Exam 2 Chapter 9: Cultural Diversity in Health Care

16. As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit? a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships.

ANS: A Acculturation refers to adapting to a particular culture. Assimilation occurs when individuals now define themselves as members of the dominant culture and is evidenced by when individuals say they are from where they live and practice. When individuals grow up within a culture and take on the characteristics of that culture, it is referred to as socialization. Assisting the staff to recognize differences in the relationships between physicians and nurses on the unit and those in their country of origin is assisting adaptation or acculturation and is promoting positive patient outcomes.

6. A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his "acupuncture doctor" for treatment of his migraine headache. The best response to this patient would be: a. "How long have you been using acupuncture treatment?"

ANS: A Acknowledging the patient's use of acupuncture demonstrates cultural sensitivity through acknowledgement of treatments that would be consistent with the patient's cultural interpretation of illness and responses to it. The other responses indicate lack of cultural sensitivity as well as cultural imposition, in that the nurse diverts the line of inquiry toward interventions that would be common to the nurse's experience of health care in Western cultures.

9. The nurse manager for a unit's culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It: a. Develops over time.

ANS: A Culture is a patterned behavioral response that evolves slowly as times change. The culture may or may not maintain a strong work ethic

Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following? a. Behavior

ANS: A Culture is determined by behaviors and beliefs and develops slowly.

In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to: a. Diabetes.

ANS: A Hispanics with diabetes are twice as likely to die from diabetes as non-Hispanics.

17. During managers' meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say: a. "I wonder if we should consider changing our policy on performance appraisals? What do you think?"

ANS: A Males and females in the workplace are likely to have different management styles, and although not all males are authoritative or females more participatory, women are likely to use more participatory and inclusive methods.

1. According to Leininger, "cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic most likely to be without cultural imposition would be: b. Wound management.

ANS: B Abortion, blood transfusion, and advance directives are heavily imbued with values, beliefs, and practices that may be different between patients and nurses.

21. Sarah, RN, complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Sarah, you consider that differences across cultures that are relevant to this situation include: b. Personal space.

ANS: B Body movements, eye contact, gestures, verbal tone, and physical closeness when communicating are all part of a person's culture. For the nurse manager, understanding these cultural behaviors is critical in accomplishing effective communication within the diverse workforce population.

19. During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgment of patients' feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia's culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of: b. Cultural awareness.

ANS: B Cultural awareness involves self-examination and in-depth exploration of one's own cultural and professional background, including biases, prejudices, and assumptions, including assumptions about thinking modes and decision making.

13. When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's cultural sensitivity. You are exhibiting: b. Cultural sensitivity.

ANS: B Cultural sensitivity refers to the affective capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people. In this situation, acknowledgement of the candidate's background in relation to eye contact demonstrates cultural sensitivity.

24. Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. Sarah's response is based on her: b. Circle of familiarity.

ANS: B The "circle of familiarity" refers to constrained interpretation based on one's values, attitudes, and beliefs.

3. One of the staff nurses on your unit makes the comment, "All this time I thought Mary was black. She says she is Jamaican." The best response would be to say: b. "What did you think when you learned she was Jamaican?"

ANS: B The response of the nurse manager invites cultural awareness, which involves self-examination and in-depth exploration of one's own biases, prejudices, and assumptions.

11. Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of: b. The need to recognize diversity within groups.

ANS: B When working with various cultural groups and diversity, it is important to recognize that diversity also exists within groups. Cultural differences among groups should not be taken in the context that all members of a certain group or subgroup are indistinguishable.

As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff (select all that apply)? b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff

ANS: B, C, D Cultural competence involves knowledge of diverse cultural and ethnic groups, including knowledge of staff members and respect for others and their cultural differences.

15. At Health Center XYZ, staff members on the rehab unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of: c. Work culture.

ANS: C Culture develops over time, is essential to survival, is learned and shared by members, and changes with difficulty.

Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a: c. Celebration of National Nurses Week with the focus on cultural care.

ANS: C Human cultures have material items or symbols such as artifacts, objects, dress, and actions that have special meaning in a culture. National Nurses Week, with a focus on nursing interests, reflects the culture of nursing.

14. Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating: c. Acculturation.

ANS: C In accepting the practices of the dominant group on the unit, Mary is demonstrating acculturation.

18. As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with which principle? c. Multiculturalism

ANS: C Multiculturalism refers to maintaining several different cultures, such as the uniqueness of different work units. Cross-culturalism means mediating between/among cultures, and transculturalism denotes bridging significant differences in cultural practices.

23. In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friend network reflects: c. The social organization of friendships and family networks in East Indian culture.

ANS: C The Giger and Davidhizar Transcultural Model identifies six phenomena to assess provision of care for patients who are from different cultures, including social organizations, which include how relationships are formed and expressed in different cultures.

Maintaining a culturally diverse staff and working with a culturally diverse patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care unit, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff? c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying.

ANS: C The cultural and religious backgrounds of nurses influence their perceptions of dignity-conserving care. For example, foreign-born Catholic nurses stated the dying experience should not be altered by analgesics to relieve suffering or by attempts to hasten death by forgoing curative therapy or by other means. Approaches to working with differences in the diverse cultural and religious backgrounds of patients, families, and nurses alike include taking time to have conversational chats with patients in end-of-life and with colleagues that will facilitate learning about each other and provide care that fits with the patient's cultural beliefs about dying.

22. A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not learn in her program. She is best described as: c. Experiencing cultural marginality.

ANS: C The new graduate is caught between two cultures at this point—work and education—and expresses feelings of belonging to neither.

25. Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. In coaching Sara, you suggest which of the following? d. "Ask him what he means by a smudge and what meaning it has for him."

ANS: D By talking with Jim, Sarah is able to step outside her "circle of familiarity" and find and enhance her understanding of personally held prejudices. Prejudice enables Sarah to find meaning in situations, but it also limits understanding. Paradox describes this tension. We have the responsibility to acknowledge the "possibility of tension" as a potential for new and different understandings derived from our communication and interpretation. Possibility, therefore, presumes a condition for openness with a person from another culture (Spence, 2004).

5. The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patient's eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to: d. Cultural sensitivity.

ANS: D Cultural sensitivity involves the capacity to feel or react to ideas, customs, and traditions unique to a group of people.

12. When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's: d. Ethnicity.

ANS: D Ethnicity refers to groups of people who are classified according to common racial, tribal, religious, linguistic, or cultural backgrounds.

4. As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, "Why is it that when John and I work together in giving patients care, he jokes about my being "a little fat Mexican"? The nurse manager's best response is, "Do you think he: d. Is stereotyping you without thinking?"

ANS: D Prejudices "enable us to make sense of the situations in which we find ourselves, yet they also constrain understanding and limit the capacity to come to new or different ways of understanding. It is this contradiction that makes prejudice paradoxical." (Spence, 2004, p. 163). Prejudices enable us to predict behaviors and make sense of situations but constrain our understanding and development of new insights.

20. Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects: d. Transcultural care.

ANS: D Transcultural care involves consideration of health beliefs and practices between genders among races, ethnic groups, and those with different socioeconomic status.