Chapter 2: Cultural Diversity and Maternal Child Nursing
After reading a journal article about culture and cultural diversity, a nurse demonstrates understanding of the information when the nurse identifies which situation as an example of cultural assimilation?
an American living in France celebrating French National Day Explanation: Cultural assimilation is the process of taking on a culture that is different from one's original culture. The best example of this is an American celebrating a national French holiday when residing in France.
The nurse is caring for a 4-year-old girl of Mexican descent who is recovering in the hospital following a diagnosis of epileptic seizures. The child's mother insists on a visit from her curandera to provide healing powers to her daughter. What would be the best intervention of the nurse in this situation?
Discuss the situation with the child's physician and arrange for a visit from the curandera at the hospital if appropriate. Explanation: The curandero (male) or the curandera (female) of the Mexican American community is believed to have healing powers as a gift from God. If the folk remedies or practices of the folk healers are compatible with the health regimen and support appropriate health practices, these practices and beliefs do no harm; in fact, they may even benefit the child and family. However, use of a folk healer can lead to a delay in beneficial treatment or create other problems; therefore, the child's physician should be consulted prior to arranging a visit.
While reviewing a woman's compliance with prenatal care, a nurse notes that which comment made by the woman may be a result of poverty rather than a cultural difference?
"I wish I could afford fresh fruits for vitamin C because I just don't remember to take those prenatal vitamins." Explanation: Many characteristic responses described as cultural limitations are actually the consequences of poverty (e.g., parents seeking medical care for their children late in the course of an illness or a woman not taking prenatal vitamins during pregnancy). Solving these problems may be a question of locating adequate financial resources and may not be related to cultural differences. Reducing alcohol intake may be an addiction problem. Many women work when they are pregnant and cannot take an afternoon rest. Working may or may not be due to poverty, so the nurse will have to ask additional questions before concluding the woman lives in poverty.
A nurse is uncomfortable caring for a pregnant client who is married to her female life partner. The best advice another nurse can give her would include which statement?
"Spend some time self-reflecting why this family difference might be bothering you." Explanation: There are some major barriers for health care providers when caring for individuals who are different from them. One of these barriers is the potential for personal bias. This barrier can only be addressed through self-reflection, trying to understand why these differences might be bothersome, and setting those feelings aside while taking care of clients. A cultural nursing course might be beneficial, but it will not help in the meantime. Pretending to be okay with the family differences will not deal with the problem. Ignoring feelings by working only with traditional family units will not solve the problem in the long term.
The nurse is caring for a teen who has been hospitalized after a motor vehicle accident. The accident is believed to have been caused by alcohol and drug use. The teen states, "I fit in when I use marijuana and, besides, it is legal in some states." Which response by the nurse is most therapeutic?
"Tell me how you feel when you use marijuana." Explanation: Substance use is problematic in the adolescent population. The education and open communication is important. It is correct that marijuana is legal in some states. It is also true that the laws where it is legal pertain to adults and not children—but this statement does not establish open, therapeutic communication. Marijuana use may lead to other "harder" drugs over time but that statement does little to establish open, therapeutic communication. Voicing criticism to the teen's friends will do little to establish open communication. The statement asking how drugs make him feel is the most open statement and may provide an introduction to a discussion.
An 11-year-old child is brought to the clinic by the parent who reports the child has had declining school performance and behavior issues since learning that the parents were divorcing. What is the most appropriate advice that the nurse can provide to the parent?
"Tell your child the divorce is not because of him and repeat this reminder as often as you can." Explanation: Children suffer many emotions during the divorce of their parents, which may result in poor behavior and school concerns. Both parents are advised to remind the child often that they are not divorcing because of the child. The reinforcement of this message is of great importance. The parent would be advised to avoid taking the role of superior parent; avoid including the child in conversations about adult concerns (such as finances); and not to expect or ask the child to take sides. Reading about divorce may be helpful, but it is foundational to the child's ability to move forward in this process that the child not feel responsible for the divorce and that the child recognizes he is loved by both parents.
The nurse is providing an educational program for the staff working at a homeless shelter. The program is focused on the impact of homelessness on children. What information should be included in the presentation? Select all that apply.
Homeless children are at an increased risk for sexual abuse. Homeless children are at risk for developing chronic health problems. Acute health conditions are increased in homeless children. Explanation: Homelessness is a psychological and physiological stressor on the family unit. Children who are homeless are at an increase risk for both acute and chronic health concerns. Even when homeless families have beds in shelter settings these children and their parents are still at an elevated risk for health problems. Incidence of sexual abuse is increased in homeless children. Although the family unit may remain together, this does not minimize the overall risk of homelessness.
A client asks a nurse how to preserve cultural heritage for the client's American-born children. What suggestion(s) might the nurse offer? Select all that apply.
Read books with children written by authors that promote your culture. Talk to children about your childhood, traditions, and values. Celebrate holidays in your traditional manner. Explanation: Preserving individual heritage when living in another culture calls for creative planning. Some common suggestions include: (1) Plan an "ethnic night" once a week when only ethnic food is served. Encourage children to invite friends for the meal and discuss the traditions behind the various foods. (2) If a foreign language is part of your traditions, reserve one night a week when family members speak only the native language so they will value two languages. (3) Choose books for children that are written by authors from your culture authors that promote your culture. Read them together as a family. (4) Monitor television for programs that focus positively on your culture. Watch them with your children. (5) As bedtime stories or "talk time," talk to your children about your childhood and traditions and values so they can appreciate how long these values have been revered by your family. (6) Celebrate holidays in your traditional manner. Including cultural influences in holiday celebrations adds a rich ingredient and feeling of security to these occasions. Learning about another friend's culture does not promote an understanding of their own culture.
The nurse caring for a woman in active labor notices a strange odor coming from some tea the family has brought. When questioned, the woman informs the nurse of herbs they have brewed in the tea to help lower the pain. Which intervention would be considered the most appropriate for the nurse to take?
Research the herbs in the tea and report the findings to the provider. Explanation: The nurse should be aware when taking health histories that many people today from all cultures rely on complementary or alternative therapies. Knowing about these is a way to be certain a medication that has been prescribed will not counteract or be synergistic with what herbs are being used. Asking the family to remove the tea from the facility is nontherapeutic. Telling the woman that she will have to rely on their herbal prep solely is not true unless the herbs are contradicted with conventional medicines. Unless research is done, making a blanket statement that herbs and medications are incompatible is untrue.
An experienced nurse is the supervisor over other nurses on a clinical unit. The nurse witnessed the following actions between pediatric clients and a nurse. Which action would the nurse address as an example of potential prejudice?
The nurse does not explain a procedure to a 9-year-old child because the nurse states that the child "would not understand anyway." Explanation: A prejudice is a preconceived notion about a person that is based on a certain characteristic such as age, gender, ethnicity, race, nationality, or culture. An example of this is the nurse who has a preconceived notion that a client will not understand the explanation because of the child's age. If a blood pressure cuff is accurate, there is no reason why it cannot be used to obtain a blood pressure of a 4-year-old child. The other examples show poor choices when interacting with pediatric clients and their families but are not examples of prejudice.
A client who does not speak the dominant language becomes upset when the nurse brings in an interpreter, rather than using a family member as the translator. Which would be the best reason for using an official interpreter in this case?
There may be cultural limitations that change how the information is being interpreted by the family. Explanation: It is unacceptable to have a family member serve as an interpreter. There may be cultural limitations that change how the information the nurse is stating is being interpreted for a parent or partner. Additionally, the medical terminology used in the health care system is best translated by a trained professional interpreter.
A nurse teaches a couple how to administer medication to their infant. Neither of the parents speaks the dominant language proficiently. The parents have a 10-year-old child at the appointment who appears to speak the dominant language fluently. Which would be the best course of action for the nurse?
Wait for an interpreter to arrive to relay the instructions. Explanation: Waiting for an interpreter to arrive to relay the instructions would be the best course of action, because it would ensure that the parents fully understand the instructions. As a general rule, it is unfair to ask children to interpret for their parents, because this can place a child in situations that require adult judgment and knowledge. In some cultures, it might be unacceptable for a younger person to serve as an interpreter for an older person or for a subservient woman to interpret for a dominant man, because this shifts authority. In many instances, written communication is even more problematic than oral communication as many people can speak a second language but cannot write or read it. Referring the parents to a pharmacy would not be appropriate, because they may not know how to contact a pharmacy and, even if they do, they will likely encounter the same language barrier again.
A woman arrives to the labor and delivery unit. The woman is 38 weeks' pregnant with her first baby and reports that her contractions began 1 hour ago. She is 1-cm dilated, rates her pain as 10/10 on the pain scale, and screams for pain medication. What is the best action from the nurse?
"Let me start your IV so we can get you an epidural as soon as possible." Explanation: The best response is to administer pain medication to this client as soon as possible. Pain is subjective, and whatever the client reports it to be is what she is experiencing.
After an initial cultural assessment, the nurse has determined that a family's time orientation is focused on the present and the past. Which is the best feeding goal to focus on for this family?
After this hour with the lactation consultant, the baby will demonstrate a good latch. Explanation: Past and present time orientation may make it difficult for a family to focus on a long-term goal. The best answer is the shortest goal, which is demonstrating a good latch in 1 hour.
A client who just learned she is pregnant says, "I can no longer eat strawberries, even though they are my favorite." What best explains this statement?
It is related to culture. Explanation: People from different cultures tend to eat different types of food. Some women may omit various foods during pregnancy because they believe a particular food will mark the baby (e.g., strawberries cause birthmarks, raisins cause brown spots). Food preferences, selections, and seasons do not explain her sudden omission of strawberries in her diet.
A cultural group that one is born into is called:
ethnicity. Explanation: Ethnicity is a cultural group. It is more narrowly defined by race.
Which is not true regarding cultural values?
They are formed early in life and seldom change. Explanation: Although cultural values are often formed early in life, they can and do often change in response to changes in the environment, lifestyle, or circumstances of an individual.
The nurse is reviewing the medical record of a female client. The history reveals that the client believes that her gender identity and sex match. The nurse would identify the client's gender identity by which term?
cisgender Explanation: Cisgender is the term to denote when an individual feels their gender and their sex match. Transgender refers to an individual who feels their gender and their sex do not match. Heterosexual and homosexual are terms that relate to sexual orientation, not gender identity.
A nurse is reviewing a journal article that describes a view of the world and a set of traditions that a specific social group uses and transmits to the next generation. The nurse is reading an article about which concept?
culture Explanation: Culture is a view of the world and a set of traditions that a specific social group uses and transmits to the next generation. Cultural values are preferred ways of acting based on those traditions. Ethnicity refers to the cultural group into which a person was born, although the term is sometimes used in a narrower context to mean only race. An ancestry group would be what a person identifies as one's heritage or lineage group.
A nurse doing an admission assessment on a new Chinese American client notices that the client will not make eye contact. The most likely reason for this is that it:
is a sign of respect. Explanation: Whether people look at one another when talking is culturally determined. Chinese Americans, for example, may not make eye contact during a conversation. This social custom shows respect for the position of the health care provider and is a compliment and not an avoidance issue.
When a labor and delivery nurse tells a coworker that an Asian client probably did not want any pain medication because "Asian women typically are stoic," the nurse is expressing a belief known as:
stereotype. Explanation: Stereotypes are preconceived and untested beliefs about people. Ethnic slur refers to a statement made about another according to their ethnicity; stigma refers to social disapproval; and bias refers to an inability to view someone or something without being objective.
A client originally from China is admitted to a medical floor right when lunch trays are being delivered. When the client expresses hunger, the nurse tells the client that the nurse will order some rice for lunch. What is the nurse practicing when telling the client this?
stereotyping Explanation: Stereotyping means expecting a person to act in a characteristic way without regard to his or her individual traits. In this case, the nurse expects that all Chinese people like rice. Prejudice is believing that some people matter less than others based on their physical or cultural traits. Assimilation means that people have adopted the values of the dominant culture. Ethnocentrism is the belief that one's own culture is superior to all others
The nurse educator has completed a presentation on caring for babies born to mothers with a substance use disorder. Which statement by a participant would indicate the need for further education?
"Babies born to a mother with a substance use disorder don't have any difficulty eating." Explanation: Babies born to mothers with a substance use disorder tend to be small for gestational age. They may also suffer from withdrawal symptoms and are at a higher risk for both physical and mental abnormalities. They may also suffer from problems eating, such as a decreased ability to suck. Some of the problems of the baby may not be immediately apparent, because these problems can also encompass cognitive and skill-attainment delays.
The nurse is caring for a child from a different culture. Which statement(s) by the nurse demonstrates an understanding of how culture impacts a client? Select all that apply.
"Culture can impact who a client chooses to see for health care needs." "Culture can impact the diet a client follows." "A client's cultural beliefs can impact spirituality and/or religion." "A client's cultural beliefs should be incorporated into the care a client receives. Explanation: Culture is a set of traditions and beliefs held by groups of people. Beliefs, diet, language, values, religion and spirituality are included in culture. Some cultures utilize folk healers to provide health care. The nurse should incorporate a client's beliefs as much as possible into care. When a client moves to a different location, the client tends to bring cultural beliefs and does not necessarily follow all the cultural practices of the new location.
A couple had decided not to circumcise their newborn for nonreligious reasons. What is the appropriate response from the nurse?
"OK, great. I will let the physician know." Explanation: The nurse should remain as nonjudgmental as possible when speaking with a client. There are many reasons why a couple may decide to leave their newborn uncircumcised. Both health benefits and risks are associated with circumcision. The nurse should respect the couple's decision.
A pregnant woman arrives in the L & D unit following premature rupture of membranes along with her spouse, who insists on being present and demands only female nurses assess his wife. When obtaining history and assessment data, the spouse provides all the answers. What is the best approach for the nurse to handle this situation?
Act as an advocate for the woman who has a male-dominant partner. Explanation: In many cultures, the man is the dominant figure. In a strongly male-dominant culture, if approval for hospital admission or therapy is needed, the man would prefer to give this approval. Since the woman is a nondominant member of the family, the nurse may have to act as an advocate for her with a more dominant partner. Security would be viewed as a threat and not appropriate at this time. To gain information from the woman, the nurse may need to confront the spouse about his role in the birthing process. It is not appropriate to educate the spouse because this is a long-standing family environment, and this is not the time to try to change the family culture toward females.
Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact with a client who has a different cultural perspective on space and distance?
Allow the client to adopt a position that is comfortable for him or her. Explanation: If the client appears to position himself or herself too close or too far away, the nurse should consider cultural preferences for space and distance. Ideally, the client should be permitted to assume a position that is comfortable to him or her in terms of personal space and distance. "Realizing" and "remembering" are not interactions. It is also incorrect to attempt to adopt someone else's cultural preference as this can be very uncomfortable for the nurse, which adds a barrier to nurse-client interactions.
A woman in active labor begins to recite a lullaby to "call the baby outside." Which action by the nurse caring for this woman is most appropriate at this time?
Allow the client to perform a ritual. Explanation: The nurse can acknowledge and celebrate a client's culture without stereotyping by such actions as ensuring that the client has the opportunity to perform her cultural traditions during labor, such as reciting a lullaby to "call her child outside." There is no indication that pain medication is needed at this time. When one respects the culture, quizzing about the purpose or importance of reciting this lullaby is inappropriate.
Native Americans who are wearing their tribal dress are demonstrating their native dance to a community group. This is an example of:
ethnicity. Explanation: Ethnicity is the bond or kinship that people feel with their country of birth or place of ancestral origin. Race refers to biologic differences in physical features, such as skin color and eye shape. Ethnocentrism is the belief that one's ethnic heritage is the "correct" one and superior to others. Acculturation involves the process of adapting to or taking on the behaviors of another group
A female-to-male (FTM) transgender individual who has undergone breast surgery wants to become a parent. During the teaching session, which instruction is essential for the client to understand will be needed to achieve the goal of pregnancy?
stopping current testosterone hormone therapy Explanation: To sustain a successful pregnancy, it is essential to stop testosterone hormone therapy to carry the pregnancy. The cessation of testosterone and the changes that occur with pregnancy can cause huge shifts in an individual's mental well-being and can lead to increased gender dysphoria. FTM transgender individuals may also find it difficult to obtain an understanding health care provider, one whom they can trust and who can care for the specific needs related to pregnancy, gender dysphoria, and lactation. Though important, this ultimately does not achieve the goal of pregnancy. Breast surgery involves removal of the breasts as part of the transitioning; therefore, there will be no leakage of milk with pregnancy. Transgender women face victimization at twice the rate that cisgender women do; however, there is no indication that this is a problem in this scenario.
The nurse is working with the 5-day-old baby boy of a young Jewish couple. What comment is not culturally sensitive?
"Oh, I see you have chosen not to have your baby circumcised." Explanation: Ritual circumcision for Jewish babies takes place on the eighth day of life. All the other comments are acceptable.
While completing admission questions, the client asks the nurse, "What is the difference between race and ethnicity?" Which response by nurse is appropriate?
"Race refers to one's physical characteristics or biology, while ethnicity refers to cultural factors." Explanation: Race refers to one's physical characteristics or biology, not simply the location of birth. Ethnicity refers to cultural factors, not religion. Telling the client the nurse will discuss this later does not address the client's question. The concepts are similar; however, this does not address the client's question.
A nurse is working to develop cultural competence. Which aspect would the nurse need to incorporate as the foundation for this concept?
Respect Explanation: Cultural competence, or respecting cultural differences, allows the nurse to plan culturally competent care and to integrate cultural elements into care.
A 12-year-old girl from Iran is visiting a clinic in the United States with her mother. The girl and mother are wearing headscarves. When the nurse, who is male, approaches the girl and the mother to introduce himself, the girl draws back in fear and hides behind the mother. The nurse, maintaining a respectful distance, introduces himself to the mother and asks why the girl is afraid. The mother explains that in Iran, girls of that age and women are not allowed to be examined by a male nurse or health care provider. The male nurse then finds a female nurse to work with the girl. Which nursing action best demonstrates an understanding by the male nurse of cultural awareness?
identifying the nonverbal action of the girl when the nurse entered Explanation: Cultural awareness is being aware that all people live and function within a culture of their own. In this situation, the male nurse is aware of the cultural difference when the 12-year-old child draws back in fear when the he entered the room. As stated by the mother, a girl being seen by a male nurse is not acceptable in Iranian culture. Cultural sensitivity is understanding and accepting the cultural values and behaviors. Keeping a distance from the girl and mother as well as finding a female nurse best represents cultural sensitivity. It is not uncommon to have individuals from specific regions and faith wear a headscarf in public.
A nurse manager is reviewing comments on satisfaction surveys that were completed by the parents of hospitalized children. Which comment could be considered an act of discrimination by the nurse?
"A nurse, sitting at the desk, did not respond to my child's call light because my child is transgender." Explanation: Discrimination is evident when a person is treated differently because of a specific trait. In this scenario, the nurse who refuses to answer the call light of a client who is transgender would be discriminating against this individual. The nurse manager would discuss the parent's comment and obtain further data from the nurse. Putting on gloves when having direct contact with a client is within a nurse's nursing judgment. The nurse may have valid reasons for using the gloves as a barrier. Documenting a therapeutic diet and assessing daily dietary intake are tasks with most clients, regardless of cultural differences.
A woman arrives to the unit in active labor with her spouse and 7-year-old child. The woman and her spouse do not speak the dominant language, but the child does. Which action(s) by the nurse is appropriate? Select all that apply.
Call the interpreter or use the interpreter phone. Ask another nurse to switch assignments with you because the nurse speaks the woman's language. Use hand gestures to communicate until the interpreter phone is working. Explanation: Culturally competent care includes attempting to overcome language barriers. However, it is not acceptable to have a child be responsible for translating pertinent medical information. This may also be unacceptable in some other cultures. The nurse should switch assignments with someone who speaks the client's language fluently or wait until interpreter services are available. Speaking loudly or slowly in a language the client does not speak is not an acceptable way to communicate. This may be seen as rude and insensitive.
While interviewing a Chinese man about his son's health, the nurse notices that the man keeps his eyes focused on the floor. What is the best action by the nurse?
Continue with the interview. Explanation: For some Chinese Americans, it is not culturally acceptable to make eye contact while conversing; this can be seen as a cultural norm for this man. Continuing with the interview is the best response so as not to make him feel uncomfortable.
A woman with Puerto Rican heritage at 30 weeks' gestation has been hospitalized for premature contractions for the past 5 days. She has lost 3 pounds since admission because she "can't find food that tastes like what she eats at home." When documenting her progress, which nursing diagnosis would be most appropriate at this time?
Imbalanced nutrition: less than body requirements related to unmet cultural food preferences Explanation: Since this woman is not eating, the priority nursing diagnosis would be: Imbalanced nutrition, less than daily requirements, related to unmet cultural food preferences. The other nursing diagnoses are related to nutrition, but they are not the highest priority or most appropriate for this scenario. There is no indication the woman is experiencing low blood sugars or electrolyte imbalances. Readiness for enhanced nutrition related to discharge from hospital soon in order to make cultural foods at home is defined as a pattern of equilibrium between fluid volume and chemical composition of body fluids that is sufficient for meeting physical needs and can be strengthened. The defining characteristics include verbalization of willingness to enhance fluid balance; stable weight; and moist mucous membranes, to name a few.
A woman in active labor is crying out in pain. She states that she has seen her spiritual healer, and has decided to refuse pain medication. Which action by the nurse is most appropriate in this situation?
Respect the woman's choice of no medication and assist with nonpharmacologic pain relief options. Explanation: A client may be reluctant to ask for pain medication for cultural or spiritual reasons. Understanding different beliefs of this kind allows the nurse to better work out mutual goals. Therefore, respecting the woman's choice of no medication and assisting with nonpharmacologic pain relief options is the best choice. Asking the woman to quiet down because she is upsetting other women is a nontherapeutic response. Concealing pain medication in juice is inappropriate. Asking the health care provider for suggestions would not be the first action to take but may occur later after nonpharmacologic measures are tried.
An Islamic woman is in active labor and informs the nurse that she is fasting during the day since it is Ramadan. What would the nurse assess for in this woman related to her cultural ritual?
Respect this woman's faith, but also assess for dehydration and hypoglycemia. Explanation: Knowing which religion a family practices can help the nurse locate the correct religious support person if one is needed. It helps in planning care if the nurse knows a woman wants a time set aside daily for private prayer or if she intends to fast, such as during Ramadan. The nurse should respect the woman's faith; however, the nurse should also assess hydration status and for hypoglycemia since she is fasting yet working hard to give birth to the infant. Most women in labor can drink fluids throughout the labor process. Asking the family to supply foods may be appropriate but also may be inappropriate if the woman is the one that cooks for the family. Hydration in the form of IV fluids may be considered inappropriate since the culture is for fasting from fluids and food.
The mother of an infant is staying on the unit. The pediatric nurse notes that the infant has not received the recommended vaccinations for his age, so the nurse provides information on immunizations to the mother. The mother informs the nurse that immunizations are against her cultural and religious beliefs, and she does not want her child to receive immunizations. In this scenario, what do immunizations represent?
a cultural taboo Explanation: Immunizations in this scenario are a cultural taboo. Cultural taboos are defined as activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group. Cultural imposition is defined as the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a cultural group adapt to or learn how to take on the behaviors of another group. Cultural blindness is the inability of people to recognize their own values, beliefs, and practices and those of others because of strong ethnocentric tendencies.
A nurse is struggling to communicate with a young man who does not speak English proficiently. He emigrated to the United States from Mexico several years ago. Finally, an interpreter arrives, and the nurse is able to communicate effectively with the client. At the end of the visit, after the client has left, the nurse says to the interpreter, "I think everyone who comes to this country should learn to speak English, don't you?" The nurse's question reveals that she expects what of ethnic minorities?
assimilation Explanation: Cultural assimilation means people blend into the general population or adopt the values of the dominant culture. This is what the nurse in the scenario appears to expect of ethnic minorities in the United States. The other answers do not accurately describe the nurse's expectations. Acculturation refers to the loss of ethnic traditions because of disuse. Stereotyping is expecting a person to act in a characteristic way without regard to his or her individual traits. Ethnocentrism is a belief that one's own culture is superior to all others.
As part of the nurse's prenatal checklist when working with an expectant mother, the nurse mentions the potentially harmful effects of the mother drinking alcohol during pregnancy. Both the mother-to-be and her spouse look offended and say, "We are Sikhs! Alcohol is prohibited in our religion." The nurse responds, "I apologize—I am afraid I do not know much about your religion, although I would like to learn more. Are there any resources you could refer me to?" Which behavior is the nurse exhibiting?
cultural humility Explanation: Cultural humility is a lifelong process of self-reflection and self-critique that begins not with an assessment of a client's beliefs, but rather an assessment of one's own. The nurse exhibits cultural humility in this scenario by being willing to learn more about another culture. The nurse does not exhibit cultural awareness, as the nurse was not already aware that Sikhs do not drink alcohol. However, the nurse is also not exhibiting prejudice, which is a preconceived judgment of a group of people, nor ethnocentrism, which is believing that one's own culture is superior to all others.
During shift hand-off, one nurse tells another nurse, "The client in room 1 has a different approach to treatment than I am used to seeing in clients. The client taught me a valuable lesson about assuming that all cultures react the same." The nurse is demonstrating which characteristic?
cultural sensitivity Explanation: Cultural sensitivity is understanding and accepting different cultural values, attitudes, and behaviors. Cultural destructiveness is making everyone fit the same cultural pattern and excluding those who do not fit. People commit cultural blindness when they do not see or believe there are cultural differences among people. Cultural competence is the capacity to work effectively with people, integrating elements of their culture—vocabulary, values, attitudes, rules, and norms.
A laboring client, 2 cm dilated and 50% effaced, is screaming in pain. The nurse caring for this client recognizes this woman's response to pain should be documented using which label?
low pain threshold Explanation: A person's response to pain is both individually and culturally determined. The pain threshold is the point at which the individual reports a stimulus is painful. Pain tolerance is the point at which an individual withdraws from a stimulus. Lack of pain control and inappropriate response to pain reflects the nurse's individual bias.
While interviewing a client, a nurse assesses the client's reaction to health care and determines that the reaction reflects the client's preferred ways of acting based on traditions. Which term would the nurse use to document this information?
cultural values Explanation: Culture is a view of the world and a set of traditions that a specific social group uses and transmits to the next generation. Cultural values are preferred ways of acting based on those traditions. Ethnicity refers to the cultural group into which a person was born, although the term is sometimes used in a narrower context to mean only race. Race refers to a category of people who share a socially recognized physical characteristic. The term is rarely used today as the research on the human genome shows no basic differences in structure among people.
A lesbian woman is in labor, and she has just arrived with her partner to the labor and delivery unit. The nurse who is up next for an assignment refuses to take care of this couple because to do so conflicts with her religious beliefs. This an example of:
discrimination. Explanation: Discrimination is an actual act in which a person or a group of people are treated differently because of a physical or cultural trait.
A nurse is counseling a client who is lactose intolerant about calcium. Which foods will the nurse include when selecting the client's dinner?
green leafy salad Explanation: The nurse should counsel this client to consider what the food choices contain to decide if milk or milk products are present. Milk products should not be recommended to a client who has an intolerance to lactose. A green leafy salad is high in calcium and contains no milk or milk products, so it is the best choice. Sour cream and yogurt both contain milk products. Processed meats, such as deli meat and hot dogs, also contain dairy as well as some breads and buns
A nurse encourages both partners in a lesbian family to come into the examining room with the newborn during a well-baby check. What type of nursing is the nurse practicing?
transcultural nursing Explanation: Transcultural nursing is care guided by cultural aspects and respects individual differences. Community nursing is nursing care that takes place for a group of people in a specific area. Ethnicity refers to the cultural group into which a person was born. Stereotyping means expecting a person to act in a characteristic way without regard to his or her individual traits.
The nurse is preparing to teach a class on cultural differences to a group of clients from the community. Which principle of culture will the nurse consider while planning the class information?
Each generation learns about culture from family and the community. Explanation: Culture is a shared, not individual, system of beliefs, values, and behavioral expectations that provide social structure for daily living. Culture includes the beliefs, habits, likes and dislikes, and customs and rituals learned from family and the community through a process called enculturation. Individuals are not born with a sense or awareness of culture. Some cultures are heavily centered on religious practices and customs, however, all are not.
A woman is in the second stage of labor, 8-cm dilated and 90% effaced. She keeps very quiet without expressing any outward signs of pain. Which intervention by the nurse would be most appropriate in this situation?
Allow the woman to labor according to her cultural beliefs. Explanation: The way people respond to pain is an example of a trait that is heavily influenced by culture. Some women and children scream with pain; others remain stoic and quiet. Both are "proper" responses, just culturally different. The best nursing intervention is to allow the woman to labor the way that is best for her. Administering pain medication without permission is unacceptable nursing practice. The nurse will have to assess the woman frequently, especially noting if any blood is coming from the vagina and performing frequent vaginal exams to know when it is time to push. "A close watch" could mean just looking into the room frequently. In some cultures, being stoic is expected behavior, so minimizing the pain may not be the goal of the woman
A woman is in the second stage of labor, 8-cm dilated and 90% effaced. She keeps very quiet without expressing any outward signs of pain. Which intervention by the nurse would be most appropriate in this situation?
Allow the woman to labor according to her cultural beliefs. Explanation: The way people respond to pain is an example of a trait that is heavily influenced by culture. Some women and children scream with pain; others remain stoic and quiet. Both are "proper" responses, just culturally different. The best nursing intervention is to allow the woman to labor the way that is best for her. Administering pain medication without permission is unacceptable nursing practice. The nurse will have to assess the woman frequently, especially noting if any blood is coming from the vagina and performing frequent vaginal exams to know when it is time to push. "A close watch" could mean just looking into the room frequently. In some cultures, being stoic is expected behavior, so minimizing the pain may not be the goal of the woman.
Which is not true regarding culture and the perception of pain?
Although many cultures communicate their pain differently, most people physically express pain in a universal manner. Explanation: The perception, communication, meaning, and expression of pain can radically differ between cultures. Personal beliefs may influence how a person expresses pain and how a clinician responds to someone in pain.
The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for children from various cultures. Which action by the UAP will cause the RN to intervene?
Following the traditions of the UAP's own culture with each client Explanation: Cultural competence, or respecting cultural differences, allows the health care providers to plan culturally competent care and the integration of cultural elements into care. Basing care on one's own culture and personal values is thinking that one's own culture is superior, which is a form of ethnocentrism. The RN would intervene if the UAP was noted performing this action. It is appropriate for the UAP to allow the clients to select foods and research cultures. Wearing appropriate personal protective equipment is not related to culture as this is a safety concern for the UAP.
A family with preschool-aged children is discussing ways to preserve their cultural heritage. Which suggestions by the community health nurse may help the family preserve the culture? Select all that apply.
Plan a traditional food night once a week. Have the children bring their friends of another culture over so everyone can share what they know about their family culture. Once a week, have a night when family members speak only the native language. Locate some books that describe the culture and read them as a family. Explanation: Suggestions to help a family preserve their heritage traditions may include planning a traditional food night once per week; encouraging children to invite friends for the meal and discuss the traditions behind the various foods; reserving one night per week when family members speak only the native language; and finding books for children written by authors from the culture or that positively describe the culture. Families can read the books together and discuss the story. Older children may understand the importance of being involved in political organizations; however, this is not a good choice for younger children.
Which intervention best demonstrates the L & D nurse is respectful of a client who is deaf and in early labor?
Seek assistance from another health care professional who can converse in sign language. Explanation: Cultural differences occur across not only different ethnic backgrounds but also different sociodemographic groups. A parent who has been deaf since birth, for example, expects her deaf culture to be respected by having health care professionals locate a sign language interpreter for her while she is in labor. If an interpreter cannot be located, writing down questions and answers is an alternative, assuming the parent has the ability to read and comprehend while dealing with labor contractions. Use of friends and family members is not considered to be the best option since many family/friends find it difficult to interpret medical terms. Hand signals can help in an emergency; however, it not the best way to interpret questions/comments from a laboring woman who is deaf.
What could be the consequence of a nurse assigning a client to a staff member who is of the same culture as the client?
Stereotyping Explanation: A nurse who thinks stereotypically may assign a client to a staff member who is of the same culture as the client because the nurse assumes that all people of that culture are alike. The nurse also may believe that clients with the same skin color have similar social situations. Because stereotypes are preconceived ideas unsupported by facts, they may not be real or accurate. They can be dangerous because they are dehumanizing and interfere with accepting others as unique individuals. Assigning a client to a staff member who is of the same culture as the client will not help in ensuring better care and understanding; assessing the client's cultural heritage; or building nurse-client relationships.
While taking a health history, the nurse finds out that the pregnant woman of Japanese descent comes from a culture that does not eat meat. Which foods will indicate sufficient protein intake? Select all that apply.
beans and rice eaten every day stir-fried carrots and beans regularly egg drop soup 2 to 3 times per week Explanation: A typical Japanese diet, for example, includes many vegetables such as bean sprouts, broccoli, mushrooms, water chestnuts, and alfalfa. Adequate protein is ingested, however, by mixing sources of incomplete protein such as beans and rice. Neither dried fruit nor apples will not meet protein needs.
A clinical nurse specialist is conducting a review class for a group of nurses about cultural competence and cultural diversity. Which term reflects the view of the world and set of traditions of a specific social group passed down through generations?
culture Explanation: Culture consists of the world view and group of traditions shared by a social group and passed down through generations.
A young black woman has just been admitted to the hospital's birth center after a rupture of membranes. The client has just moved to the area and has a strong accent. The client explains that she lost an infant in childbirth several years earlier. Her spouse has not arrived yet. The client seems nervous when responding to questions as she has difficulty finding the correct terminology. Which problem related to cultural diversity would best explain the client's nervousness?
embarrassment about her accent Explanation: Although the client may well be nervous about the possibility of losing the infant or about whether her spouse will arrive in time, neither of these pertains to cultural diversity. Moreover, although it is possible that she may be anxious because she fears not receiving proper care because of her race, there is no evidence in the scenario to support this. It is more likely that she is embarrassed about her strong regional accent and difficulty expressing herself as she does not have the correct terminology.
When caring for woman who speaks a different language than one's own, the nurse must ask for an interpreter before having the client sign which forms to ensure clarity can be confirmed? Select all that apply.
surgical permit end-of-life care consent to blood transfusions Explanation: When caring for clients who speak a different dialect or language, the nurse should always ask them to repeat instruction to be certain it was interpreted correctly. The nurse should repeat what the client said so he or she can confirm understanding the nurse correctly. The nurse should not be reluctant to ask for an interpreter to help clarify forms, such as consent for blood transfusion, informed consent for surgery, or wishes regarding right-to-life care, as necessary. Dietary preferences and smoking cessation policy are not as important as the other forms that result in invasive procedures.
