Ch. 5 Cultural Diversity
The clinic nurse is obtaining demographic data from a client. The client states, "Why do you need to know what my ethnicity is?" How should the nurse respond? -"Collecting this information allows us to develop a personalized plan of care to meet your needs." -"We require the information for identification purposes." -"Understanding your background will prevent us from doing anything to offend you." -"Insurance companies requires us to ask all clients."
"Collecting this information allows us to develop a personalized plan of care to meet your needs." Explanation: Identifying and understanding the client's ethnicity will assist the nurse and healthcare team to develop and provide individualized culturally competent care. Ethnicity is not used for client identification. Insurance companies may request this data; however, it is not the priority reason for the nurse to collect the data.
Which nursing intervention reflects culturally appropriate care when addressing a client? "Good morning, Mr. Smith. I am your nurse, John." "You can sit in this chair, Sally." "Thank you for coming to the clinic today." "I see you are here because you have a sinus infection."
"Good morning, Mr. Smith. I am your nurse, John." Explanation: The nurse can demonstrate professionalism and culturally appropriate care by addressing clients by their last names and introducing oneself. The nurse should follow up thoroughly with requests, respect the client's privacy, and ask open-ended rather than direct questions until trust has been established.
A nurse who usually works on the surgical unit is asked to float to the oncology unit because of staffing needs. Which statement by the nurse indicates the possibility of the nurse experiencing culture shock? -"I am very stressed now because I do not understand how things work on this unit." -"Can someone please give me an orientation to this unit?" -"The way we do things on the surgical unit are so much better than the procedures of this unit." -"I was expecting all the clients on the oncology unit to be depressed."
"I am very stressed now because I do not understand how things work on this unit." Explanation: The nurse is experiencing culture shock because of the new environment. When the culture one has learned differs from the culture in one's environment, a person can become disoriented and stressed. The acute experience of not comprehending the culture of the current environment is called culture shock. Asking for an orientation to a new unit is proper procedure for a float nurse. The third statement indicates ethnocentrism, not culture shock. The fourth statement indicates stereotyping.
While performing the initial assessment of an infant, the nurse notes a soiled string of yarn around the infant's neck. Which response from the nurse would facilitate culturally competent care? -"I see you have a string tied to your child's neck. Can you explain why you do this?" -"I noticed the string around your child's neck. Why do you include this practice in your child's health care?" -"I see the sacred string is dirty. In your culture, is it okay that I clean it?" -"I noticed a ritual string on your child. Is this a cultural practice to protect the child's health?"
"I see you have a string tied to your child's neck. Can you explain why you do this?" Explanation: The culturally competent nurse would ask the parent the meaning of the string and if it can be placed elsewhere on the body to prevent injury to the infant. The nurse does not presume the string or such practices are specifically related to health care and doing so could be considered stereotyping or demonstrate cultural incompetence. Washing the string with soap and water does not address the purpose of the string or safety. Asking yes and no questions (close-ended questions) does not facilitate communication with the client and/or the parents and thus does not facilitate culturally competent care.
The nurse is teaching a Black client about common health conditions. Which statement by the client most directly addresses a health problem with an increased incidence in this population group? -"I need to watch the amount of high-density lipids I eat." -"It is important to monitor my blood pressure." -"Getting a mammogram in my thirties is important." -"Increasing dairy will improve my bones."
"It is important to monitor my blood pressure." Explanation: Monitoring the blood pressure is important for identifying the risk for hypertension and stroke, which are common health conditions among the Black population. The other statements are correct for preventing diabetes, breast cancer, and osteoporosis, but these diseases are not disproportionately common health conditions for the population.
A nurse is admitting a client to the unit. Which cultural question is most appropriate? -"Will you be able to eat the normal food provided?" -"What are your dietary needs and preferences?" -"Do you have food restrictions?" -"Will you be making requests for special food based on your religion?"
"What are your dietary needs and preferences?" Explanation: By asking about dietary needs and preferences, the nurse can gain insight into religious and cultural dietary practices. Asking about "normal" foods assumes that a cultural dietary request is abnormal. The other options will produce limited insight and imply that a cultural dietary need is a restriction or hindrance.
The unlicensed assistive personnel reports to the nurse that the client is refusing to eat the food on the meal tray. The nurse observes the client eating the food brought in by family members. How should the nurse respond? -"What type of food did your family prepare for you, and does it have special meaning?" -"You can only eat the food that we serve you." -"Do you understand that you are on a strict diet and any variation can cause you harm?" -"I will need to get permission from your health care provider for you to eat the food your family brought in."
"What type of food did your family prepare for you, and does it have special meaning?" Explanation: The culturally competent nurse should assess the type of food the client is eating and if the food has special meaning. Some cultures use food for healing and balance during times of illness. The client may have a restricted diet, but educating the client and family can allow the client to meet the cultural needs while still getting nutrition and meeting the dietary restrictions. The nurse does not need to ask permission from the health care provider regarding the food brought in from the family. Telling the client that he or she must only eat the food offered in the health care setting is not true or empathetic.
The nurse is caring for a client 4 days after total hip arthroplasty and notes the client has lost weight. The unlicensed assistive personnel reports the client's food intake has decreased. Which question will the nurse ask the client to determine if cultural causes are responsible for the weight loss? -"Is there something wrong with the food?" -"Would you like to speak with a nutritionist?" -"What type of food do you like to eat at home?" -"Can you ask your family to bring you something you like?"
"What type of food do you like to eat at home?" Explanation: The culturally sensitive nurse will determine the type of food a client prefers to eat. The nurse should try to accommodate a client's food preferences. Asking if there is something wrong with the food is confrontational and does not address the problem. There is no need to consult a nutritionist unless a client has special food preferences or dietary concerns. The nurse will need to assess a client's preferences before determining if it would be helpful for the family to bring the client food.
A client has been admitted to the unit for chest pain. A nurse told the family that they could not be with the client. The family became very upset, and now the client wants to leave. What is the most culturally appropriate response by the charge nurse? -"Would you feel more comfortable with your family with you?" -"If you leave, you will be asked to sign a form indicating that you are leaving against medical advice." -"Sometimes family can cause stress, and we try to maintain a stress-free care environment." -"Why do you think you need to leave?"
"Would you feel more comfortable with your family with you?" Explanation: Some cultures are very family oriented; others may have members who are skeptical of modern health care. The request for the client's family to leave most likely frightened the client. Asking the client how to make the client more comfortable is the best option. Asking the client why the client wants to leave is judgmental, implying there is no real reason to leave. Citing the hospital's policy regarding clients who leave against medical advice is not culturally sensitive and does not address the client's concerns. Clearly in this client's case, having the family present reduces, not causes, stress, so the comment about maintaining a stress-free environment is not valid.
When providing culturally competent care to clients, a nurse understands that cultural competence involves which characteristics? Select all that apply. -A process that requires life-long learning -A commitment to promoting health equity -Knowledge of influences on the clients' beliefs -Awareness of one's own influences on responses -Guidance by the principles of fidelity
-A process that requires life-long learning -A commitment to promoting health equity -Knowledge of influences on the clients' beliefs -Awareness of one's own influences on responses Explanation: Cultural competency is an integral component of the knowledge and practice base of nursing and is continually improved through a life-long learning process and commitment to health equity. It requires a knowledge of the influences on clients' beliefs and self-awareness of one's own influences on clients' responses. Standards of practice for culturally competent nursing care continue to be refined and are driven by the principles of social justice and health equity, not fidelity, with the aim of reducing health disparities.
Which scenarios are examples of a culturally appropriate nursing intervention? Select all that apply. -Asking the client's grandmother, who is the head of the family, to be involved in the plan of care -Asking the client's ex-husband to be involved in the plan of care -Asking for cultural assistance from clergy at the client's request -Telling a client that wellness is more important than values -Allowing the client to eat food from home that is consistent with the client's dietary plan -Asking sincerely for the client to explain religious rituals
-Asking for cultural assistance from clergy at the client's request -Asking the client's grandmother, who is the head of the family, to be involved in the plan of care -Allowing the client to eat food from home that is consistent with the client's dietary plan -Asking sincerely for the client to explain religious rituals Explanation: Asking the client to explain a ritual is part of developing cultural knowledge and is acceptable when motivated by sincerity and respect. Accommodating dietary preference is important, as long as it does not contradict the client's meal plan, and can increase nutritional intake. Telling a client that wellness trumps values is a form of mandated change and is not culturally appropriate. Seeking cultural assistance can help the client accept health care services. Asking the grandmother to be involved is respectful of family roles, and disregarding this person could lead to conflict. Asking the ex-husband to be involved is inappropriate.
A nurse is providing care to a medically compromised client with limited ability to speak the dominant language. To obtain information about the client's culture, who would be appropriate for the nurse to use as a key informant? Select all that apply. -Family -Friends -Interpreters -Staff -Client's religious contact
-Family -Friends -Interpreters -Client's religious contact Explanation: For most clients with limited ability to speak the dominant language, the most useful key informants in the hospital or clinic situation may be trained interpreters who are bilingual and bicultural, or family and friends. The role of religious figures in health, including as key informant, is important because people often interpret life-death and health-illness issues in terms of their cultural heritage or religious beliefs. The staff would be an inappropriate choice as a key informant.
Which concepts are considered cultural norms of the health care system? Select all that apply. -Inability to define health and illness -Frequent use of jargon and documentation -Professional deference to pecking order -Use of a problem-solving methodology -Belief in the fallibility of technology
-Frequent use of jargon and documentation -Professional deference to pecking order -Use of a problem-solving methodology Explanation: Cultural norms of the health care system include standardized definitions of health and illness, frequent use of jargon and documentation, professional deference and adherence to the pecking order found in autocratic and bureaucratic systems, use of a systematic approach and problem-solving methodology, belief in the omnipotence of technology, and the use of certain procedures for birth and death.
The nurse is taking a client history. With which client is direct eye contact appropriate? -32-year-old white woman -44-year-old woman of Asian descent -55-year-old Native American/First Nations woman -60-year-old woman of Arab descent
32-year-old white woman Explanation: White Westerners generally make and maintain eye contact throughout communication. Although it may be natural for whites to look directly at a person while speaking, that is not always true of people from other cultures. It may offend clients of Asian descent or Native Americans/First Nations clients, who are likely to believe that lingering eye contact is an invasion of privacy or a sign of disrespect. Clients with Arab heritage may misinterpret direct eye contact as sexually suggestive.
Which scenario is an example of cultural competence in nursing? -Assessing the rate at which an illness causes death in a culture -Attending a conference for cultural diversity -Attending one's own church -Assuming the provider and the client share beliefs and values
Attending a conference for cultural diversity Explanation: Cultural competence can be shown by actively learning about culture through attending a conference. Assessing the rate at which an illness leads to death does not develop cultural competence. One's own church is a familiar culture, and attending it does not breed cultural expansion or competence. The provider should never assume that beliefs or values are shared.
A client is admitted with end-stage pancreatic cancer and is experiencing extreme pain. The client asks the nurse whether an acupuncturist can come to the hospital to help manage the pain. The nurse states, "You won't need acupuncture. We have pain medications." Which characteristic has the nurse displayed? -Stereotyping -Cultural conflict -Cultural imposition -Culture shock
Cultural imposition Explanation: The nurse has demonstrated cultural imposition by assuming that traditional pain relief measures are superior and the client should conform to the nurse's belief regarding pain control. This is not an example of cultural conflict because the nurse did not ridicule the request; it was simply dismissed. The nurse is not stereotyping, as no generalization is made about a group of people. The nurse is not demonstrating culture shock because the view of pain medications that the nurse expresses is consistent with the majority, Western culture.
The emergency department nurse is caring for a client injured in a motor vehicle collision. The client recently immigrated to the country. The nurse should implement interventions aimed at addressing which issue? -Culture shock -Ethnocentrism -Generalization -Ageism
Culture shock Explanation: Culture shock is bewilderment over behavior that is culturally atypical for the client. The client who recently immigrated from another country would experience culture shock over being in a new culture, including a new culture of health care in the new country of residence. Ethnocentrism is the belief that one's culture is better than other cultures. Generalization is the belief that a person shares cultural characteristics with others from a similar background. Ageism is a negative belief that older adults are physically and cognitively impaired.
A nurse is caring for a postoperative client after knee arthroplasty. The nurse plans to help the client ambulate but is aware that the client may feel threatened by physical closeness because the client is from a culture that tends to prefer more personal space when interacting with others. Using the principles of culturally competent care, what would be the most appropriate nursing action? -Let the client ambulate slowly on his or her own when stable. -Explain the purpose and need for assistance during ambulation. -Instruct family members to assist in ambulating the client. -Ambulate the client explaining it is an expected outcome of their treatment.
Explain the purpose and need for assistance during ambulation. Explanation: The nurse should explain the purpose of ambulation and the need for assistance while ambulating to the client. This would relieve the client's anxiety associated with physical closeness. However, the client won't be able to ambulate without assistance. Even though the nurse can instruct a family member to ambulate the client, this is not an appropriate action. Ambulating the client without recognizing the cultural difference is nontherapeutic, as the nurse would be not be performing culturally competent care by not acknowledging cultural practice.
The nurse is caring for a client who perceives time differently. What action should the nurse take for this client? -Set all interventions to be done at specific times. -Maintain flexibility when the client requests interventions at specific times. -Have the client set all times for the interventions. -Perform interventions at random times during shift.
Maintain flexibility when the client requests interventions at specific times. Explanation: People view time differently. Social time can reflect attitudes regarding punctuality that vary among cultures. The nurse should maintain a flexible attitude and adapt the time of interventions to the client's needs and requests. It is not realistic to have the client set all the times for the interventions or to have the interventions at a specific time or interventions at random times during the shift.
The nurse is caring for a client admitted with an upper respiratory infection. The client tells the nurse about following the holistic belief of hot/cold. Which food items should the nurse provide to the client based on this information? -Soup, hot tea, and toast -Turkey sandwich, milk, and gelatin -Chicken salad, water, and a frozen fruit juice bar -Fruit salad, apple juice, and pudding
Soup, hot tea, and toast Explanation: The client believes in the hot/cold theory of disease, so the client needs to treat cold diseases with hot food and hot diseases with cold food. The most appropriate choice would be the soup, hot tea, and toast. The other options are all cold foods, which the client would not use to treat a cold disease such as an upper respiratory infection.
A family has immigrated and settled in a neighborhood that primarily speaks their native language. The nurse caring for this family recognizes that which family member will likely require the greatest amount of time to learn the dominant language? -The 45-year-old mother in the family who does not work outside the home -The 58-year-old father in the family who works in a nearby factory -The 12-year-old son in the family who attends public school -The 18-year-old daughter in the family who works at a restaurant in a neighboring town
The 45-year-old mother in the family who does not work outside the home Explanation: The 45-year-old mother will have the greatest challenge in learning the dominant language due to not working outside the home and living in a community that speaks the native language. Children usually assimilate more rapidly and learn the language of the dominant culture quickly because they leave home each day to go to school, making new friends in the dominant culture. Wage earners also tend to learn a new language more quickly through the work setting. Language acquisition is tied to necessity and assimilation, rather than to the degree of difficulty.
The younger nurses on a unit, who seem to adapt easily to the new technology presented, are perceived as threatening by two nurses who have worked on the unit for years. The older nurses begin to ridicule the younger nurses, saying, "You might be able to work a computer, but we know how to provide real care." How should the charge nurse respond? -The charge nurse should discuss the concept of cultural conflict and help both parties see their respective value to the unit. -The charge nurse should demonstrate cultural blindness and pretend that the issue does not exist. -The charge nurse should understand that this is stereotyping in the form of racism and intervene immediately. -The charge nurse should recognize that this is cultural imposition and the younger nurses are forcing new technology on the older nurses.
The charge nurse should discuss the concept of cultural conflict and help both parties see their respective value to the unit. Explanation: The scenario presents a classic example of cultural conflict. The older nurses feel threatened by those who are technologically savvy and try to prove their value so that they feel more secure. Both parties have value, and the charge nurse can use knowledge of diversity to help bring cohesion to the unit.
In addressing health promotion for a client who is a member of another culture, the nurse should be guided by which principle? -The client may have a very different understanding of health promotion. -Health promotion is a concept that is largely exclusive to Western cultures. -A culture's conceptualization of health promotion is a result of that culture's level of socioeconomic development. -The nurse should avoid performing health promotion education if this is not a priority in the client's culture.
The client may have a very different understanding of health promotion. Explanation: As a component of cultural assessment, the nurse should seek to understand the cultural lens through which the client may understand health promotion. Health promotion is not a concept exclusive to Western cultures, though it may be considered differently among non-Western cultures. Even if health promotion is not a priority in a client's culture, the nurse should still address issues related to health promotion in a respectful and relevant manner. Health promotion is not directly linked to socioeconomic development levels.
A nurse convinces a client who is a Jehovah's Witness that receiving blood products is more important than the legalistic components of religion. What client reaction may be expected following this mandated change? -The client states, "I feel like I abandoned my religion." -The client states, "I am glad that nurse told me what to do." -The client states, "I can't get over my feelings of legalism as a Jehovah's Witness." -The client states, "Why isn't blood administration forced on all who need that treatment?"
The client states, "I feel like I abandoned my religion." Explanation: When clients are forced to participate in care that conflicts with their values, feelings of guilt and abandonment are likely. These feelings may deepen and threaten the client's well-being. The other answer choices are not related to mandated change.
A client is seeking care at the local clinic. The nurse is completing a cultural assessment. Which scenario would demonstrate cultural assimilation? -The client does not speak the dominant language and requires an interpreter. -The client's child learned the dominant language as a second language. -The client and child cook traditional foods for the family. -The client enjoys watching television programs from the home country.
The client's child learned the dominant language as a second language. Explanation: The child is demonstrating an example of cultural assimilation by taking on the language of the dominant culture. When a minority group lives within a dominant group, its members may adapt some of their cultural practices that once made them different. This process is referred to as cultural assimilation. Watching television from the home country, cooking traditional foods, and speaking only the original language demonstrate the original culture and an attempt to bring the minority culture into the dominant culture.
The nurse is using an interpreter to communicate with a client who speaks a different language. What would be the best way to choose an interpreter for this client? -The interpreter should speak in a loud voice. -The interpreter should conduct the conversation quickly to avoid misinterpretation. -The interpreter should understand the health care system. -The interpreter should always make direct eye contact.
The interpreter should understand the health care system. Explanation: Obviously, nurses cannot become fluent in all languages, but certain strategies for fostering effective cross-cultural communication are necessary when providing care for clients who are not fluent in the dominant language. Cultural needs should be considered when choosing an interpreter; however, it is also important to use an interpreter who understands the health care system. In choosing an interpreter, the nurse should not select one who speaks in a loud voice, conducts the conversation quickly, or always makes direct eye contact. Direct eye contact is regarded differently among cultures.
Which is a cultural norm of the health care system? -There is the use of a systematic approach and problem-solving methodology. -There is a tolerance of tardiness, disorderliness, and disorganization. -There are rigid procedures attending birth and death. -The omnipotence of technology is yet to be recognized.
There is the use of a systematic approach and problem-solving methodology. Explanation: Cultural norms of the health care system include the use of a systematic approach and problem-solving methodology; the omnipotence of technology; the dislike of tardiness, disorderliness, and disorganization; and the use of certain procedures attending birth and death.
The client, visiting from a foreign country, arrived at the facility seeking medical assistance following an accident. The client has limited proficiency in the dominant language. An onsite certified interpreter is unavailable. To assist in interpretation, what is an appropriate nursing intervention? -Use a contracted video interpretation service. -Access voice-to-text apps on the nurse's own mobile device. -Ask the client's child to translate. -Obtain a dual-language communication book.
Use a contracted video interpretation service. Explanation: Federal law in the United States requires the same health care and social services for those individuals who have limited proficiency in the dominant. Many agencies contract with other companies to provide translation services either through video or by telephone. These companies use certified interpreters. Other avenues for interpretation are mobile apps and communication books. Neither of these avenues meets the needs for clients who require interpretation services. Using family members may be a civil rights violation.
The nursing researcher is studying so-called "unnatural illnesses." What cause of such illnesses would be included in the study? -Cold air -Food -Impurities in water -Witchcraft
Witchcraft Explanation: "Unnatural illnesses" are thought to be punishments for failing to follow a god's rules, resulting in evil forces or witchcraft causing physical or mental health problems. "Natural illnesses" are thought to be caused by dangerous agents such as cold air or impurities in the air, water, or food.
Persistent gaps between the health status of minorities and non-minorities are defined as: -racism. -ethnocentrism. -health disparities. -cultural relativity.
health disparities. Explanation: Despite continued advances in health care and technology, racial and ethnic minorities continue to have higher rates of disease, disability, and premature death than non-minorities. These differences are known as health disparities. Racism is the belief that one's race is superior to another. Ethnocentrism is the belief that one's culture is superior to another. Cultural relativity is the belief that an understanding of a person's behavior depends, at least in part, on an understanding of that person's cultural context.
Nurses are socialized into the: -nursing specialties. -healthcare culture. -caring paradigm. -diagnostic process.
healthcare culture. Explanation: Culture enables people of similar cultural heritage to understand the meanings of each other's words as part of the particular context, to read each other's nonverbal behavior fairly accurately, and to communicate through symbols. All of these characteristics apply to health care, so health care can be considered a culture into which one can be socialized. The other answers pertain to the career, practice, or intellectual aspects of nursing but not as much to the social aspect of nursing.
A client says to the nurse, "Why don't you wear a white cap like nurses do on the soap operas?" This is an ethnocentric statement based on the: nursing personality. past history. media. genetics.
media. Explanation: Ethnocentrism is a way of looking at the world through a personal lens that has been influenced by personality, genetics, family/relationships, and media. None of the remaining options play a role in the client's comment to the nurse.
A 35-year-old client was admitted to the hospital following an automobile accident with a fractured leg. Which action should the nurse prioritize after learning this client's family is of Italian descent? -monitor hemoglobin and hematocrit for possible anemia -daily aspirin is prescribed to prevent blood clots -monitor diet to avoid dairy products -monitor blood glucose levels
monitor hemoglobin and hematocrit for possible anemia Explanation: People with Mediterranean or African heritage commonly lack the enzyme G-6-PD which helps red blood cells metabolize glucose. This deficiency makes red blood cells vulnerable during stress, which can result in the destruction of red blood cells at a much greater rate than in unaffected people. If the production of red blood cells cannot match the rate of destruction, anemia develops. The use of aspirin is contraindicated with this disorder, because it can increase the rate of red blood center destruction. Individuals with lactase deficiency must avoid dairy products. Monitoring blood glucose is not a priority in this situation.
