Ch. 4 Culture and Spirituality Awareness

Which situations would be a health care provider barrier to the nurse developing cultural competence? Select all that apply.

A nurse who is unaware of personal biases to other ethnic groups represents a health care provider barrier along with the provider who does not incorporate alternative therapies. Having no family rooms or limiting visiting hours is an example of a system barrier. Nurses who seek encounters with individuals from other cultures have a developed sense of cultural competence.

What would be an appropriate spiritual nursing intervention for a client experiencing loneliness and social alienation?

Active listening is an example of a spiritual nursing intervention. Other interventions include the following: prayer, presence, scripture reading, peaceful environment, meditation, music, pastoral care, inspiring hope, validation of the client's thoughts and feelings, values clarification, sensitive responses to client beliefs, and developing a trusting relationship. Identifying level of functioning and ADLs and IDLs address basic human needs. Assessing cognitive function is identifying the client's ability to understand events.

A client is experiencing spiritual distress related to loneliness and social alienation. What would be included in spiritual nursing interventions?

Active listening is an example of a spiritual nursing intervention. Other interventions include the following: prayer, presence, scripture reading, peaceful environment, meditation, music, pastoral care, inspiring hope, validation of the client's thoughts and feelings, values clarification, sensitive responses to client beliefs, and developing a trusting relationship. Identifying level of functioning regarding IADLs and ADLs addresses basic human needs. Evaluating the ability to understand events is addressing cognitive function.

An older adult who is a member of the Jewish community is hospitalized. Her son has been at the bedside daily. When the nurse tries to communicate with the client and the son, the son avoids eye contact with the nurse. What would be the best nursing measure?

An older adult who is a member of the Jewish community is hospitalized. Her son has been at the bedside daily. When the nurse tries to communicate with the client and the son, the son avoids eye contact with the nurse. What would be the best nursing measure?

What is a nursing best practice when communicating with a client who speaks a different language?

Arranging for an interpreter would be a nursing best practice when communicating with a client who speaks a different language. Facing the client and speaking slowly and not loudly is appropriate communication providing it is in the client's language. Having the family interpret is inappropriate because it violates privacy and does not ensure correct translation. Using a translation dictionary is not reliable.

During a home care visit, the nurse explains to the daughter of an elderly client the importance of turning the client every 2 hours to prevent pressure ulcers on her bed-ridden mother. On a follow-up visit, the nurse notes that the schedule of checking off to turn the client has not been followed. The client's daughter tells the nurse that she is taking good care of her mother "their way, but it is not on your schedule." What would be an appropriate response by the nurse?

Asking the daughter to become involved in the care of her mother will assist the nurse in gaining compliance of the daughter's behavior to turn her bedridden mother every 2 hours. Giving her a turning clock without gaining her acceptance and willingness to use it will not be effective. It is important to acknowledge the daughter's cultural customs, but telling her that she has to turn her every 2 hours without getting the daughter's cooperation will fall short of the expectations. Suggesting that caring for her mother is too much work is an assumption that the nurse should not make without verifying this as an issue with the daughter.

Which religious group would most likely refuse a blood transfusion?

Blood, blood products, and plasma are prohibited for the client who is a Jehovah's Witness. In addition, clients will not consume any food that containing blood, e.g., rare cooked steak. Blood volume expanders that are not blood derivatives are permitted.

What is the rationale for completing a cultural assessment on an older adult who is a member of the Navajo nation and requires short-term skilled nursing care following knee replacement surgery? Select all that apply.

Cultural congruent nursing care is meaningful, supportive and facilitative because it takes into consideration valued life patterns of clients from different cultures. Attitudes of aging are noted during the assessment. There is variance among the Native Americans as to their culture and practices. Health disparity refers to a higher burden of illness, injury, disability, or mortality experienced by one population group relative to another. A cultural assessment does not eliminate a health care disparity.

The nurse understands the following about culture and ethnicity:

Ethnicity is the person's identification with or membership in a particular racial, national, or cultural group and observation of the group's customs (e.g., traditions, symbols), beliefs, and language. Race refers to a group of individuals with biological similarities (e.g., similar physical characteristics, such as facial features, color of hair, eyes, and skin). Culture and ethnicity have different definitions. Ethnic groups can be located in different geographic locations.

The nurse observes a mother breastfeeding her 4-year-old child, who is hospitalized. During report, other nurses talk about why a mother would continue to breastfeed a preschool aged child. They conclude that the American way is better, which is to discontinue breastfeeding at a much younger age. What are the nurses expressing?

Ethnocentrism is the belief that one ethnic or cultural group and their practices are superior to that of another group. Cultural competence is the complex process and integration of acquiring specific knowledge, skills, and attitudes to ensure delivery of culturally congruent care, which involves cultural awareness (self-examination), knowledge, skills, encounters (cross-cultural interactions), and desire/motivation/commitment. Acculturation is the process by which a person from one culture adapts to another culture. Stereotyping is a preconceived notion or fixed general idea or image, usually about a group of people; many stereotypes are racist, sexist, or homophobic.

What is ethnocentrism?

Ethnocentrism is the belief that one ethnic or cultural group is superior to that of another group. Acculturation is the process by which a person from one culture adapts to another culture. Cultural assimilation happens when members of a minority group are absorbed by a dominant culture by taking on the characteristics of that dominant culture. A stereotype is a preconceived notion or fixed general idea or image, usually about a group of people; many stereotypes are racist, sexist, or homophobic

The nurse is conducting an admission assessment interview with an adult Native-American client. Which therapeutic approach would be most effective?

Indigenous cultures, such as the Native-American culture, place special significance on the place of humans in the natural world. That culture emphasizes the importance of a holistic body-mind-spirit and living in harmony with nature. Using a soft voice with open-ended statements that reflect a cooperative, sharing style rather than competitive or intrusive approaches would be the preferred therapeutic approach (i.e., a passive style would be best received). Also, some Native-American cultures use silence to a far greater degree, which should not be mistaken for belligerence or sullenness, but likened more to a common response in dealing with strangers or noted as a sign of wisdom. The other options would be more effective to use with clients of a Western culture orientation.

An 18-month old child is in the 50th percentile for height and weight. The parents report that the child eats a variety of foods within the vegetarian practices of their religion and continues to breastfeed twice a day. What would be an appropriate nursing response?

It is important for the nurse to base her response on the fact that parents can provide a nutritionally adequate vegetarian diet (except with the strictest diets), but it requires careful planning and knowledge of nutrient sources, which is why a review of what the child is eating should form the basis of the nutritional assessment. For children the lacto-ovo vegetarian diet is nutritionally adequate; however, the vegan diet requires supplementation with vitamins D and B12 for children ages 2 to 12 years. Breastfeeding mothers on a strict vegan diet should supplement their infants with vitamin B12, since their milk will be low in vitamin B12. In addition, breastfeeding infants of strict vegans should receive foods fortified with zinc after 7 months of age. Although the option that the child is underweight and the family needs nutritional counseling is not an incorrect answer, however obtaining an assessment is a better response. The weight-for-length goal for growth in the first two years of life should be above the 50th percentile on WHO standard growth charts, so being at the 50th percentile alerts the nurse to obtain a nutrition assessment. It is not appropriate to question the parent's religious practices and the inclusion of the child in those practices.

What is a nursing intervention for a client who is experiencing spiritual distress?

It is important that the nurse develop a trusting relationship with the client, as well as being supportive of the client's needs. The nurse should allow the client a quiet environment that allows time for prayer and meditation.

The nurse is developing a plan of care for a hospitalized Asian American client. Which nursing measures should be included in the client's plan of care? Select all that apply.

It is important to check for understanding of what is being said about the plan of care for all clients, not just Asian American. Consider that periods of silence by the client are indicative of reflection on what has been said. Avoiding physical closeness, limiting eye contact, avoiding hand gestures, and clarifying responses to questions are all components of the plan of care for an Asian American client.

A client expresses to the nurse that he needs to pray with his church group leader to get well. What would be an appropriate response by the nurse?

It is important to respect and understand a client's preferences and wishes about prayer. It would not be appropriate to delay in contacting the church leader until discharge. Although taking medications and following the treatment plan will help the client improve his physical condition, prayer also is important in the overall plan of care. Asking a client "why" focuses communication on the client having to defend their comment or request, which is a nontherapeutic response.

A client of Latino heritage is refusing treatment at the clinic and wants a curandero called. What should the nurse understand about the practices of a curandero?

Latino clients may use home remedies and consult folk healers known as curanderos or curanderas rather than traditional Western health care providers. Curanderos provide a holistic form of healing, which combines prayer, herbal remedies, rituals, psychic healing, spiritualism, and massage. Curanderos believe in the hot and cold theory of disease.

Which of the following describes how cultural diversity may affect a client's health?

Many cultural factors affect a client's approach to health and health care. Alternative remedies, such as St. John's wort, are used for self-treatment of depression. For most cancers, certain racial and ethnic groups have lower survival rates than Caucasians. Hypertension has a higher rate of occurrence in African-Americans, and they are at greater risk of developing heart disease, end-stage renal disease, and stroke than the general population. Asian-Americans have a higher incidence of stomach and liver cancers. Ethnic groups respond differently to medications. Caucasians are more sensitive to the effects of beta-adrenergic blockers, such as propranolol, whereas African-Americans are less responsive to this drug group.

A nurse wants to improve cultural competence. What action shows progress toward this goal?

One action nurses can take to improve cultural competence is to learn how to use cultural assessment tools. The other actions are good steps but do not demonstrate progress to the stated goal as well as using an evidence-based tool.

A client has identified that they are a practicing Orthodox Jew. The nurse understands the following about Kosher diets.Select all that apply.

The Kosher diet includes only meats allowed that are by vegetable eaters or cloven-hoofed animals (cattle, dear, goats, sheep) and animals that are ritually slaughtered. Fish that have scales and fins are allowed. No meat and milk combination is allowed; fish and milk eaten together are not allowed. Pork is prohibited. Fresh fruits are allowed.

The nurse is caring for a client who is unconscious and is dying. The family has requested a priest to come. Which of the following sacraments would the family of a Catholic client re-quest at this time?

The Sacrament or Anointing of the Sick may be administered, along with other sacraments of reconciliation and communion, providing the client is conscious and can participate in reconciliation and communion. Because the client is Catholic, they would have already been baptized.

A family practices Buddhism and brings their 2 year-old2-year-old child to the clinic for an annual well-child visit. The child is in the 60th percentile for both height and weight. The mother re-ports that she continues to breastfeed her child twice a day in the morning and at bedtime. She also states that the child eats most foods in their vegetarian diet. What would be an ap-propriate response by the nurse?

The nurse should assess and determine what foods the child is eating, so the nurse can identify any dietary deficiencies and provide information to support nutrition for the child, so that improvement is noted in height and weight measurements. After an assessment is made by the nurse, the option to make a nutritional referral may be considered. Referral to home care services is not appropriate at this time. It is never appropriate to tell the family that they need to change their religious practices.

What is the most effective approach to obtaining a cultural assessment on a client?

The nurse should use a cultural assessment guide to obtain information during the admission assessment. This information can be included in the client's plan of care and is an objective an evidence-based approach. Although asking the client about their culture is not incorrect, a cultural assessment guide will direct the nurse in obtaining information that may not have readily been provided by asking the client or observing their behavior.

A client is being admitted to a psychiatric unit for anxiety disorder. The nurse is conducting the admission interview and asks the client their religious preference. The client responds and states that they have not practiced their religion in many years and asks the nurse if religious practices would help decrease the symptoms of anxiety. What would be an appropriate therapeutic response?

The nurse's response of providing information about research studies supporting the reduction of stress and anxiety due to spiritual practices and religious beliefs is appropriate and directly addresses the client's question. Asking "why" questions tend to make the person justify their comment or belief. Nurses can and should discuss with the client when they have asked questions about religious and spiritual practices. The nurse calling the hospital chaplain does not answer the question.

When the nurse asks the client, "How has being sick affected your spiritual practices?" the nurse is trying to determine the need in what spiritual dimension?

The question assists the nurse to determine the client's spirit-enhancing practices or rituals. As a testing strategy, note that the answer has the "spiritual practices" and so does the question. Other responses assess sources of hope, compassion, and strength, involvement in the spiritual or religious community, and their experience of God or a higher power.

When you care for a client who does not speak English, it is necessary to call on a profes-sional interpreter. Which of the following are proper principles for working with interpreters?

There are helpful guidelines for working with interpreters, which include if you feel an interpretation is not correct, stop and address the situation directly with the interpreter. Pace a conversation so there is time for the client's response to be interpreted. Ask the client for feedback and clarification at regular intervals. During interview, look and speak with client, not interpreter. Watch and listen to client's nonverbal communication, when client is talking. It is not recommended to use of family, children, or support staff as interpreters.

A older adult female immigrant tells the nurse that where she grew up women had no voice in the family, because the men made all the decisions. Over the past 20 years since becoming a US citizen, I have the same voice and control in the family that my husband has. What is this an example of?

This client has described the process of acculturation by which a person from one culture adapts to another culture. Ethnicity is the person's identification with or membership in a particular racial, national, or cultural group and observation of the group's customs, beliefs, and language. Cultural assimilation happens when members of a minority group are absorbed by a dominant culture by taking on the characteristics of that dominant culture. Ethnocentrism is the belief that one ethnic or cultural group is superior to that of another group.

Which behavior indicates that an 18-month-old infant is developing a nonadaptive reaction to hospitalization?

Usually the toddler clings to the mother. As separation anxiety becomes intolerable, the child ignores the parent. At this stage the child relates better to the staff and doesn't mind the absence of the parent. Eating with fingers and being afraid of the dark are normal for this age infant.

The nurse is preparing to conduct an interview with a non-English speaking client. An interpreter is scheduled. Which of the following actions are appropriate?

Watch and listen to client's nonverbal communication, when client is talking. During interview, look and speak with client, not interpreter. Pace a conversation so there is time for the client's response to be interpreted. Do not ask the interpreter to paraphrase or insert their meaning into the client's words. Ask the client for feedback and clarification at regular intervals. Use brief, concise sentences and simple language - avoid technical terms and slang language.

The clinic nurse answers a phone call from an Asian American client who is experiencing a fever. The client wants to self-treat first before taking an antipyretic medication. What would the nurse suggest to the client?

Yin foods are cold foods and yang foods are hot foods. With the client experiencing a fever, they will want to eat yin foods or cold foods. Having a massage and meditating and praying are not part of the yin and yang approach to address symptoms of illness.