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Cultural sensibility Sally N Ellis Fletcher describes a framework for managing generational and cultural differences among staff THE HEALTHCARE system is made up of a four-generational workforce, whose members tend to have different attitudes towards work. These are known as the: ■■ Silent generation: born before 1946 and characterised as hard workers. ■■ Post-war baby boomers: born between 1946 and 1964, and characterised as loyal. ■■ Generation X: born between 1965 and 1980, who want a good worklife balance. ■■ Generation Y or millennials: born between 1980 and 1995, and characterised as innovators. As people born between 1996 and 2013, known as Generation Z, join the workforce it will expand to five generations. To avoid conflict and achieve positive care outcomes, senior nurses should acknowledge these generational attitudes and cultural differences, such as those related to gender and ethnicity. One way to manage people’s preconceived ideas is to make staff aware of the concept of cultural sensibility in health care. NURSING MANAGEMENT

This comprises five steps: 1. Understand that, consciously or subconsciously, we all have biases, prejudices and stereotypes (BPS). 2. Recognise personal BPS. 3. Bracket BPS. 4. Practise critical thinking and reflection‑in‑action. 5. Practise culturally sensible interactions. Cultural sensibility is proactive, logical and practical, and incorporates skills that many healthcare workers have already gained via their education. As with any new skill, cultural sensibility may be difficult to adopt initially, but practising with one example of BPS at a time can increase confidence and make the process easier. Step 1. Understanding BPS BPSs must be addressed so that they do not affect roles or patient outcomes. ■■ Managers can begin by discussing non‑threatening topics, such as food, television programmes or books. The use of usual communication methods or online surveys can enhance cultural sensibility.

Step 2. Recognising personal BPS The following two quotes suggest that the nurses involved were expressing BPS without trying to see the other’s perspective. ‘[Older nurses] expect me to work even after I’ve done my required shifts. I’m not a baby boomer who will jump to work when they say “jump”,’ Generation Y nurse. ‘[Younger nurses] don’t want to pay their dues. They have no loyalty and are too quick to leave the bedside,’ Baby boomer nurse. ■■ Managers can ask staff to identify the two nurses’ BPS and share comments. Step 3. Bracketing BPS Bracketing involves gathering as many known BPS as possible. ■■ Managers can encourage staff members to create visualisations of the bracketed BPSs for display in the workplace. Step 4. Critical thinking and reflection‑in‑action When BPS are removed, participants are asked to develop and apply skills in critical thinking and reflection so that, in the future, they can examine situations and suggest behaviour without BPS. ■■ Managers can ask staff to think critically, and reflect and identify ways to build bridges, that promote patient safety. Collect anonymous responses for discussion. Step 5. Cultural sensibility interactions ■■ Managers can share comments, ask questions that give staff insight into their work and generate further discussion, and ask teams to decide if the ideas presented can be implemented. Sally N Ellis Fletcher is associate dean for students at the School of Nursing and Health Studies, University of Missouri, Kansas City, Missouri

Find out more Ellis Fletcher SN (2015) Cultural Sensibility in Healthcare: A Personal and Professional Guidebook. Sigma Theta Tau International, Indianapolis IN. March 2016 | Volume 22 | Number 10 17

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