Mental Health - Chapter 5 - Cultural Implications

An adult patient with anxiety and a history of alcohol abuse is an inpatient on the psychiatric unit. The patient becomes angry and aggressive, strikes another patient, and then attacks a staff member. The patient is taken to seclusion and medicated with haloperidol and lorazepam. In this case, the haloperidol and lorazepam may be considered what type of intervention? 1 A restraint 2 Malpractice 3 False imprisonment 4 A medication time-out

1 A restraint Chemical restraints are defined by those medications or dose of medication that is not being used for the patient's condition. Medication time-out is incorrect; false imprisonment and malpractice refer to specific legal terms that do not have any bearing on this medication scenario.

Which cultural group perceives mental illness as a failure of the family? 1 Asian 2 Aboriginal 3 Native American 4 African American

1 Asian Asian cultures may perceive mental illness as a failure of the family. These cultures emphasize the interdependence and harmony of the family. Aboriginal and Native American cultures are more likely to place special significance on humans in the natural world. African American cultures approach illness as an individual occurrence.

A nurse is learning about different views regarding individuality in different cultures. In Western culture, which qualities would be most valued in an individual? Select all that apply. 1 Autonomy 2 Self-reliance 3 Dependence 4 Independence 5 Group-oriented

1 Autonomy 2 Self-reliance 4 Independence The Western tradition appreciates individuality. Thus, it values autonomy, self-reliance, and independence. Dependence is valued in traditions other than Western culture, such as Chinese and Indian traditions where importance is given to family and community. Group-oriented decision making is valued in Eastern tradition.

The psychiatric nurse planning and implementing care for culturally diverse patients should understand 1 Holistic theory 2 Systems theory 3 Adaptation theory 4 Political power theory

1 Holistic theory In most cultures a holistic perspective prevails, one without separation of mind and body.

A nurse is learning about cultural diversity and its relation to nursing practice. Which factors should the nurse apply when caring for patients? Select all that apply. 1 Respecting a patient's cultural views 2 Dictating one's cultural view for all patients 3 Stereotyping patients with one perspective 4 Performing culturally sensitive assessments 5 Considering a patient's concepts of health care

1 Respecting a patient's cultural views 4 Performing culturally sensitive assessments 5 Considering a patient's concepts of health care By learning about cultural diversity, a nurse should be able to respect the patient's cultural views and concept of health care. The nursing assessments should be culturally sensitive to prevent disrespecting the patient's beliefs. The patient's concept of health care should be included in the nursing care to promote compliance. Dictating one cultural view for all patients or stereotyping patients with one perspective is not advisable because due respect should be given to the patient's cultural views and perspectives.

For conducting clinical trials of a new drug, the nurse has been assigned to perform the initial screening to select Alzheimer's patients with severe impairment of thoughts and memory. As the patients' advocate, the nurse ensures that patients are well informed before signing the informed consent. Which information should be provided to the patients before obtaining informed consent? 1 Risks and benefits of the treatment 2 The 100% safety of the treatment for use 3 The unavailability of alternative treatment options 4 The inability to withdraw from the study after enrolling his or her name

1 Risks and benefits of the treatment The nurse ensures that the patients sign the informed consent form after being explained about the trial in detail. If the patient has impaired thoughts and memory, the nurse informs the patient's guardians about the risks and benefits of the treatment. The nurse informs the patients or their guardians about the alternative treatment options. The patient has the right to choose the appropriate treatment. The nurse does not give false assurance about the new drug being 100% safe, because no medication is 100% safe. The nurse indicates the probability of side effects and the success rate of the treatment. The patient has the right to refuse the treatment and can withdraw from the study at any time.

A nurse is learning about worldviews on the concept of identity. What would the nurse analyze about Western views on identity? 1 Self is the origin of identity. 2 Family is the origin of identity. 3 Community is the origin of identity. 4 Self-identity exists in relation to others.

1 Self is the origin of identity. Western worldviews are based on self, and they believe that the self is the starting point of identity. Family is considered as the starting point in Eastern worldviews. Community is the starting point according to the indigenous worldviews. The concept of self-identity existing only in relation to others is maintained by the indigenous worldviews.

Which type of culturally competent care is the nurse practicing when incorporating the use of a translator into patient care? 1 Skill 2 Knowledge 3 Awareness 4 Encounters

1 Skill Cultural skills includes the use of a medical translator in patient care. It is the ability to perform a cultural assessment in a sensitive way, such as ensuring communication is meaningful with the patient by seeking out a medical interpreter when needed. Cultural knowledge occurs when the nurse seeks out knowledge of different cultures in various ways. Cultural awareness occurs when the nurse recognizes the enormous impact culture makes on a patient's health values and practices. Cultural encounters occur when the nurse has the opportunity to provide care to diverse patients.

A nurse is planning to use a professional interpreter when caring for a patient from another culture. Which factor should the nurse consider about the activities of the interpreter? 1 The interpreter should interpret language and cultural norms. 2 The interpreter should interpret only the language of the patient. 3 The interpreter should be of a different social status than the patient. 4 The interpreter should ignore diverse nonverbal communication patterns.

1 The interpreter should interpret language and cultural norms. The interpreter should interpret language, nonverbal communication patterns, and cultural norms, and should act as a cultural broker. The interpreter should not only interpret language, but also the nonverbal communication patterns. The interpreter should closely match the patient in terms of social status, age, and gender to interpret the nonverbal communication effectively. The interpreter should not ignore nonverbal communication patterns and should be able to interpret them.

An Asian patient diagnosed with severe anxiety states "I am a failure and a disgrace" after losing a job as an accountant. What is the likely basis for the patient's statement and diagnosis? 1 The patient feels that he or she has shamed his or her family. 2 The patient feels that he or she did not achieve personal goals. 3 The patient feels anxious because his or her failure may result in a changed fate. 4 The patient feels inadequate because he or she failed in the quest for independence and self-reliance.

1 The patient feels that he or she has shamed his or her family. Eastern tradition, such as in many Asian countries, sees the family as the basis for one's identity, and family interdependence as the norm. In the Eastern view one is born into an unchangeable fate. The remaining options demonstrate Western tradition, where self-reliance, individuality, and autonomy are highly valued.

Exclusive use of Western psychological theories by nurses making patient assessments will result in 1 A high level of care for all patients 2 Inadequate assessment of patients of diverse cultures 3 Standardization of nomenclature for psychiatric disorders 4 Greater ease in selecting appropriate treatment interventions

2 Inadequate assessment of patients of diverse cultures Unless patients have faith in a particular healing modality, the treatment may not be effective. When nurses make assessments on the basis of Western theories, treatments consistent with those assessments follow. Patients of other cultures may find the treatment modalities unacceptable or not useful. Treatments consistent with the patient's cultural beliefs as to what will provide a cure are better.

A nurse finds it difficult to assess pain by observing a person belonging to an Asian culture. What is the reason for this? 1 The patient expresses pain dramatically. 2 The patient does not freely express pain. 3 The patient is not able to locate the point of pain. 4 The patient is not able to quantitatively describe pain.

2 The patient does not freely express pain. Patients belonging to Asian cultures tend not to express the negative feelings associated with pain. Therefore, it is difficult for the nurse to identify the behaviors associated with pain. Extreme dramatic expression of pain is seen in patients belonging to African and Middle Eastern cultures. It is impossible to observe whether the patient is able to locate the point of pain or describe pain quantitatively. These are subjective assessments of pain.

A nurse provides discharge instructions to a patient of Middle Eastern heritage who immigrated to this country 1 year ago. Which strategy is most important to assure the patient's understanding of the instructions? 1 Handwrite the discharge instructions. 2 Use a professional interpreter when providing instruction. 3 Give instructions to a family member proficient in English. 4 Show the patient a video in the patient's dominant language.

2 Use a professional interpreter when providing instruction. If a patient is not proficient in English, a professional medical interpreter should be engaged. The interpreter can facilitate provision of instructions as well as question-and-answer. The patient cannot ask questions of a video. Family members may or may not correctly understand the instructions or deliver them to the patient.

A nurse cares for a patient who originally emigrated from Vietnam but who has now lived in the United States for many years. Which statement demonstrates this person has adopted the American view regarding health care services? The patient says, 1 "My problem was caused by an imbalance of hot and cold." 2 "I need to resume a diet that helps balance my body's energy forces." 3 "I need more information about my medication before I decide to take it." 4 "Wait for my family to get here before we talk about the treatments for my problem."

3 "I need more information about my medication before I decide to take it." This patient likely has adapted to Western traditions, which have a scientific worldview that begins with the self and focuses on an individual's rights. The correct response demonstrates this perspective. The incorrect responses demonstrate the Eastern traditions that protect patients from truth, view energy imbalance as the cause of health problems, and see the family as the starting point of one's identity.

A patient informs the nurse that he or she has a strong urge to beat up one particular staff member. The nurse, who is very busy, finishes her shift and leaves. The next day, the nurse finds that the patient had beaten up the staff member. Which nursing action could have prevented the incident? 1 Increase in the number of the staff working the facility 2 Adequate treatment of the patient's psychiatric condition 3 Timely and accurate documentation of the patient's intent 4 Recruitment of staff members who are careful of their security

3 Timely and accurate documentation of the patient's intent Timely and accurate documentation is very crucial for providing effective nursing care and preventing mishaps in the health care facility. The incident could have been prevented if the nurse had documented the patient's intent, so that all team members could be informed of it. Preventive actions might have been taken as a result. Adequacy of the treatment is not related to the patient's violent behavior. The increased number of staff members or recruitment of careful staff members could not have prevented the incident because no one knew of the patient's intent.

A nurse is assessing a patient from Asia who has lived in the United States for 20 years. The nurse asks the patient, "Do you want me to call your husband and parents when we discuss your treatment?" Which response of the patient indicates that the patient predominantly follows U.S. culture? 1 "Yes, sure, I would feel so protected with them." 2 "I don't think they would be interested in coming." 3 "I think I can make my own health-related decisions." 4 "I don't want to disturb their schedule by calling them."

3 "I think I can make my own health-related decisions." People belonging to U.S. culture believe in autonomy and autonomous decision making. Therefore, the response "I think I can make my own health-related decisions" indicates that the patient is self-reliant. Unlike people belonging to the Asian culture, American patients do not consider it necessary for the family to take part in the decision-making process. "Yes, sure, I would feel so protected with them" indicates that the patient is more comfortable with the family around when making decisions. This would be the probable response of a patient belonging to a non-Western culture. The responses "I don't think they would be interested in coming" and "I don't want to disturb their schedule by calling them here" indicate that the patient is willing to have the family around but the family would not be interested in being involved in the patient's health care process.

Which ethical principle refers to the individual's right to make his or her own decisions? 1 Fidelity 2 Veracity 3 Autonomy 4 Beneficence

3 Autonomy Autonomy refers to self-determination, or the right to make one's own decisions.

A nurse is aware of the patterns of nonverbal communication in different cultures. When assessing a group of patients from the United States, what does the nurse consider regarding eye contact? 1 It is considered rude. 2 It is accepted as a challenge. 3 It is associated with attentiveness. 4 It is avoided as a sign of arrogance.

3 It is associated with attentiveness. In the United States, eye contact is linked with attentiveness and respect. In cultures other than the United States, eye contact is avoided because it is considered rude. Some cultures also consider eye contact as a sign of challenge. In some cultures, eye contact is avoided as a sign of arrogance.

Which is the predominant cultural concept of illness in the United States? 1 Fatalism 2 Present orientation 3 Master of one's fate 4 External locus of control

3 Master of one's fate The predominant cultural concept in the United States is that one is the master of one's own fate. Fatalism, present orientation, and external locus of control are patterns and concepts in other cultures.

Family members are worried about a depressed relative whose job recently was terminated. The family requests hospitalization of this person. An assessment reveals the person is moderately depressed but without intent or thoughts about self-harm. Which action demonstrates application of the least restrictive alternative doctrine? 1 Hospitalize the person as a temporary admission. 2 Contact with the person's prior employer for additional information. 3 With the person's agreement, arrange for immediate outpatient counseling. 4 Admit the person involuntarily to an inpatient mental health treatment unit.

3 With the person's agreement, arrange for immediate outpatient counseling. The least restrictive alternative doctrine mandates that the least drastic means be taken to achieve a specific purpose. Outpatient counseling is the least restrictive intervention. With the person's agreement, this intervention will provide services. Temporary admission is used for people who are so confused or demented they cannot make decisions on their own or are so ill they need emergency admission. Contacting the person's prior employer violates confidentiality. Involuntary admission is necessary when a person is in need of psychiatric treatment, presents a danger to self or others, or is unable to meet his or her own basic needs. This scenario does not fulfill those criteria.

A nurse is assessing a patient from the Western tradition. Which action should the nurse perform when treating the patient? 1 Call for folk healers. 2 Work to regain the lost balance. 3 Arrange for traditional remedies. 4 Arrange for prescribed treatment.

4 Arrange for prescribed treatment. Western biomedical perspective believes in prescribed medical treatment in order to treat an illness. Folk healers are called for treatment in cultures other than Western tradition. Regaining the lost balance to heal patients is a belief in cultures other than the Western traditions. Traditional remedies are performed in other cultures, not in the Western tradition.

Of all healthcare workers, those working in which field are most likely to be assaulted by patients? 1 Pediatrics 2 Obstetrics 3 Psychiatric 4 Emergency

4 Emergency Emergency room nurses are most likely to be physically assaulted. Psychiatric nurses have a high incidence, but it is lower than in the emergency department. Pediatrics and obstetrics do not rank as highly.

An experienced nurse is teaching novice nurses about the expected behavior from competent nurses. Which behavior should the nurse include when teaching them? 1 Think that patients' values are incorrect 2 Impose cultural norms on their patients 3 Believe in only their way of patient care 4 Examine their assumptions about a patient's culture

4 Examine their assumptions about a patient's culture By examining their assumptions about a patient's culture, nurses can become more aware and educated about the patient's culture. It would help the nurse to provide the best and culturally competent patient care. Thinking that only their values are correct and patients' values are incorrect is not appropriate because it can cause bias and ethnocentrism. Imposing cultural norms on their patients is not appropriate behavior for nurses; instead, nurses should learn to consider patients' cultural values. Although nurses should believe in their ways of patient care, it is equally important to understand and respect the patient's beliefs.

After the death of a patient, what rule of confidentiality should be followed by nurses who provided care for the individual? 1 Confidentiality is now reserved to the immediate family. 2 The nurse must confer with the next of kin before divulging confidential, sensitive information. 3 Only human immunodeficiency virus (HIV) status continues to be protected and privileged. 4 Nothing may be disclosed that would have been kept confidential before death.

4 Nothing may be disclosed that would have been kept confidential before death. Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a patient that they would have kept confidential while the patient was alive.

Which healing practice is least used in the Western health system of healing practices? 1 Surgery 2 Antibiotic medication 3 Targeted cellular destruction 4 Restoring lost balance or harmony

4 Restoring lost balance or harmony The best treatment perspectives of various cultures include regaining lost balance and harmony. This perspective is not used in Western culture.

A nurse provides discharge instructions to a patient of Vietnamese heritage who immigrated to this country 1 year ago. Which strategy would be important to ensure the patient's understanding of the instructions? 1 Show the patient a video. 2 Handwrite the instructions. 3 Contact a bilingual translator. 4 Use a professional interpreter.

4 Use a professional interpreter. Use of a professional interpreter ensures that information is provided in familiar terms and at the literacy level of the patient and that feedback from the patient can be evaluated. The nurse and other health care providers need to be aware of the meaning of gestures, body positions, facial expressions, eye movements, and the tone of voice during all communication with individuals from various cultures.

Family members report a Native American adult is self-mutilating and experiencing auditory and visual hallucinations. The patient says, "My dead father told me to cut myself to remove the bad spirits." Which action is an appropriate nursing intervention for the nursing care plan? 1 Refer the patient for grief counseling services. 2 Initiate a consultation with the hospital chaplain. 3 Provide the patient with frequent periods alone for meditation and prayer. 4 With the patient's consent, confer with a spiritual healer from the patient's tribe.

4 With the patient's consent, confer with a spiritual healer from the patient's tribe. Native Americans often find tribal healing ceremonies helpful as a complement to the therapeutic program. This patient may have ghost sickness, thought to be caused by an evil spirit. It is treated by overcoming the evil spirit with a stronger spiritual force. The healer, a "singer," calls forth this force through a powerful healing ritual. Grief counseling services or a hospital chaplain are less effective interventions. In the interest of safety, the patient should not be left alone.