Chapter 5 pre/post questions

The question that would give data of least value to the assessment of family dynamics is

"Do you expect others to shun or avoid you because you are seeing a therapist?" -- The question about others' reaction to seeking help from a psychotherapist will not provide data about family dynamics.

A peer asks you to help him differentiate between culture and ethnicity for clarification. Which statement by the peer would acknowledge that you had appropriately helped him clarify the difference between the two terms?

"So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." --Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group's members in patterned ways of thinking and acting. The other options are all incorrect definitions of ethnicity and culture.

The nurse assesses the wellness beliefs and values of a client from another culture best when asking

"What do you think is making you ill?" -- Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness.

Which assessment question would produce data that would help a nurse understand healing options acceptable to a client

"What usually helps people who have the same type of illness you have?" --Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client.

You are working on the psychiatric unit and assisting with the care for Mr. Tran, a refugee from Darfur, who came to the United States 1 year ago. Although Mr. Tran understands and speaks some very limited English, he is much more comfortable conversing in his native language. Mike, the nurse working directly with Mr. Tran, says to you, "I am so frustrated trying to communicate with Mr. Tran! He insists on speaking his language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which of the following responses you could make promotes culturally competent care? (select all that apply):

"What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." Correct "Mr. Tran's ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known." Correct -- Cultural imposition is imposing our own cultural norms onto those from another cultural group. By obtaining an interpreter for Mr. Tran, the nurse is promoting culturally competent care, ensuring the patient can communicate his feelings and needs thoroughly to the staff. Patients do have a right to an interpreter, but stating that Mike is right is not promoting culturally competent care and is instead confirming his opinion. Asking family members to convince the patient to speak English is not promoting culturally competent care and also undermines the trust between nurse and patient. Instead of encouraging the patient to speak English an interpreter should be obtained for the patient.

Which statement best explains the term "worldview"?

Beliefs and values held by people of a given culture about what is good, right, and normal. --A worldview is a system of thinking about how the world works and how people should behave in the world and toward each other. It is from this view that people develop beliefs, values, and the practices that guide their lives.

Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces?

Cleansings -- Rituals, cleansings, prayer, and even witchcraft may be the treatment expectation of a client who believes his illness is caused by spiritual forces.

Ms. Wong, aged 52 years, comes to the emergency room with severe anxiety. She was raised in China but immigrated to the United States at age 40 years. She was recently fired from her job because of a major error in the accounting department that she managed. Ms. Wong's aged parents live with her. Ms. Wong states, "I am a failure." Which of the following statements may accurately assess the basis for Ms. Wong's anxiety and feelings of failure?

Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them. --Eastern tradition, such as in China, where Ms. Wong is from, sees the family as the basis for one's identity, and family interdependence as the norm. The views expressed in options a and c demonstrate Western tradition where self-reliance, individuality, and autonomy are highly valued. In the Eastern view one is born into an unchangeable fate.

Which of the following best explains the concept of cultural competence?

Nurses adjust their own practices to meet their patients' cultural preferences, beliefs, and practices. -- Cultural competence means that nurses adjust and conform to their patients' cultural needs, beliefs, practices, and preferences rather than their own. This option does not describe cultural competence. Although nurses are continually learning regarding culture, it is a career-long process. The goal is not to educate patients about our own culture but rather to adjust to their cultural preferences. Although nurses may take continuing education regarding culture, this does not describe the term cultural competence. The other options do not describe cultural competence.

According to the Western scientific view of health, illness is the result of

Pathogens --Disease has a cause (e.g., pathogens, toxins) that creates the effect; disease can be observed and measured.

Which healing practice is least used in the Western health system of healing practices?

Restoring lost balance or harmony --The best treatment perspectives of various cultures include regaining lost balance and harmony. This perspective is not used in Western culture.

Which idea held by the nurse would best promote the provision of culturally competent care?

Western biomedicine is one of several established healing systems. -- A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions.

The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports

appeasement of the spirits. --Appeasement of spirits might be a viable outcome criterion if the client believes the illness was caused by angry spirits. In each of the other options useful outcomes would be decreased somatic symptoms, reinstatement of energy balance, and decreased anxiety.

People who have an indigenous worldview

are concerned with being part of a harmonious community. --Clients with an indigenous worldview are interested in connectedness and being in harmony with others. They have little interest in personal goals and autonomy.

When members of a group are introduced to the culture's worldview, beliefs, values, and practices, it is called

enculturation. --Members of a group are introduced to the culture's worldview, beliefs, values, and practices in a process called enculturation. Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way. Acculturation is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations. Cultural encounters occur when members of varying cultures meet and interact.

The Eastern tradition, disease is believed to be caused by

fluctuations in opposing forces. -- In the Eastern tradition, disease is believed to be caused by fluctuations in opposing forces, the yin-yang energies.

The Eastern world view can be identified by the belief that

holds responsibility to family as central. --The Eastern traditional world view is sociocentric. Individuals experience their selfhood and their lives as part of an interdependent web of relationships and expectations.

The psychiatric nurse planning and implementing care for culturally diverse clients should understand

holistic theory. -- In most cultures a holistic perspective prevails, one without separation of mind and body.

Deviation from cultural expectations is considered by members of the cultural group as a demonstration of

illness. --Deviation from cultural expectations is considered by others in the culture to be a problem and is frequently defined by the cultural group as "illness."

When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects

imbalance. --Many Eastern cultures explain illness as a function of imbalance.

Exclusive use of Western psychological theories by nurses making client assessments will result in

inadequate assessment of clients of diverse cultures. --Unless clients have faith in a particular healing modality, the treatment may not be effective. When nurses make assessments on the basis of Western theories, treatments consistent with those assessments follow. Clients of other cultures may find the treatment modalities unacceptable or not useful. Treatments consistent with the client's cultural beliefs as to what will provide a cure are better.

Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of

insensitive interviewing techniques. Correct --Inaccurate information or insufficient information may be obtained if the interviewer is not culturally sensitive. Only when assessment data are accurate can effective treatment be planned.

A client reporting gastric pain, tells the nurse, "I think my symptoms started when a neighbor cast a spell on me." The assessment the nurse can make is that the client

is expressing a culture-bound illness. --Many culture-bound illnesses, such as ghost illness, or hwa byung, seem exotic or irrational to American nurses. Many of these illnesses cannot be understood within a Western medicine framework. Their causes, manifestations, and treatments do not make sense to nurses whose understanding is limited to a Western perspective on disease and illness.

Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to

power and control. Correct -- Power and control are often products of culturally determined beliefs about who should hold power. In many cultures the elderly are venerated. In other cultures women are virtually powerless. For some cultures, higher education equates with power.

Josefina Juarez, aged 36 years, comes to the mental health clinic where you work after being referred by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. She is now a single mother to 6 children, ages 2 to 15, following the death of her husband last year. During the initial intake assessment, Josefina tells you her problem is that she has headaches and backaches "almost every day" and "can't sleep at night." She shakes her head no and looks away when asked about anxiety or depression and states she does not know why she was referred to the mental health clinic. You recognize that Josefina may be exhibiting:

somatization. --Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. Regression is a defense mechanism meaning to begin to function at a lower or previous level of functioning. Enculturation refers to how cultural beliefs, practices, and norms are communicated to its members. Assimilation refers to a situation in which immigrants adapt to and absorb the practices and beliefs of a new culture until these customs are more natural than the ones they learned in their homeland.