Difficulties Encountered in an ethno-religious diverse Nursing Workforce
Globalization has led to more interaction among people from varied backgrounds. Individuals no longer live and work in an enclosed environment, but they are now part of the global economy competing internationally. Ethnicity and religion are some of the aspects that significantly affect the nursing workforce. The Australian nursing workforce is characteristic of a wealth of ethno-religious diversity. Healthcare providers recognize well the relationship between a nursing workforce that is ethno-religious and the ability to offer quality and culturally competent patient care. Nursing in Australia has taken significant initiatives in recruiting and educating nurses that are from Indigenous communities such as those from Aboriginal and Torres Strait Islander peoples. Despite of the strides made in nursing towards the achievement of a culturally diverse and inclusive nursing workforce in Australia, there are still challenges that impede this noble course. This paper seeks to highlight some of the challenges by examining the difficulties encountered in an ethno-religious diverse workforce, the role of nurse in responding to an ethno-religious diverse workforce and inclusion in the workplace, and the role of the government policy in promoting the benefits of workforce diversity.
Negative views and stereotypes function as a barrier to fostering workplace diversity in nursing. For example, approximately 31% of Australians believe that Indigenous Australians should conduct themselves like other Australians, and over 37% believe that that Indigenous Australians are naturally lazy at work (Blue, 2014). The traditional health beliefs of the Indigenous peoples of Australia are interlinked with various facets of their life such as kinship responsibility, religion, and land (Senior & Chenhall, 2013). The Aboriginal people belief that illness is as a result of social and spiritual dysfunction. Their understanding is that the health of an individual is dependent on the faithful discharge of responsibilities to the society and land (Waldram, 2014). This implies that one’s social responsibility and duty is highly esteemed above his/her health because of the primacy that is accorded to the social relationships. For instance, diseases such as lung complications, headaches, diarrhoea, or physical harms are believed to be caused by resentment, worry, anxiety, and sadness. Additionally, death, nausea, complications in pregnancy etc. are caused by breach of taboos. If for example a patient is diagnosed with pregnancy complications, an Aboriginal nurse will perceive that as a direct natural cause due to transgression of the law and thus only supernatural intervention can heal the patient.
Aboriginal perception of causation
These Indigenous understanding of the cause of illness becomes a challenge when a nurse from the Aboriginal Peoples is to diagnose a patient of any kind of illness for it goes against the contemporary healing approach. It even becomes worse when there are few nurses from non-Indigenous group that are at work because this will force them to attend to such cases in which the Aboriginal nurse finds it difficult to go against his/her religious beliefs on the causation of illness.
The Aboriginal People have grouped sickness into indirect supernatural, direct supernatural, natural, environmental or Western causes among others (Dudgeon & Bray, 2018). This categorization is used as a way of determining the cause and the approach to healing. They belief that spiritual and supernatural effects lead to sickness that cannot be cured without help (Smith, 2016). All of the different categorization of illness regard supernatural involvement as the primary cause of major sicknesses. For instance, a breach of a taboo is regarded as a cause of illness and can only be treated by supernatural powers (Waldram, 2014; Wakerman et al., 2017). This contradicts the contemporary Western approach of categorization of diseases which each healthcare professional including nurses from the Indigenous groups should adopt. Nurses from the Indigenous groups may refuse to attend to a patient if they are of the belief that the illness is supernatural and therefore requires supernatural intervention for healing. Examples of illnesses classified as natural according to the ethno-religious beliefs of the Aboriginals include loss of weight, lung complications, and physical injuries among others. This implies that if a patient is brought in with physical injuries, the Aboriginal nurse would treat this as a natural cause and therefore not needing any treatment because that’s part of everyday life which leads to a provisional state of weakness. Thus, the categorization of diseases by the Indigenous Australian nurses is another difficulty that an ethno-religious diverse workforce of nurses face.
A nursing workforce that understands and appreciates culture and religious inclinations of other nurses and of the patient will end up providing an ultimate care to the patients (Mareno, & Hart, 2014). The authors observe that a nursing workforce that reflects the demographic of the patient will lead to improved communication thus making the patient feel more comfortable. This makes the nurses and the patient to have more things in common and thus enabling them to adequately advocate for their benefits. Therefore, healthcare providers can exhaust their potential by learning the religious beliefs of other nurses and in doing so they will be exercising cultural competency or awareness at the workplace.
Disease Categorization
Additionally, a study was done by Betancourt et al. (2016) on defining cultural competence and the findings indicate that equality in the provision of healthcare by nurses was largely dependent on the understanding of culture and religious beliefs of both the patients and colleagues.
Nurses and their leaders can promote an organizational climate with an inclusive culture that promotes collaboration, flexibility and equity in addition to equal participation of the nurses from the minority groups in decision making (Jackson, & Gracia, 2014; Douglas et al., 2014; Clifford, McCalman, Bainbridge, & Tsey, 2015). The nursing workforce can foster cultural diversity at the workplace by collaborating with other healthcare providers or the hospital management towards enforcing policies and protocols that encourage cultural diversity and inclusion. Phillips, and Malone (2014) recommends the implementation of protocols and guidelines for various aspects of diversity in each healthcare centre as a means of providing fostering cultural diversity at the workplace. A study conducted by Loftin, Hartin, Branson, and Reyes (2013) showed that additional training on cultural awareness fostered cultural diversity in a nursing workforce. Thus, nurses can actively foster the creation of an organizational climate that fosters diversity by undergoing training on cultural awareness.
Nurses can increase cultural diversity and inclusion at the workplace by creating a welcoming environment for the nurses from the minority groups. Studies have shown that the rate at which Aboriginal nurses enter and leave the nursing workforce in the first few years of practice is higher than normal. According to Paradies (2016) the nurses from the Aboriginal and Torres Strait Islander community that left nursing complained of a workplace environment that lacked respect, inclusion and acceptance with regard to their ethnicity and religious inclinations.
Nurses can identify barriers that hinder a successful culturally diverse workforce and work towards eliminating these barriers in collaboration with other healthcare providers and the management of the hospital. Hart, and Mareno (2014) conducted a study on cultural barriers through the voice of nurses and found out that the inclusion of the nursing workforce in decision making regarding equality in the provision of healthcare services helped to identify possible barriers to diversity and inclusion at the workplace and take corrective actions early enough. The authors of the study asserted that nurses have a key role in ensuring that cultural diversity and inclusion is fostered and maintained at the workplace.
The government policy plays a significant role in promoting the benefits of workforce diversity in many ways such as providing legislative framework for diversity and the strategies and mechanisms for fostering work diversity.
Role of the Nurse in Responding to Cultural Diversity and Inclusion in the Workplace
One of the legal and ethical responsibility of the government is law enforcement. The law is a representation of the will of the governed who possess varying cultural and ethical insights of reality. Consequently, the ethical and moral values of the citizens are enforced by the government. Since there are varying cultures and religious inclinations, it is likely that there will be prejudice with regard to the ones considered as minor. Thus the law provides a standard guideline that tries to respect everyone’s ethnicity and religious inclinations, and disrespect or discrimination of one of different culture at the workplace amounts to the violation of the law (New South Wales Government, 2016). The government plays a key role in maintaining workplace equity by enforcing the law on those who violate it thus ensuring that the rights and religious inclinations of people are respected even at the workplace .
It is an ethical responsibility of the government to make critical decisions for its people who through the contract social theory have surrendered their freedoms in exchange for order (Niskanen, 2017). The government had the moral and ethical responsibility of making decisions that are in line with the values and interest of the society including those of the minority groups. This ethical role of government in decision making requires that all of agencies and leaders make decisions that do not discriminate the rights and responsibilities of all employees despite of their cultural background or religious inclination.
The Australian government through the Department of Labour is has both the legal and ethical responsibilities of ensuring equality in a diverse nursing workforce. The Department of Labour is responsible for industrial relations such as conciliation and arbitration, employees and employers rights and obligations, rules and regulations governing employment etc. The Department of Labour is responsible for ensuring that the rights of both the employees and the employers as outlined in the constitution are adhered to. This promotes workplace diversity because each nurse is required to be flexible to accommodate the religious beliefs of other colleagues. Furthermore, the laws and regulations governing employment as enforced by the government ensures that there is equality during employment and that the nurses from Indigenous groups are discriminated on the basis of their culture and religious inclinations. This develops and promotes a culturally diverse nursing workforce which is also maintained by the enforcement of the rule of law.
The government policy on diversity provides principles that are in agreement with the values and Code of Conduct of the Australian Public Service (APS). These values include devotion to service, respectful, ethical, impartial, and accountable. The government policy on workplace diversity outlines the groups or aspects that require more focus with regard to equity and justice. These include ethnicity, cultural background, sexual orientation, religious beliefs, disability, and family responsibilities among others. The government policy on workplace diversity provides APS values that are aimed at eliminating bias associated with employment that is usually experienced in specific groups such as women, disabled people, Aboriginal and/or Torres Strait Islander peoples, and individuals from communities that are diverse culturally and linguistically (Australian Commission on Safety and Quality in Healthcare, 2014).
Understanding and appreciating diversity
Conclusion
An ethno-religious diverse nursing workforce are without difficulties due to the varying religious inclinations of the nurses from the Indigenous communities in Australia. The Aboriginal perception of causation is perhaps one of the most difficult encounter in affecting a diverse nursing workforce. This is because the Australian Indigenous community exercise religious beliefs that connects every illness to land, religion or kinship. Additionally, the categorization nature of disease by the Aboriginals is another difficulty that faces a culturally diverse nursing workforce. This is because nurses from the Indigenous community will used the categorization approach to ascertain the cause of the disease and hence the treatment. Such religious inclinations are in direct conflict with the Contemporary Western approach of healing which all health practitioners are expected to follow. Despite of the challenges that a diverse nursing workforce in Australia undergoes, the greater part of the solution lies with the nurses and government organizations. The nurses have the role of understanding and appreciating diversity at the workplace, creation of an organizational climate that promotes diversity, and identifying barriers to cultural diversity and inclusion and working towards eliminating them. Equally, the government can foster workplace diversity through law enforcement, decision making, and providing general principles of equity and diversity at the workplace.
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