Ch 3: Cultural and Spiritual Issues Related to Mental Health Care

c) Speak with Jonas further about his needs to assess how best to intervene Pg. 27 A thorough assessment is the initial step in providing nursing care of any type.

1. A client, Jonas, hints that he would like to discuss his spiritual and religious beliefs with someone. What is the best nursing intervention at this point? a) Ask Jonas if he would like to speak with you on a daily basis; you pray daily and would be happy to include Jonas in your prayer sessions b) Tell Jonas that you would like to speak with his wife regarding her perception of his spirituality and religious needs c) Speak with Jonas further about his needs to assess how best to intervene d) Begin meeting with Jonas as often as he likes to discuss spirituality

c) Interventions need to work for various groups, not individuals Pg. 20 Interventions should be tailored toward the individual; one intervention does not work for everyone. One should demonstrate genuine interest in, and respect for, the individual. Conducting a thorough social and cultural assessment is a component of becoming culturally competent. It is important not to assume that all individuals of a racial or ethnic group are the same.

10. Which of the following is an inaccurate statement with regard to cultural competence and mental health? a) A nurse should demonstrate a thorough interest in and respect for the individual b) It is important to conduct a thorough social and cultural assessment c) Interventions need to work for various groups, not individuals d) Nurses should not assume that all individuals of a racial or ethnic group are the same

c) Demonstrate an appreciation of, and a genuine interest in, the individual and his or her cultural beliefs Pg. 20 Cultural competence requires that a nurse demonstrates a willingness and ability to draw on community-based values, traditions, and customs and that the nurse values clients' cultural beliefs. The nurse needs to demonstrate a genuine interest in, and respect for, the individual and his or her beliefs. The nurse should learn about the client's country of origin and culture before assessing the client. Cultural competence requires the nurse to adjust or recognize his or her own culture in order to understand the client's culture. It also requires the nurse to understand and appreciate the cultural differences and similarities within, among, and between groups. Nurses need to avoid assuming that all individuals of a racial or ethnic group are the same.

11. A psychiatric-mental health nurse is working on developing cultural competence. Which would be most appropriate for the nurse to do? a) Recognize that one's own culture is the predominant way of addressing a client's health care needs b) Research information about the cultures of the population being served after assessing the client c) Demonstrate an appreciation of, and a genuine interest in, the individual and his or her cultural beliefs d) Assume that any individual of a racial or ethnic group is the same as another individual in that group

d) Commitment and caring Pg. 24 The nurse must encourage family members to continue to support the client even while he or she is in the hospital and should identify family strengths, such as love and caring, as a resource for the client. Overly concerned family support can impede the client's decision making ability, and family support should be available in the hospital and upon discharge. Inquisitiveness can be an asset but can also be a liability if it is excessive. Commitment is beneficial.

12. A nurse is gathering information regarding discharging a client and documenting the client's support system. Which are factors in family support? a) Available only at discharge b) Cautious of commitment c) Concerned and inquisitive d) Commitment and caring

a) Feeling a connection to a higher power Pg. 22 Spirituality develops over time and is a dynamic, conscious process characterized by two movements of transcendence; either deep within the self or beyond the self. Self-transcendence involves self-reflection and living according to one's values in establishing meaning to events and a purpose to life. Closely intertwined with beliefs about health and mental illness, living according to one's beliefs, and participation in common ways of worshipping are not things that are most consistent with spirituality.

13. The nurse educator is discussing spirituality for nurses in a mental health class. The nurse educator asks a student nurse, "Which of the following is most consistent with spirituality?" The student nurse identifies which description? a) Feeling a connection to a higher power b) Living according to one's beliefs c) Closely intertwined with beliefs about health and mental illness d) Participation in common ways of worshiping

d) "Can you show me how you will set up this nebulizer for your son?" Pg. 21 The nurse must be able to assess a client or client's family member for health literacy. In order to ensure that the client's parent has understood instructions, the teach-back method enables the client's parent to show what they have learned. The nurse can easily identify knowledge deficits and provide the needed teaching to improve health literacy and learning. The additional answer choices are not inappropriate questions to ask; however, these do not best assess the parents' health literacy.

14. The nurse is caring for a pediatric client whose parent is at the bedside. The nurse wants to assess the parent's understanding of discharge instructions. Which question will best assess the parent's understanding of the discharge instructions? a) "What can you tell me about your son's diagnosis?" b) "Can you tell me what questions came up after talking to your son's health care provider?" c) "Do you have any questions about your son's treatment?" d) "Can you show me how you will set up this nebulizer for your son?"

c) Recognizing one's own culture Pg. 21 Cultural and linguistic competence involves an adjustment or recognition of one's own culture in order to understand the culture of another person. Thus a nurse must first recognize his or her own culture. Linguistic competence, the capacity to communicate effectively and convey information that is easily understood by diverse audiences, is an important part of cultural competence. Identifying a client's culture and understanding a client's cultural beliefs are components that are addressed once the nurse recognizes his or her own culture.

15. When describing the concept of cultural competence to a group of nursing students, the nursing instructor identifies what as a first step? a) Identifying the client's culture b) Understanding the client's cultural beliefs c) Recognizing one's own culture d) Developing linguistic competence

c) "How do you want me to help you?" Pg. 21 To provide culturally competent care, the nurse must find out as much as possible about a client's cultural values, beliefs, and health practices. Often, the client is the best source for that information, so the nurse must ask the client what is important to him or her. An open and objective approach to the client is essential. Clients will be more likely to share personal and cultural information if the nurse is genuinely interested in knowing and does not appear skeptical or judgmental. Assuming the client wants a preacher or has special dietary preferences is assuming the client's values. Asking about preferred family members does little to assess the nature of family relationships.

16. Which question best encourages the client to disclose information that the nurse must assess to provide culturally competent care? a) "Do you want me to contact your preacher?" b) "Which family members do you want to receive calls from?" c) "How do you want me to help you?" d) "What special diet do you have?"

d) Prayer Pg. 27 Prayer can be a powerful form of coping that helps people physically and mentally. The others are examples of medical or pharmacological interventions that may help the patient but are not forms of coping.

17. A nursing student recognizes which of the following as a powerful form of spiritual coping that also helps people both physically and mentally? a) Medication b) Dietary treatments c) Acupuncture d) Prayer

d) Spirituality Pg. 24 Spirituality can be defined as thinking about one's self as a part of a spiritual force such as a God, a spirit, or nature and a feeling of connectedness, relationship, or oneness with God, spirit, nature, or unifying force (Corrigan, McCorkle, Schell, Kidder, 2003; Hill et al., 2000). Native American cultures emphasize respect and reverence for the earth and nature, from which come survival and comprehension of life and one's relationships with a separate, higher spiritual being and with other human beings.

18. The nurse is doing an assessment interview of a client. During the interview, the client comments, "Our people are connected with nature. Our world, our seasons, and our weather—they all have many lessons to teach us." The nurse interprets the client's statement as an expression of which of the following? a) Religiousness b) Tribal law c) Ecological beliefs d) Spirituality

a) "I have not talked to my friends lately" Pg. 24 The client is likely experiencing spiritual distress from the loss of a spouse. The nurse must be able to recognize that a client who has withdrawn socially may be experiencing spiritual distress. The remaining answer choices are positive statements and do not require follow-up by the nurse.

19. The nurse is caring for an older adult whose spouse recently died. Which statement made by the client requires follow-up by the nurse? a) "I have not talked to my friends lately" b) "My children think I should go to a grief support group" c) "The church I attend dedicated a bench in my spouse's honor" d) "One day I will see my spouse again"

a) Educate the staff to help them assist the client in selecting food choices from the client's menu that supports this belief Pg. 21 In cultural care preservation/maintenance, the nurse assists the client in maintaining health practices that are derived from membership in a certain ethnic group. The nurse helps the client select and obtain foods congruent with these beliefs most effectively by educating staff. This is not necessarily possible or even advised if there are medically required food restrictions.

2. In order to help preserve and maintain a client's cultural belief regarding the need for "hot foods," which action should the culturally competent nurse take? a) Educate the staff to help them assist the client in selecting food choices from the client's menu that supports this belief b) Assure the client that these needs will be considered by the staff c) Discuss the possibility of the family providing the appropriate foods d) Ask for a dietary consult with an understanding of the "hot and cold food" belief

d) Recognize one's own culture to enhance understanding of other cultures Pg. 21 Psychiatric-mental health nurses have an obligation to be culturally and linguistically competent to provide quality care. There is a general consensus that cultural and linguistic competence involves an adjustment or recognition of one's own culture in order to understand the culture of another person. This would be the first step in developing cultural and linguistic competence. Communicating effectively and addressing the health literacy needs of clients are important components of linguistic competence. Linguistic competence is an important part of cultural competence. A nurse who is culturally competent understands and appreciates cultural differences in health care practices and similarities within, among, and between groups.

20. A psychiatric-mental health nurse is working to develop cultural and linguistic competence. Which action would be most important for the nurse to do first? a) Appreciate cultural differences in health care practices of groups b) Communicate effectively to convey information in an easy-to-understand manner c) Address the health literacy needs of those being served d) Recognize one's own culture to enhance understanding of other cultures

b) The ability to understand and effectively interact with individuals or members of a community from diverse cultural or ethnic backgrounds Pg. 25 Cultural competence involves the desire and attempt by health care workers to learn about and work within the cultural context of the client from a diverse cultural or ethnic background.

21. The mental health nurse is interviewing a client of a different cultural background regarding the client's health care practices. The nurse understands that cultural competence is important in the care of this client. Cultural competence in health care can be best described as what? a) A combination of a person's beliefs about cultural values and knowledge about his or her own culture b) The ability to understand and effectively interact with individuals or members of a community from diverse cultural or ethnic backgrounds c) The client's ability to tell the health care provider about his or her cultural beliefs and practices d) Knowing the characteristics of each individual cultural group in America

c) The client's perception of the stressor Pg. 22 The client will respond to the stressor based on his or her appraisal (perception) of the stressor. Resilience is related to positive outlook. Experience may color the client's perception of the event, but experiences are subject to the client's perception and do not have a direct effect independent of perception and interpretation.

22. Which factor would be the most influential in determining a client's response to a particular stressor? a) The severity of the stressor b) The client's experience with stress c) The client's perception of the stressor d) The duration of the stressor

b) Culture is shared attitudes, customs, and beliefs Pg. 22 Members of groups share an accepted way of life that provides a general structure for living, as well as patterns by which they interpret reality. The structure includes all of the socially learned behaviors, values, beliefs, customs and ways of thinking of a population that guide its members' views of themselves and the world.

23. Which represents the best brief definition of culture? a) Culture refers to a person's religious beliefs b) Culture is shared attitudes, customs, and beliefs c) Culture refers to a person's racial background d) Culture is a society's social norms

b) Linguistic competence Pg. 21 Linguistic competence, the capacity to communicate effectively and convey information that is easily understood by diverse audiences and address the health literacy needs of patients and their families, is an important part of cultural competence. Cultivation analysis, negociation skills, and dramatism is not included in examples of cultural competence.

24. An important part of cultural competence includes the capacity to communicate effectively and convey information that is easily understood. When providing care the nurse should know that cultural competence includes which example? a) Dramatism b) Linguistic competence c) Negotiation skills d) Cultivation analysis

a) Spirituality involves self-transcendence and transcendence beyond the self c) Spirituality can be expressed through adherence to a particular religion d) Spirituality develops over time e) Religious beliefs often influence approaches to mental health Pg. 24 Spirituality develops over time and is a dynamic, conscious process characterized by two movements of transcendence (going beyond the limits of ordinary experiences): either deep within the self or beyond the self. Related to but different than spirituality, religiousness is the participation in a community of people who gather around common ways of worshiping. Spirituality can be expressed through adhering to a particular religion. Religious beliefs often influence approaches to mental health.

25. A nurse is reading a journal article about spirituality, religion, and mental health. Which information would the nurse likely find? Select all that apply. a) Spirituality involves self-transcendence and transcendence beyond the self b) Spirituality is the same as religiousness c) Spirituality can be expressed through adherence to a particular religion d) Spirituality develops over time e) Religious beliefs often influence approaches to mental health

c) A friend who will share his or her perspective on an issue Pg. 22 Social support is emotional sustenance that comes from friends, family members, and even health care providers who help a person when a problem arises. It is different from social contact, which does not always provide emotional support. An example of social contact is the friendly talk that goes on at parties. Social support is emotional sustenance that comes from friends, family members, and even health-care providers who help a person when a problem arises. A friend who is willing to share his or her perspective is likely providing emotional support. This is different from social contact, which does not always provide emotional support. Sports may provide social interaction without providing emotional support. Education and transportation are practical needs that do not necessarily consist of emotional components.

26. Which situation would most likely provide social support to a client? a) The transportation service that provides access to daily rehabilitation services b) The teacher assisting a client to obtain a GED c) A friend who will share his or her perspective on an issue d) Fellow teammates participating in a community softball league

a) Black Americans Pg. 22 According to statistics and research, Black Americans are disproportionately diagnosed as having schizophrenia when compared to other groups.

27. When reading a research report about cultural groups and mental illness, which group would the nurse expect to find as being diagnosed with schizophrenia more often than other groups? a) Black Americans b) Native Americans c) Asian Americans d) Hispanic Americans

b) "Do you have a way to contact your shaman?" Pg. 24 Many members of Native American/First Nations cultures believe in shaman, or medicine men. These healers are believed to be psychic and rely on herbal medicines, healing ceremonies, and feasts to heal diseases or illnesses. The other answer choices are dismissive to the client's culture and preferences and demonstrate a lack of cultural competence.

3. The nurse is caring for a client of Native American/First Nations heritage. The client tells the nurse, "I would like a shaman at my bedside to tell me if I will heal from this disease." Which response by the nurse best demonstrates cultural competence for this client? a) "The outcome of the disease you have cannot be predicted by anyone" b) "Do you have a way to contact your shaman?" c) "Can you tell me why you want a shaman?" d) "The disease you have can be treated, and you will recover"

a) Partner with the local community health center to provide screenings within the community b) Provide free bus vouchers for those needing to get to and from the clinic d) Eliminate demographic information on intake forms that would reveal immigration status e) Hire office staff members who speak Spanish Pg. 22 Clients of Hispanic descent tend to use all other resources available to them before seeking mental health services. When services are sought, those that are offered in nonprofit hospitals and community health centers are used most often. Exact reasons for this are not clear, but barriers to accessing services, language, and cultural barriers, and concerns about immigration status are thought to contribute to this disparity. Hiring bilingual office staff members, providing ways to access the clinic, eliminating concerns about immigration status, and partnering with the community health center are all interventions that can improve access to care for this population. Providing pamphlets about health information may not serve this population well, due to potential problems with reading or understanding the written material in a non-native language.

4. The nurse is working in a local for-profit mental health clinic. After reviewing the demographic data of the clients seeking treatment at the clinic, the nurse finds that there is a low Hispanic population using the clinic, despite a high Hispanic population in the area. Which intervention(s) does the nurse perform to best serve this population? Select all that apply. a) Partner with the local community health center to provide screenings within the community b) Provide free bus vouchers for those needing to get to and from the clinic c) Provide pamphlets and brochures about resources in the area d) Eliminate demographic information on intake forms that would reveal immigration status e) Hire office staff members who speak Spanish

c) Communication Pg. 21 Communication involves verbal and nonverbal communication such as touch and eye contact. Social organization refers to family structure and organization, religious values and beliefs, ethnicity, and culture. Environmental control refers to a client's ability to control the surroundings or direct factors in the environment. Biologic variations do not directly affect preferences around touch and eye contact.

5. The nurse is taking care of clients in a large metropolitan city. Which cultural phenomenon should be assessed by the nurse that includes preference such as touch and eye contact? a) Biologic variations b) Environmental control c) Communication d) Social organization

c) "What are your religious beliefs about taking medication?" Pg. It is imperative for the nurse to focus on what is keeping the client from taking prescribed medications. In this situation, it is the client's religious beliefs. Therefore, the nurse should focus on these. It is important to know when the client last had medication, however this is not the most important information in this situation. The question "Why can you not take your medications?" belittles the clients choice of religion over medication and is accusatory in nature.

6. A nurse is caring for a client who has paranoid schizophrenia and is refusing to take medications due to religious beliefs. Which question is most important for the nurse to ask? a) "How long has it been since you have had your medication?" b) "Would you like to see an improvement in your symptoms?" c) "What are your religious beliefs about taking medication?" d) "Why can you not take your medications?"

b) Spirituality is a person's experience of, or belief in, a power apart from himself or herself, whereas religion is the outward practice of a spiritual system of beliefs Pg. Spirituality is an internal, private, and subjective experience of belief. Religion involves external organized structures designed to be an avenue to connect with one's inner spirituality.

7. Spirituality and religion differ along the following lines: a) Religion is more often used in clinical practice because it is easier to implement within an acute hospital setting than is spirituality b) Spirituality is a person's experience of, or belief in, a power apart from himself or herself, whereas religion is the outward practice of a spiritual system of beliefs c) Religion has been recognized for at least 3,000 years, whereas spirituality has been recognized for only 1,000 to 1,500 years d) Spirituality is the belief that one's spirit will go to heaven or hell upon death; religion is a way to ensure that the individual will go to heaven

a) "Spirituality is the same as religion" Pg. 24 Spirituality and religion have many important differences and are not the same.

8. A nursing instructor is teaching about the importance of including spirituality in client care. The instructor realizes a need for further instruction when a student states which of the following? a) "Spirituality is the same as religion" b) "Not every person who professes to be spiritual is religious" c) "Spirituality is different from religion" d) "Spirituality may exist within, but is ultimately apart from a single person"

c) Spirituality guides beliefs about the meaning of life events Pg. 24 Spirituality involves the essence of a person's being and his or her beliefs about the meaning of life and the purpose for living. Spirituality is a genuine help to many adults with mental illness, serving as a primary coping device and a source of meaning and coherence in their lives. It may also help to provide a social network and meaningful goals and activities, but it serves primarily as a belief system that provides meaning.

9. Spirituality is especially important in helping people cope primarily for which reason? a) Spirituality gives people meaningful daily activities in which to participate b) Spirituality provides a reliable support network c) Spirituality guides beliefs about the meaning of life events d) Spirituality helps people set personal goals