Chapter 9 Cultural Awareness

Question 5 of 15 Which statement made by a new graduate nurse about the teachback technique requires intervention and further instruction by the nurse's preceptor?"After teaching a patient how to use an inhaler, I need to use the Teach Back technique to test my patient's understanding.""The Teach Back technique is an ongoing process of asking patients for feedback.""Using Teach Back will help me identify explanations and communication strategies that my patients will most commonly understand.""Using pictures, drawings, and models can enhance the effectiveness of the Teach Back technique."

* "After teaching a patient how to use an inhaler, I need to use the Teach Back technique to test my patient's understanding." - Teach Back is not a test of patient knowledge or ability to use devices but a confirmation of how well the nurse explained concepts to patients.

Question 4 of 15 Which of the following are examples of problems with the health care system that contribute to health disparities? Select all that apply. A health care provider assumes that the patient missed two appointments because the patient does not care about his or her health and does not inquire about the reasons for missed visits. The discharge nurse at a hospital uses Teach Back with a patient to ensure that she has communicated the discharge instructions clearly. A community hospital lacks an adequate staff of social workers who are able to ensure patients' access to resources they need to take care of their health. A hospital discharges a patient without ensuring that the patient has a primary care provider and has made a follow-up appointment. A nurse uses a family member as an interpreter to explain the patient's medications. The hospital conducts quality improvement without stratifying data by race, ethnicity, language, socioeconomic status, sexual orientation, and other axes of social group identities.

* A health care provider assumes that the patient missed two appointments because the patient does not care about his or her health and does not inquire about the reasons for missed visits. * A community hospital lacks an adequate staff of social workers who are able to ensure patients' access to resources they need to take care of their health. * A hospital discharges a patient without ensuring that the patient has a primary care provider and has made a follow-up appointment. * A nurse uses a family member as an interpreter to explain the patient's medications. * The hospital conducts quality improvement without stratifying data by race, ethnicity, language, socioeconomic status, sexual orientation, and other axes of social group identities. - A large body of research shows that health care systems and health care providers contribute significantly to the problem of health disparities. Inadequate resources (lack of social workers), poor patient-provider communication (discharge instructions), a lack of culturally competent care, system fragmentation (not ensuring that the patient has a primary care provider or a follow-up appointment), and inadequate language access (use of interpreters) are critical factors that contribute to inequities in patient outcomes. RESPECT is the mnemonic for Rapport, Empathy, Support, Partnership, Explorations, Cultural competence, Trust.

Question 6 of 15 During an encounter with an elderly patient, the nurse recognizes that a thorough cultural assessment is necessary because the patient has recently come to the United States from Russia and has never been hospitalized before. The nurse wants to discuss cultural similarities between herself and the patient. Which step of the LEARN mnemonic is this? Listen Explain Acknowledge Recommend treatment Negotiate agreement

* Acknowledge - The nurse's desire to discuss cultural similarities is an example of Acknowledging.

Question 10 of 15 Which of the following changes can help create a more inclusive environment for lesbian, gay, bisexual, and transgender (LGBT) patients? Select all that apply. Explicitly including sexual orientation and gender identity into nondiscrimination policies Displaying art that reflects LGBT community Modifying health care forms to provide opportunities for gender identity and sexual orientation disclosure Not asking patients about their gender identity and sexual orientation to avoid making them uncomfortable Ensuring access to unisex or single-stall bathrooms

* Explicitly including sexual orientation and gender identity into nondiscrimination policies * Displaying art that reflects LGBT community Modifying health care forms to provide opportunities for gender identity and sexual orientation disclosure Ensuring access to unisex or single-stall bathrooms

Question 14 of 15 A nurse is preparing to perform a cultural assessment of a patient. Which of the following questions is an example of a contrast question?Tell me about your ethnic background.Have you had this problem in the past?Where do other members of your family live?How different is this problem from the one you had previously?

* How different is this problem from the one you had previously? "Tell me about your ethnic background" is an example of an ethnohistory statement. "Have you had this problem in the past?" is an example of a focused question, and "Where do other members of your family live?" is an example of a social organization question.

Question 13 of 15 When you care for a patient who does not speak English, it is necessary to call on a professional interpreter. Which of the following are proper principles for working with interpreters? Select all that apply. Expect the interpreter to interpret your statements word-for-word so there is no misunderstanding by the patient. If you feel an interpretation is not correct, stop and address the situation directly with the interpreter. Pace a conversation so there is time for the patient's response to be interpreted. Direct your questions to the interpreter. Ask the patient for feedback and clarification at regular intervals.

* If you feel an interpretation is not correct, stop and address the situation directly with the interpreter. * Pace a conversation so there is time for the patient's response to be interpreted. * Ask the patient for feedback and clarification at regular intervals - You should not expect the interpreter to interpret your statements word for word. Although the interpreter must ensure that everything that was said is interpreted, he or she may need to use more or fewer words to convey the meaning of your conversation with a patient. Direct your questions to the patient. Look at the patient instead of at the interpreter.

Which of the following are considered social determinants of health? Lack of primary health care providers in a zip code Poor-quality public school education that prevents a person from developing adequate reading skills Lack of affordable health insurance Employment opportunities that do not provide paid vacation or sick leave The number of times a person exercises during a week Neighborhood safety that prevents a person from walking around the block or socializing with neighbors outside of his or her home

* Lack of primary health care providers in a zip code * Poor-quality public school education that prevents a person from developing adequate reading skills * Lack of affordable health insurance * Employment opportunities that do not provide paid vacation or sick leave * Neighborhood safety that prevents a person from walking around the block or socializing with neighbors outside of his or her home - The social determinants of health are the circumstances in which people are born and grow up; the neighborhood in which they live, work, and age; and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.

Question 3 of 15 In the United States, there has never been a president of Asian or Hispanic culture. This is an example of: social inequality marginalization under inclusion social location

* Marginalization - Not having a U.S. president representing an Asian or Hispanic culture is an example of marginalization—when a group is left out from facets of society. Social inequality is when people have unequal access to resources, services, and positions. Under inclusion is when a group has been overlooked in research and the design of interventions. Social location occurs when a person's place in society is based on his or her membership in a social group that determines access to resources.

Question 15 of 15 Match each letter of the RESPECT mnemonic with a statement that describes the concept the letter represents. R E S P E C T Work closely together with the patient by being flexible with regard to issues of control, negotiating roles when necessary, and stressing that you will be working together to mutually address medical problems. Ask about and try to understand barriers to care and adherence, and then offer resources to help the patient overcome them, involving family members if appropriate, and reassuring the patient that you are and will be available to help. Approach the encounter with empathy, remembering that the patient has come to you for help. Seek out and understand the patient's rationale for his or her behaviors or illness, verbally acknowledging and legitimizing his or her feelings. Provide explanations for the process and your action, checking often for understanding and using verbal clarification techniques such as Teach Back.Approach each encounter thinking about cultural competence and how you can demonstrate respect for the patient and his or her culture and beliefs. Patients may have different reasons for not disclosing important information. Earn a patient's confidence through actions and attitude that demonstrate respect, compassion, and your interest in partnership. Connect on a social level, seeking the patient's point of view; consciously attempt to suspend judgment; and avoid making assumptions.

* R Connect on a social level, seeking the patient's point of view; consciously attempt to suspend judgment; and avoid making assumptions. E Approach the encounter with empathy, remembering that the patient has come to you for help. Seek out and understand the patient's rationale for his or her behaviors or illness, verbally acknowledging and legitimizing his or her feelings. S Ask about and try to understand barriers to care and adherence, and then offer resources to help the patient overcome them, involving family members if appropriate, and reassuring the patient that you are and will be available to help. P Work closely together with the patient by being flexible with regard to issues of control, negotiating roles when necessary, and stressing that you will be working together to mutually address medical problems. E Provide explanations for the process and your action, checking often for understanding and using verbal clarification techniques such as Teach Back. C Approach each encounter thinking about cultural competence and how you can demonstrate respect for the patient and his or her culture and beliefs. T Patients may have different reasons for not disclosing important information. Earn a patient's confidence through actions and attitude that demonstrate respect, compassion, and your interest in partnership.

Question 8 of 15 How can a nurse work on developing cultural awareness? Select all that apply. Reflect on his or her past learning about health, illness, race, gender, and sexual orientation Develop greater self-knowledge about personal biases Recognize consciously the multiple factors that influence his or her own world view Engage in an in-depth self-examination of his or her own background Learn as many facts as possible about an ethnic group

* Reflect on his or her past learning about health, illness, race, gender, and sexual orientation * Develop greater self-knowledge about personal biases * Recognize consciously the multiple factors that influence his or her own world view * Engage in an in-depth self-examination of his or her own background

Question 7 of 15 A new nurse is caring for a hospitalized obese patient who is homeless. This is the first time the patient has been admitted to the hospital, and the patient is scheduled for surgery. Which of the following is a universal skill that will help the nurse work effectively with this patient?The nurse shifts her focus to understanding the patient by asking her, "Describe for me the course of your illness."The nurse tells the patient, "Your choices of foods and unwillingness to exercise are adding to your health problems."The nurse asks the patient, "Tell me about the main problems you have had with your health from not having a home."The nurse explains, "Because you have obesity, it is important to know the effects it has on wound healing because of reduced tissue perfusion."

* The nurse asks the patient, "Tell me about the main problems you have had with your health from not having a home." - This response enables the nurse to elicit the patient's explanation of her health problems and their causes. The nurse saying "Describe for me the course of your illness"uses a biomedical explanatory model instead of the patient's explanatory model. The nurse saying "Your choices of foods and unwillingness to exercise are adding to your health problems" shows the nurse's disrespect and unwillingness to understand the patient's perceptions and health beliefs.

Question 1 of 15 A patient is admitted through the emergency department (ED) after a serious car accident. The nurse assesses the patient and quickly learns that he speaks little English. Spanish is his primary language. The nurse speaks some Spanish. Which interventions would be appropriate at this time? Select all that apply. The nurse requests a professional interpreter. Since this is an emergent situation, the nurse will interpret and identify the patient's priority needs. The nurse determines the interpreter's qualifications and makes sure that the interpreter can speak the patient's dialect. The nurse uses short sentences to explain the treatments provided in the ED. The nurse directs questions to the patient by looking at the patient instead of at the interpreter.

* The nurse requests a professional interpreter. * The nurse determines the interpreter's qualifications and makes sure that the interpreter can speak the patient's dialect. * The nurse uses short sentences to explain the treatments provided in the ED. * The nurse directs questions to the patient by looking at the patient instead of at the interpreter. - In any situation the nurse should use an interpreter and not the family to convey information to the patient. As the nurse you need to question the interpreter about his or her ability to speak the patient's dialect. It is your responsibility to introduce the interpreter to the patient. You are communicating with the patient and should direct your questions and responses to the patient and not the interpreter. Short sentences make it easier for the patient to understand complex information.

Question 11 of 15 A nurse has worked in a home health agency for a number of years. She goes to visit a patient who has diabetes and who lives in a public housing facility. This is the first time the nurse has cared for the patient. The patient has four other family members who live with her in the one-bedroom apartment. Which of the following, based on Campinha-Bacote's (2002) model of cultural competency, is an example of cultural awareness? The nurse begins a discussion with the patient by asking, "Tell me about your family members who live with you?" The nurse asks, "What do you believe is needed to make you feel better?" The nurse silently reflects about how her biases regarding poverty can influence how she assesses the patient. The nurse uses a therapeutic and caring approach to how she interacts with the patient.

* The nurse silently reflects about how her biases regarding poverty can influence how she assesses the patient. Cultural awareness involves becoming more self-aware of your biases and attitudes about human behavior and considering these factors when you interact with patients.

Question 12 of 15 Match the following definitions with the key terms related to intersectionality. Under inclusion Social inequality Social location Groups have unequal access to resources, services, and positions. One's place in society is based on membership in a social group that determines access to resources. A group has been overlooked in research and the design of interventions.

* under inclusion - A group has been overlooked in research and the design of interventions. * social inequality- Groups have unequal access to resources, services, and positions. * One's place in society is based on membership in a social group that determines access to resources.

Question 9 of 15 A nurse enters the examination room of the emergency clinic and meets a 29-year-old patient who missed her last two follow-up appointments. The nurse notes from the medical record that the patient has high blood pressure that the doctor has been trying to help her manage. The patient just spoke with her doctor who left the room frustrated because the patient has not been taking her medication as prescribed. The patient confronts the nurse, saying, "I'm tired of being treated this way; no one cares. I need to find another doctor!" Using the C-LARA mnemonic, match the nurse's response to the correct letter of the mnemonic. C _ L _ A _ R _ A _ The nurse uses a relaxation technique before responding to the patient's concerns. Calm yourself. Take a deep breath. Check your pulse. The nurse says, "I want to help you. I can do that better if you tell me what's making it difficult for you to come to your appointments and take your medicine each day." The nurse maintains eye contact and allows the patient to discuss her perspective while remaining attentively quiet. The nurse acknowledges that it is absolutely reasonable for patients to expect that their health care providers care about their situations and that it is disappointing when they have experiences that make them feel like they do not. The nurse explains, "One thing I want you to understand is that your blood pressure medicine will only work if you take the same amount each day. Your follow-up appointments are important so we can get this blood pressure under control. Let me get a social worker who can help you figure out these transportation issues or see if he can find a doctor closer to your house."

1. B2. D3. A4. C5. E C- the nurse uses a relaxation technique before responding to the patients concerns. Calm yourself. Take a deep breath. Check your pulse. L- the nurse maintains eye contact and allows the patient to discuss her perspective while remaining attentively quiet A- the nurse acknowledges that it is absolutely reasonable for patients to expect that their health care providers care about their situations and that it is disappointing when they have experiences that make them feel like they do not R- the nurse says, :I want to help you. I can do that better if you tell me what's making it difficult for you to come to your apts and take your meds each day A- the nurse explains, "One thing I want you to understand is that your blood pressure med will only work if you take the same amount each day. Your follow-up apts are important so we can get this blood pressure under control. Let me get a social worker who can help you figure out these transportation issues or see if he can find a doc closer to your house."