Chapter 10 Cultural Diversity and Values

1. A group of teens develop their own method of texting in a language that they feel is all their own. The change is subtle, but the meanings and the feelings associated with the text are known only to a select few. This behavior is an example of: A) Culture B) Cultural competence C) Cultural safety D) Ethnocentrism

Ans: A Feedback: Culture is the knowledge, values, practices, customs, and beliefs of a group and includes a "unique meaning and information system, shared by a group." Cultural competence is openness to others' ideas and ways of life; respect, curiosity, patience, and self-awareness of one's own culture and culturally mediated ideas. Cultural safety is the practice of providing culturally appropriate health services to disadvantaged groups while stressing dignity and avoiding institutional racism, assimilation (forcing people to adopt a dominant culture), and repressive practices. Ethnocentrism is the assumption that others believe and behave as the dominant culture does, or the belief that the dominant culture is superior to others.

3. The nurse is present when a mother begins cupping her child. She states that it will help to heal the child's respiratory tract infection. The nurse understands that the cultural belief that cupping will aid in the healing process is a: A) Shared instinct B) Learned behavior C) Private idiosyncrasy D) Genetically programmed idea

Ans: B Feedback: Usually culture is first "learned" from parents and siblings and then from peers, teachers, neighbors, books, television, and other media. Thus, it is not innate instinct, a private idiosyncrasy, or a genetically programmed idea.

11. During an ice storm, people in one neighborhood banded together and shared the home of a neighbor who still had power and heat. Other neighbors provided food, water, and bedding. In another neighborhood the neighbors did not know one another and weathered the storm alone. Both neighborhoods are part of the same community. What characteristic did the people in the first neighborhood share that made them a subculture that those in the second neighborhood lacked? A) Belief in the value of cooperation B) Religion C) Socioeconomic status D) Geography

Ans: A Feedback: A subculture may be large or small, clustered together or scattered, but its members share some cultural facets such as experience, belief, language (or lingo), practices, and values. The only common characteristic that the neighbors in the first neighborhood had with each other that the neighbors in the second neighborhood lacked was a belief in the value of cooperating with one another during the storm. There is no indication that they were of the same religion or socioeconomic status. People in both neighborhoods have geography as a common characteristic.

4. A Mexican-American client arrives at the emergency department. He reports abdominal pain and has been vomiting for 5 days. The nurse notes that he is exhibiting symptoms of dehydration, and his vital signs and labs confirm this. The nurse asks the client why he waited so long to seek medical care. He states that he is being treated by the Curandero and wishes to continue while in the hospital. The nurse recognizes the different cultural assumptions regarding care. This situation is an example of: A) Cross-cultural nursing B) Ethnocentrism C) Cultural safety D) Transcultural bias

Ans: A Feedback: Cross-cultural nursing is any nursing work in which the nurse and the client have different cultures. Ethnocentrism is the assumption that others believe and behave as the dominant culture does, or the belief that the dominant culture is superior to others. Cultural safety is the practice of providing culturally appropriate health services to disadvantaged groups while stressing dignity and avoiding institutional racism, assimilation (forcing people to adopt a dominant culture), and repressive practices. There is no evidence of bias in this scenario.

19. The client is admitted to the hospital for new-onset hypertension and chest pain. During the admission interview you ask the client if she takes over-the-counter medications, and she states no. She adds that she routinely visits a folk healer. The nurse's response should include: A) Obtaining a list of the herbs and folk medications that are taken and notifying the physician B) Requesting the client to stop the ingestion of the folk herbs C) Calling poison control with the list of herbs and folk medications D) Encouraging the client to continue to take the herbs and folk medications

Ans: A Feedback: Just as nurses ask about over-the-counter medication use, they should also inquire, respectfully, about what other preparations or nonpharmacologic strategies their clients may be using to maintain or regain health. The list is given to the physician. It would not be appropriate to either ask the client to stop taking the herbs or to encourage the client to continue taking the herbs, as this is beyond the scope of practice of the nurse. There is no need to call poison control regarding the herbs, as they are not likely to be poisonous or even harmful.

16. The nurse cares for a client in a community health clinic. The nurse is uncomfortable because the client remains very close when communicating. This discomfort makes it difficult to concentrate on the interview. When the nurse backs away, the client stops speaking and leaves. This is an example of: A) Differing views of personal space B) Treatment limitation C) Aggressive behavior D) Cultural bias

Ans: A Feedback: Nonverbal language varies significantly with culture, and misinterpretation of body language, including use of personal space, can lead to clinical misunderstandings. Clients from cultures in which people normally stand close together (e.g., Italian and many Latin American cultures) may feel that a nurse who sits or stands further away is cold and unfriendly. However, people from a Nordic-influenced culture may be more comfortable with larger spaces between people.

18. The physician approaches the client with a treatment plan for his cancer. The client states that his life is in God's hands and refuses conventional treatment. This is an example of: A) Fatalistic behavior B) Denial C) Anger D) Bargaining

Ans: A Feedback: One central facet of culture is religion, and this also directly affects health, illness, and treatment. Some religions attribute disease to divine forces, for instance. Some cultures are relatively fatalistic, which affects their health behaviors. Insha'Allah ("if God wills") is a common refrain for many Muslims, although they may mean it more or less literally. There is no evidence that the client is in denial, angry, or bargaining.

7. The nurse is called to make an unscheduled visit to a new client in her home. The purpose of the visit is to admit the client and treat an abdominal wound. The nurse discovers that the client is from a culture unfamiliar to her. In this situation, the nurse should demonstrate cultural competence and awareness by: (Select all that apply.) A) Being open to the client's ideas and way of life B) Obtaining objective data when caring for the client C) Exhibiting respect and patience D) Being aware of your own culture E) Assuming that you have enough knowledge to get by

Ans: A, C, D Feedback: Although the nurse will not be fluent in all cultures at all times, certain principles will make him or her a more culturally competent nurse: openness to others' ideas and ways of life, respect, curiosity, patience, and self-awareness of one's own culture and culturally mediated ideas, as well as the humility to know that one can always learn more about a certain client's culture and that person as an individual. Obtaining objective data about the client will not help the nurse demonstrate cultural competence and awareness. The nurse should not assume that he or she has enough knowledge but should be willing to learn more.

6. A nurse, new to the community health agency, works in a culturally diverse area of the community. The nurse is responsible for providing holistic care to clients and to be culturally competent. The health agency requires the nurse to demonstrate which competency to exhibit cultural competence? (Select all that apply.) A) Value diversity B) Adopt the client's cultural values C) Acquire cultural knowledge D) Adapt to diversity E) Speak the language of the client

Ans: A, C, D Feedback: For community and public health agencies to be culturally competent, they must do the following: have a defined set of values and principles and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally; have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural contexts of the communities they serve; and incorporate this capacity in all aspects of policy making, administration, practice, and service delivery, as well as systematically involve consumers, key stakeholders, and communities.

15. A client is admitted to the hospital. On admission, it is noted that the client does not speak English. It will take 20 minutes for the hospital interpreter to arrive. The nurse decides to wait for the interpreter rather than relying on the client's husband. Appropriate rationales for this decision include that the interpreter is: (Select all that apply.) A) More likely to be fluent in both languages B) More likely to be familiar with the client's symptoms C) Trained in ethics and will be better at explaining cultural differences D) More likely to understand the client's needs E) More likely familiar with technical healthcare terms

Ans: A, C, E Feedback: Interpretation should never be conducted by family or friends of a client, except in emergencies. Use of family or friends as interpreters subverts privacy and confidentiality. Furthermore, professional interpreters are not only fluent in both languages and technical healthcare terms but also trained in issues of ethics and cultural brokerage. "Cultural brokerage" means mediating an interaction between people of different cultures. A broker may point out and/or explain cultural differences to the participants, in order for the parties to understand each other better. An interpreter is not more likely to be familiar with the client's symptoms or needs.

2. The nurse is caring for a client who refuses the food as served. He states that the food is foreign to him and will make him ill. All food must be blessed. The personal care attendant is upset by this behavior and states that the client should eat the food anyway. The client's behavior is most likely a result of: A) Psychosocial deficit B) Cultural belief C) Allergies D) Hygiene

Ans: B Feedback: Culture is how people approach the world. Culture includes language, religion, occupation, economics, art, politics, and philosophy, along with diet. The fact that the client says that the food must be "blessed" indicates a religious belief that is part of his culture. There is no evidence of a psychosocial deficit in this client, or of allergies or hygiene concerns.

17. A new client, who is Latin American, is getting settled in the hospital. She is expecting her family to arrive soon. A physician enters and informs the client that she requires surgery and asks that she sign the necessary documents. The client refuses and becomes agitated. Which is the most likely cultural reason for the client's reluctance to sign the documents? A) Client is reluctant to have the surgery. B) Decision of importance is typically made by the family as a group. C) Client does not feel comfortable with the surgeon. D) Client is medicated and is having difficulty making a decision.

Ans: B Feedback: Cultures around the world have different expectations of roles of children, young adults, and elderly adults; of men versus women; and of sick people. For instance, some children speak for themselves whereas others are taught to remain silent; in some cultures, such as American and British ones, a sick person makes decisions for himself or herself; in others, such as many Asian and Latin-American ones, the family makes treatment decisions as a group.

10. During a conference after rounds, a nurse states, "They are in the United States now; you would think that they would act like us." This nurse is exhibiting: A) Cultural humility B) Ethnocentrism C) Cultural competence D) Cross-cultural nursing

Ans: B Feedback: Ethnocentrism refers to the tendency of people to view their way of doing things and their culture as superior to the cultures and ways of others. Cultural humility requires community health nurses to continually self-evaluate and critique their own cultural assumptions and advocate for their clients in a nonpaternalistic way. In nursing, cultural competence means considering cultural aspects of health, illness, and treatment for each client or community, as well as doing so at each stage of the nursing process. Cross-cultural nursing is any nursing work in which the nurse and client have different cultures.

9. The nurse is caring for a client who is from a culture for which the nurse has a limited knowledge base. The nurse conducts the admission interview using cultural humility. Which should the nurse ask in the interview? (Select all that apply.) A)Yes or no questions B) About traditions C) Open-ended questions D) How the client has addressed the illness E) If the cause of the illness is spiritual

Ans: B, C, D Feedback: Cultural humility requires community health nurses to continually self-evaluate and critique their own cultural assumptions and advocate for their clients in a nonpaternalistic way. To do this, they should ask open-ended questions (not yes or no questions) about beliefs and practices of the client and family; ask about traditions; and ask what the client does think may have caused the illness and how the client has already tried to address it. Asking if the cause of the illness is spiritual is a yes or no question.

5. The nurse conducts a well-child clinic in your community. The client population is culturally diverse, and, although the clinic is busy, it runs smoothly because it has an interpreter. In addition to the interpreter, it is important that the nurses treat each client that reflects his or her individual cultural needs. This is cultural: A) Bias B) Artwork C) Competence D) Beliefs

Ans: C Feedback: In nursing, cultural competence means considering cultural aspects of health, illness, and treatment for each client or community, as well as doing so at each stage of the nursing process. The nurse should not display cultural bias or favoritism to any specific culture. The nurse does not need to display the beliefs of other cultures, just a respect and understanding of them. The nurse does not need to display cultural artwork.

20. The nurse educator is responsible for conducting educational seminars for the staff. After the education component of the program, the group engages in discussion. It is important that nurses routinely attend educational programs related to cultural competence because: A) The information is lost when caring for clients in real life. B) One can't be competent at all times. C) Nurses can facilitate social change. D) Classes are necessary for regulatory compliance.

Ans: C Feedback: It is imperative that healthcare organizations such as hospitals and visiting nurses agencies conduct ongoing cultural assessments of their service areas. Racher and Annis (2007) write that "creating spaces for voices to be heard and groups to be represented produces opportunities to break down resistance and facilitate social change. Nurses have both opportunity and responsibility to take action in creating such spaces."

8. The nurse is caring for a client who is a refugee from Haiti. The client's family has been displaced because of an earthquake in their country. The client has healing fractures on his right arm as well as fractured ribs. He tells the nurse that, before care begins, the nurse must consult with his Voodoo healer. Which is the nurse's best response? A) Teaching the client that he is in the United States and should abide by Western medical practices B) Informing the physician that the client is noncompliant C) Consulting with the healer and updating the physician regarding treatment and any herbal medications that may be used D) Encouraging the client to use a complementary approach to his care

Ans: C Feedback: Some practices of healthcare institutions and clinicians have historically been discriminatory and hurtful to minority groups. Cultural safety refers to providing culturally appropriate health services to disadvantaged groups while stressing dignity and avoiding institutional racism, assimilation, and repressive practices. For the community health nurse, this means ongoing learning about the health beliefs and practices of clients and never dismissing or disrespecting folk traditions. In this case, it would be wise for the nurse to consult the healer, not only out of respect for the client's beliefs, but also to learn what herbal medications the client may be receiving, to prevent any adverse reactions with drugs the physician might prescribe.

13. To demonstrate true cultural sensitivity and awareness, the nurse must: A) Travel to other countries on occasion B) Become bilingual C) Be competent in his or her own cultural heritage D) Know the practices of all major cultures in one's region of the country

Ans: C Feedback: The first imperative of cultural competence is to be competent in one's own cultural heritage. International travel, being bilingual, and knowing practices of major cultures are all helpful, but not as important as being competent in one's own cultural heritage.

14. A client, diagnosed with hypertension, is prescribed a no-added-salt, low-fat diet. He agrees and repeats the teaching principles. At the next visit, the nurse notices salted meat on the counter and the client shows the nurse his food diary. The diet in the past week does not reflect the physician's orders. What cultural component may have contributed to the noncompliance with the diet order? A) Diet may be too lean B) Wife cooks according to the husband's preferences C) Diet may not meet the cultural criteria for food choices D) Food tastes bland and unappetizing

Ans: C Feedback: What and how people eat varies tremendously among cultures, the understanding of which is crucial to good nursing care. A nurse educating a client who is newly diagnosed with diabetes or hyperlipidemia about dietary restrictions will be much more effective if he or she chooses examples that resonate with that particular client. Although the diet could be too lean or bland and unappetizing or the wife might cook according to the husband's preferences, these are not cultural components.

21. The nurse is scheduling a follow-up appointment for a client who recently immigrated from Nicaragua. The client agrees to a 9:00-AM appointment on the following Wednesday. The nurse should anticipate that on the following Wednesday, this client will: A) Show up half an hour before the scheduled time B) Not return at all for the follow-up appointment C) Arrive late for the appointment, after completing whatever tasks the client feels need to be accomplished first D) Arrive exactly on time

Ans: C Feedback: Differences in how people view time can create a clash of expectations in clinical encounters. For Anglo-American culture, for instance, time is thought of as linear and perishable. This is especially true in the healthcare world, in which time is considered a scarce commodity. In contrast, a Hispanic immigrant may view 10:00 AM as a suggested time for a clinic appointment and will arrive when other responsibilities are accomplished.

12. The nurse enters a client's home to provide care to a wound and teach the client's wife how to care for the wound. The nurse is comfortable with the client's culture and the fact that it is matriarchal in nature. As teaching begins, the husband interrupts and states that the woman does not change bandages according to his culture. He asks if the nurse is familiar with his culture and then says that all members of his neighborhood follow its principles. The nurse should suspect that the client is a member of: A) A cult B) An orthodox religious group C) A subculture D) An occupation

Ans:C Feedback: Just as any group of people from a certain place may share a culture, any group of people who share a certain characteristic can share a smaller culture, or subculture. In this situation, although the nurse is familiar with the culture of the client and her husband, it is apparent that they also belong to a subculture that the nurse is unfamiliar with. There is no indication that the client and her husband are members of a cult, orthodox religious group, or certain occupation, all of which are types of subcultures.