community: chapter 5
16. For a bedridden Muslim patient, the nurse rearranges the room and moves the bed so that it faces toward Mecca for the patient's daily prayers. Which of the following is the nurse demonstrating through these actions? a. Accommodation b. Awareness c. Brokering d. Imposition
A Cultural accommodation involves including aspects of the patient's religious beliefs and/or folk practices in the traditional health care system to implement essential treatment plans. For this patient, daily prayer in the tradition of Islam is important—from the patient's perspective, possibly more important than medical treatment. Cultural awareness is the self-examination and in-depth exploration of one's own biases, sterotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients. Cultural imposition ist he belief in one's own superiority, or ethnocentrism, and is the act of imposing one's values on others.
4. A nurse is caring for a client of another culture. Which of the following actions would be most appropriate for the nurse to take? a. Alter personal nonverbal behaviors to reflect the cultural norms of the client. b. Keep all behaviors culturally neutral to avoid misinterpretation. c. Rely on friendly gestures to communicate caring for the client. d. Avoid any pretense of prejudice by treating the client in the same way as any other client.
A Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent respect people from other cultures and value diversity, which helps them to provide more responsive care. Nurses should be knowledgeable of other cultures and communicate with the client based on cultural norms. Cuturally skillful nurses understand the unique difference among individuals within a given culture and work with those individuals to learn more about their culture and provide culturally sensitive care.
15. At a local hospital, the postpartum care policy requires that nurses observe the mother during infant care to assess the mother's ability to care for the new baby and to promote bonding. A new mother expresses concern that in her country, all infant care is provided by other family members so that the mother can rest and recover. Which of the following actions would be taken by a culturally competent nurse? a. Allow family members to provide the newborn's care and assess the mother's knowledge of child care through discussion. b. Reinforce the importance of bonding and that all good mothers gladly assume these responsibilities. c. Explain that the process of postpartum recovery does not require this much rest and require that she provide infant care. d. State that she must abide by hospital policy because documentation of the mother's ability to give the infant care is required for discharge.
A Culturally competent nursing care focuses on the specific patient, reflects the patient's individual beliefs and values, and is provided with sensitivity. The nurse should accept the cultural norms and behviors of this client and her family. Thus, the nurse should provide culturally competent care and comply with the client's desire. This should take priority over any judgments the nurse could make about this client or hospital documentation related to infant care by the mother.
9. An American nurse says, "I'm not going to change the way I practice nursing based on where the client is from because research shows that Western health care technology and research is best." Which of the following is being demonstrated by the nurse's statement? a. Ethnocentrism b. Prejudice c. Racism d. Stereotyping
A Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that one's own group determines the standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think, "The way we do it is the only right way to provide this care." Prejudice refers to having a deeply held reaction, often negative, about another group or person. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals, beauty, or self-worth. Sterotyping means attributing certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences.
12. A nurse who is explaining to a Latino client why it is important to take medication states, "The medication takes a couple of weeks to be effective, but then you should feel better." When the client is next seen, no medication has been purchased. Which of the following is the most likely explanation? a. The nurse emphasized that eventually the client would feel better, but the client needed to feel better immediately so didn't bother with the drug. b. The medication required a trip to the pharmacy, and the client just hadn't had time to obtain the drug yet. c. The medication was too expensive for the client's family. d. The client really hadn't understood why the medication was important.
A If we look closely at what the nurse stated, there may have been a cultural disconnect based on time perception. Many nurses are future oriented, whereas many families may place greater value on quality of life and view present time as being more important. When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus on the immediate benefits these clients would gain rather than emphasizing future outcomes. The cultural disconnect of time should be the immediate concern of the nurse. It is posssible that the client did not have the necessary resource or did not understand the importance of the medication, but the nurse should first investigate the potential cultural disconnect.
1. Which of the following best describes most Americans' attitude toward immigrants? a. Ambivalence because there are no clear solutions about how to address their needs b. Strongly negative because immigrants take jobs that native-born Americans could have instead c. Strongly positive because immigrants bring useful job skills and often join previous family members already in the United States d. Strong opposition to further immigration because of the increasing population in the United States
A Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that it is a complex issue that has no clear solutions. Because Americans' have an attitude of ambivalence, there is not strong negative or positive attitudes towards immigrants. However, many times immigrants do enter the United States because the have useful job skills or family ties. They are more likley to be a low-income worker who works in low-wage, blue-collar jobs and industries.
19. When teaching a nutrition class to a student group with a large Hispanic population, the school nurse incorporates foods such as salsa and other healthy dishes familiar to Hispanic students into the presentation. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary prevention
A Primary prevention involves activities such as health teaching to prevent a problem from occurring. Secondary prevention occurs when a nurse completes screenings. Tertiary prevention occurs after a problem has occurred and aims to restore the client to the highest level of functioning as possible.
2. A nurse recognizes that although a patient speaks English, the patient is from a culture with which the nurse is unfamiliar. Therefore, a cultural assessment should be attempted. Which of the following questions should the nurse ask? (Select all that apply.) a. "Can you tell me where your family is from?" b. "Do you practice a particular religious faith?" c. "What other countries have you lived in?" d. "Is there anything special we need to know about your food preferences?"
A, B, D In a general cultural assessment, nurses ask clients about their ethnic background, language, education, religious affiliation, dietary practices, family relationships, hospital experiences, occupation and socioeconomic status, cultural beliefs, and language. Nurses want to also ask about the client's perception of the health issue and what caused it and how it should be treated as well as the results they expect from the care they get. Such basic data help nurses understand the client from the client's point of view and recognize what is unique about the person, thus avoiding stereotyping. Knowing the other countries that the client has lived in may be helpful; however, necessary information about the client's culture should be able to be collected through broad questions about the client's culture.
1. An undocumented immigrant comes to a physician's office to receive care. Which of the following services can the client receive? (Select all that apply.) a. Treatment for tuberculosis b. Treatment for type 2 diabetes c. Immunization for polio d. Physical examination
A, C Undocumented immigrants or illegal aliens are individuals who have crossed a border into the United States illegally or whose legal permission to stay in the United States has expired. They are eligible only for emergency medical services, immunizations, treatment for the symptoms of communicable diseases, and access to school lunches. Undocumented immigrants are not eligible to receive treatment for chronic diseases such as Type 2 diabetes or physical examinations.
14. A Buddhist patient enters the hospital for diagnostic testing just before lunch time. The nurse tells the aide to give a meal tray to the new patient, because no tests will be done until later that evening. The aide gives the patient a meal of Salisbury steak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. Which of the following considerations was omitted by the nurse? a. The patient should not be served any food until a physician's order is obtained. b. The patient's Buddhist faith probably requires a vegetarian diet. c. The patient may be too frightened about the tests to want to eat very much. d. The patient may have diabetes or be allergic to some foods.
B Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and don't eat meat. The nurse should be aware of the cultural considerations that should be made for Buddhist patients. The nurse should ask the client about dietary restrictions before ordering a meal for the client so that these considerations can be made.
3. A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first? a. Complete a survey of all the various ethnicities represented in the nurse's community. b. Consider how the nurse's own personal beliefs and decisions are reflective of his or her culture. c. Invite a family from another culture to join the nurse for an event. d. Study the beliefs and traditions of persons living in other cultures.
B Cultural awareness requires self-examination and an in-depth exploration of one's own beliefs and values as they influence behavior. Cultural awareness is the first element in the model of cultural competence. Following the development of cultural awareness, the next step is cultural knowledge in which information about organizational elements of diverse cultures and ethic groups is collected. The next stage of the model, cultural skill, occurs with the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients. The fourth construct essential to this model is cultural encounter which is the process that permits nurses to seek opportunities to engage in cross-cultural interactions with clients of diverse cultures to modify existing beliefs about a speciifc cultural group.
10. A nurse states, "The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and needs." What does this statement reflect in relation to culture? a. Awareness b. Blindness c. Knowledge d. Preservation
B Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different cultures may have different expectations, wants, and needs. Cultural awareness is the self-examination and in-depth exploration of one's own biases, sterotypes, and prejudices that influence behavior. Cultural knowledge is information about organizational elements of diverse cultures and ethic groups; emphasis is on learningabout the client's worldview from an emic (native) perspective. Cultural preservation means that the nurse suports and facilitates the use of scientifically supported cultural practices from a person's culture along with those from the biomedical health care system.
2. A nurse is about to despair. Earlier in the week, she carefully taught a patient from a different culture exactly how much medication to take and emphasized the importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdose although the patient denies taking more than the label indicated. Which of the following is the most likely explanation? a. The patient was taking more mediation in the hope of getting well faster. b. The patient was also taking folk medicines that had many of the same effects and perhaps some of the same ingredients as the prescribed medication. c. The patient truly did not understand and thought the dose being taken was correct. d. The patient had a unique response to the medication and should have a smaller dose ordered.
B For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop feelings of inadequacy and helplessness because they are often unable to effectively help their clients. It is unlikely that tne patient was taking too much medication, taking the incorrect dose, or having a unique reaction to the medication. Rather the nurse should first interview the patient about use of folk medicine which may interact with the prescribed medication regimen.
18. A 40-year-old Bosnian, Muslim woman who does not speak English presents to a community health center in obvious pain. She requests a female health care provider. Through physical gestures, the woman indicates that the pain is originating in either the pelvic or genital region. Which of the following interpreters would be the most appropriate in this situation? a. A Bosnian male who is certified as a medical interpreter b. A female from the client's community c. A female who does not know the client d. The client's 20-year-old daughter
C Although having experience in medical interpretation is important, in many cultures it is inappropriate to have a male interpreter for females. This client has specifically requested a female provider; therefore, one might anticipate that the client will not be as forthcoming with a male interpreter. Regardless of certification and ability, the interpreter cannot interpret information the client may withhold because she feels it inappropriate to discuss private matters in front of a male. This client may also feel it inappropriate to have private matters interpreted by her daughter (especially if they are of a sexual nature or if they involve infidelity). Additionally, to avoid a breach of confidentiality, the nurse should avoid using an interpreter from the same community as the client.
7. Mexican immigrants who take metamizole ("Mexican aspirin") for pain may experience life-threatening agranulocytosis. Which of the following actions would be taken by a nurse who employs cultural repatterning? a. Complete a cultural assessment to identify any other dangerous medications that the client may be taking. b. Put this into perspective by considering that many drugs used in the United States cause agranulocytosis. c. Explain the harmful effects of metamizole and recommend an alternative medication for pain. d. Recognize that taking metamizole is common among persons living in Mexico and accept this as a cultural tradition.
C Cultural repatterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when the practice is harmful to them. Completing a cultural assessment involves learning more about the client's culture but does not address the need to consider changing or modifying cultural practices. In order to complete cultural repatterning, the nurse has to take an action to resolve this potential problem.
13. A client is crying softly and saying, "What did I do to deserve this punishment, Lord?" Which of the following responses by the nurse would be the most appropriate? a. "God doesn't punish people. You're sick just because of bad luck." b. "I can call the hospital chaplain to help you talk about these feelings" c. "What can I do to be helpful to you right now?" d. "Would you like to confess your sins and repent so this illness will go away?"
C Some clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do not share their beliefs. Because the nurse may not be a member of the client's religious faith group, an open-ended response showing caring is the most appropriate statement. The most therapeutic response from the nurse is an open-ended question. This allows the client to share information and not feel like his/her actions are being judged by the nurse. Also, this allows the nurse to not give advice or offer false information to the client.
17. A nurse gives detailed information on how to apply for Medicaid to a new mother who moved to the United States from Russia about 10 years ago. The nurse's next client is an African American mother of newborn twins who worked until the children were born. The nurse knows the woman is eligible to maintain her insurance after her employment was lost and does not discuss insurance options at all. Which of the following errors is being made by the nurse? a. Covert intentional prejudice b. Covert unintentional prejudice c. Overt intentional prejudice d. Overt unintentional prejudice
C The nurse may have assumed that the African American mother knew the available resources and could negotiate for assistance on her own and that the immigrant Russian woman had no experience negotiating government programs and thus needed the nurse to advocate for her and inform her of the programs available to her. The nurse, not knowing the health-seeking behaviors of either client, stereotyped both women and intentionally used her informational power to help one client while denying assistance to the other client. Covert prejudice involves subtle or passive acts of prejudice. This can occur intentionally or unintentionally. In this case, the actions of the nurse were intentional which means it was an overt behavior. Overt prejudice includes any action that intends to give unequal treatment to an individual or group. Given the scenario, it appears that the action of the nurse was intentional, not unintentional.
11. A family from Mexico comes to the public health department. No one in the family speaks English, and nobody at the health department speaks Spanish. Which of the following actions should be taken by the nurse? a. Attempt communication using an English-Spanish phrase book. b. Call the local hospital and arrange a referral. c. Emphatically state, "No hablo Español" (I don't speak Spanish). d. Obtain an interpreter to translate.
D Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the client's language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client. The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received. The nurse must contact an interpreter in order to provide the best care for the client - attempting communication using a book, stating that he/she does not speak English, and arranging for a referral do not address the priority action of finding an interpreter.
6. The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin prescribed because his illness is "hot" and he believes that penicillin, a "hot" medicine, will not provide balance. Which of the following terms best describes the action taken by the NP when the client's prescription is changed to a different yet equally effective antibiotic? a. Cultural awareness b. Cultural brokering c. Cultural knowledge d. Cultural skill
D Cultural skill involves the provision of care that is beneficial, safe, and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nurse practitioner's need to prescribe an effective antibiotic. Cultural awareness is the self-examination and in-depth exploration of one's own biases, sterotypes, and prejudices that influence behavior. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients. Cultural knowledge is information about organizational elements of diverse cultures and ethic groups; emphasis is on learning about the client's worldview from an emic (native) perspective.
5. A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a client's history. He stopped doing this around Muslim clients after being told that Muslims were offended when he exposed the sole of his foot (shoe) to their face. Which of the following was exhibited by the nurse when he changed his behavior? a. Cultural accommodation b. Cultural imposition c. Cultural repatterning d. Cultural skill
D Cultural skill is the effective integration of cultural knowledge and awareness to meet client needs—in this case, the clients need to not be offended by having the bottom of the nurse's foot or shoe in view of the client's face. The nurse using cultural skill makes sure nonverbal communication techniques take into consideration the client's use of body language and space. Cultural accommodation involves negotiation with clients to include aspects of their folk practices with the traditional health care system to implement essential treatment plans. Cultural imposition is the process of imposing one's values on others. Cultural repatterning is working with clients to make changes in their health practices if cultural behaviors are harmful or decrease their well-being.
8. A health care worker tells a nurse, "It does no good to try to teach those Medicaid clients about nutrition because they will just eat what they want to no matter how much we teach them." Which of the following is being demonstrated by this statement? a. Cultural imposition b. Ethnocentrism c. Racism d. Stereotyping
D Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food. Cultural imposition is the belief in one's own superiority, or ethnocentrism, and is the act of imposing one's values on others. Ethnocentrism is a type of cultural prejudice at the population level which involves the belief that one's own group determines the standards for behavior by which all other groups should be judged. Racism refers to the belief that persons who are born into a particular group are inferior in intelligence, morals, beauty, or self-worth.
