Chapter 05: Cultural Implications for Psychiatric Mental Health Nursing
Which idea held by the nurse would best promote the provision of culturally competent care? a. Western biomedicine is one of several established healing systems. b. Some individuals will profit from use of both Western and folk healing practices. c. Use of cultural translators will provide valuable information into health-seeking behaviors. d. Need for spiritual healing is a concept that crosses cultural boundaries.
A A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions. REF: Page 85-86
Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture? a. "Is there someone in your community who usually cures your illness?" b. "What usually helps people who have the same type of illness you have?" c. "What questions would you like to ask about your condition?" d. "What sorts of stress are you presently experiencing?"
B Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client. REF: Page 86-87
Ms. Wong, aged 52 years, comes to the emergency room with severe anxiety. She was raised in China but immigrated to the United States at age 40 years. She was recently fired from her job because of a major error in the accounting department that she managed. Ms. Wong's aged parents live with her. Ms. Wong states, "I am a failure." Which of the following statements may accurately assess the basis for Ms. Wong's anxiety and feelings of failure? a. Ms. Wong may feel that she has let herself down since she did not achieve her personal goals in the workplace. b. Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them. c. Ms. Wong may feel personally inadequate since she failed in her quest for independence and self-reliance. d. Ms. Wong may be feeling anxiety because in her family's traditions her failure may result in a changed fate.
B Eastern tradition, such as in China, where Ms. Wong is from, sees the family as the basis for one's identity, and family interdependence as the norm. The views expressed in options a and c demonstrate Western tradition where self-reliance, individuality, and autonomy are highly valued. In the Eastern view one is born into an unchangeable fate. Cognitive Level: Apply (Application) Nursing Process: Outcome Identification NCLEX: Psychosocial Integrity Text page: 85-86
A client reporting gastric pain, tells the nurse, "I think my symptoms started when a neighbor cast a spell on me." The assessment the nurse can make is that the client a. has a major mental illness. b. is expressing a culture-bound illness. c. requires hospitalization to protect the neighbor. d. will probably not respond to Western medical treatment.
B Many culture-bound illnesses, such as ghost illness, or hwa byung, seem exotic or irrational to American nurses. Many of these illnesses cannot be understood within a Western medicine framework. Their causes, manifestations, and treatments do not make sense to nurses whose understanding is limited to a Western perspective on disease and illness. REF: 90-91
Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to a. health practices. b. power and control. c. psychological stability. d. assimilation and conformity.
B Power and control are often products of culturally determined beliefs about who should hold power. In many cultures the elderly are venerated. In other cultures women are virtually powerless. For some cultures, higher education equates with power. REF: Page 88
The question that would give data of least value to the assessment of family dynamics is a. "What changes have occurred recently at work?" b. "Are your wife and children conforming to your expectations?" c. "Are you experiencing stress associated with conforming to family expectations?" d. "Do you expect others to shun or avoid you because you are seeing a therapist?"
D The question about others' reaction to seeking help from a psychotherapist will not provide data about family dynamics. REF: Page 87-88 Awarded 1.0 points out of 1.0 possible points.
Match the culture-bound syndrome in the left column with the patient most likely to experience it from the right column. Answers from the right column may be used more than once. Culture-Bound Syndrome 1.Ataque de nervios 2.Ghost sickness 3.Hwa-byung 4.Susto 5.Wind illness Patient's Cultural Heritage a. Navajo b. Korean c. Latin American d. Chinese
1.ANS:C 2.ANS:A 3.ANS:B 4.ANS:C 5.ANS:D PTS:1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 90-91 (Box 5-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity. Culture-bound syndromes apply to selected population groups
In the DSM-5, a major change in how culture is viewed within each disorder is that: a. issues related to culture and mental illness are now integrated into the discussion of each disorder rather than separately discussing culture-bound syndromes. b. issues related to culture and mental illness are markedly absent in the discussion of each disorder. c. it is noted that it is impossible for health practitioners to be expected to be culturally aware with the increasing diversity of the United States. d. issues related to culture and mental illness are less important than previously thought in diagnostic criteria.
A
The nurse is planning care for a patient of the Latin American culture. Which goal is appropriate? a. Patient will visit with spiritual healer once weekly. b. Patient will experience rebalance of yin-yang by discharge. c. Patient will identify sources that increase "cold-wind" within 24 hours of admission. d. Patient will contact "singer" to provider healing ritual within three days of admission.
A
Which statement best explains the term "worldview"? a. Beliefs and values held by people of a given culture about what is good, right, and normal. b. Ideas derived from the major health care system of the culture about what causes illness. c. Cultural norms about how, when, and to whom illness symptoms may be displayed. d. Valuing one's beliefs and customs over those of another group.
A A worldview is a system of thinking about how the world works and how people should behave in the world and toward each other. It is from this view that people develop beliefs, values, and the practices that guide their lives. REF: 84
The nurse assesses the wellness beliefs and values of a client from another culture best when asking a. "What do you think is making you ill?" b. "When did you first feel ill?" c. "How can I help you get better?" d. "Did you do something to cause the illness?"
A Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness. REF: Page 85-87
According to the Western scientific view of health, illness is the result of a. pathogens. b. energy blockage. c. spirit invasion. d. soul loss.
A Disease has a cause (e.g., pathogens, toxins) that creates the effect; disease can be observed and measured. REF: 84-85
The psychiatric nurse planning and implementing care for culturally diverse clients should understand a. holistic theory. b. systems theory. c. adaptation theory. d. political power theory.
A In most cultures a holistic perspective prevails, one without separation of mind and body. REF: Page 86-88
In the Eastern tradition, disease is believed to be caused by a. fluctuations in opposing forces. b. outside influences. c. members' disobedience. d. adoption of Western beliefs.
A In the Eastern tradition, disease is believed to be caused by fluctuations in opposing forces, the yin-yang energies. REF: 85-86
The Eastern world view can be identified by the belief that one's identity is found in individuality. a. holds responsibility to family as central. b. time waits for no one. c. disease is a lack of harmony with the environment.
A The Eastern traditional world view is sociocentric. Individuals experience their selfhood and their lives as part of an interdependent web of relationships and expectations. REF: Page 85-86
Which nursing actions demonstrate cultural competence. SELECT ALL THAT APPLY. a. Planning meal time around the patient's prayer schedule. b. Advising a patient to visit with the hospital chaplain. c. Researching foods that a lacto-ovo-vegetatrian will eat. d. Providing time for a patient's spiritual healer to visit. e. Ordering standard meal trays to be delivered three times daily.
A, B, C, D
1. Sequence the intensity of these psychiatric treatments from highest to lowest: A. Clinic visits at a community mental health center B. Psychosocial rehabilitation program C. Partial hospitalization D. Crisis stabilization
ANS: 1. D 2. C 3. B 4. A The continuum of psychiatric treatment offers services along a range of intensity. Each patient's needs are evaluated for the most appropriate venue of treatment. Patients may move from one level to another as their needs change. DIF: Cognitive Level: Analysis REF: Text Pages: 92-93TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment
Which statement(s) by patients with serious, persistent mental illness best demonstrate that the case manager has established an effective long-term relationship? (Select all that apply.) "My case manager: a. talks in language I can understand. " b. helps me keep track of my medication." c. gives me little gifts from time to time." d. looks at me as a whole person with lots of needs." e. lets me do whatever I choose without interfering."
ANS: A, B, D Each correct answer is an example of appropriate nursing foci: communicating at a level understandable to the patient, providing medication supervision, and using holistic principles to guide care. The distracters violate relationship boundaries or suggest a laissez faire attitude on the part of the nurse. DIF: Cognitive Level: Application REF: Text Pages: 91-92TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
A person in the community asks the nurse, "People with mental illnesses went to state hospitals in earlier times. Why has that changed?" Select the nurse's accurate response(s). (Select all that apply.) a. "Science has made significant improvements in drugs for mental illness, so now many persons may live in their communities." b. "There's now a better selection of less restrictive treatment options available in communities to care for people with mental illness." c. "National rates of mental illness have declined significantly. There actually is not a need for state institutions anymore." d. "Most psychiatric institutions were closed because of serious violations of patients' rights and unsafe conditions." e. "Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than institutional settings."
ANS: A, B, E The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. Funding for treatment of mental illness remains largely inadequate but now focuses on community rather than institutional care. Antipsychotic medications improve more symptoms of mental illness; hence, management of psychiatric disorders has improved. Rates of mental illness have increased, not decreased. Hospitals were closed because funding shifted to the community. Conditions in institutions have improved. DIF: Cognitive Level: Analysis REF: Text Pages: 87-88TOP: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment
A patient with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns that the patient: Will begin attending an activities group at the mental health outreach center. Is worried about being able to pay for the therapy. Does not know how to get from home to the outreach center. Has an appointment to have blood work at the same time the activities group meets. Wants to attend services at a church that is a half mile from the patient's home. Which task(s) would be part of the role of a community mental health nurse? (Select all that apply.) a. Rearranging conflicting care appointments b. Negotiating the cost of therapy for the patient c. Arranging transportation to the outreach centered. d. Accompanying the patient to church services weekly e. Monitoring to ensure the patient's basic needs are met
ANS: A, C, E The correct answers reflect the coordinating role of the community psychiatric nurse case manager. Negotiating the cost of therapy and accompanying the patient to church services are interventions the nurse would not be expected to undertake. The patient can walk to the church services; the nurse can provide encouragement. DIF: Cognitive Level: Application REF: Text Pages: 91-93TOP: Nursing Process: Planning MSC: Client Needs: Safe and Effective Care Environment
Which statement(s) most clearly reflect the stigma of mental illness? (Select all that apply.) a. "Many mental illnesses are hereditary." b. "Mental illness can be evidence of a brain disorder." c. "People claim mental illness so they can get disability checks." d. "If people with mental illness went to church, they would be fine." e. mental illness results from the breakdown of American families."
ANS: C, D, E Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. Many mental illnesses are genetically transmitted. Neuroimaging can show changes associated with some mental illnesses. DIF: Cognitive Level: Analysis REF: Text Pages: 97-98TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
An experienced psychiatric nurse plans to begin a new job in a community-based medication clinic. The clinic sees culturally diverse patients. Which action should the nurse take first to prepare for this position? a. Investigate cultural differences in patients' responses to psychotropic medications. b. Contact the clinical nurse specialist for guidelines regarding cultural competence. c. Examine the literature on various health beliefs of members of diverse cultures. d. Complete an online continuing education offering about psychopharmacology.
ANS:A An experienced nurse working on a mental health inpatient unit would be familiar with the action and side effects of most commonly prescribed psychotropic medications. However, because the clinic serves a culturally diverse population, reviewing cultural differences in patients' responses to these medications is helpful and vital to patient safety. The distracters identify actions the nurse would take later. PTS:1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 91-92 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity
Which viewpoint of an Asian American family will most affect decision making about care? a. The father is the authority figure. b. The mother is head of the household. c. Women should make their own decisions. d. Emotional communication styles are desirable.
ANS:A Asian American families traditionally place the father in the position of power as the head of the household. Mothers, as well as other women, are usually subservient to fathers in these cultures. Asian Americans are more likely to be reserved. PTS:1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 89 (Table 5-5) | Page 93-95 TOP: Nursing Process: Planning/Outcomes Identification MSC: Client Needs: Psychosocial Integrity
The sibling of an Asian American patient tells the nurse, "My sister needs help for pain. She cries from the hurt." Which understanding by the nurse will contribute to culturally competent care for this patient? Persons of an Asian American heritage: a. often express emotional distress with physical symptoms. b. will probably respond best to a therapist who is impersonal. c. will require prolonged treatment to stabilize these symptoms. d. should be given direct information about the diagnosis and prognosis.
ANS:A Asian Americans commonly express psychological distress as a physical problem. The patient may believe psychological problems are caused by a physical imbalance. Treatment will likely be short. The patient will probably respond best to a therapist who is perceived as giving. Asian Americans usually have strong family ties and value hope more than truth. PTS:1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 89-90 (Table 5-5) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
A nurse speaks with family members of a Chinese American parent recently diagnosed with major depression. Which comment by the nurse will the family find most comforting? "The nursing staff will: a. take good care of your parent." b. pray with your parent several times a day." c. teach your parent important self-care strategies." d. educate your parent about safety information regarding medication."
ANS:A Chinese Americans hold an Eastern (balance) worldview. Persons who are ill or need health care are vulnerable and need protection. The family will find comfort in a nurse's statement that good care will be provided. The distracters apply to persons with a Western or indigenous worldview. PTS:1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 86 (Table 5-2) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
A nurse in the clinic has a full appointment schedule. A Hispanic American patient arrives at 1230 for a 1000 appointment. A Native American patient does not keep an appointment at all. What understanding will improve the nurse's planning? These patients are: a. members of cultural groups that have a different view of time. b. immature and irresponsible in health care matters. c. acting out feelings of anger toward the system. d. displaying passive-aggressive tendencies.
ANS:A Hispanic Americans and Native Americans traditionally treat time in a way unlike the Western culture. They tend to be present-oriented; that is, they value the current interaction more than what is to be done in the future. If engaged in an activity, for example, they may simply continue the activity and appear later for an appointment. Understanding this, the nurse can avoid feelings of frustration and anger when the nurse's future orientation comes into conflict with the patient's present orientation. PTS:1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 85-86 (Table 5-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
A psychiatric nurse leads a medication education group for Hispanic patients. This nurse holds a Western worldview and uses pamphlets as teaching tools. Groups are short and concise. After the group, the patients are most likely to believe: a. the nurse was uncaring. c. the teaching was efficient. b. the session was effective. d. they were treated respectfully.
ANS:A Hispanic individuals usually value relationship behaviors. Their needs are for learning through verbal communication rather than reading and for having time to chat before approaching the task. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 85-86 (Table 5-2) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
A nurse prepares to teach important medication information to a patient of Mexican heritage. How should the nurse manage the teaching environment? a. Stand very close to the patient while teaching. b. Maintain direct eye contact with the patient while teaching. c. Maintain a neutral emotional tone during the teaching session. d. Sit 4 feet or more from the patient during the teaching session.
ANS:A Latin American cultures use close personal space, closer than many other minority groups. Standing very close to the patient frequently indicates acceptance. Direct eye contact should not be prolonged with this patient. Persons of this cultural heritage have high emotionality. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 87 (Table 5-3) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
A Chinese American patient diagnosed with an anxiety disorder says, "My problems began when my energy became imbalanced. " The nurse asks for the patient's ideas about how to treat the imbalance. Which comment would the nurse expect from this patient? a. "My family will bring special foods to help me get well." b. "I hope my health care provider will prescribe some medication to help me." c. "I think I would benefit from talking to other patients with a similar problem." d. "I would like to have a native healer perform a ceremony to balance my energy."
ANS:A The concept of energy imbalance as a source of illness is an explanatory model familiar to Asian cultures. A source of healing is dietary change to include either "hot" or "cold" foods to correct the imbalance. "Hot" and "cold" in this case do not refer to thermal properties of the foods. Medication would not be a treatment suggested by a patient with an Eastern worldview. Someone from an indigenous culture may suggest rituals. Group discussion of mental illness would not be appealing to a Chinese American. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 86 (Table 5-2) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
The nurse should be particularly alert to somatization of psychological distress among patients whose cultural beliefs include: (select all that apply) a. mental illness reflects badly on the family. b. mental illness shows moral weakness. c. intergenerational conflict is common. d. the mind, body, and spirit are merged. e. food choices influence one's health.
ANS:A, B, D Physical symptoms are seen as more acceptable in cultural groups in which interdependence and harmony of the group are emphasized. Mental illness is often perceived as reflecting a failure of the entire family. In groups in which mental illness is seen as a moral weakness and both the individual and family are stigmatized, somatization of mental distress is better accepted. In groups in which mind, body, and spirit are holistically perceived, somatization of psychological distress is common. Somatization and food are not commonly related. Intergenerational conflict has not been noted as a risk factor for somatization. PTS:1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 90-91 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
A psychoeducational session will discuss medication management for a culturally diverse group of patients. Group participants are predominantly members of minority cultures. Of the four staff nurses below, which nurse should lead this group? a. Very young registered nurse c. Newly licensed registered nurse b. Older, mature registered nurse d. A registered nurse who is very thin
ANS:B Persons of minority cultures value age and wisdom. Persons with a Western worldview tend to value youth. An older, mature registered nurse would be the most credible leader of this group. The nurse's size has no bearing on credibility. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 88-89 (Table 5-4) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
Which intervention best demonstrates that a nurse correctly understands the cultural needs of a hospitalized Asian American patient diagnosed with a mental illness? a. Encouraging the family to attend community support groups b. Involving the patient's family to assist with activities of daily living c. Providing educational pamphlets to explain the patient's mental illness d. Restricting homemade herbal remedies the family brings to the hospital
ANS:B The Asian community values the family in caring for each other. The Asian community uses traditional medicines and healers, including herbs for mental symptoms. The Asian community describes illness in somatic terms. The Asian community attaches a stigma to mental illness, so interfacing with the community would not be appealing. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 89 (Table 5-5) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
A Native American patient describes a difficult childhood and dropping out of high school. The patient abused alcohol as a teenager to escape feelings of isolation but stopped 10 years ago. The patient now says, "I feel stupid. I've never had a good job. I don't help my people." Which nursing diagnosis applies? a. Risk for other-directed violence c. Deficient knowledge b. Chronic low self-esteem d. Social isolation
ANS:B The patient has given several indications of chronic low self-esteem. Forming a positive self-image is often difficult for Native American individuals because these indigenous people must blend together both American and Native American worldviews. No defining characteristics are present for the other nursing diagnoses. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 92-93 TOP: Nursing Process: Diagnosis/Analysis MSC: Client Needs: Psychosocial Integrity
A group activity on an inpatient psychiatric unit is scheduled to begin at 1000. A patient, who was recently discharged from United States Marine Corps, arrives at 0945. Which analysis best explains this behavior? a. The patient wants to lead the group and give directions to others. b. The patient wants to secure a chair that will be close to the group leader. c. The military culture values timeliness. The patient does not want to be late. d. The behavior indicates feelings of self-importance that the patient wants others to appreciate.
ANS:C Culture is more than ethnicity and social norms; it includes religious, geographic, socioeconomic, occupational, ability- or disability-related, and sexual orientation-related beliefs and behaviors. In this instance, the patient's military experience represents an aspect of the patient's behavior. The military culture values timeliness. The distracters represent misinterpretation of the patient's behavior and have no bearing on the situation. PTS:1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 84 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
A Haitian patient diagnosed with depression tells the nurse, "There's nothing you can do. This is a punishment. The only thing I can do is see a healer." The culturally aware nurse assesses that the patient: a. has delusions of persecution. b. has likely been misdiagnosed with depression. c. may believe the distress is the result of a curse or spell. d. feels hopeless and helpless related to an unidentified cause.
ANS:C Individuals of African American or Caribbean cultures who have a fatalistic attitude about illness may believe they are being punished for wrongdoing or are victims of witchcraft or voodoo. They may be reticent to share information about curses with therapists. No data are present in the scenario to support delusions. Misdiagnosis more often labels a patient with depression as having schizophrenia. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 86 (Table 5-2) | Page 88 (Table 5-4) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
Which communication techniques would be most effective for a nurse to use during an assessment interview with an adult Native American patient? a. Open and friendly; ask direct questions; touch the patient's arm or hand occasionally for reassurance. b. Frequent nonverbal behaviors, such as gestures and smiles; make an unemotional face to express negatives. c. Soft voice; break eye contact occasionally; general leads and reflective techniques. d. Stern voice; unbroken eye contact; minimal gestures; direct questions.
ANS:C Native American culture stresses living in harmony with nature. Cooperative, sharing styles rather than competitive or intrusive approaches are preferred; thus, the more passive style described would be best received. The other options would be more effective to use with patients of a Western orientation. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 86 (Table 5-2) | Page 87 (Table 5-3) | Page 90 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
Why is the study of culture so important for psychiatric nurses in the United States? Select all that apply. a. Psychiatric nurses often practice in other countries. b. Psychiatric nurses must advocate for the traditions of the Western culture. c. Cultural competence helps protect patients from prejudice and discrimination. d. Patients should receive information about their illness and treatment in terms they understand. e. Psychiatric nurses often interface with patients and their significant others over a long period of time.
ANS:C, D, E One purpose of cultural competence is for the psychiatric nurse to relate and explain information about the patient's illness and treatment in an understandable way, incorporating the patient's own beliefs and values. A fundamental aspect of nursing practice is advocacy. Cultural competence promotes recognition of prejudices in care, such as stigma and misdiagnosis. Psychiatric nurses often interface with patients and families over years and in community settings. PTS:1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 83-84 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
A nurse begins work in an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after: a. identifying culture-bound issues. b. implementing scientifically proven interventions. c. correcting inferior health practices of the population. d. exploring commonly held beliefs and values of the population.
ANS:D Cultural competence is dependent on understanding the beliefs and values of members of a different culture. A nurse who works with an individual or group of a culture different from his or her own must be open to learning about the culture. The other options have little to do with cultural competence or represent only a portion of the answer. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 86 | Page 93 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
Which Western cultural feature may result in establishing unrealistic outcomes for patients of other cultural groups? a. Interdependence b. Present orientation c. Flexible perception of time d. Direct confrontation to solve problems
ANS:D Directly confronting problems is a highly valued approach in the American culture but not part of many other cultures in which harmony and restraint are valued. American nurses sometimes mistakenly think that all patients should take direct action. Patients with other values will be unable to meet this culturally inappropriate outcome. Present orientation, interdependence, and a flexible perception of time are not valued in Western culture. These views are more predominant in other cultures. See relationship to audience response question. PTS:1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 88 (Table 5-4) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
A Native American patient sadly describes a difficult childhood. The patient abused alcohol as a teenager but stopped 10 years ago. The patient now says, "I feel stupid and good for nothing. I don't help my people." How should the treatment team focus planning for this patient? a. Psychopharmacological and somatic therapies should be central techniques. b. Apply a psychoanalytic approach, focused on childhood trauma. c. Depression and alcohol abuse should be treated concurrently. d. Use a holistic approach, including mind, body, and spirit.
ANS:D Native Americans, because of their beliefs in the interrelatedness of parts and about being in harmony with nature, respond best to a holistic approach. No data are present to support dual diagnosis, because the patient has resolved the problem of excessive alcohol use. Psychopharmacological and somatic therapies may be part of the treatment, but the focus should be more holistic. Psychoanalysis is a long-term expensive therapy; cognitive therapy might be a better choice. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 86-87 | Page 86 (Table 5-2) | Page 88(Table 5-4) TOP: Nursing Process: Planning/Outcomes Identification MSC Client Needs: Psychosocial Integrity
A patient in the emergency department shows a variety of psychiatric symptoms, including restlessness and anxiety. The patient says, "I feel sad because evil spirits have overtaken my mind. " Which worldview is most applicable to this individual? a. Eastern/balance c. Western/scientific b. Southern/holistic d. Indigenous/harmony
ANS:D Persons of an indigenous worldview believe disease results from a lack of personal, interpersonal, environmental, or spiritual harmony and that evil spirits exist. The holism of body-mind-spirit is a key component of this view. If one believes an evil spirit has taken control, distress results. Western and Eastern worldviews do not embrace spirits. See relationship to audience response question. PTS:1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 85-86 (Table 5-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
A black patient, originally from Haiti, has a diagnosis of depression. A colleague tells the nurse, "This patient often looks down and is reluctant to share feelings. However, I've observed the patient spontaneously interacting with other black patients." Select the nurse's best response. a. "Black patients depend on the church for support. Have you consulted the patient's pastor?" b. "Encourage the patient to talk in a group setting. It will be less intimidating than one-to-one interaction." c. "Don't take it personally. Black patients often have a resentful attitude that takes a long time to overcome." d. "The patient may have difficulty communicating in English. Have you considered using a cultural broker?"
ANS:D Society expects a culturally diverse patient to accommodate and use English. Feelings are abstract, which requires a greater command of the language. This may be especially difficult during episodes of high stress or mental illness. Cultural brokers can be helpful with language and helping the nurse to understand the Haitian worldview and cultural nuances. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 88-89 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
To provide culturally competent care, the nurse should: a. accurately interpret the thinking of individual patients. b. predict how a patient may perceive treatment interventions. c. formulate interventions to reduce the patient's ethnocentrism. d. identify strategies that fit within the cultural context of the patient.
ANS:D The correct answer is the most global response. Cultural competence requires ongoing effort. Culture is dynamic, diversified, and changing. The nurse must be prepared to gain cultural knowledge and determine nursing care measures that patients find acceptable and helpful. Interpreting the thinking of individual patients does not ensure culturally competent care. Reducing a patient's ethnocentrism may not be a desired outcome. PTS:1 DIF: Cognitive Level: Apply (Application) REF: Page 93 TOP: Nursing Process: Planning/Outcomes Identification MSC: Client Needs: Psychosocial Integrity
You are caring for Maria, a patient who states she has "ghost sickness". Which is the appropriate nursing response? a. "I have no idea what 'ghost sickness' is." b. "How does 'ghost sickness' make you feel?" c. "'Ghost sickness' is not listed in the manual of psychiatric disorders." d. "Let's talk about why you believe in evil spirits."
B
Josefina Juarez, aged 36 years, comes to the mental health clinic where you work after being referred by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. She is now a single mother to 6 children, ages 2 to 15, following the death of her husband last year. During the initial intake assessment, Josefina tells you her problem is that she has headaches and backaches "almost every day" and "can't sleep at night." She shakes her head no and looks away when asked about anxiety or depression and states she does not know why she was referred to the mental health clinic. You recognize that Josefina may be exhibiting: a. regression. b. somatization. c. enculturation. d. assimilation.
B Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. Regression is a defense mechanism meaning to begin to function at a lower or previous level of functioning. Enculturation refers to how cultural beliefs, practices, and norms are communicated to its members. Assimilation refers to a situation in which immigrants adapt to and absorb the practices and beliefs of a new culture until these customs are more natural than the ones they learned in their homeland. Cognitive Level: Apply (Application) Nursing Process: Outcome Identification NCLEX: Psychosocial Integrity Text page: 90-91
Julio is a 31-year-old patient who comes to your mental health outpatient clinic. Which of the following would alert you to the potential for somatization? a. Julio states, "I have been feeling sad for weeks." b. Julio shows you bottles of medication he has been prescribed for anxiety. c. Julio presents with concerns involving headaches, dizziness, and fatigue. d. Julio states, "I have been sleeping all the time."
C
The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports a. increased somatic expressions of distress. b. disruption of energy balance. c. appeasement of the spirits. d. increased anxiety.
C Appeasement of spirits might be a viable outcome criterion if the client believes the illness was caused by angry spirits. In each of the other options useful outcomes would be decreased somatic symptoms, reinstatement of energy balance, and decreased anxiety. REF: Page 85-86
Which of the following best explains the concept of cultural competence? a. Nurses have enough knowledge about different cultures to be assured they are delivering culturally sensitive care. b. Nurses are able to educate their patients from other cultures appropriately about the cultural norms of the United States. c. Nurses adjust their own practices to meet their patients' cultural preferences, beliefs, and practices. d. Nurses must take continuing education classes on culture in the process of becoming culturally competent.
C Cultural competence means that nurses adjust and conform to their patients' cultural needs, beliefs, practices, and preferences rather than their own. This option does not describe cultural competence. Although nurses are continually learning regarding culture, it is a career-long process. The goal is not to educate patients about our own culture but rather to adjust to their cultural preferences. Although nurses may take continuing education regarding culture, this does not describe the term cultural competence. The other options do not describe cultural competence. Cognitive Level: Understand (Comprehension) Nursing Process: Outcome Identification NCLEX: Psychosocial Integrity Text page: 93
A peer asks you to help him differentiate between culture and ethnicity for clarification. Which statement by the peer would acknowledge that you had appropriately helped him clarify the difference between the two terms? a. "So, ethnicity refers to having the same life goals whereas culture refers to race." b. "So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes." c. "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." d. "So, ethnicity refers to race, and culture refers to having the same worldview."
C Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group's members in patterned ways of thinking and acting. The other options are all incorrect definitions of ethnicity and culture. Cognitive Level: Analyze (Analysis) Nursing Process: Assessment NCLEX: Psychosocial Integrity Text page: 84-85
Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of a. biased assessment tools. b. insensitive practitioners. c. insensitive interviewing techniques. d. lack of the availability of cultural translators.
C Inaccurate information or insufficient information may be obtained if the interviewer is not culturally sensitive. Only when assessment data are accurate can effective treatment be planned. REF: 86-87
When members of a group are introduced to the culture's worldview, beliefs, values, and practices, it is called a. acculturation. b. ethnocentrism. c. enculturation. d. cultural encounters.
C Members of a group are introduced to the culture's worldview, beliefs, values, and practices in a process called enculturation. Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way. Acculturation is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations. Cultural encounters occur when members of varying cultures meet and interact. REF: 85-86
Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces? a. Acupuncture b. Dietary change c. Cleansings d. Herbal medicine
C Rituals, cleansings, prayer, and even witchcraft may be the treatment expectation of a client who believes his illness is caused by spiritual forces. REF: Page 92-93
Exclusive use of Western psychological theories by nurses making client assessments will result in a. a high level of care for all clients. b. standardization of nomenclature for psychiatric disorders. c. inadequate assessment of clients of diverse cultures. d. greater ease in selecting appropriate treatment interventions.
C Unless clients have faith in a particular healing modality, the treatment may not be effective. When nurses make assessments on the basis of Western theories, treatments consistent with those assessments follow. Clients of other cultures may find the treatment modalities unacceptable or not useful. Treatments consistent with the client's cultural beliefs as to what will provide a cure are better. REF: 85-86
People who have an indigenous worldview a. see themselves as spiritual and believe that they are linked with all other living things. b. focus on the articulation of individual needs and ideas. c. view the self as an extension of cosmic energy that is repeatedly reborn. d. are concerned with being part of a harmonious community.
D Clients with an indigenous worldview are interested in connectedness and being in harmony with others. They have little interest in personal goals and autonomy. REF: 84-85
Deviation from cultural expectations is considered by members of the cultural group as a demonstration of a. hostility. b. lack of self-will. c. variation from tradition. d. illness.
D Deviation from cultural expectations is considered by others in the culture to be a problem and is frequently defined by the cultural group as "illness." REF: 85-86
When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects a. supernatural causes. b. negative forces. c. inheritance. d. imbalance.
D Many Eastern cultures explain illness as a function of imbalance. REF: Page 85-86
Which healing practice is least used in the Western health system of healing practices? a. Antibiotic medication b. Surgery c. Targeted cellular destruction d. Restoring lost balance or harmony
D The best treatment perspectives of various cultures include regaining lost balance and harmony. This perspective is not used in Western culture. REF: 84-85
You are working on the psychiatric unit and assisting with the care for Mr. Tran, a refugee from Darfur, who came to the United States 1 year ago. Although Mr. Tran understands and speaks some very limited English, he is much more comfortable conversing in his native language. Mike, the nurse working directly with Mr. Tran, says to you, "I am so frustrated trying to communicate with Mr. Tran! He insists on speaking his language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which of the following responses you could make promotes culturally competent care? (select all that apply): a. "You are right that Mr. Tran needs to speak English, but all patients do have a right to an interpreter, so you need to comply." b. "I agree that it is frustrating trying to communicate with Mr. Tran. Maybe we could see if his family members can help convince him to try speaking English." c. "Mr. Tran will have to learn to speak English eventually to live and work successfully in this country. Just try to be patient and encourage him to try speaking English." d. "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." e. "Mr. Tran's ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known."
D, E Cultural imposition is imposing our own cultural norms onto those from another cultural group. By obtaining an interpreter for Mr. Tran, the nurse is promoting culturally competent care, ensuring the patient can communicate his feelings and needs thoroughly to the staff. Patients do have a right to an interpreter, but stating that Mike is right is not promoting culturally competent care and is instead confirming his opinion. Asking family members to convince the patient to speak English is not promoting culturally competent care and also undermines the trust between nurse and patient. Instead of encouraging the patient to speak English an interpreter should be obtained for the patient. Cognitive Level: Apply (Application) Nursing Process: Outcome Identification NCLEX: Psychosocial Integrity Text page: 88
