Chapter 18- Culturally Responsive Nursing Care

A client has requested that she have a special item present in her room and explains that it gives her a feeling of comfort and a sense of organization. On which psychosocial component is this client focusing? 1. Culture 2. Religion 3. Ethnicity 4. Socialization

Correct Answer: 2 Rationale 2: Religion may be defined by a system of beliefs, practices, and ethical values about divine or superhuman power and is closely related to ethnicity. Religion gives a person a frame of reference and a perspective with which to organize information. pg 277

folk medicine

beliefs and practices relating to illness prevention and healing that derive from cultural traditions rather than from modern medicine's scientific base Ex. Special teas or "cures" such as chicken soup used by older family members to prevent or treat colds, fevers, indigestion, and other health problems

Generalizations

statements about common cultural patterns

Assimilation

process by which an individual develops a new cultural identity

CLAS standards

- culturally and linguistically appropriate services - provides language assistance and information, promote ongoing improvement and accountability for culturally appropriate care

The nurse needs to determine the apical pulse of a client from a different culture. In order to show appropriate sensitivity to the client, the nurse should take which action? 1. Explain the procedure, then wait for permission to continue. 2. Explain to the client what will occur during the assessment. 3. Ask the client to stay quiet because the nurse will be listening to the heart. 4. Take the baseline vital signs, then determine if cardiac auscultation is necessary.

Correct Answer: 1 Rationale 1: Cardiac assessment requires that the nurse move into the clients intimate space. Before beginning this, the nurse should explain the procedure and then await permission to continue. pg 286

The nurse is planning to conduct a physical assessment with a client from a different culture. What is the best way for the nurse to show cultural sensitivity when addressing the personal questions required of the nursing history? 1. Break the assessment into shorter intervals and discuss general topics first. 2. Thoroughly explain the reason for asking many questions before beginning the assessment. 3. Pick a time when the family is present and can help with the admission assessment questions. 4. Wait until the nurseclient relationship has been established.

Correct Answer: 1 Rationale 1: Clients may be offended when the nurse immediately asks personal questions. In some cultures, courtesies should be established before business or personal topics are discussed. Discussing general topics can convey that the nurse is interested and has time for the client. This enables the nurse to develop a rapport with the client before progressing to discussion that is more personal. pg 284

A new graduate nurse is working in a busy emergency department of a hospital, situated in a culturally diverse area of the city. In striving to be culturally sensitive, what should the nurse do? 1. Try to learn about the attitudes toward health care and traditions of the different cultures in that area. 2. Understand and attend to the total context of the clients situation, using knowledge, attitudes, and skills. 3. Possess the underlying background knowledge that will provide these clients with the best possible health care. 4. Continuously strive to be culturally competent.

Correct Answer: 1 Rationale 1: Cultural sensitivity implies that nurses possess some basic knowledge of and constructive attitudes toward the health traditions observed among the diverse cultural groups found in the setting in which they are practicing. PG 288

A community health nurse works with a variety of cultures providing health care services that include preventive care, acute treatment, and education. Of the following clients, which is most likely to use folk medicine? 1. The client who speaks little English and does not have a job 2. A family who has numerous relatives in a Spanish-American sector of the city 3. A female client whose culture is one of male dominance 4. A Chinese client who has a small, familyrun business in the area

Correct Answer: 1 Rationale 1: Folk medicine is defined as beliefs and practices that relate illness prevention and healing to cultural traditions rather than modern medicines scientific base. People who have limited access to scientific health care may turn to folk medicine or folk healing. Because folk healing is more culturally based, it may be more comfortable and less frightening for the client who is not fluent in the English language and has limited access to scientific health care. pg 282

A client who is from a different culture than the nurse has not been able to achieve this goal: Client will select low-fat foods from a list by the end of the month. What should the nurse do? 1. Consider whether the clients belief system has been an influencing factor. 2. Extend the time frame and give the client a longer period to achieve the goal. 3. Make sure that the client understands the importance of the goal. 4. Select a different goal.

Correct Answer: 1 Rationale 1: If the outcomes are not achieved for a client from a different culture, the nurse should be especially careful to consider whether the clients belief system has been adequately included as an influencing factor. pg 291

The school nurse is conducting head lice screenings. Before checking the head of an Asian child, the nurse should first take which action? 1. Ask permission. 2. Make sure the child understands the reason for the contact. 3. Put gloves on. 4. Ask the child to wait until last, to avoid embarrassing the child.

Correct Answer: 1 Rationale 1: In some Asian cultures, only certain elders are permitted to touch the head of others, and children are never patted on the head. Nurses should, therefore, touch a clients head only with permission. pg 286

A client makes the following statement: I must be paying for all the wrongs I did in my life, to have such a diagnosis as this. The nurse suspects that this client views health from which type of belief? 1. Magico-religious belief 2. Holistic health belief 3. Biomedical health belief 4. Folk medicine

Correct Answer: 1 Rationale 1: In the magico-religious health belief view, health and illness are controlled by supernatural forces. The client may believe that illness is the result of being bad or opposing Gods will. pg 282

A nurse educator uses Madeleine Leiningers model and describes a formal area of study and practice focused on comparative human-care differences and similarities of the beliefs, values, and patterned lifeways of cultures to provide culturally congruent, meaningful, and beneficial health care to people. What type of nursing is the educator practicing? 1. Transcultural nursing 2. Cultural competence 3. Cultural knowledge 4. Competent nursing

Correct Answer: 1 Rationale 1: Transcultural nursing focuses on providing care within the differences and similarities of the beliefs, values, and patterns of cultures. pg 280

A community health nurse is learning about the REACH initiative and has decided to implement community education on this approach. What topics should the nurse include in this education? Standard Text: Select all that apply. 1. Child and adult immunizations 2. Cardiovascular disease 3. Chronic lower respiratory disease 4. Stroke 5. Infant mortality

Correct Answer: 1, 2, 5 PG 279

The community health nurse is using the Heritage Assessment Interview tool with a group of community members. Which data indicate heritage consistent? Standard Text: Select all that apply. 1. A client frequently visits the old country neighborhood he grew up in. 2. A client is raised by a single parent. 3. The clients education occurred at a religious school. 4. The client participates in religious festivals and cultural events. 5. The client has been the first of his family to earn a college degree.

Correct Answer: 1, 3, 4 pg 288

The nurse is planning to provide culturally responsive care to a minority client and family. What actions should the nurse perform when providing this care? Standard Text: Select all that apply. 1. Personally reflecting on feelings related to the clients nationality 2. Making an effort to direct all assessment questions initially to the client 3. Involving the family with the clients permission 4. Assessing the clients interest in alternative healing methods 5. Educating the client and family when appropriate

Correct Answer: 1, 3, 4, 5 Rationale 2: Determine the cultural expectations related to the hierarchy of the family. pg 288

A non-Englishspeaking client is needs to have an emergency surgical procedure. The hospital has an interpreter available. When the interpreter arrives to explain the procedure and help with the consent form, the nurse provides the best support when 1. asking the interpreter to use words the client is familiar with for the best understanding. 2. requesting that the interpreter translate, as closely as possible, the same words used by the professional staff. 3. suggesting that the questions be directed to the interpreter, so nothing is omitted. 4. addressing the questions to the clients family.

Correct Answer: 2 Rationale 2: An interpreter is an individual who mediates spoken or signed communication between people using different languages without adding, omitting, or distorting meaning or editorializing. The objective of the professional interpreter is for the complete transfer of the thought behind the utterance in one language into an utterance in a second language. pg 284

A nurse is working with a home health client whose spouse was not born in the United States. During the home visit, the nurse realizes that the client has acquired the identity of her spouses culture and has adopted some of the health practices of that culture. Which process should the nurse identify as occurring with the spouse? 1. Acculturation 2. Assimilation 3. Diversity 4. Heritage consistency

Correct Answer: 2 Rationale 2: Assimilation is the process by which an individual develops a new cultural identity. It encompasses various aspects such as behavior, marital roles, identification, and civic duties. The underlying assumption is that the person from a given cultural group loses his or her original cultural identity to acquire the new one. pg 279

A newly immigrated client is constantly attended to by family members. This has presented a problem to the nursing staff and the delivery of nursing care. In order to address this issue in a culturally sensitive manner, the nurse should take which action? 1. Explain to the client that he has to limit visitors. 2. Evaluate the benefits of family participation in the clients care. 3. Question the family members as to how they see their interaction with the client. 4. Have the physician limit the number of visitors the client can have.

Correct Answer: 2 Rationale 2: Cultural family values may dictate the extent of the familys involvement in the hospitalized clients care. In some cultures, the entire community may want to visit and participate in the clients care. The nurse should evaluate the positive benefits of family participation in the clients care and modify visiting policies as appropriate. pg 283

The nurse is teaching a client from a culture that is present oriented about a dressing change that should be performed twice a day. How should the nurse address the cultural issue? 1. Allow the client to select the times the dressing will be changed. 2. Instruct the client to change the dressing after breakfast and before going to bed. 3. Explain that the client should complete the dressing change at 10 AM and 4 PM. 4. Suggest that the dressing change can be performed whenever the client chooses, as long as it gets done twice daily.

Correct Answer: 2 Rationale 2: For clients who are present oriented, it is important to avoid fixed schedules. The nurse can offer a time range for activities and treatments, such as in the morning or after breakfast, and in the evening or before going to bed. This would fit better with the client who isnt focused on times of the day, such as 10 AM and 4 PM, but will provide for a dressing change twice daily. pg 286

A female client is being discharged after a lengthy hospitalization. The family is from a male-dominated culture. Before discharge instructions are given, which action should the nurse take? 1. Make sure instructions are understood by the client. 2. Arrange for teaching when the spouse is available. 3. Make sure that the physician gives the instructions. 4. Ask the client when the best time for teaching would be.

Correct Answer: 2 Rationale 2: The nurse needs to identify who has the authority to make decisions in a clients family. If the decision maker is someone other than the client, as in this situation, the nurse needs to include that person in health care discussions. In this situation, we do not know if the nurse is male or female, so the best answer given with the information that is known is to arrange for teaching when the spouse is available. pg 283

The nurse is preparing a menu for a Jewish client who observes kosher customs. Which food items would be appropriate to serve this client, assuming all have been properly inspected and prepared? 1. Hamburger, fruit, and milk 2. Fish, vegetables, and hot tea 3. Ham, baked potato, and fresh fruit 4. Cream soup, sausage, and toast

Correct Answer: 2 Rationale 2: This menu is in accordance with the kosher tradition because there is no pork being served and dairy and meat are not served together. pg 287

A client is the child of an African American father and Asian American mother. The client has been exposed to cultural foods, traditions, and customs from both parents throughout life. What term should the nurse use to describe this clients cultural development? 1. Diversity 2. Subculture 3. Multicultural 4. Cultural sensitivity

Correct Answer: 3 Rationale 3: Multicultural is used to describe a person who has multiple patterns of identification or crosses several cultures, lifestyles, and sets of values. PG 277

During the admission interview, the culturally diverse client averts her eyes and refrains from answering questions for long periods of time. The culturally sensitive nurse should take which action? 1. Come back at a different time, when the client is feeling more communicative. 2. Have another nurse finish the interview, as there is something uncomfortable the client senses. 3. Understand that this may be completely appropriate and take cues accordingly. 4. Leave the room and come back after having learned more about this particular culture.

Correct Answer: 3 Rationale 3: Nonverbal communication includes silence, touch, eye movement, facial expressions, and body posture. Some cultures are quite comfortable with long periods of silence. Many people value silence and view it as essential to understanding a persons needs or use silence to preserve privacy. Before assigning meaning to nonverbal behavior, the nurse must consider the possibility that the behavior may have a different meaning for the client and family. pg 285

The nurse manager is concerned that a staff nurse provides client care with a cultural prejudice. Which situation did the manager observe to come to this conclusion? 1. Making an assumption that all members of each culture are alike 2. Believing that all culture members will have the same beliefs 3. Bringing previous negative information and experiences into this situation 4. Taking general knowledge from literature and applying it to the situation

Correct Answer: 3 Rationale 3: Prejudice is a negative belief or preference that is generalized about a group, which leads to prejudgment. Prejudice occurs when the person making the judgment generalizes an experience of one individual from a culture to all members of that group. pg 278

Before a client goes to surgery, he requests to have his spiritual leader present and pray over him. According to the HEALTH traditions model, which traditional method is the client invoking? 1. Maintaining HEALTH 2. Protecting HEALTH 3. Restoring HEALTH 4. Changing HEALTH

Correct Answer: 3 Rationale 3: Traditional methods of restoring HEALTHphysical, mental, and spiritualinclude the use of herbal remedies, exorcism, and health rituals. This situation describes a healing ritual. pg 281

The nurse is working in a clinic setting and is meeting a new client for the first time. In order to convey cultural sensitivity, how should the nurse introduce herself? 1. Im Jane, and Ill be your nurse today. 2. Im Dr. Smiths nurse, Jane. 3. Im Jane Brown, and Im a nurse here at the clinic. 4. Im glad to meet you. You can call me Jane.

Correct Answer: 3 Rationale 3: Ways for nurses to be culturally sensitive and to convey sensitivity to clients include introducing themselves by full name, then explaining their role. This helps establish a relationship and provides an opportunity for clients, others, and nurses to learn the pronunciation of one anothers names and their roles. pg 288

A new graduate nurse is moving from a small rural college town to a metropolitan area to begin work in a county hospital. The nurse has had limited prior experience with the various cultural groups that are served by the hospital. What might be this nurses greatest challenge? 1. Prejudice 2. Stereotyping 3. Discrimination 4. Assimilation

Correct Answer: 4 Rationale 4: Assimilation is the process by which an individual develops a new cultural identity. Assimilation means becoming like the members of the dominant culture. Because this is a conscious effort, it is not always possible, and the process may cause severe stress and anxiety. pg 279

A home health client participates in cultural health practices that the nurse feels may be detrimental to his health. In order to remain attentive to cultural sensitivity and provide appropriate cultural nursing care, the nurse should take which action? 1. Explain the right and wrong of the clients treatment and try to persuade him to follow the scientific perspective. 2. Have the clients physician explain the care to the client in a firm but gentle manner. 3. Validate the clients practices and understand that for this client, it may be beneficial to continue with his preferences. 4. Try to negotiate with the client by exploring his views and then provide relevant scientific information.

Correct Answer: 4 Rationale 4: Negotiation acknowledges that the nurseclient relationship is reciprocal and that different views exist of health, illness, and treatment. During the negotiation process, the clients views are explored and acknowledged, then relevant scientific information is provided. pg 290

A Chinese client is hospitalized with a fever of unknown origin and follows a very traditional, cultural view of illness. Which food should the nurse offer the client? 1. Hot tea 2. Warm soup 3. Spicy meat 4. Cold liquids

Correct Answer: 4 Rationale 4: The concept of yin and yang in the Chinese culture is an example of a holistic health belief. A Chinese client who has a yang illness, or a hot illness, may prefer a yin or cold treatment. In this case, the fever would be considered a hot illness and the client may prefer the opposite or yin treatment. pg 282

The nurse is planning to explain the importance of culturally appropriate care to a new nursing assistant. What should the nurse include when explaining the term culture to this staff person? Standard Text: Select all that apply. 1. Culture involves groups who share biological markers. 2. Cultures seldom have diversity within them. 3. Male nurses are an example of a culture. 4. A culture is primarily exhibited through shared thoughts, actions, and beliefs. 5. A culture shapes its members view of the world.

Correct Answer: 4, 5 pg 276

quick assessment tools to better understand the client's perspectiv

Listen - actively w/ empathy to the client's perception of the problem Explain - what you think you heard/ask for clarification Acknowledge - the importance of what is said and what is meant Recommend - inclusive strategies Negotiate - the plan of care by collaborating with the client and others

Magicoreligious

Supernatural powers predominate in area of health and illness Examples include voodoo, witchcraft, and faith healing Pt may make statements such as "If it's God's will, I will recover" Illness due to opposing God's will, evil eye, etc Seek folk healers, sorcerers first then to scientific therapy

HEALTH traditions model includes:

The body: physical aspects such as genetic inheritance, body chemistry, gender, age, nutrition and physical condition Mind: cognitive process such as thoughts, memories, and knowledge of such emotional processes as feelings, defenses, and self-esteem Spirit: includes both positive and negative learned spiritual practices and teachings, dreams, symbols, stories, protecting forces, and metaphysical or native forces

4 C's:

What do you call the problem? (What do you think is wrong?) What do you think caused the problem? (this helps get the clients beliefs regarding the source) How do you cope with your condition? (what have you done to make this better?) What are your concerns regarding the condition or recommended treatment? (How serious do you think this is? / How does this interfere with your life or your ability to function?)

Racism

assumptions held about racial groups

Ethnocentrism

belief in the superiority of one's own culture and lifestyle

cultural encounters

engaging in face-to-face cultural interactions with persons from diverse backgrounds, and learning to modify one's existing beliefs and prevent possible stereotyping

Transcultural Nursing

focuses on providing care within the differences and similarities of the beliefs, values, and patterns of cultures

holistic health belief

holds that the forces of nature must be maintained in balance or harmony ex- yin/yang, hot-cold theory

biomedical health belief

life is controlled by physical and biochemical processes that can be manipulated by humans illness is caused by germs, viruses, bacteria, or a breakdown of the body

Stereotyping

making the assumption that an individual reflects all characteristics associated with being a member of a group

Discrimination

negative treatment of individuals or groups on the basis of their race, ethnicity, gender, or other group membership

cultural knowledge

obtaining a sound educational foundation concerning the various worldviews of different cultures

Prejudice

preconceived notion or judgement that is not based on sufficient knowledge; it may be favorable or unfavorable

American Association of Colleges of Nursing (AACN)- 5 competencies

published cultural compentence for BSN -apply knowledge of social and cultural factors that affect nursing and health care across multiple contexts -use relevant data sources and best evidence in providing culturally competent care -promote achievement of safe and quality outcomes for care -advocate for social justice -participate in continuous cultural education

Nationality

refers to the sovereign state or country where an individual has membership, which may be through birth, inheritance (parents), or through naturalization

cultural awareness

self-examination of one's own prejudices and biases toward other cultures, and an in-depth exploration of one's own cultural/ ethnic background

cultural skills

the ability to collect culturally relevant data regarding the client's health in a culturally sensitive manner

Xenophobia

the fear or dislike of people different from one's self

cultural desire

the motivation to "want to" engage in the process of becoming culturally aware, culturally knowledgeable, culturally skillful, and seeking cultural encounters

cultural competence

the ongoing process in which the health care professional continuously strives to achieve the ability and availability to work effectively within the cultural context of the patient

holistic health

the view that the mind, body, and spirit are interdependent and function as a whole within the environment

Heritage

things passed down from previous generations

Multicultural

used to describe a person who has multiple patterns of identification or crosses several cultures, lifestyles, and sets of value

Subculture

usually composed of people who have a distinct identity and yet are related to a larger cultural group

Ethnicity

viewed as the relationship among individuals who believe that they have distinctive characteristics that make them a group

Acculturation:

when people incorporate traits from another culture