing individuality Values: Abstract standards that give a person a sense of what is right or wrong and establish a code of conduct for living to provide health care that is culturally acceptable In order to achieve this, practitioners need to increase their knowledge of the health-care practices of people from different sociocultural groups and recognize the differences in perspectives between themselves and their clients (Anderson, 1990) CULTURAL CONCEPTS Culture encompasses shared values, behaviors, and beliefs that are reinforced through social interactions, shared by members of a particular group, and transmitted from one generation to the next Culture exerts considerable influence over most of an individual’s life experiences, including illness It can be perceived as a form of tradition for a group, which is based on beliefs about survival of group mores and customs These concepts make culture very distinct from external managerial control, such as policies and procedures (Coeling & Simms, 1993) Culture is deeply rooted within the group and within the human interpersonal dynamics that occur naturally within the groups—brought about by child rearing, language, and religious beliefs— as a natural result of people in the groups Dochterman and Kennedy-Grace (2001) describe culture as being a system of learned patterns unique to members of a group Spector (2000) has specified that one’s cultural background is a fundamental component of one’s ethnic heritage and should have a vast impact on the type of nursing care that is rendered to patients Culture has also been described as differences and variety in customs and practices of defined social groups (Poss, 1999) Three levels of culture have been identified by Schein (1985): The visible level: this includes physical space and social environment What image is projected at first encounter? Does the nurse use sensitivity when admitting a client from another culture? Are respect and understanding demonstrated by the nurse who is questioning the new client? The values: this includes elements of what ought to be; for example, nurses value caring and high quality of care Whose values should predominate? Is there awareness of the values within the culture of the client being cared for, or is the client treated like any other within the general population? 19Jones Leadership(F)-ch 19 1/14/07 3:51 PM Page 317 Nursing Celebrates Cultural Diversity The basic underlying assumptions: this includes the actual guides to behavior that are deeply held and not open to challenge or debate, such as the influence that our own cultural inheritance has on our personal health beliefs (Betancourt, Green, & Carrillo, 2002) Without an understanding of cultural differences, U.S health-care providers tend to impose Western ideas on individuals from other cultures, which infringe on their values Nurses tend to respond to sick people based on their own socialization, culture, and education For instance, because the U.S culture is an informal one, nurses may be inclined to call patients by their first names People who grew up in another culture, however, may consider it disrespectful to address others by their first names, especially when there is an age difference between the client and caregiver The caregiver should ask clients how they wish to be addressed so as to not seem disrespectful Moreover, nurses are trained to respect patient autonomy and decisions Yet some Asian clients may expect nurses to provide directives, be authoritative, and be expert practitioners who take charge Out of respect for this authority, they may nod, smile, verbally agree to anything that the nurse proposes, and may not speak until spoken to (Giger & Davidhizar, 1999) Nurses may also find their perceptions of appropriate personal space called into question Many people from South America and the Middle East stand close to the person with whom they are conversing Many Americans feel very uncomfortable if someone is standing closer than feet while conversing Hispanic patients expect the health-care provider to shake hands with them at the beginning of the conversation, whereas most Japanese clients would feel uncomfortable with shaking hands, preferring to bow instead (Salimbene, 1998) Most immigrants to the United States appear to be fully acculturated and speak without a trace of a foreign accent, such as those who immigrated from Western Europe and other English-speaking countries Values change as new generations adopt the new country’s views over time It is easy for healthcare practitioners to overlook the impact that cultural inheritance has had on both conscious and subconscious health beliefs, however In the United States, individuals are classified into five ethnic groups: African-Americans, AsianAmericans and Pacific Islanders, HispanicAmericans, Native Americans, and Caucasian 317 Americans This tendency, however, does little to promote understanding of the health beliefs, practices, needs, and diversity that are represented within each of these population classifications It may, in fact, impose stereotypical judgments on persons within these groups because they are viewed by the health-care providers in traditional ways But nurses should keep in mind, as Benner and Wrubel (1998) observe, “changes in lifestyles and health habits work best when they are integrated into the person’s own cultural patterns and traditions, for it is hard to sustain new patterns if they go against the grain of one’s social patterns” (p 155) IMPACT OF CULTURE ON NURSING PRACTICE Nurses today are recognizing that awareness of cultural differences in their health-care delivery is imperative for their practice The role expectations of nurses may even vary from culture to culture A common Anglo-American view of nurses is that they treat people as equals, tend to be passive, and take direction from physicians These patients feel free to ask questions of their nurses that they may not ask of physicians Despite the fact that awareness of cultural diversity directly affects diagnosis, assessment, and intervention strategies, cultural diversity is often not seen as an essential variable in how nurses mediate conflict, communicate, or interpret different behaviors For instance, in the Navajo culture, great value is placed on keeping pain and discomfort to oneself Therefore, the nurse who expects clients from the Navajo nation to request medication for pain may make a false assumption on the client’s comfort level, when the opposite is true (Kirkpatrick & Deloughery, 1995) Communication is a vital part of the cultural interaction that takes place between the health-care provider and client Patterns of communication are strongly influenced by culture and include not only language differences but verbal and nonverbal behaviors as well Without a sense of their own cultural values, nurses fail to provide culturally competent care to patients Nurses must culturally assess each patient individually while keeping in mind that differences can occur not only between cultures but also within cultures Culture directly affects client care Often, culture affects a client’s ... (2001) Nursing leadership and management: Concepts and practice (4th ed.) Philadelphia: Davis Yoder-Wise, P.S (1999) Leading and managing in nursing (2nd ed.) St Louis: Mosby 19Jones Leadership( F)-ch... & Cummings, S.H (1996) Nursing management in the new paradigm Gaithersburg, MD: Aspen Marquis, B.L., & Huston, C.J (2000) Leadership roles and management functions in nursing: Theory & application... appraisals Nursing Management, 34(1): 16–18 Swansburg, R.C., & Swansburg, R.J (2002) Introduction to management and leadership for nurse managers (3rd ed.) Boston: Jones & Bartlett Tappen, R.M (2001) Nursing