Culture Competence
Which are signs of a "good death"?
A good death is one that allows a person to die on their own terms, relatively free of pain, and with dignity. It is free from avoidable distress and suffering for clients, families, and caregivers; in general accord with clients' families wishes; and reasonably consistent with clinical, cultural, and ethical standards (Institute of Medicine, 1997). The definition of a good death varies for each client, but there are factors important for a good death, including control of symptoms, preparation for death, opportunity to have a sense of completion of one's life, and a good relationship with health care professionals.
Which stereotypical ideas about older adult clients does the nurse associate with the concept of ageism?
Ageism, a form of negative stereotypical thinking about older adults, promotes false beliefs about older adults being physically and cognitively impaired, lacking interest in sex, and being burdensome to families and society. Ageism is not associated with concepts of cognitive enhancement or financial independence.
A client's spouse has asked that the client be cared for exclusively by female nurses. How should the nurse incorporate this request into the care plan?
Although cultural assessment in a tactful and respectful manner is likely appropriate in this situation, the care team's guiding principle and obligation should be to accommodate and respect the couple's request. It would be inappropriate for the care team to attempt to convince the couple to change their minds or assume that it is a personal preference. The nurse would not teach the couple that male nurses on the unit are empathetic, as having female nurses is the client's preference.
A client is admitted to the health care facility with hypoglycemia. After the client is stable, the nurse discovers that the client has not had the prescribed medicines. The client believes that eating saffron will keep blood sugar under control. What is the most appropriate response by the nurse?
Although the nurse may disagree with the client's beliefs concerning the cause of health or illness, respect for these beliefs helps the nurse to achieve health care goals. Asking the client to consider the benefits of medicine is appropriate because the nurse, without disrespecting the client's beliefs, persuades the client to have medicines also. Stating that saffron does not have any effect on blood sugar level is inappropriate, as it disregards the client's beliefs. Agreeing with the client may encourage him or her and indicate low faith in the present treatment. It is inappropriate to call the health care provider and report on the client.
A nurse is conducting an ethnographic interview with a client. Which step would the nurse do first?
An ethnographic interview begins with an open-ended, general question. Then, based on the client's response, the nurse selects some key terms and asks for clarification, repeating the exact words and phrases that the client used. The terms are clues to what is important to the client, so the nurse asks the client to talk more about them. Finally, the nurse documents the information on the client's view of self or of the issue discussed.
Which factors contribute to the concept of a culture? Select all that apply
Culture includes, but is not limited to, language, communication style, traditions, religion, art, music, dress, health beliefs, and health practices. The type of disease contracted is influenced by physiological status, not culture.
Which term describes the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture?
Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. Acculturation is the process by which members of a cultural group adapt to, or learn how to, take on the behaviors of another group. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group.
The nurse is caring for a client whose treatment has been based on the Ayurveda medical system. Which nursing intervention incorporates this client's beliefs into the nursing plan?
Central to Ayurvedic medicine is an understanding of th client's basic constitution, or dosha. The three doshas in Ayurvedic medicine are vata (changeable), pitta (intense), and kapha (relaxed). Yin-yang and qi are associated with traditional Chinese medicine. A shaman is associated with shamanism (involves the spirit world).
Which community characteristics affect the health of individuals?
Characteristics of a community that influence the health of the members of the community include: education and recreation programs; transportation and communication facilities; healthcare resources; production of services and goods; prevailing values and beliefs; and protection, safety, and aesthetic concerns. Genetic testing is a resource available to families for the diagnosis of a hereditary disorder.
Which scenario is an example of cultural competence in nursing?
Cultural competence can be shown by actively learning about culture through attending a conference. Assessing the rate at which an illness leads to death does not develop cultural competence. One's own church is a familiar culture, and attending it does not breed cultural expansion or competence. The provider should never assume that beliefs or values are shared.
The nurse cares for a client who is a member of a different culture from the nurse's. Which question is most important for the nurse to ask to assess the client's beliefs about treatment?
Culture is defined in many ways, but at the broadest level, it can be understood to be a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. It is important for the nurse to realize that people are individuals who may or may not ascribe to the norms of his or her culture. Asking what the client's expectations for treatment are specifically assesses beliefs. The client may not eat a diet from his/her culture.
Which are factors that impact how a client defines health?
Each client defines health in terms of the client's own values and beliefs. The person's family, culture, community, and society also influence this personal perception of health. Music does not affect how a person defines health.
The student is explaining the factors affecting sensory stimulation to his professor. The professor knows that which of the student's statements is most accurate?
Ethnic norms, religious norms, income group norms, and the norms of subgroups within a culture all influence the amount of sensory stimulation a person seeks and perceives as meaningful. The amount of stimuli different people consider optimal appears to vary considerably. Sensory functioning tends to decline progressively throughout adulthood. Narcotics and sedatives decrease awareness of sensory stimuli.
When a home-bound client expresses the client's past-oriented ancestral heritage and family rituals, the nurse recognizes that the client is expressing:
Ethnicity or ethnic identity refers to a self-conscious, past-oriented form of identity based on a notion of shared cultural (and perhaps ancestral) heritage and current position in larger society. Race is based on biologic characteristics; assimilation refers to new customs and attitudes that are acquired through contact and communication among persons of a particular culture; subculture refers to a group of people within a culture who have ideas and beliefs that are different from the rest of that society.
The nurse is caring for two clients with the same ethnic background. The nurse notices some differences between the two in the religious practices and the slang used for communicating. What is most likely the etiology of these differences?
Ethnicity or ethnic identity refers to the differences among a group who share the same cultural and/or ancestral heritage. Cultural norms are the actions that are expected by others within the culture. Cultural relativity refers to the differences between cultures in the meaning of various behaviors. Ethnocentrism is the belief that one's own practices are the only correct practices.
While interviewing a client, a nurse is told that the client practices Catholicism. This client is identifying:
Faith is a term also used to describe a cultural or institutional religion such as Judaism, Islam, Catholicism, or Confucianism. Spirituality refers to anything that pertains to a person's relationship with a higher power or force. Values refer to those beliefs most meaningful to a person. Culture pertains to a person's background.
A nurse is working with a culturally diverse group of clients. The nurse understands that cultural norms:
Knowing a cultural norm does not enable one to predict a person's response. Generalizing about cultural norms in contemporary societies is inappropriate because people belong to more than one subcultural group and are influenced uniquely by multiple and diverse groups. Exceptions to cultural norms always exist. Therefore the nurse needs to approach each person as an individual.
Which nursing intervention reflects practice according to Madeline Leininger's transcultural nursing theory?
Leininger's theory of transcultural nursing includes assessing a cultural nature, accepting each client as an individual, having knowledge of health problems that affect particular cultural groups, and planning of care within the client's health belief system to achieve the best health outcomes. Therefore, incorporating the client's request for complementary treatment therapy is an example of this theory. The others do not support this theory.
What is the priority assessment for the nurse when developing a plan of care for a client living in poverty?
Poverty has long been a barrier to adequate health care. If clients cannot access health care, it does not matter if they have affordable housing, health insurance, or financial assistance. It is not possible to create a plan of care with client involvement without adequate support and access to care.
When an adult client from Indonesia refuses a complete bath on the day after abdominal surgery, the nurse should:
Preferences for hygiene vary widely among individuals and across cultures.
A nurse overhears another nurse make a statement that indicates racism. The nurse makes this determination based on which characteristic indicative of social value?
Racism uses skin color, not size, language or dress, as the primary indicator of social value.
A nursing student's parents are both physicians. The nursing instructor may feel the student has
Socialization happens by the process of living and experiencing in family and society. If the student comes from a family of healthcare professionals, this too is part of the socialization process.
The nurse overhears a colleague state, "All people from that client's country are rude." What is the appropriate nursing response?
Stereotypes are preconceived ideas usually unsupported by facts. They tend to be neither real nor accurate. They can be dangerous because they interfere with accepting others as unique individuals. The nurse can professionally educate the colleague about the harm involved in stereotyping individuals. Ignoring the comment or reporting the colleague to the nurse manager would result in a missed opportunity to educate the colleague on stereotyping. Agreeing would only strengthen this harmful practice.
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?
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.
A client is seeking care at the local clinic. The nurse is completing a cultural assessment. Which scenario would demonstrate cultural assimilation?
The child is demonstrating an example of cultural assimilation by taking on the language of the dominant culture. When a minority group lives within a dominant group, its members may adapt some of their cultural practices that once made them different. This process is referred to as cultural assimilation. Watching television from the home country, cooking traditional foods, and speaking only the original language demonstrate the original culture and an attempt to bring the minority culture into the dominant culture.
A family recently immigrated to a new country. The parent reports that the teenager is showing signs of fear, has vague reports of stomach pain, and feels humiliated by peers because of their culture. What is the priority assessment for the nurse?
The client is experiencing symptoms associated with culture shock. Culture shock occurs when a person is immersed in a different culture that is perceived as strange. The person may feel foolish, fearful, incompetent, or humiliated, and these feelings can lead to frustration and anxiety. 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 his or her beliefs onto another person.
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 best response by the nurse?
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.
In addition to understanding the culture of the client, what other actions are required to provide culturally competent nursing care? Select all that apply.
The emphasis of culturally competent nursing is understanding the culture of the client, recognizing one's own culture and biases, and recognizing the culture of the healthcare system. Although information can be found in the literature about culture, the nurse obtains key cultural information from the client, who is the expert in the client's culture. Although culture shapes all learned human responses, it does not determine them. Individuals reflect the influence of their cultures; however, they do not share the same culture equally.
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?
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. The nurse is not stereotyping, as no generalization is made about a group of people. The nurse is not demonstrating culture shock because the view of pain medications that the nurse expresses is consistent with the majority, Western culture.
A nurse is caring for a postoperative client after knee arthroplasty. The nurse plans to help the client ambulate but is aware that the client may feel threatened by physical closeness because the client is from a culture that tends to prefer more personal space when interacting with others. Using the principles of culturally competent care, what would be the most appropriate nursing action?
The nurse should explain the purpose of ambulation and the need for assistance while ambulating to the client. This would relieve the client's anxiety associated with physical closeness. However, the client won't be able to ambulate without assistance. Even though the nurse can instruct a family member to ambulate the client, this is not an appropriate action. Ambulating the client without recognizing the cultural difference is nontherapeutic, as the nurse would be not be performing culturally competent care by not acknowledging cultural practice.
The nurse should instruct an Islamic female client who is reluctant to undergo pelvic examination from an assigned male health care provider to:
The woman is from a culture or ethnic group whose values influence her feelings about a pelvic examination, particularly one done by a male health care provider.
A client is completing a health history form and asks the nurse, "Why does this ask for my ethnicity instead of my race?" What is the appropriate nursing response?
To answer the question, the nurse needs to address why the form asks for ethnicity instead of race. Ethnicity or ethnic group is being used to replace the term race, as race often has a negative connotation. Race and ethnicity are not the same thing. Race is based on physical characteristics; however, ethnicity is not specific to where one resides. Ethnicity is indeed a sense of identity with a cultural group; however, this answer selection does not answer the client's question.
When an American client states, "I only want an American doctor," the client is expressing:
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.
