Chapter 5

The nurse just attended a seminar on cultural diversity. Which statement by the nurse would require further education?

"Ethnicity and race are the same thing and are affected by cultural practice." explaination People are often born into an ethnic group, or ethnicity develops by immersion in a community. People of the same ethnicity often speak similar dialects and share similar values. Ethnicity and race are terms used interchangeably; however, they are not the same thing. Race refers specifically to physical characteristics.

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." explaination 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.

The nurse is collecting the health history of a client and notes the client is apprehensive in answering questions. The client states, "My spiritual healer will be here soon." What is the bestresponse by the nurse?

"We can wait until your spiritual healer arrives and work together to answer these questions." explaination The culturally sensitive nurse understands that some cultures rely on a spiritual healer to restore harmony and health. If the client requests the spiritual healer to be present, the nurse should respect the client's beliefs and decision. Leaving the questionnaire with the client is not acceptable because the nurse needs to make sure the questionnaire is completed with the client. Telling the client that he or she is the only one who can fill out the questionnaire is not necessary and rude. Telling the client that the questions need to be answered so the health care team can provide the best care is important, but recognizing and supporting the client and his or her beliefs is the priority.

The nurse is caring for a client who practices Catholicism and was newly diagnosed with cancer. The client states, "God is punishing me for my past sins." How should the nurse respond?

"You sound upset. Would like you to talk about it?" explanation The culturally sensitive nurse should provide the client with the opportunity to talk and express feelings in a nonjudgmental environment. Asking why God is punishing him or her or telling the client that cancer is not a punishment dismisses the client's feelings. Asking the client to get someone from church does not address the client's feelings.

The nurse is taking a client history. With which client is direct eye contact appropriate?

32-year-old white woman explaination 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 nursing intervention reflects practice according to Madeline Leininger's transcultural nursing theory?

Incorporating the client's request for complementary treatment therapy explaination

A nurse is providing care to a client from a culture different from the nurse's own. The nurse is having difficulty relating to the client. What intervention by the nurse is most appropriate?

Ask the client how the client wants to be treated based on the client's values and beliefs.

When completing a transcultural assessment of communication, which assessment by the nurse is most appropriate?

Assessment of eye contact, personal space, and social taboos explaination Components of the transcultural assessment of communication are the cultural values associated with communication—eye contact, personal space, and social taboos. Religious assessment, racial identification, and income levels are not part of the transcultural assessment of communication.

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?

Cultural imposition explaination 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.

A client tells the nurse that the only thing that helps the client sleep is a glass of warm milk. The nurse caring for the client insists that this cultural practice is a myth and tries to convince the client that reading a book would be better. What is the nurse demonstrating?

Ethnocentrism explaination Sometimes healthcare providers assume that their cultural belief (whether of the healthcare culture of or their own personal culture) is better than their clients' cultural beliefs. This is a form of ethnocentrism. Cultural pervasiveness refers to learning a set of behaviors within a particular culture. Culture shock is the feelings a person experiences when placed in a different culture. Stereotyping refers to preconceived and untested beliefs about people.

How is culture learned by each new generation?

Formal and informal experiences explaination Culture is a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. Culture includes the beliefs, habits, likes, dislikes, customs, rituals, and ethnic heritage that are learned through formal and informal experiences within one's family and within the cultural group to which one belongs. Involvement in religious experiences can be part of the culture learned through formal and informal experiences.

Which factors contribute to the concept of a culture? Select all that apply.

Language Art and music Items and clothing worn Beliefs about health practices Styles used for communication

The labor and delivery nurse is getting report from the previous shift regarding a client with Asian heritage. The nurse is told that the client did not ask for pain medication because "Asian people can handle pain." The nurse receiving report understands that this an example of what?

Stereotyping

A newly hired young nurse overheard the charge nurse talking with an older nurse on the unit. The charge nurse said, "All these young nurses think they can come in late and leave early." What cultural factor can the new nurse assess from this conversation?

Stereotyping explaination The charge nurse is clearly exhibiting ageism, which is a form of stereotyping. Cultural assimilation is when one begins to assume some characteristics of a culture outside of one's own. Cultural blindness occurs when cultural differences are ignored. Cultural imposition occurs when one pushes one's cultural beliefs onto another person.

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 understand the health care system.

A nurse is assigned to care for a client who does not speak the dominant language. An interpreter has been contacted and will be at the bedside shortly. Which action by the nurse would be mosteffective in reassuring the client until the interpreter arrives?

Using reassuring body language and making eye contact to assess needs explaination The nurse assigned to care for a client who does not speak the dominant language can reassure the client by using appropriate body language and anticipating needs until an interpreter arrives. Doing so is important because there may be a delay in the interpreter arriving. Gestures and symbols can be confusing, as can enlisting multiple people to communicate. Avoiding the client's room is not appropriate or in the best interest of the client.

When an American client states, "I only want an American doctor," the client is expressing:

ethnocentrism. explaination Viewing one's own culture as superior to all others is ethnocentrism. Cultural relativity is the belief that to understand a person, you must understand that person's cultural context. Cultural pervasiveness refers to how widespread the effects of a culture are. Racism is the belief that one's race is superior to others.

A nurse is providing care for clients of different cultures in a blended community clinic. Which characteristics of culture should the nurse consider when planning culturally competent care? Select all that apply.

Culture guides behavior into acceptable ways for people in a specific group. Culture influences the way people of a group view themselves. There are differences both within cultures and among cultures. Subcultures exist within most cultures. explaination Culture may be defined as a shared system of beliefs, values, and behavioral expectations that provides social structure for daily living. Culture influences roles and interactions with others as well as within families and communities, and is apparent in the attitudes and institutions unique to particular groups. Within most cultures are subcultures. A subculture is a large group of people who are members of the larger cultural group but who have certain ethnic, occupational, or physical characteristics that are not common to the larger culture. Culture is affected by a group's social and physical environment. Cultural practices and beliefs do not constantly evolve and change to satisfy a group's needs. Behavior within a specific group of people is guided by culture. Culture influences the way a group of people view themselves.

The nurse is caring for a client who does not speak the dominant language. In order to facilitate unencumbered communication with the client, the nurse will take which action(s)? Select all that apply.

Determine in which language the client communicates effectively. Review facility policy on communication with clients who do not speak the dominant language. Schedule a certified interpreter when collecting client health history. explaination All clients have the right to unencumbered communication with a health care provider. Using children as interpreters or requiring clients to provide their own interpreters is a civil rights violation. In addition, the use of untrained interpreters, volunteers, or family is considered inappropriate because it undermines confidentiality and privacy. It also violates family roles and boundaries. The best form of communication with a client who does not speak or has limited ability in the dominant language is through a certified interpreter. A certified interpreter is a translator who is certified by a professional organization through rigorous testing based on appropriate and consistent criteria.