Foundations Chapter 9 Cultural Awareness
The nurse asks a patient, "How is this health problem different from the previous one you had?" Which type of nursing assessment question has the nurse asked? 1 Contrast 2 Bicultural ecology and health risks 3 Open-ended 4 Focused
1 Asking the patient about the difference between the present problem and the previous one is a contrast nursing assessment question. Asking the patient whether he or she had the problem earlier is a focused nursing assessment question. An open-ended question may be asked to obtain information from the patient about what he or she thinks the cause of a problem is. A bicultural ecology and health risks nursing assessment question might ask about how a problem affects the patient and those close to the patient.
Which statement is true regarding culturally congruent care? 1 Culturally congruent care sometimes diverges from the values of the professional health care system. 2 In culturally congruent care, transcultural nursing enables primary health care providers to deliver uniform services irrespective of health beliefs. 3 Culturally congruent care bridges gaps to provide supportive care for patients from certain cultures. 4 Culturally congruent care has predetermined criteria from which patterns of life and the system of meaning are generated.
1 Culturally congruent care sometimes diverges from the values and meanings of the professional health care system. Patterns of life and systems of meaning are generated by people themselves. Culturally congruent care bridges gaps to provide supportive care for all patients, not only patients from certain cultures. Transcultural nursing provides culturally congruent care, or care that fits a person's life patterns, values, and the system of meaning.
The nurse at an outpatient clinic asks a Chinese American patient with newly diagnosed hypertension if he is limiting sodium intake as directed. The patient nods his head but does not make eye contact with the nurse. What should the nurse do next? 1 Ask the patient how much salt he is consuming each day. 2 Suggest some low-sodium dietary alternatives. 3 Remind the patient that many foods such as soy sauce contain hidden sodium. 4 Discuss the health implications of sodium and hypertension.
1 In Asian cultures spoken messages often have little to do with their meanings. The nurse should clarify how much salt the patient is consuming in his diet.
An older Chinese woman is admitted to the hospital after a hip fracture. Once the fracture has healed, the nurse encourages the patient to walk about the room. The patient refuses to walk without her son. What should the nurse do in this scenario? 1 Respect the patient's wish and ask her to walk when her son is present. 2 Tell the patient that she needs to walk now and that it is inappropriate to be dependent on her son. 3 Explain to the patient calmly that she can't be dependent on her son. 4 Leave the patient alone but understand that the patient has no self-confidence.
1 In some cultures, families make decisions together. This patient may only be comfortable when her son is present, so the nurse should respect her wishes and come back when the son is there. It would be wrong to describe the woman as lacking confidence. It is not therapeutic to speak sternly with the patient and tell her that she is dependent on others.
Which process is involved in the ETHNIC mnemonic communication technique? 1 Intervention 2 Empathy 3 Calm 4 Trust
1 Intervention is one of the processes involved in the ETHNIC communication technique. It involves agreement on an appropriate intervention, which may incorporate alternate treatments. Calm is included in the C-LARA communication technique. Trust and empathy are aspects of the RESPECT communication technique.
Which concept of intersectionality involves unequal access to resources and services? 1 Social inequality 2 Matrix of domination 3 Marginalization 4 Overinclusion
1 Social inequality is the concept of intersectionality that involves groups with unequal access to resources, services, and positions. Overinclusion addresses groups that have been overlooked in research and the design of interventions. Marginalization the concept of intersectionality that provides limited access or exclusion from different facets of the society such as a political system, labor market, or positions of power. Matrix of domination is a concept of intersectionality that involves the groups with a larger system of power and more privileges than other groups in the society.
The registered nurse is evaluating the statements of a student nurse after teaching about cultural assessment models. Which statement by the student nurse needs correction? 1 "Cultural assessment models are used to stereotype a particular group of patients." 2 "Cultural assessment models help one to understand the complex factors that influence a patient's cultural world view." 3 "Cultural assessment models can be used to understand a patient's religious beliefs." 4 "Cultural assessment models help to focus on the information relevant to patient's problem."
1 Stereotyping is generalizing a patient based on his or her cultural group. Cultural assessment models are used to understand the cultural beliefs of a patient and are not used to generalize (stereotype) the patient. Cultural assessment models help to focus on the information relevant to patient's problem by providing a worldview. Cultural assessment models are used to understand patient's religious beliefs and the complex factors that influence a patient's cultural worldview.
The nurse is using the "Teach Back" technique to evaluate a patient after teaching about medication adherence. Which question by the nurse is appropriate to verify the patient's understanding? 1 "Please review what we talked about. How will you make it work at home?" 2 "Please let me know whether this information was useful to you." 3 "Do you have any questions?" 4 "Did you understand?"
1 The "Teach Back" technique helps the nurse confirm whether the patient has understood the teaching or not. When using the teach-back technique, the nurse should ask open-ended questions such as asking the patient to review the information and explain how he or she will make it work at home. This question will help the nurse to verify the patient's understanding. The nurse should not ask the patient whether he or she understood the teaching, whether he or she has any questions, or about the usefulness of the provided information, because these are unlikely to elicit detailed answers that reflect the patient's understanding.
Which is an example of a contrast question? 1 "How severe is your headache compared to the last one?" 2 "How long have you been alone?" 3 "What area hurts most often?" 4 "Do you have siblings?"
1 The questions pertaining to comparison of two events are called contrast questions. The question, "How severe is your headache compared to the last one?" compares pain occurring at two different times. "Do you have siblings?", "Where does it hurt more often?", and "How long have you been alone?" are examples of open-ended questions.
What is the correct order of steps involved in the LEARN communication technique for cultural assessment and planning? 1. Listening to the patient's explanation of the present problem 2. Explaining the nurse's perception of the problem to the patient 3. Recognizing the similarities and differences between the patient's and nurse's perceptions 4. Involving the patient and his or her family while providing recommendations 5. Obtaining a mutually agreeable, culturally oriented, patient-centered plan
1, 2, 3, 4, 5 The LEARN communication technique for cultural assessment and planning includes five steps. The first step is to listen to the patient's explanation of the present problem. The next step is explaining the nurse's perception regarding the problem to the patient. The third step is acknowledging or recognizing the similarities and differences between the patient and the nurse's perceptions. The fourth step is making a recommendation involving the patient and his/her family in the decision-making process. The fifth step is the negotiation, which involves obtaining a mutually agreeable, culturally oriented, patient-centered plan.
After assessing a patient's immediate complaint, the nurse asks a patient, "What other problems do you have?" What is the nurse trying to assess by posing this question to the patient? 1 Sexual orientation and gender identity 2 Bicultural ecology and health risks 3 Caring beliefs and practices 4 Socioeconomic status
2 Asking the patient about the other problems helps to assess bicultural ecology and health risks. Asking the patient about employment status and sources of income helps to assess the patient's socioeconomic status. Asking the patient about home care management helps to assess caring beliefs and practices. Asking the patient about gender, current relationship status, and current sexual partner helps to assess the patient's sexual orientation and gender identity.
The nurse is caring for an elderly patient who has diarrhea, and the nurse suspects that the patient has a biomedical perspective of illness. Which statement by the patient helped the nurse to reach this conclusion? 1 "I am sick because of supernatural forces surrounding me." 2 "I am sick because of unhygienic surroundings." 3 "I will feel better after meeting with a mambo." 4 "I will recover if I drink hot beverages."
2 Biomedical theory postulates that microorganisms are responsible for specific disease conditions. Therefore, the patient's statement that unhygienic surroundings are responsible for the illness supports the nurse's conclusion. Patients who believe in the yin/yang or hot/cold theory believe in a naturalistic approach to healing. Therefore, the statement that the patient will be better after drinking hot beverages indicates that the patient believes in the naturalistic perspective. People who believe in a magico-religious perspective believe that illness is a result of supernatural powers. A mambo is a female voodoo priest who treats illness with faith healing. Therefore, the statement that the patient will be better after meeting a mambo would indicate belief in a magico-religious perspective. Many Southeast Asian patients believe that illness is caused by supernatural forces.
Which type of cultural competency recognizes biases, prejudices, and assumptions about other people? 1 Cultural knowledge 2 Cultural awareness 3 Cultural desire 4 Cultural skills
2 Cultural awareness refers to recognizing biases, prejudices, and assumptions about other people. Cultural skills assess social, cultural, and biophysical factors that influence patient treatment and care. Cultural desire describes the motivation to learn from the others, accept the learner, be open to and accepting of cultural differences. Cultural knowledge includes sufficient comparative knowledge of diverse groups, including the values, health beliefs, care practices, and worldview.
The senior nurse observes that a newly appointed American nurse is having trouble relating to a patient from a different culture. What advice can the senior nurse give this nurse to enhance cultural competency? 1 Learn about various dialects prevalent in the country. 2 Obtain sufficient knowledge about a patient's cultures and beliefs. 3 Learn at least three foreign languages. 4 Obtain in-depth knowledge about medical concepts and nursing care.
2 It is extremely important for the nurse to be culturally competent. The nurse should try to obtain knowledge about various cultures and cultural practices prevalent in the population, because this will help the nurse understand the patients better and provide better care. The nurse already has medical and nursing knowledge. It is not mandatory for nurses to know foreign languages, although that may be helpful in the long term. Knowledge about languages and dialects is not sufficient; the nurse should learn about and respect the culture.
The registered nurse is admitting a patient of French heritage to the hospital. Which question asked by the nurse indicates that the nurse is stereotyping the patient? 1 "Do you have any health issues that we should know about?" 2 "Do you bathe and use deodorant more than one time a week?" 3 "What time do you typically go to bed?" 4 "What are your dietary preferences?"
2 Nurses need to avoid stereotypes or unwarranted generalizations about any particular group that prevents further assessment of the individual's unique characteristics.
A Jamaican immigrant has been late to the last two clinic visits, which in turn had to be rescheduled. Which is the best action that the nurse could take to prevent the patient from being late to the next appointment? 1 Refer the patient to a clinic that is closer to the patient's home. 2 Explore what has prevented the patient from being at the clinic in time for the appointment. 3 Call the patient the day before the appointment as a reminder to be on time. 4 Give the patient a copy of the city bus schedule.
2 Present-time orientation is in conflict with the dominant organizational norm in health care that emphasizes punctuality and adherence to appointments. Nurses need to expect conflicts and make adjustments when caring for patients from certain ethnic groups.
The nurse has to examine a patient and administer an intravenous medication that is not a life-saving drug. The patient is a devout Muslim. When the nurse goes to administer the medication the nurse finds that patient is getting ready for namaz (prayers). The nurse understands that the patient prays at certain times, as specified in his culture. What should the nurse do in this scenario? 1 Tell the patient that the nurse has other patients to look after and cannot come later. 2 Allow the patient to pray and come back later to administer the medication. 3 Ask the patient to pray after the medication is administered. 4 Administer the drug while the patient prays.
2 The nurse should respect the patient's religious beliefs. Muslims offer namaz, or prayers, at specific times of the day. The nurse should let the patient complete the prayers and then administer the medication. It would be inappropriate to administer the drugs while the patient is praying because that would show disrespect to the patient. It would be inappropriate for the nurse to ask the patient to delay prayer, because his culture dictates that he pray at specific times. The nurse should not refer to responsibilities with other patients.
The nurse is assessing patients from different cultural backgrounds. Which actions should the nurse perform to obtain a systematic cultural assessment? Select all that apply. 1 Obtain information about economic backgrounds. 2 Gather area demographic information from census data. 3 Obtain information by asking open-ended questions. 4 Establish trusting relations with the patient. 5 Overlook the patient's beliefs about health care.
2, 3, 4 Cultural assessment is time-consuming and establishing trusting relations with the patient is helpful. Using open-ended and focused questions can encourage patients to provide information about their cultural values. Gathering background demographic knowledge of the patient's culture can help in cultural assessment. Understanding patients' beliefs about health care is an important part of cultural assessment. Obtaining information about economic backgrounds is not relevant to cultural assessment.
The nurse is learning about the impact of different cultures on nursing. Which are benefits of culturally congruent care? Select all that apply. 1 It will help the nurse to deliver different remedies for an illness as practiced in the patient's culture. 2 It will help the nurse to deliver the specific kind of health care that is expected from patients who belong to a different culture. 3 It will help the nurse to identify the similarities and differences of various patients across different cultures. 4 It will help the nurse to interpret the needs of the patient who belongs to a different culture. 5 It will help the nurse to interact with different people in their language.
2, 3, 4 Culturally congruent nursing refers to a comparative study of cultures to understand similarities and differences across human groups. It helps the nurse to identify the needs of a patient who belongs to a different culture. Culturally congruent nursing can help the nurse to identify the similarities and differences in various patients across different cultures. It also helps the nurse to meet the health care expectations of patients who belong to different cultures. Culturally congruent nursing does not help the nurse to interact with people in different languages. The nurse does not deliver remedies common in different cultures.
The nurse attends to an Asian male patient at a clinic, who is joined by his family. The nurse is developing a transcultural care plan that identifies both with the patient's native and American culture. Which nursing actions are required for providing culturally congruent care? Select all that apply. 1 Work in the patient's culture and practice nursing within those cultural limitations. 2 Assess cultural and biophysical factors that influence treatments. 3 Self-examine the nurse's own culture. 4 Obtain the patient's health beliefs. 5 Ignore cross-cultural learning.
2, 3, 4 The patient who identifies with both his native and American culture has obtained biculturalism. The goal of transcultural nursing is culturally congruent care. Obtaining the patient's health beliefs and self-examination of one's own culture help in delivering culturally congruent care. The nurse should also develop the skills of assessing cultural and biophysical factors that influence treatments and care for the patient. It is important to engage in cross-cultural learning. Working in another culture and learning about cultural differences is beneficial for the patient's health, but the practice should not be limited to the patient's culture.
The nurse is explaining the concept of being culturally competent to another nurse. Which are components of cultural competence? Select all that apply. 1 Cultural difference 2 Cultural desire 3 Cultural encounters 4 Cultural skills 5 Cultural knowledge 6 Cultural awareness
2, 3, 4, 5, 6 Cultural competence consists of five components: cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desires. Cultural awareness refers to an in-depth self-examination of one's beliefs to help recognize biases, prejudices, and assumptions. Cultural knowledge involves obtaining adequate information about cultural groups. Cultural skills allow a person to assess social, cultural, and biophysical factors that affect treatment and care of patients. Cultural encounters involve engaging in cross-cultural interactions that provide information about other cultures. Cultural desire refers to the motivation and commitment to build on cultural similarities. Cultural difference is not a component of cultural competence.
The nurse is caring for an Islamic patient who is recovering from a motor vehicle accident. The patient is observing Ramadan, the ninth lunar month, in which Muslims fast during daylight for 28 days. The nurse understands that a good diet is important for the patient's wounds to heal. What should the nurse do when planning the patient's diet? Select all that apply. 1 Try to convince the patient not to fast, because it will affect recovery. 2 Respect the cultural beliefs and assure the patient that medical needs will be taken care of. 3 Start enteral tube feedings if the patient refuses to take food orally. 4 Ask the patient's closest kin to ask him not to fast. 5 Reschedule meals.
2, 5 The nurse should understand the patient's cultural and spiritual beliefs and deliver health care accordingly. Muslims fast during Ramadan. Therefore, the nurse should not assume that the patient will take regular meals during Ramadan. Likewise, the treatment and medication regimen should be rescheduled according to the cultural needs of the patient. The nurse should respect the patient's culture and assure the patient that the hospital staff will provide optimal care. Asking the patient's family to ask the patient not to fast would be emotionally disturbing. Starting enteral tube feedings is also not ethical, because they would be against the patient's will. Trying to convince the patient to have meals may indicate that the nurse disrespects the patient's personal beliefs.
An Arab woman is admitted to the hospital. A male nurse is assigned to examine this patient. The patient is uncomfortable and expresses displeasure at being assigned a male nurse. What should the nurse manager do? 1 Explain to the patient that they are short of staff and that she has to cooperate. 2 Remain in the room when the male nurse is examining the patient. 3 Assign a female nurse to carry out the examination. 4 Ask the male nurse to go ahead with the examination
3 Arab women are generally reluctant to have males examine them. The head nurse should respect the patient's wish and culture and assign a female nurse to her. The head nurse should not ask the male nurse to proceed, because this would violate the patient's wish. The mere presence of a female nurse during an examination by a male nurse would not make the patient comfortable. Telling the patient the hospital is short-staffed may not be true and should not be used as an excuse to disobey the patient's wishes.
What is the importance of core measures? 1 Help assess social, cultural, and biophysical factors that influence patient treatment and care 2 Help provide care to fit with patient's own values, beliefs, and traditions 3 Help reduce mortality, complications, and inpatient readmissions 4 Help recognize prejudices, and assumptions about other people
3 Core measures help to reduce mortality, complications, and inpatient readmissions. Cultural awareness helps to recognize prejudices, and assumptions about other people. Culturally congruent care helps to provide care to fit with patients' own values, beliefs, and traditions. Cultural skills help to assess social, cultural, and biophysical factors that influence patient treatment and care.
During their clinical postconference meeting, several nursing students were discussing their patients with their instructor. One student from a middle-class family shared that a patient was homeless. Which difference is being described? 1 Religion 2 Heritage 3 Culture 4 Ethnicity
3 Culture is the context in which groups of people interpret and define their experiences relevant to life transitions. These include events such as birth, illness, and dying. Culture refers to the system of meanings by which people make sense of their experiences.
The nurse finds that a patient has not understood the health education provided on personal hygiene. How does the nurse ensure that the patient understands the teachings? 1 The nurse requests that a family member help the patient understand. 2 The nurse provides a video demonstration of personal hygiene. 3 The nurse clarifies the information and requests a teach back. 4 The nurse provides reading material on personal hygiene.
3 If the patient does not understand instructions, the nurse should clarify the information and request that the patient teach back the instructions. This approach helps the nurse ascertain whether the patient has understood the teachings or not. Providing reading material and a video demonstration on personal hygiene to the patient reinforces the teaching but does not necessarily ensure that the patient has understood. Requesting that a family member help the patient understand will not help the nurse to assess the patient's understanding.
The registered nurse prepares a mutually agreeable, culturally oriented patient-centered plan. Which step of the LEARN communication technique is the nurse using? 1 Acknowledgement 2 Recommendation 3 Negotiation 4 Perception
3 Negotiation is the fifth step of the communication technique, which involves preparing a culturally oriented and patient-centered plan by mutual agreement with the patient. Perception involves explaining the nurse's perception of the problem to the patient. Recommendation is involving the patient and his or her family in making decisions. Acknowledgement is the recognition of the similarities and differences between the patient's perception and the nurse's perceptions.
The nurse is conducting a health interview for a patient. Which assessment question is an example of an open-ended question? Select all that apply. 1 "Is there someone with whom you want us to talk about your care?" 2 "How different is this problem from the one you had previously?" 3 "How do you want us to help you with your problem?" 4 "What do you think caused your illness?" 5 "Did you have this problem before?
3, 4 An open-ended question is asked to encourage the patient to provide expansive responses. Asking what the patient thinks caused the illness and how the patient wants the health care team to help him or her are examples of open-ended questions. Asking whether the patient has had the problem before is an example of a focus question. Inquiring about the difference between the present and the previous problem is a contrast question. Asking whether the patient would like the nurse to discuss the required care with a guardian indicates caring beliefs and practices but is not an example of an open-ended question.
Which measures taken by the health care organizations would create an inclusive environment for patients belonging to the lesbian, gay, bisexual, transgender (LGBT) community? Select all that apply. 1 Ensure that gender-inclusive information is asked in the hospital forms 2 Avoid enquiring about their gender to avoid discomfort 3 Ensure that gender-inclusive language is used while talking 4 Make sure that they have access to unisex bathrooms 5 Identify on the basis of their appearance
3, 4 Patients belonging to the LGBT community may differ in appearance from the conventional male and female appearance and may feel uncomfortable using gender-specific restrooms. Therefore, the health care organizations should ensure that patients belonging to the LGBT community have access to unisex restrooms. Health care professionals should use neutral language while talking to patients, such as partner or a significant other instead of husband and wife, because LGBT patients may also be married. Health care organizations should not encourage identification of patients on the basis of their physical appearance, because the assumptions made may be wrong. Health care organizations should ensure that patients are asked about gender, because presumptions may cause errors in treatment. All the forms used in the hospital should have an LGBT query section to facilitate disclosure.
When interviewing a Native American patient on admission to the hospital emergency department, which questions are appropriate for the nurse to ask? Select all that apply. 1 "Do you have medical insurance to cover your emergency room admission?" 2 "Does your family have a history of alcohol abuse?" 3 "Do you use a Shaman?" 4 "Do you have a family physician?" 5 "Do you use any folk remedies?"
3, 4, 5 The nurse should obtain information about folk remedies and cultural healers that the patient uses. Assessment data yield information about the patient's beliefs about the illness and the meaning of the signs and symptoms.