Nur110 Ch9 Final Exam

Three dimensions of cultural competency

- Building a relationship with the other -Working outside the usual practice framework -reinventing practice in action

Cultural encounters

Cross cultural interactions that provide oppurtunities to learn about other cultures and develop effective intercultural communication

Ethnic

Explanation Treatment Healers Negotiate Intervention Collaboration

Culture

Is associated with norms, values and traditions passed down through generations, also perceived as the same ethnicity, race, and natinaolality, and language

Linguistic competence

Is the ability of organization and it's staff to communicate effectively and convey information in a manner that is easily understood in a diverse audience

Learns stands for what?

Listen with empathy Explain your perceptions of the problem Acknowledge and discuss cultural differences and similarities between you and your patient. Recommend treatment Negotiate agreement

cultural assessment

systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities

linguistic competence

the ability of an organization and its staff to communicate effectively and convey information in a manner that is easily understood by diverse audiences.

A nurse is using Campinha-Bacote's model of cultural competency to improve cultural care. Which actions describe the components the nurse is using? a. In-depth self-examination of one's own background b. Ability to assess factors that influence treatment and care c. Sufficient comparative understanding of diverse groups d. Motivation and commitment to continue learning about cultures e. Cross-cultural interaction that develops communication skills 1. Cultural skills 2. Cultural desires 3. Cultural awareness 4. Cultural knowledge 5. Cultural encounters

1.ANS:B 2.ANS:D 3.ANS:A 4.ANS:C 5.ANS:E

health care disparities

differences among populations in the availability, accessibility, and quality of health care services.

oppression

formal and informal system of advantages and disadvantages tied to our membership in social groups, such as those at work, at school, and in families

culture

integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups

health disparity

particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage

cultural competency

process in which the health care professional continually strives to achieve the ability and availability to work effectively with individuals, families, and communites

Key Points,

• An effective approach to patient assessment is to use a patient's explanatory model instead of a traditional biomedical model to reveal your patient's views on illness.

Key Points,

• Becoming culturally competent is an ongoing long-term process for a health care provider.

Key Points,

• Cultural desire involves a natural inclination to engage in the cultural competence process that is characterized by passion, commitment, and caring.

Key Points,

• Culturally competent health care providers and organizations can contribute to elimination of health disparities.

Key Points,

• Current evidence shows that addressing limited health literacy and cultural differences often reduces medical errors and improves adherence, patient-provider-family communication, and outcomes of care.

Key Points,

• Disparities in the access to quality of health care, preventive health, and health education contribute to poor population health.

Key Points,

• Health care systems and providers contribute to the problem of health disparities as a result of inadequate resources, poor patient-provider communication, lack of culturally competent care, fragmented delivery of care, and inadequate access to language services.

Key Points,

•A person's culture and life experiences shape his or her world view about health, illness, and health care.

Cultural assessment Questions

- open ended( what do you think caused the illness) -focused (did you have this problem before) -contrast(how different is the problem than the one you had previously) -ethohistory ( what is your background or ancestors) - sexual orientation(how do you prefer to be addressed Social organizations ( who do you live with at home) socioeconomic( what is your main source of income) Health risks( what caused your problem) Language( hat languages to you speak at home) Caring beliefs ( what do you to keep your self well)

9. Which action indicates the nurse is meeting a primary goal of cultural competent care for patients? a. Provides care to transgender patients b. Provides care to restore relationships c. Provides care to patients that is individualized d. Provides care to surgical patients

ANS: A Although cultural competence and patient-centered care both aim to improve health care quality, their focus is slightly different. The primary aim of cultural competence care is to reduce health disparities and increase health equity and fairness by concentrating on people of color and other marginalized groups, like transgender patients. Patient-centered care, rather than cultural competence care, provides individualized care and restores an emphasis on personal relationships; it aims to elevate quality for all patients.

6. A nurse is beginning to use patient-centered care and cultural competence to improve nursing care. Which step should the nurse take first? a. Assessing own biases and attitude b. Learning about the world view of others c. Understanding organizational forces d. Developing cultural skills

ANS: A Becoming more aware of your biases and attitudes about human behavior is the first step in providing patient-centered care, leading to culturally competent care. It is helpful to think about cultural competence as a lifelong process of learning about others and also about yourself. Learning about the world view, developing cultural skills, and understanding organizational forces are not the first steps.

4. When asked to describe the differences between ethnicity and race, what should the student nurse explain? a. Ethnicity refers to a shared identity, whereas race is limited to biological attributes. b. Ethnicity and race are actually the same and are based in cultural norms. c. Ethnicity can be understood only through an ethic worldview. d. Race refers to a shared identity, whereas ethnicity is limited to biological attributes.

ANS: A Ethnicity refers to a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics. Ethnicity is different from race, which is limited to the common biological attributes shared by a group such as skin color or blood type. In any intercultural encounter, there is an insider or native perspective (ethic worldview) and an outsider's perspective (ethic worldview). Ethnicity is best understood by those who are a part of that ethnicity and have an "emic" worldview.

13. A nurse is assessing population groups for the risk of suicide requiring medical attention. Which group should the nurse monitor most closely? a. Young bisexuals b. Young caucasians c. Asian Americans d. African-Americans

ANS: A Gay, lesbian, and bisexual young people have a significantly increased risk for depression, anxiety, suicide attempts, and substance use disorders, being 4 times as likely as their straight peers to make suicide attempts that require medical attention. Caucasian youth, Asian Americans, and African-Americans are not as likely to attempt suicide resulting in medical attention.

6. The nurse is caring for a Native American who has had recent surgery. In the patient's culture, it is a sign of weakness to complain of pain. In the nurse's culture, people who are having pain ask for pain medicine. The nurse has assumed that the patient has not been having pain and does not need medication because he has not complained of pain. What is the nurse doing? a. Utilizing cultural imposition by not asking the patient about his pain b. Striving to provide culturally congruent care by allowing the patient to suffer c. Operating from an emic worldview of the patient's cultural beliefs d. Practicing discrimination by not giving the patient pain medicine

ANS: A Health care practitioners who have cultural ignorance or cultural blindness about differences generally resort to cultural imposition and use their own values and lifestyles as the absolute guide in dealing with patients and interpreting their behaviors. Culturally competent care is the care provided by the nurse who attempts to bridge cultural gaps in caring, work with cultural differences, and enable patients and families to achieve meaningful and supportive caring. The nurse in this case has not been able to do this. Any intercultural encounter consists of an inside or native perspective (emic worldview) and an outsider's perspective (ethic worldview). The nurse is obviously utilizing an ethic worldview. The nurse may be acultural, but she/he did not purposefully ignore the patient's need.

12. A nurse is designing a form for lesbian, gay, bisexual, and transgender (LGBT) patients. Which design should the nurse use? a. Use partnered rather than married. b. Use mother rather than father. c. Use parents rather than guardian. d. Use wife/husband rather than significant other.

ANS: A Include LGBT-inclusive language on forms and assessments to facilitate disclosure, knowing that disclosure is a choice impacted by many factors. For example, provide options such as "partnered" under relationship status. For parents, use parent/guardian, instead of mother/father. Use neutral and inclusive language when talking with patients (e.g., partner or significant other), listening and reflecting patient's choice. Remember that some LGBT patients are also legally married.

7. In performing a cultural assessment, knowledge of a patient's country of origin and its history and ecological contexts is known as a. Ethnohistory. b. Biocultural history. c. Social organization. d. Religious and spiritual beliefs.

ANS: A Knowledge of a patient's country of origin and its history and ecological contexts is significant to health care and is known as ethnic heritage and ethnohistory. Biocultural history identifies a patient's health risks related to the ecological context of the culture. Social organization refers to units of organization in a cultural group defined by kinship status and appropriate roles for their members. Religious and spiritual beliefs are major influences in the patient's worldview about health and illness, pain and suffering, and life and death. Nurses need to understand the emic perspective of their patients.

9. The nurse is caring for a patient who has emigrated from another country. The patient is in need of abdominal surgery but seems reluctant to sign the surgical permits. What is one tactic that the nurse should use? a. Determine the family social hierarchy. b. Encourage the patient to sign the permits. c. Call the physician so that surgery can be canceled. d. Impress on the patient that her life is in jeopardy.

ANS: A Nurses should determine the family social hierarchy as soon as possible to prevent offending patients and their families. Working with established family hierarchy prevents delays and achieves better patient outcomes. Encouraging the patient to sign against her social beliefs can cause familial strife. Explaining the level of jeopardy may create undue stress. Nurses should be able to determine the correct hierarchy and should not involve the physician at this time.

Core measures

Are quality indicators that help health care institutions improve performance, increase accountability and reduce costs Screening for depression or controlling high blood pressure

2. Eliminating disparities in the health status of people from diverse racial, ethnic, and cultural backgrounds has become one of the two most important priorities of Healthy People 2020 because populations with health disparities have a. Increased incidence of disease. b. Lower levels of morbidity. c. Lower mortality rates. d. Decreased incidence of disease.

ANS: A Populations with health disparities have a significantly increased incidence of disease or increased morbidity and mortality when compared with the general population.

3. According to the Office of Minority Health (OMH), the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups are known as a. Culture. b. Subculture. c. Ethnicity. d. Cultural backlash.

ANS: A The OMH describes culture as the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Subcultures represent various ethnic, religious, and other groups with distinct characteristics from the dominant culture. Ethnicity refers to a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics. Cultural backlash occurs when an individual rejects a new culture because experience with a new or different culture is extremely negative.

17. Providing culturally congruent care means providing care that a. Fits the patient's valued life patterns and set of meanings. b. Is based on meanings generated by predetermined criteria. c. Is the same as the values of the professional health care system. d. Holds one's own way of life as superior to those of others.

ANS: A The goal of transcultural nursing is culturally congruent care, or care that fits the person's valued life patterns and set of meanings. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Culturally congruent care is sometimes different from the values and meanings of the professional health care system. Ethnocentrism is a tendency to hold one's own way of life as superior to those of others. It is not part of culturally congruent care.

17. A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of providing culturally congruent care? a. Provides care that fits the patient's valued life patterns and set of meanings b. Provides care that is based on meanings generated by predetermined criteria c. Provides care that makes the nurse the leader in determining what is needed d. Provides care that is the same as the values of the professional health care system

ANS: A The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person's life patterns, values, and system of meaning. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Discovering patients' cultural values, beliefs, and practices as they relate to nursing and health care requires you to assume the role of learner (not become the leader) and to partner with your patients and their families to determine what is needed to provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different from the values and meanings of the professional health care system.

18. A nurse is assessing the patient's meaning of illness. Which area of focus by the nurse is priority? a. On the way a patient reacts to disease b. On the malfunctioning of biological processes c. On the malfunctioning of psychological processes d. On the way a patient reacts to family/social interactions

ANS: A To provide culturally congruent care, you need to understand the difference between disease and illness. Illness is the way that individuals and families react to disease, whereas disease is a malfunctioning of biological or psychological processes. The way a patient interacts to family/social interactions is communication processes and family dynamics.

3. A nurse is assessing the health care disparities among population groups. Which area is the nurse monitoring? a. Accessibility of health care services b. Outcomes of health conditions c. Prevalence of complications d. Incidence of diseases

ANS: A While health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases and related complications, health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications.

1. A nurse is using Campinha-Bacote's model of cultural competency. Which areas will the nurse focus on to become competent? (Select all that apply.) a. Cultural skills b. Cultural desire c. Cultural transition d. Cultural knowledge e. Cultural encounters

ANS: A, B, D, E Campinha-Bacote's model of cultural competency has five interrelated components: cultural awareness; cultural knowledge; cultural skills; cultural encounters; and cultural desire. Cultural transition is not a component of this model.

2. Foster (1976) identified two distinct categories of healers cross-culturally. Of the following characteristics, which are congruent with the healing practices of naturalistic practitioners? (Select all that apply.) a. Illness is impersonal and is due to biological forces. b. Illness is caused by alterations in the body equilibrium. c. Sorcerers can cause health and illness. d. Human relationships should be emphasized. e. Healing modalities include herbs, massage, and surgery.

ANS: A, B, E Naturalistic practitioners attribute illness to natural, impersonal, and biological forces that cause alteration in the equilibrium of the human body. Healing emphasizes use of naturalistic modalities, including herbs, chemicals, heat, cold, massage, and surgery. In contrast, personalistic practitioners believe that an external agent, which can be human (i.e., sorcerer) or nonhuman (e.g., ghosts, evil, deity), causes health and illness. Personalistic beliefs emphasize the importance of humans' relationships with others, both living and deceased, and with their deities.

2. A nurse is using the RESPECT mnemonic to establish rapport, the "R" in RESPECT. Which actions should the nurse take? (Select all that apply.) a. Connect on a social level. b. Help the patient overcome barriers. c. Consciously attempt to suspend judgment. d. Stress that they will be working together to address problems. e. Know limitations in addressing medical issues across cultures.

ANS: A, C The "R" in RESPECT stands for rapport and includes the following behaviors: connect on a social level; seek the patient's point of view; and consciously attempt to suspend judgment. The "S" stands for support and includes the behavior of helping the patient overcome barriers. The "P" stands for partnership and includes the following behaviors: be flexible with regard to issues of control and stress that you will be working together to address medical problems. The "C" stands for cultural competence and includes the behavior of knowing your limitations in addressing medical issues across cultures.

15. A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy? a. A patient 35 years old b. A patient 68 years old c. A patient with a college degree d. A patient with a high-school diploma

ANS: B About 9 out of 10 people in the United States experience challenges in using health care information. Patients who are especially vulnerable are the elderly (age 65+), immigrants, persons with low incomes, persons who do not have a high-school diploma or GED, and persons with chronic mental and/or physical health conditions. A 35-year-old patient and patients with high-school and college education are not identified in the vulnerable populations.

13. In comparing American culture with Asian cultures, which of the following statements is true? a. American culture supports collectivism. b. Asian communication can be ambiguous. c. American communication patterns downplay autonomy. d. Asian communication is direct to avoid conflict.

ANS: B Among Asian cultures, face-saving communication promotes harmony through indirect, ambiguous communication and conflict avoidance. American culture supports individualism, where people value assertive communication because it manifests the ideals of individual autonomy and self-determination.

14. A nurse is assessing a patient's ethnohistory. Which question should the nurse ask? a. What language do you speak at home? b. How different is your life here from back home? c. Which caregivers do you seek when you are sick? d. How different is what we do from what your family does when you are sick?

ANS: B An ethnohistory question is the following: How different is your life here from back home? Caring beliefs and practice questions include the following: Which caregivers do you seek when you are sick and How different is what we do from what your family does when you are sick? The language and communication is the following: What language do you speak at home?

4. A nurse is providing care to a patient from a different culture. Which action by the nurse indicates cultural competence? a. Communicates effectively in a multicultural context b. Functions effectively in a multicultural context c. Visits a foreign country d. Speaks a different language

ANS: B Cultural competence refers to a developmental process that evolves over time that impacts ability to effectively function in the multicultural context. Communicates effectively and speaking a different language indicates linguistic competence. Visiting a foreign country does not indicate cultural competence.

8. The nurse is caring for a patient of Hispanic descent who speaks no English. The nurse is working with an interpreter. Which action should the nurse take? a. Use long sentences when talking. b. Look at the patient when talking. c. Use breaks in sentences when talking. d. Look at only nonverbal behaviors when talking.

ANS: B Direct your questions to the patient. Look at the patient, instead of looking at the interpreter. Pace your speech by using short sentences, but do not break your sentences. Observe the patient's nonverbal and verbal behaviors.

10. The nurse is caring for a Chinese patient who is reluctant to answer questions about her health background. The nurse asks the patient if she would like her husband present when health questions are asked. The nurse does this knowing that the Chinese culture is a collectivistic and patrilineal culture. What does this mean? a. Kinship extends to both the father's side and the mother's side of the family. b. Kinship is limited to the side of the father. c. Kinship is limited to the side of the mother. d. The husband becomes part of the wife's clan after marriage.

ANS: B In collectivistic cultures, families are made up of distant blood relatives across three generations and fictive or nonblood kin. Kinship extends to both the father's and the mother's side of the family (bilineal) or is limited to the side of either father (patrilineal) or mother (matrilineal). Patrilineally extended families exist among Chinese and Hindus, where a woman moves into her husband's clan after marriage and minimizes ties with her own parents and siblings.

15. The nurse is caring for a member of the Jewish faith who needs to undergo a critical procedure on Saturday. The patient is refusing the procedure because it is scheduled to be done on the Sabbath. The nurse impresses on the patient the urgency of the procedure, stating that delaying the procedure would put his life at risk. The patient continues to refuse. What should the nurse do? a. Cancel the procedure. b. Seek permission from the patient to contact the patient's rabbi. c. Have a family member sign the permit. d. Have the procedure done against patient wishes.

ANS: B Nurses need to identify and contact patients' religious and spiritual leaders before problems occur. Nurses work with these leaders to mediate in times of crises. Canceling the procedure may occur, but not at this time. Doing so prematurely could lead to the patient's death. A family member cannot make decisions for a competent patient. Having the procedure done against the patient's wishes cannot be done.

2. A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this patient? a. There is a decreased frequency of morbidity. b. There is an increased incidence of disease. c. There is an increased level of health. d. There is a decreased mortality rate.

ANS: B Populations with health disparities (immigrant with low income) have a significantly increased incidence of disease or increased morbidity and mortality when compared with the general population. Although Americans' health overall has improved during the past few decades, the health of members of marginalized groups has actually declined.

7. A nurse is performing a cultural assessment using the ETHNIC mnemonic for communication. Which area will the nurse assess for the "H"? a. Health b. Healers c. History d. Homeland

ANS: B The "H" in ETHNIC stands for healers: Has the patient sought advice from alternative health practitioners? While health, history, and homeland are important, they are not components of "H."

5. Care that includes the nurse learning about cultural issues involved in the patient's health care belief system and enable patients and families to achieve meaningful and supportive care is known as a. Ethnocentrism. b. Culturally competent care. c. Cultural imposition. d. Culturally congruent care.

ANS: B The goal of transcultural nursing is culturally congruent care, or care that fits the person's valued life patterns and set of meanings. Culturally competent care reflects the ability of a nurse to bridge cultural gaps in caring and enables patients and families to achieve meaningful and supportive caring. It is a step toward reaching culturally congruent care. Ethnocentrism is a tendency to hold one's own way of life as superior to those of others. It is the cause of biases and prejudices. Cultural imposition is the use of one's own values and lifestyles as the absolute guide in dealing with patients and interpreting behaviors.

11. A nurse is using core measures to reduce health disparities. Which group should the nurse focus on to cause the most improvement in core measures? a. Caucasians b. Poor people c. Alaska Natives d. American Indians

ANS: B To improve results, the nurse should focus on the highest disparity. Poor people received worse care than high-income people for about 60% of core measures. American Indians and Alaska Natives received worse care than Caucasians for about 30% of core measures.

1. A nurse is working at a health fair screening people for liver cancer. Which population group should the nurse monitor most closely for liver cancer? a. Hispanic b. Asian Americans c. Non-Hispanic Caucasians d. Non-Hispanic African-Americans

ANS: B While Asian Americans generally have lower cancer rates than the non-Hispanic Caucasian population, they also have the highest incidence rates of liver cancer for both sexes compared with Hispanic, non-Hispanic Caucasians, or non-Hispanic African-Americans.

14. When caring for a patient of a different culture, it is important for the nurse to understand that a. The nurse should protect the patient from family intrusion in her health care decisions. b. Working within the established family hierarchy produces better outcomes. c. Women as primary caregivers make independent health decisions. d. Gender is not a factor when it comes to role expectations.

ANS: B Working with established family hierarchy prevents delays and achieves better patient outcomes. Nurses need to determine who has authority for making decisions within the family and how to communicate with the proper individuals. Do not assume that just because the woman is the primary caregiver, she will make decisions independently. Determine the family social hierarchy as soon as possible. Gender also differentiates role expectations.

3. A nurse is using the explanatory model to determine the etiology of an illness. Which questions should the nurse ask? (Select all that apply.) a. How should your sickness be treated? b. What do you call your problem? c. How does this illness work inside your body? d. What do you fear most about your sickness? e. What name does it have?

ANS: B, C, E The questions for etiology include "What do you call your problem?" and "What name does it have?" Recommended treatment is asked by the question "How should your sickness be treated?" Pathophysiology is asked by the question "How does this illness work inside your body?" The course of illness is asked by the question "What do you fear most about your sickness?"

1. Compare the following statements. Which are considered predominant in non-Western cultures? (Select all that apply.) a. Causes of illness are biomedical in nature. b. Illness is an imbalance between humans and nature. c. Caring patterns are based in self-care and self-determination. d. Diagnoses are described as holistic. e. Treatment of disease can be magico-religious based.

ANS: B, D, E Many non-Western cultures see the cause of illness as being an imbalance between humans and nature. Method of diagnosis is described as holistic, and treatment of illness is mixed to include magico-religious, supernatural herbal, biomedical, etc. Western cultures view the cause of illness as biomedical using scientific, high-tech methods of diagnosis.

1. Despite significant improvements in the overall health status of the U.S. population over the past few decades, disparities among ethnic and racial minorities have a. Decreased as education levels equal those of non-Hispanic whites. b. Disappeared in relation to non-Hispanic white populations. c. Remained a serious challenge locally and nationally. d. Decreased faster than anticipated.

ANS: C Despite significant improvements in the overall health status of the U.S. population over the past few decades, the persistence of disparities in health status among ethnic and racial minorities continues to be a serious local and national challenge. Hispanics, African Americans, and some Asian subgroups are less likely than non-Hispanic whites to have a high school education and often experience poorer access to care and lower quality of preventive, primary, and specialty care.

11. The nurse is caring for a patient who does not speak English. She decides to use an interpreter to explain procedures and to answer questions that the patient may have. In performing the interview, what should the nurse do? a. Direct questions to the interpreter to ask the patient. b. Disregard the age and gender of the interpreter. c. Direct questions to the patient. d. Ask the interpreter to ask the patient for clarification at the end.

ANS: C If the patient needs an interpreter, the nurse should ensure gender, age, and ethnic compatibility of the interpreter with the patient's preference and the topic of discussion. The nurse should direct questions to the patient and not to the interpreter and should have the interpreter ask the patient for feedback and clarification at regular intervals, not only at the end.

10. The nurse is caring for a Chinese patient using the Teach-Back technique. Which action by the nurse indicates successful implementation of this technique? a. Asks, "Does this make sense?" b. Asks, "Do you think you can do this at home?" c. Asks, "What will you tell your spouse about changing the dressing?" d. Asks, "Would you tell me if you don't understand something so we can go over it?"

ANS: C The Teach-Back technique asks open-ended questions, like what will you tell your spouse about changing the dressing, to verify a patient's understanding. When using the Teach-Back technique do not ask a patient, "Do you understand?" or "Do you have any questions?" Does this make sense and do you think you can do this at home are closed-ended questions. Would you tell me if you don't understand something so we can go over it is not verifying a patient's understanding about the teaching.

8. The nurse is caring for a patient of Asian descent who speaks very little English. The nurse is especially concerned and attempts to develop a trusting relationship with the patient. She does this knowing that a. Cultural assessment needs to be done quickly to provide the best care early. b. Miscommunication cannot be tolerated in cultural assessment. c. The goal is to get the patient to conform to American health care norms. d. Cultural assessment is intrusive in contrast to other types of interviews.

ANS: D In contrast to other types of interviews, cultural assessment is intrusive and time-consuming and requires a trusting relationship between participants. Miscommunication commonly occurs in intercultural interactions as the result of language and communication differences between and among participants, as well as differences in interpreting each other's behaviors. The goal is to generate knowledge about the patient's values, beliefs, and practices about nursing and health care.

18. Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care. These modes are "cultural care preservation or maintenance," "cultural care accommodation," and "cultural care repatterning." When assessing patients during the admission process, the nurse utilizes a. These action modes in a distinct order. b. These action modes individually, one at a time. c. Only one action mode per patient. d. All these action modes simultaneously.

ANS: D Nurses are able to use any or all of these action modes simultaneously. These actions require that nurses have knowledge of the patient's culture and have the willingness, commitment, and skills to work with patients and families in decision making. The outcome sought through these actions and decisions is meaningful, supportive, and facilitative care as judged by the patient.

16. A nurse works at a hospital that uses equity-focused quality improvement. Which strategy is the hospital using? a. Document staff satisfaction. b. Focus on the family. c. Implement change on a grand scale. d. Reduce disparities.

ANS: D Organizations can implement equity-focused quality improvement by recognizing disparities and committing to reducing them. Staff diversity is a priority for equity-focused quality improvement, not staff satisfaction. While the family is important, the focus is on the patients. Organizations should start by implementing a change on a small scale (pilot testing), learning from each test, and refining the intervention through performance improvement cycles (e.g., plan, do, study, and act).

12. Which statement is true relative to caring for a Hindu patient who is dying? a. The family will turn his head eastward or to the right. b. A close kin will stay with the patient to hear his last wishes. c. Anointing of the sick is a common right of the dying. d. The family will place a drop of water on the patient's lips.

ANS: D The family of a dying Hindu remains at the bedside to place a drop of the holy water from the River Ganges on the patient's lips immediately after death to help his or her soul to the next life. The family of a critically ill Jewish patient will turn his or her head eastward or to the right side. A dying Hispanic patient will not be left alone, so that a close kin is able to hear the patient's wishes, allowing the soul to leave in peace. Anointing of the sick is a Roman Catholic sacrament.

5. The nurse learns about cultural issues involved in the patient's health care belief system and enables patients and families to achieve meaningful and supportive care. Which concept is the nurse demonstrating? a. Marginalized groups b. Health care disparity c. Transcultural nursing d. Culturally congruent care

ANS: D The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a person's life patterns, values, and system of meaning, provides meaningful and beneficial nursing care. Marginalized groups are populations left out or excluded. Health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g. screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. Transcultural nursing is a comparative study of cultures in order to understand their similarities (culture that is universal) and the differences among them (culture that is specific to particular groups).

16. The nurse is providing diabetic diet teaching to a Hispanic man and his wife. When the nurse is discussing foods that are acceptable, the wife continues to interrupt with statements like, "Oh, he doesn't eat that," or, "All he eats is rice and beans." What should the nurse do? a. Ask the wife to leave so he/she can focus on teaching the patient. b. Explain how "rice and beans" are not acceptable foods on a diabetic diet. c. Provide a diet plan with only food alternatives selected by the patient. d. Refer the patient and his wife to a dietitian familiar with Spanish food choices.

ANS: D The nurse should refer the patient to speak with a dietitian who is familiar with cultural food choices. If possible, he/she should develop a diet plan that includes the patient's cultural diet preferences and can provide culturally sensitive teaching brochures that describe healthy food choices. Rice and beans may be acceptable alternatives in a balanced diet. The nurse should include people in the family who help shop for and prepare food in the home, along with the wife.

Cultural skills

Ability to asses social and cultural, and bio physician factors that influence patient treat ment and care

C-LARA

Calm your self down Listen to the patients Affirm Respond Add

Explanatory model

His or her views about health and illness and its treatment

Health disparity

Inequality or difference between health status of a disadvantaged group such as people with low incomes and wealth

Emic world view

Insider perspective

Oppression

Is a formal or informal system of advantages and disadvantages tied to our memebershhip in social groups, such as work or school in families

Etic world view

Outsiders perspective

Respect

Rapport Empathy Support Partnership Explanations Cultural competence Trust

marginalized groups

Segments of the population that lack power, knowledge, social recognition, respect, and economic resources, and are subsequently excluded or pushed to the margins of society.

Marginalized groups

Social exclusion, is the social disadvantage and relegation to the fringe of society. ( white trash or people in s trailer park)

Cultural knowledge

Sufficient comparative knowledge of diverse groups, including the values beliefs, care practices, world view, and bicultural ecology commonly found within each group

Cultural desire

The motivation and commitment to caring that moves an individual to learn from others, accept the role as a learner, be open to and accepting of cultural differences, and build on cultural similarities.

intersecontionality

a more contemporary view of culture which acknowledges its many other facets such as gender, sexual orientation, location, class, and immigration status. the more dynamic perspective recognizes that we all belong simultaneously to multiples social groups within changing social and political contexts.

explanatory model

a person's views about health and illness and its treatment

culturally congruent care

care that fits people's valued life patterns and sets of meanings generated from the people themselves. sometimes this differs from the professionals' perspective on care

transcultural nursing

comparative study of cultures to understand their similarities and differences among them

social determinants of health

the conditions in which people are born, grow, live, work and age. shaped by the distribution of money, power and resources at global, national, and local levels

world view

the way people tend to look out upon the world or their universe from a picture or value stance about life or the world around them