Ch. 9 Cultural Competence/Transcultural Nursing

The RN is evaluating the statements of a student nurse after teaching about cultural assessment models. What statement by the student nurse needs correction?

"Cultural assessment models are used to stereotype a particular group of patients." *Stereotyping is generalizing a patient based on his or her cultural group. Cultural assessment models are used to understand the cultural beliefs of a patient and are not used to generalize (stereotype) the patient. Cultural assessment models help focus on the information relevant to a patient's problems by providing a world view. Cultural assessment models are used to understand a patient's religious beliefs and the complex factors that influence a patients cultural world view

The nurse is performing a cultural assessment of a patient. What question by the nurse reflects a focused question?

"Is there soeone with whom you may want us to talk about your care?" Asking the patient if there is someone with whom he or she would like the healthcare team to discuss his or her care is an example of a focused question.

12 domains of culture-framework for nursing history

- overview of inhabited localities - communication - family roles - workforce issues - biocultural ecology - high risk behaviors - nutrition - pregnancy/childbearing practices - death rituals - spirituality - health care practices - health care providers

While assessing a patient of a different culture, the nurse wants to know the patients perception of the etiology of the disease. Which is the most appropriate question asked by the nurse using a patient's explanatory model? 1. "What do you call your problem" 2. "Why do you think it started when it did?" 3. "What do you think your sickness does to you?" 4. "What are the chief problems your sickness has caused you?"

1. "What do you call your problem?" A patients explanatory model is an effective approach to assess the disease condition by asking questions of a patient belonging to a different culture. Asking the patient what she calls the problem can help identify the cause of the disease.

A patient diagnosed with a diabetic ulcer with gangrene to his foot. The health care provider advises surgery but the patient refuses because removal of a body part is not permitted according to his or her religion. Which concept justifies this scenario? 1. Marginalization 2. Iceberg Analogy 3. Intersectionality 4. Health Disparity

2. Iceburg Analogy The concept of the iceberg analogy helps in understanding the visual and virtual aspects of the way humans perceive things. The patient may have come to get relief from symptoms. However, the health care provider may think that the patient should consider undergoing surgery. These differences in perception reflect the iceberg analogy.

How many interrelated components are present in Campinha-Bacote's model of cultural competency ?

5 *Cultural awareness, cultural skills, cultural encounters, cultural knowledge, and cultural desire are the five interrelated components in Campinha-Bacote's model of cultural competence

Health disparity

A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage

The Nurse has to examine a patient and administer an IV med that is not a lifesaving drug. The patient is a devout Muslim. When the nurse goes to administer the medication, the nurse finds that patient is getting ready for prayer. The nurse understands that the patient prays at certain times, as specified in his culture. What should the nurse do in this scenario?

Allow the patient to pray and come back later to administer the medication *The nurse should respect the patients religious beliefs.

During a nursing assessment a patient displayed several behaviors. Which behavior suggests the patient may have a health literacy problem? 1. Patient has difficulty completing a registration form at a medical office 2. Patient asks for written information about a health topic 3. Patient speaks Spanish as primary language 4. Patient states unfamiliarity with a newly ordered medicine

Answer: 1. Behaviors that might reflect a health literacy deficit include having difficulty completing registration forms or health histories, failing to make follow-up appointments, and asking few questions during a nursing history or physical examination.

Which statement made by a new graduate nurse about the teach back technique requires intervention and further instruction by the nurse's preceptor? 1. "After teaching a patient how to use an inhaler, I need to use the teach-back technique to test my patient's technique." 2. "The teach-back technique is an ongoing process of asking patients for feedback." 3. "Using teach-back will help me identify explanations and communication strategies that my patients will most commonly understand." 4. "Using pictures, drawings, and models can enhance the effectiveness of the teach-back technique."

Answer: 1. Teach-back is not a testing of patient knowledge or ability to use devices but is a confirmation of how well a nurse explains concepts to patients.

Which explanation provided by the nurse is the most accurate meaning for "providing culturally congruent care"? 1. It fits the patient's valued life patterns and set of meanings. 2. It is the same set of values as those of the health care team member providing daily care. 3. It holds one's own way of life as superior to those of others. 4. It redirects the patient to a more socially expected set of values

Answer: 1. The ongoing process of cultural competence refers to the need of the health care professional to be culturally sensitive in providing culturally appropriate care specific to the needs of the patient, family, and community.

A nurse working in a large occupational health clinic knows that many of the workers at her company are marginalized and at risk for poor health outcomes. Which of the following individuals are most likely to be marginalized? 1. Wives of the employees 2. The head supervisors of the company 3. Workers who have a high school education 4. Workers employed for less than a year at the company

Answer: 3. Marginalized groups are more likely to have poor health outcomes and die earlier because of a complex interaction among their individual behaviors, environment of the communities in which they live, the policies and practices of health care and governmental systems, and the clinical care they receive. Examples of marginalized groups include people who are gay, lesbian, bisexual, or transgender; people of color; people who are physically and/ or mentally challenged; and people who are not college educated.

A mother is concerned about her child's flulike symptoms. You learn from the health assessment that the mother practices use of "hot" and "cold" foods to treat ailments. Which of the following foods do you expect the mother to use to treat her child? 1. Chicken 2. Yogurt 3. Fresh fruits 4. Eggs

Answer: 4. Certain cultures believe in the importance of balance and harmony in health. Natural or holistic balance is believed to be achieved by using "hot" and "cold" foods as remedies to treat illness

Health care organizations must provide which of the following based on federal civil rights laws? (Select all that apply.) 1. Provide language assistance services at all points of contact free of charge. 2. Provide auxiliary aids and services, such as interpreters, note takers, and computer-aided transcription services. 3. Use patients' family members to interpret difficult topics. 4. Ensure that interpreters are competent in medical terminology. 5. Provide language assistance to all patients who speak limited English or are deaf.

Answers: 1, 2, 4, 5. The CLAS standards include standards for communication and language assistance, including providing language assistance free of charge, auxiliary aids and services, interpreters competent in medical terminology, and language assistance for patients with limited English or who are deaf.

A 35-year-old woman has Medicaid coverage for herself and two young children. She missed an appointment at the local health clinic to get an annual mammogram because she has no transportation. She gets the annual screening because her mother had breast cancer. Which of the following are social determinants of this woman's health? (Select all that apply.) 1. Medicaid insurance 2. Annual screening 3. Mother's history of breast cancer 4. Lack of transportation 5. Woman's age

Answers: 1, 4, 5. Social determinants of health are the conditions under which persons are born, grow, live, work, and age. The social determinants of health are mostly responsible for health disparities. Examples include age, race and ethnicity, socioeconomic status (as reflected by the woman's insurance), access to nutritious food, transportation resources, religion, sexual orientation, level of education, literacy level, disability (physical and cognitive), and geographic location (e.g., access to health care).

Which of the following is an example of a patient with a health disparity? (Select all that apply.) 1. A patient who has a homosexual sexual preference 2. A patient unable to access primary care services 3. A patient living with a chronic disease 4. A family who relies on public transportation 5. A patient who has had a history of smoking for 10 years

Answers: 2, 3, 5. Poor health status (chronic disease), disease risk factors (smoking history), poor health outcomes, and limited access to health care (unable to access primary care) are types of health disparities

The nurse is using an interpreter to communicate with ap atient who does not speak English. Which action by the nurse may hamper the communication between the nurse and the patient?

Asking the patient's family members to serve as interpreters. Interpreters are used to communicate effectively with a patient of a different culture. The family members of the patient should not be asked to serve as interpreters because the patient may not be comfortable sharing certain information with them.

Health disparities are unequal burdens of disease morbidity and mortality rates experienced by racial and ethnic groups. These disparities are often exacerbated by: A. bias B. stereotyping C. prejudice D. all of the above

D. All of the above

When the nurse has a prejudice against a particular culture, which type of behavior is likely to result?

Discrimination *Prejudices associate negative characteristics with people who are different from a valued group. When a person acts on these prejudices, discrimination occurs. *Prejudices are not compatible with culturally congruent care, effective intercultural communication, or sufficient knowledge of diverse groups.

You are in the process of admitting an ethnically diverse patient. To plan culturally competent care, you will conduct a cultural assessment that includes:

Ethnohistory

World View

Factor that shapes how people perceive others and how they relate to reality

Oppression

Formal and informal system of advantages and disadvantages tied to membership in social groups, reinforced by societal norms, biases, interactions, and beliefs - occurs at individual and group experiences Example: a patient experiencing oppression has limited access to resources, such as health care, housing, education, employment, and legal services

Storytelling

Helps identify the real problems affecting a patient's health status and find culturally appropriate ways to intervene

Emic World View

Insider's perspective in an intercultural encounter

Which concept of intersectionality refers to limited access to certain facets of society? 1. marginalization 2. under inclusion 3. social inequality 4. matrix of domination

Marginalization Marginalization is a concept of intersectionality that refers to groups that are left out of or have limited access to certain facets of society. *Under inclusion involves the concept of overlooking a particular group. *Social inequality refers to unequal access to positions and serves by certain groups. *Matrix of domination refers to the privilege and support of powerful segments of society

What advice can a senior nurse give to a nurse enhance cultural competency?

Obtain Sufficient knowledge about a patients culture and beliefs.

Acculturation

Occurs when an individual or group transitions from one culture and develops traits of another culture

Each of us is at the intersection of two categories:

Privilege Oppression

Assimilation

Process in which the individual adapts to the host's cultural values and no longer prefers the components of the origin culture

Intersectionality

Research policy model used to study complexities of people's lives and experiences The model looks at how being marginalized affects people's health and access to care Serves to describe the forces, factors, and power structures that shape and influence life - It is a way of understanding and analyzing our complex world by looking at the human experience

In older chinese woman is admitted to the hospital after a hip fracture. Once the fracture has healed, the nurse encourages the patient to walk around the room. The patient refuses to walk without her son. What should the nurse do in this scenario?

Respect the patient's wish and ask her to walk when her son is present *In some cultures, families make decisions together. This patient may only be comfortable when her son is present, so the nurse should respect her wishes and come back when the son is there.

The nurse is caring for a Korean woman who has just delivered her first baby. Which soup would the nurse anticipate the family to provide as the first meal to the woman?

Seaweed Soup *Koreans believe that seaweed soup should be given to a woman immediately postpartum because it cleans the blood and helps healing and lactation.

Core Measures

Set of evidence-based, scientifically researched standards of care - Key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs

Culture

Shared experiences & commonalities that have developed & continue to evolve in relation to changing social and political contexts based on multiple social group memberships

What concept of intersectionality involves unequal access to resources and services?

Social Inequality *Social Inequality is the concept of intersectionality that involves groups with unequal access to resources, services, and positions.

Linguistic Competence

The ability to communicate effectively and convey information in a manner that is easily understood by diverse audiences

Ethic World View

The motivation of a health care professional to "want to" engage in cultural competency

Cultural Desire

The motivation of a health care professional to "want to"—not "have to"—engage in the process of becoming culturally competent

What statement is true regarding the goal of core measures?

They help reduce mortality, complications, and inpatient readmissions *Core measures help reduce mortality, complications, and inpatient readmissions. Cultural awareness helps the nurse recognize prejudices and assumptions about other people. Culturally congruent care helps provide care that fits with patients own values, beliefs, and traditions. Cultural skills help assess social, cultural, and biophysical factors that influence patient treatment and care

Socialization

Through family, friends, community, peers, schooling, media, work, religious institutions, government, legal system, heath care system, etc

Primary Goal of patient-centered care?

To provide individualized care and restore an emphasis on personal relationships

Racial identity

based on one's self-identification with one or more social groups in which a common heritage with a particular racial group is shared

Examples of marginalized groups

gay, lesbian, bisexual, or transgender; people of color; people who are physically or mentally challenged; and people who are not college educated

Marginalized Groups are more likely

to have poor health outcomes and die earlier because of complex interaction among their individual behaviors, environment of the communities in which they live, the policies and practices of health care and governmental systems and the clinical care they receive