Fundamentals of Nursing Chp 7, Caring in Nursing, ch9 Culture

The registered nurse is evaluating the statements of a student nurse after teaching about cultural assessment models. Which statement by the student nurse needs correction? 1 "Cultural assessment models are used to stereotype a particular group of patients." 2 "Cultural assessment models help to focus on the information relevant to patient's problem." 3 "Cultural assessment models can be used to understand a patient's religious beliefs." 4 "Cultural assessment models help one to understand the complex factors that influence a patient's cultural world view."

"Cultural assessment models are used to stereotype a particular group of patients." Stereotyping is generalizing a patient based on his or her cultural group. Cultural assessment models are used to understand the cultural beliefs of a patient and are not used to generalize (stereotype) the patient. Cultural assessment models help to focus on the information relevant to patient's problem by providing a worldview. Cultural assessment models are used to understand patient's religious beliefs and the complex factors that influence a patient's cultural worldview.

The nurse is caring for an elderly patient who has diarrhea, and the nurse suspects that the patient has a biomedical perspective of illness. Which statement by the patient helped the nurse to reach this conclusion? 1 "I will recover if I drink hot beverages." 2 "I will feel better after meeting with a mambo." 3 "I am sick because of unhygienic surroundings." 4 "I am sick because of supernatural forces surrounding me."

"I am sick because of unhygienic surroundings." Biomedical theory postulates that microorganisms are responsible for specific disease conditions. Therefore, the patient's statement that unhygienic surroundings are responsible for the illness supports the nurse's conclusion. Patients who believe in the yin/yang or hot/cold theory believe in a naturalistic approach to healing. Therefore, the statement that the patient will be better after drinking hot beverages indicates that the patient believes in the naturalistic perspective. People who believe in a magico-religious perspective believe that illness is a result of supernatural powers. A mambo is a female voodoo priest who treats illness with faith healing. Therefore, the statement that the patient will be better after meeting a mambo would indicate belief in a magico-religious perspective. Many Southeast Asian patients believe that illness is caused by supernatural forces.

The nurse is performing a cultural assessment of a patient. Which question of the nurse reflects a focused question? 1 "Who lives with you?" 2 "What do you do to keep yourself well?" 3 "What do you think caused your illness?" 4 "Is there someone with whom you want us to talk about your care?

"Is there someone with whom you want us to talk about your care? Asking the patient if there is someone with whom he or she would like the health care team to discuss his or her care is an example of a focused question. Asking the patient what he or she does to keep him- or herself well assesses the patient's beliefs and practices. Asking the patient with whom he or she lives assesses the patient's social organization. Asking the patient what he or she thinks the reason is for an illness is an open-ended question.

The registered nurse is teaching a patient of a different cultural background the procedure to self-administer insulin. After teaching, the nurse asks the patient to self-administer insulin. Which type of technique does the nurse use in this situation? 1 "Teach Back" 2 Health literacy 3 Cultural encounter 4 Linguistic competence

"Teach Back" The "Teach Back" technique is an ongoing process of asking patients for feedback by demonstration. In this instance, the registered nurse is asking the patient to self-administer insulin in front of the nurse. Health literacy is the ability to obtain and understand health information. Cultural encounter is an intervention that involves a nurse directly interacting with patients from culturally diverse backgrounds. Linguistic competence is the ability of the nurse to communicate effectively and convey information in a manner that is easily understood by the patient.

While assessing a patient of a different culture, the nurse wants to know the patient's perception of the etiology of the disease. Which is the most appropriate question asked by the nurse using a patient's explanatory model? 1 "What do you call your problem?" 2 "Why do you think it started when it did? 3 "What do you think your sickness does to you?" 4 "What are the chief problems your sickness has caused you?

"What do you call your problem?" A patient's explanatory model is an effective approach to assess the disease condition in a patient belonging to different culture by asking questions. Asking the patient about what he or she calls his or her problem can help identify the cause of the disease. Questioning the patient about why he or she thinks the disease started will help identify the time and onset of the disease. Asking the patient about what he or she thinks the disease does to him or her will help the nurse understand the pathophysiology of the disease. Questioning the patient about the chief problems the disease caused him or her will help the nurse understand the course of illness of the disease.

Which question does the nurse ask a patient to assess the beliefs and practices of the patient? 1 "What caused your problem?" 2 "What is your main source of income?" 3 "What do you do to keep yourself well?" 4 "How should we address you or what should we call you?

"What do you do to keep yourself well?" Asking the patient about what he or she does to keep well indicates that the nurse is assessing the beliefs and practices of the patient. Asking the patient what caused the problem indicates assessment of bicultural ecology. Questioning the patient about the main source of income indicates assessment of socioeconomic status. Asking the patient how to address him or her indicates that the nurse is assessing language and communication.

The nurse is carrying out an assessment of a Chinese patient with pain in the abdomen. Which question by the nurse is open-ended? 1 "Is the pain here?" 2 "Is the pain very severe or mild?" 3 "What do you think of your problem?" 4 "How many days have you had this pain?"

"What do you think of your problem?" Open-ended questions allow the patient to express feelings or to elaborate more on the situation. Open-ended questions do not limit the patient's response to either "yes" or "no" or a short answer. In this scenario, asking what the patient thinks about the problem is an open-ended question. Asking about the location, severity, or duration of the pain are closed-ended questions.

Open-ended questions/statements

"What will you tell your wife about the changes we made to your diet today?" "In your own words, please tell me what changes we have made to your medications today. I want to make sure I explained everything clearly."

Insider

(emic)

Outsider

(etic)

Which carative factor does the nurse illustrate when helping a patient find the meaning of cancer by supporting beliefs about life? 1 Instilling hope and faith 2 Forming a human-altruistic value system 3 Cultural caring 4 Meeting human needs

1 Instilling hope and faith Instilling hope and faith helps to increase an individual's capacity to get through an event or transition and to face the future with meaning. Forming a human-altruistic value system promotes a therapeutic relationship between the nurse and patient. Cultural caring and meeting human needs are important nursing activities; however, they do not focus on supporting beliefs about life.

The nurse wants to care for a patient using Swanson's theory of caring. Which of the following are processes included in Swanson's theory of caring? Select all that apply. 1 Touching 2 Knowing 3 Being with 4 Enabling 5 Maintaining belief

2 Knowing 3 Being with 4 Enabling 5 Maintaining belief Swanson's theory of caring includes five processes of care: knowing, being with, doing for, enabling, and maintaining belief. Knowing refers to striving to understand an event as it has meaning in the life of the other. Being with means that the nurse is emotionally present for the patient. Doing for is performing for others as they would do for themselves if it were possible. Enabling refers to the activities that facilitate the patient's passage through changes in life. Maintaining belief means keeping faith in the other person's ability to get through an event. Touch is a caring behavior, but it is not included in Swanson's theory of caring

A patient is admitted to the hospital for treatment of lymphoma. The nurse enters the patient's room to find the patient worried and depressed. According to the caring principles, what should the nurse do? Select all that apply. 1 Leave the patient alone. 2 Greet the patient and gently touch the patient's shoulder. 3 Make good eye contact and sit next to the patient. 4 Do necessary work and leave without speaking. 5 Ask the patient about any concerns and listen to complaints patiently..

2 Greet the patient and gently touch the patient's shoulder. 3 Make good eye contact and sit next to the patient. 5 Ask the patient about any concerns and listen to complaints patiently. The nurse should always follow the caring principles when caring for any patient. The patient who is suffering from lymphoma may get depressed at times. The nurse must be patient enough to handle such patients. The nurse should greet the patient warmly and touch the patient's shoulder gently to acknowledge the patient's presence. Making good eye contact and sitting next to the patient gives the impression that the nurse is interested in listening to the patient's problems. Asking about the patient's concerns and listening patiently is an important principle of caring, which makes the patient feel that the nurse is not there just for her task but connects with the patient on a personal level. Greeting the patient does not imply that the nurse is disturbing the patient. The patient may feel uncared for if the nurse leaves the room without speaking.

A patient who is quadriplegic complains of being cold and asks for an extra blanket. The nurse covers the patient and draws the room's curtains. Which process did the nurse follow? 1 Knowing 2 Doing for 3 Being with 4 Maintaining belief

2 Doing for Doing for is the process in which the nurse carries out tasks for patients as they would do for themselves, if possible. The quadriplegic patient is unable to cover himself; hence the nurse does the task. Knowing is getting to know the patient. Being with refers to being present emotionally for the patient. Maintaining belief is instilling hope and faith in the patient.

The nurse is caring for an elderly patient who has diarrhea, and the nurse suspects that the patient has a biomedical perspective of illness. Which statement by the patient helped the nurse to reach this conclusion? 1 "I will recover if I drink hot beverages." 2 "I will feel better after meeting with a mambo." 3 "I am sick because of unhygienic surroundings." 4 "I am sick because of supernatural forces surrounding me

3 "I am sick because of unhygienic surroundings." Biomedical theory postulates that microorganisms are responsible for specific disease conditions. Therefore, the patient's statement that unhygienic surroundings are responsible for the illness supports the nurse's conclusion. Patients who believe in the yin/yang or hot/cold theory believe in a naturalistic approach to healing. Therefore, the statement that the patient will be better after drinking hot beverages indicates that the patient believes in the naturalistic perspective. People who believe in a magico-religious perspective believe that illness is a result of supernatural powers. A mambo is a female voodoo priest who treats illness with faith healing. Therefore, the statement that the patient will be better after meeting a mambo would indicate belief in a magico-religious perspective. Many Southeast Asian patients believe that illness is caused by supernatural forces.

The nurse, while caring for a patient of a different cultural background, learns about their cultural practices that affect health. The nurse uses these facts to plan the patient's care for better acceptance. Which component of Campinha-Bacote's model of cultural competency is reflected in this scenario? 1 Cultural skill 2 Cultural desire 3 Cultural encounter 4 Cultural knowledge

3 Cultural encounter Campinha-Bacote's model of cultural competency includes interrelated components. Cultural encounter involves the cross-cultural interactions between the nurse and the patient that provide opportunities to learn about other cultures and develop effective intercultural communication. Cultural skill is the ability to assess the social, cultural, and biophysical factors that influence patient treatment and care. Cultural desire is the motivation and commitment to care for a patient. Cultural knowledge is the knowledge of diverse groups, including the values, health beliefs, care practices, worldview, and bicultural ecology commonly found within each group.

The nurse wants to assess health literacy in a group of patients. Which measure does the nurse use to evaluate word recognition? 1 Calm-Listen, Affirm, Respond, Add (C-LARA) 2 Test of Functional Health Literacy in Adults (TOFHLA) 3 Rapid Estimate of Adult Literacy in Medicine (REALM) 4 Culturally and Linguistically Appropriate Standards (CLAS)

3 Rapid Estimate of Adult Literacy in Medicine (REALM)

Which best describes presence? 1 A person-to-person encounter that enables patients to care for self. 2 A person-to-person encounter that provides personal care to a patient. 3 A person-to-person encounter that conveys closeness and a sense of caring. 4 A person-to-person encounter that describes being in close contact with a patient.

A person-to-person encounter that conveys closeness and a sense of caring. Providing presence is a person-to-person encounter conveying closeness and a sense of caring. It involves being there and being with. Being there is not only a physical presence but also includes communication and understanding. Presence is an interpersonal process that is characterized by sensitivity, holism, intimacy, vulnerability, and adaptation to unique circumstances.

The nurse has to examine a patient and administer an intravenous medication that is not a life-saving drug. The patient is a devout Muslim. When the nurse goes to administer the medication the nurse finds that patient is getting ready for namaz (prayers). The nurse understands that the patient prays at certain times, as specified in his culture. What should the nurse do in this scenario? 1 Administer the drug while the patient prays. 2 Ask the patient to pray after the medication is administered. 3 Allow the patient to pray and come back later to administer the medication. 4 Tell the patient that the nurse has other patients to look after and cannot come later

Allow the patient to pray and come back later to administer the medication. The nurse should respect the patient's religious beliefs. Muslims offer namaz, or prayers, at specific times of the day. The nurse should let the patient complete the prayers and then administer the medication. It would be inappropriate to administer the drugs while the patient is praying because that would show disrespect to the patient. It would be inappropriate for the nurse to ask the patient to delay prayer, because his culture dictates that he pray at specific times. The nurse should not refer to responsibilities with other patients.

The nurse is using an interpreter to communicate with a patient who does not speak English. Which action by the nurse may hamper the communication between the nurse and the patient? 1 Introducing the interpreter to the patient 2 Determining the interpreter's qualifications 3 Looking at the patient instead of the interpreter 4 Asking the patient's family members to serve as interpreters

Asking the patient's family members to serve as interpreters Interpreters are used to communicate effectively with a patient of a different culture. The family members of the patient should not be asked to serve as interpreters, because the patient may not be comfortable sharing certain information with them. The interpreter should be introduced to the patient for better understanding. The interpreter's qualifications should be determined for effective outcomes. While communicating with the patient, the nurse should look at the patient and not the interpreter to encourage the patient and to gain his or her trust and confidence.

The nurse is interacting with a patient who is experiencing depression and reassures the patient by saying, "I know you are feeling sad; please speak up and do not keep your feelings to yourself. It will help you feel better." Which caring process of Swanson's theory is the nurse following in this situation? 1 Knowing 2 Enabling 3 Being with 4 Maintaining belief

Being with The nurse is trying to reassure the depressed patient by encouraging the patient to express feelings. Thus, the nurse is following the process of being with the patient, according to Swanson's theory of caring. Being with refers to maintaining emotional contact with others. In the process of knowing, the nurse follows the patient's cues and assesses them thoroughly. In the enabling process, the nurse generates alternatives and provides supportive feedback to a patient. While providing care for a patient, the nurse offers realistic optimism and ensures that the patient has a hope-filled attitude to maintain his or her belief.

Being with (swanson)

Being with refers to being emotionally present for the patient. Enabling is facilitating the patient's passage through changes in life.

Differences in physical features, i.e. skin, build, hair, etc.

Biologic Variations Sample: Giger & Davidhizar's Transcultural Assessment Model

Which term best describes the type of elements that people in Western cultures believe cause illness? 1 Supernatural 2 Biomedical 3 Medicoreligious 4 Imbalance between humans and nature

Biomedical Most Western cultures believe that illnesses have biomedical causes. Beliefs that illnesses are caused by supernatural or medicoreligious causes, or by an imbalance between humans and nature, are more common in non-Western cultures.

Greeting a patient with a smile while touching the patient's shoulder is an example of the

Carative Factor "developing a helping, trusting, human caring relationship."

"Explaining a medication to a patient before administering it is an example of the

Carative Factor "promoting transpersonal teaching-learning."

Providing guided imagery therapy and putting a picture of the patient's family in the patient's room while providing care is an example of the

Carative Factor "providing for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment.

The nurse gently touches the shoulder of a patient lying with eyes closed. When the patient opens his eyes, the nurse smiles and asks how he is feeling. Which kind of touch is this? 1 Caring 2 Protective 3 Task-oriented 4 Healing touch

Caring In this scenario, the nurse practices caring touch. Caring touch is a form of nonverbal communication. It helps to improve a patient's comfort and security, enhances self-esteem, increases confidence in the caregivers, and improves mental well-being. Protective touch is used to protect the patient from any harm. Task-oriented touch occurs when the nurse is performing nursing duties. Healing touch is a type of energy therapy used for healing certain diseases.

E T H N I C C

Collaboration with client, family, healers and ancillary personnel test Skills and Interventions Cultural Assessment

Verbal and non-verbal, languages, dialects

Communication Sample: Giger & Davidhizar's Transcultural Assessment Model

The nurse asks a patient, "How is this health problem different from the previous one you had?" Which type of nursing assessment question has the nurse asked? 1 Contrast 2 Focused 3 Open-ended 4 Bicultural ecology and health risks

Contrast Asking the patient about the difference between the present problem and the previous one is a contrast nursing assessment question. Asking the patient whether he or she had the problem earlier is a focused nursing assessment question. An open-ended question may be asked to obtain information from the patient about what he or she thinks the cause of a problem is. A bicultural ecology and health risks nursing assessment question might ask about how a problem affects the patient and those close to the patient.

What will happen to you? What do you fear most about your sickness?

Course of illness explanatory model

Which is a strategy for creating work environments that enable nurses to demonstrate more caring behaviors? 1 Increasing the working hours of the staff 2 Decreasing salary benefits of the staff 3 Creating a setting that allows flexibility and autonomy for staff 4 Encouraging increased input concerning nursing functions from physicians

Creating a setting that allows flexibility and autonomy for staff Encouraging flexibility and autonomy increases nursing satisfaction. When nurses' job satisfaction is high, they have a greater connectedness with their patients and believe that caring practices are part of the nursing culture. Increasing the working hours of staff usually decreases nursing satisfaction. Encouraging increased input concerning nursing functions from physicians decreases nursing autonomy and thus decreases nursing satisfaction. Decreasing salary benefits usually decreases job satisfaction

Model of Cultural Competence Campinha-Bocote, 2007

Cultural Awareness Cultural Knowledge

In-depth self-examination of one's own background; recognizing biases, prejudices, and assumptions about others 1st step

Cultural Awareness Model of Cultural Competence Campinha-Bocote

"R-E-S-P-E-C-T" C

Cultural Competence

The enabling of health care providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients

Cultural Competency

The motivation of a health care professional to "want to", not "have to", engage in the process of becoming culturally competent Accepts cultural differences and builds on cultural similarities

Cultural Desire Model of Cultural Competence Campinha-Bocote, 2007

Cross-cultural interactions that provide opportunities to learn about other cultures and develop effective intercultural communication (going to Mexico)

Cultural Encounters Model of Cultural Competence Campinha-Bocote, 2007 Cultural encounter is an intervention that involves a nurse directly interacting with patients from culturally diverse backgrounds.

Perception Insider (emic) Outsider (etic)

Cultural Knowledge Model of Cultural Competence Campinha-Bocote

Sufficient comparative knowledge of diverse groups, including values, health beliefs, care practices, etc. Don't stereotype/bias

Cultural Knowledge Model of Cultural Competence Campinha-Bocote

Ability to assess factors (social, cultural, biophysical) that influence client treatment and care

Cultural Skills

Which type of cultural competency recognizes biases, prejudices, and assumptions about other people? 1 Cultural skills 2 Cultural desire 3 Cultural awareness 4 Cultural knowledge

Cultural awareness Cultural awareness refers to recognizing biases, prejudices, and assumptions about other people. Cultural skills assess social, cultural, and biophysical factors that influence patient treatment and care. Cultural desire describes the motivation to learn from the others, accept the learner, be open to and accepting of cultural differences. Cultural knowledge includes sufficient comparative knowledge of diverse groups, including the values, health beliefs, care practices, and worldview.

The nurse, while caring for a patient of a different cultural background, learns about their cultural practices that affect health. The nurse uses these facts to plan the patient's care for better acceptance. Which component of Campinha-Bacote's model of cultural competency is reflected in this scenario? 1 Cultural skill 2 Cultural desire 3 Cultural encounter 4 Cultural knowledge

Cultural encounter Campinha-Bacote's model of cultural competency includes interrelated components. Cultural encounter involves the cross-cultural interactions between the nurse and the patient that provide opportunities to learn about other cultures and develop effective intercultural communication. Cultural skill is the ability to assess the social, cultural, and biophysical factors that influence patient treatment and care. Cultural desire is the motivation and commitment to care for a patient. Cultural knowledge is the knowledge of diverse groups, including the values, health beliefs, care practices, worldview, and bicultural ecology commonly found within each group.

Care that fits a person's life patterns, values, and system of meaning

Culturally congruent care

Respect Shift understanding client's explanation explain negotiate treatment plan

Culture Care Theory Leininger

The nurse visits the patient for a chat every morning and evening. Which carative factor does this illustrate, according to Watson's theory of care? 1 Applying creative problem solving 2 Developing a human caring relationship 3 Promoting transpersonal teaching-learning 4 Allowing for existential-phenomenological-spiritual forces

Developing a human caring relationship Visiting the patient every morning and evening for a chat helps in effective communication and the formation of a caring relationship. This is an example of the carative factor of developing a human caring relationship. An example of the carative factor of creative problem solving would be to help the patient with decision making. An example of the carative factor of promoting transpersonal teaching and learning would be to teach the patient proper skills for self-care. Caring for the patient from a spiritual aspect would address Watson's carative factor of providing for existential-phenomenological-spiritual forces.

doing for (swanson)

Doing for is performing for others as the patient would have done for herself if it were possible.

"R-E-S-P-E-C-T" E

Empathy

The nurse is providing emotional support for a patient who has lost a parent in an accident. Which caring process of Swanson's theory of caring is the nurse following? 1 Knowing 2 Enabling 3 Doing for 4 Maintaining belief

Enabling Providing emotional support to a patient who has lost a parent or who is undergoing a life transition indicates that the nurse is following the caring process of enabling, according to Swanson's theory. An example of the caring process of knowing is when the nurse follows the patient's cues and tries to understand the patient. An example of doing for is when the nurse performs skillful nursing procedures while providing care. An example of maintaining belief is when the nurse helps to maintain a hope-filled attitude and offer optimism.

Enabling (Swanson)

Enabling: Facilitating client's passage through life transitions and unfamiliar events Enabling refers to the activities that facilitate the patient's passage through changes in life.

Traditional health beliefs; Traditional healers: magic, folk health, medicine man

Environmental Control Sample: Giger & Davidhizar's Transcultural Assessment Model

What do you call your problem?

Etiology explanatory model

E T H N I C E

Explanation of problem test Skills and Interventions Cultural Assessment

E T H N I C test Skills and Interventions Cultural Assessment

Explanation of problem Treatments already tried Healers consulted Negotiate mutually acceptable option Intervention mutually agreeable Collaboration with client, family, healers and ancillary personnel

"R-E-S-P-E-C-T" E

Explanations

E T H N I C H

Healers consulted test Skills and Interventions Cultural Assessment

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

Health Care Disparities

A difference in health status closely linked with social, economic, and/or environmental disadvantage (USDHHS, 2015)

Health Disparity

While attending to a patient, the nurse finds that the patient is having difficulty in getting up to a sitting position. The nurse cares for this patient by applying the process of doing for. Which is the most appropriate action the nurse can take? 1 Sympathize with the patient regarding the inability to get into position. 2 Help the patient by raising the head end of the bed. 3 Help the patient move into the sitting position. 4 Encourage the patient to move independently.

Help the patient move into the sitting position. Doing for the patient means helping the patient to perform various tasks. The patient is trying to sit up but is unable to do so. The nurse should help the patient to sit up and position the patient well. Sympathizing with the patient would be an example of the caring process of being with. Raising the head end of the bed would be enabling the patient. Encouraging the patient to move independently indicates the caring process of maintaining belief.

How does the nurse demonstrate caring to family members? 1 Helping the family to become active participants in care 2 Preventing the family from providing activities of daily living (ADLs) 3 Sharing all health care information without the patient's permission 4 Allowing the family to make health care decisions for the patient

Helping the family to become active participants in care The nurse sees the patient and the whole family as active participants in the care of the patient. Therefore, the nurse should include the family members willing to perform activities of daily living (ADL). The patient must give permission to share health care information, even with family members. Patients make their own health care decisions.

Protective touch

Holding a patient to avoid a fall is an example of protective touch. The use of touch is often a comforting approach while dealing with patients. Touch is classified into different categories based on the type of touch. Protective touch is used to protect the patient or the nurse.

Which nursing intervention indicates a protective touch for a patient with a major injury after an accident? 1 Shaking the patient's hand while meeting for the first time 2 Touching the patient's shoulder while explaining a medication 3 Holding the patient's hand while starting an intravenous catheter 4 Holding the patient while assisting with walking

Holding the patient while assisting with walking The risk of falls is high in patients with injuries from an accident. Therefore, the nurse holds the patient while walking and protects the patient from falling. This indicates that the nurse is using a protective touch. The nurse touches the patient's shoulder while talking to provide comfort or to convey presence to the patient. Shaking the patient's hand when being introduced or while greeting indicates a professional touch. Holding the patient's hand while completing a procedure indicates a task-oriented touch.

A patient is depressed due to chronic illness and disability and reports being unable to sleep. The nurse uses caring touch. Which is an example of caring touch? 1 Holding the patient's hand 2 Touching the forehead to assess warm skin 3 Holding the arm to start an IV line 4 Holding the patient to avoid a fall

Holding the patient's hand Caring touch is an extremely important aspect of nursing. Because the patient is depressed, the nurse should hold the patient's hand and talk to him or her. The nurse should participate in the conversation and help the patient to feel better. Touching the forehead to assess temperature does not indicate caring touch. Holding the arm to start an intravenous (IV) line does not indicate caring touch. Holding the patient to avoid a fall does not indicate caring touch.

While measuring the vital signs of a Muslim patient, the nurse observes that the patient is anxious. Which statement by the nurse indicates a good understanding of transcultural nursing? 1 "I know modesty is very important for you, but you'll have to adjust this time." 2 "I know modesty is very important for you, but it should not interrupt the assessment." 3 "I know modesty is very important for you. However, we have to adhere to hospital rules." 4 "I know modesty is very important for you. Is there any way I can make you comfortable?

I know modesty is very important for you. Is there any way I can make you comfortable? Muslim patients often highly value modesty and may be uncomfortable with certain procedures, particularly if the health care worker is of the opposite sex. Therefore, the nurse should make the patient comfortable by showing an attitude of helpfulness and asking what can be done to make the patient more comfortable. The nurse should demonstrate flexibility and should not instruct the patient to adjust, because it may violate the patient's core values. The nurse should provide culturally congruent assessment to the patient. The nurse should not force the patient to adhere to the hospital rules; instead, the nurse should provide patient-centered care.

A patient is diagnosed with a diabetic ulcer with gangrene to his foot. The primary health care provider advises surgery, but the patient refuses because removal of a body part is not permitted according his or her religious preference. Which concept justifies this scenario? 1 Marginalization 2 Iceberg analogy 3 Intersectionality 4 Health disparity

Iceberg analogy The concept of the iceberg analogy helps in understanding the visual and virtual aspects of the way we perceive things. The patient may have come to get relief from symptoms. However, the primary health care provider may think that the patient should consider undergoing surgery. These differences in perception reflect the iceberg analogy.

A nursing student is doing a community health rotation in an inner-city public health department. The student investigates socio-demographic and health data of the people served by the health department and detects disparities in health outcomes between rich and poor. What does this example illustrate? 1 Illness attributed to natural and biological forces 2 Creation of the student's interpretation and descriptions of the data 3 Influence of socioeconomic factors on morbidity and mortality 4 Combination of naturalistic, religious, and supernatural modalities

Influence of socioeconomic factors on morbidity and mortality A health disparity exists in populations that have a significant increased incidence or prevalence of disease or increased morbidity, mortality, or survival rates compared to the health status of the general population.

A student nurse is reluctant to touch a patient who is suffering from a noncommunicable skin disorder. Which is the most appropriate action by the nurse? 1 Appreciate the nursing student's attitude. 2 Inform the student that touch comforts the patient. 3 Advise the student to touch the patient only while performing a task. 4 Promote only noncontact touch such as eye contac

Inform the student that touch comforts the patient. Touch is comforting to the patient and addresses the patient's concerns. Moreover, as the disorder is noncommunicable, there is no harm in touching the patient. The student nurse should be encouraged to adopt a different attitude and to practice caring and protective touch as well as task-oriented touch, because all forms of touch are a part of effective patient care. Task-oriented touch is important in performing any task well. Eye contact helps to build a trusting relationship.

Belonging simultaneously to multiple social groups

Intersectionality

Which process is involved in the ETHNIC mnemonic communication technique? 1 Trust 2 Calm 3 Empathy 4 Intervention

Intervention Intervention is one of the processes involved in the ETHNIC communication technique. It involves agreement on an appropriate intervention, which may incorporate alternate treatments. Calm is included in the C-LARA communication technique. Trust and empathy are aspects of the RESPECT communication technique.

hich process is involved in the ETHNIC mnemonic communication technique? 1 Trust 2 Calm 3 Empathy 4 Intervention

Intervention is one of the processes involved in the ETHNIC communication technique. It involves agreement on an appropriate intervention, which may incorporate alternate treatments. Calm is included in the C-LARA communication technique. Trust and empathy are aspects of the RESPECT communication technique.

E T H N I C I

Intervention mutually agreeable test Skills and Interventions Cultural Assessment

The nurse has long conversations with a patient about the patient's health, family, religious, and cultural practices. What impact will such a conversation likely have on the healing relationship? 1 It may distract the nurse from important nursing tasks. 2 It will have no impact on the patient's healing. 3 It will help to assist the patient in using social resources. 4 It will make the patient uncomfortable to reveal personal information..

It will help to assist the patient in using social resources. Having long conversations helps the nurse provide the patient with social, emotional, and spiritual resources. Such conversations will not necessarily distract the nurse from important tasks because conversation can be held while the nurse performs routine care tasks. These conversations extend the healing relationship so that the patient's recovery will be faster, and it may build the patient's confidence in the nurse. Usually patients are happy to reveal personal information to professionals involved in providing health care.

A patient is undergoing treatment for lung cancer and is depressed due to the diagnosis. The nurse tries to understand the patient's feelings without making any assumptions. Which caring process is this, according to Swanson's theory? 1 Enabling 2 Knowing 3 Doing for 4 Being with

Knowing According to Swanson's theory, the caring process of knowing comprises understanding an event as it has affected the life of the other person. Enabling is facilitating the other person through various passages. The process of doing for refers to providing the same standard of care as the nurse would provide for herself. The process of being with refers to being emotionally present for the other person.

Swanson's theory of caring is comprised of five processes of nursing.

Knowing Maintaining belief Doing for Being with Enabling Knock before entering dangerous mansions,"

Knowing (Swanson)

Knowing is striving to understand an event as it has meaning in the life of the other. The nurse tries to understand the patient's life conditions. Knowing the patient happens over time. This involves knowing and understanding the patient as a whole, including knowing the patient's disease and the needed interventions.

-Illiterate or low literacy skills -Limited English proficiency (LEP) -Hearing disabilities

Legal Requirements Audience

-Verbal and written notification of rights -Provide free services -Qualified interpreters ---ASL for deaf clients -Medical terminology -Language lines -NO FAMILY -Written materials

Legal Requirements Linguistic Competence Linguistic competence is the ability of the nurse to communicate effectively and convey information in a manner that is easily understood by the patient.

Audience Legal Requirements

Linguistic Competence

A patient is suffering from a hormonal disorder. The nurse tries to retain a hope-filled positive attitude for this patient. The nurse also offers realistic optimism to the patient. Which component of Swanson's caring theory is the nurse applying? 1 Knowing 2 Doing for 3 Being with 4 Maintaining belief

Maintaining belief Maintaining belief is sustaining faith in the other person's ability to get through an event. Knowing is striving to understand an event as it has meaning in the life of the other. The nurse tries to understand the patient's life conditions. Doing for is performing for others as the patient would have done for herself if it were possible. Being with refers to being emotionally present for the patient. Enabling is facilitating the patient's passage through changes in life.

maintaining belief (swanson)

Maintaining belief is sustaining faith in the other person's ability to get through an event. Maintaining belief means keeping faith in the other person's ability to get through an event.

is the segregation of patients on the basis of political systems, labor markets, and positions of power.

Marginalization

E T H N I C N

Negotiate mutually acceptable option test Skills and Interventions Cultural Assessment

A system of advantages and disadvantages tied to our membership in social groups

Oppression

"R-E-S-P-E-C-T" P

Partnership

What do you think your sickness does to you?

Pathophysiology explanatory model

A patient loses balance, and the nurse holds the patient to avoid a fall. Which kind of touch is this? 1 Caring 2 Protective 3 Noncontact 4 Task-oriented.

Protective Holding a patient to avoid a fall is an example of protective touch. The use of touch is often a comforting approach while dealing with patients. Touch is classified into different categories based on the type of touch. Protective touch is used to protect the patient or the nurse. Caring touch helps to comfort the patient and establish a personal connection between the nurse and the patient. Noncontact touch mainly involves eye contact, not physical touch. Task-oriented touch is the touch that takes place while the nurse is performing a nursing task or procedure.

The nurse wants to assess health literacy in a group of patients. Which measure does the nurse use to evaluate word recognition? 1 Calm-Listen, Affirm, Respond, Add (C-LARA) 2 Test of Functional Health Literacy in Adults (TOFHLA) 3 Rapid Estimate of Adult Literacy in Medicine (REALM) 4 Culturally and Linguistically Appropriate Standards (CLAS)

Rapid Estimate of Adult Literacy in Medicine (REALM) Rapid Estimate of Adult Literacy in Medicine (REALM) is one of the health literacy measurements that used to assess word recognition. C-LARA is a communication technique used during cultural assessment. The Test of Functional Health Literacy in Adults (TOFHLA) is used to measure reading skills and numeracy of patients. Culturally and Linguistically Appropriate Standards (CLAS) is an organization that advances health equity, improves quality, and helps eliminate health disparities.

"R-E-S-P-E-C-T" R

Rapport

Which communication technique is demonstrated when the nurse connects with a patient on a social level? 1 Rapport 2 Support 3 Empathy 4 Partnership

Rapport Having a rapport helps the nurse to connect to the patient on a social level.

Which nursing action is an example of Watson's Carative Factor "creative problem-solving, caring processes"? 1 Greeting a patient with a smile while touching their patient shoulder. 2 Recognizing a patient's discomfort and providing an assistant of the same gender. 3 Explaining a details of a prescribed pain medication to the patient before administration. 4 Providing guided imagery therapy and putting a picture of a patient's family in the room

Recognizing a patient's discomfort and providing an assistant of the same gender.

How should your sickness be treated?

Recommended treatment explanatory model

An older Chinese woman is admitted to the hospital after a hip fracture. Once the fracture has healed, the nurse encourages the patient to walk about the room. The patient refuses to walk without her son. What should the nurse do in this scenario? 1 Leave the patient alone but understand that the patient has no self-confidence. 2 Respect the patient's wish and ask her to walk when her son is present. 3 Explain to the patient calmly that she can't be dependent on her son. 4 Tell the patient that she needs to walk now and that it is inappropriate to be dependent on her son

Respect the patient's wish and ask her to walk when her son is present. In some cultures, families make decisions together. This patient may only be comfortable when her son is present, so the nurse should respect her wishes and come back when the son is there. It would be wrong to describe the woman as lacking confidence. It is not therapeutic to speak sternly with the patient and tell her that she is dependent on others.

of a client's experience from a physiological disease to that of an illness within context of client's culture

Shift understanding Leininger

Develop a trusting relationship Use open-ended, focused and contrasted questions

Skills and Interventions Cultural Assessment

Sample: Giger & Davidhizar's Transcultural Assessment Model

Skills and Interventions Cultural Assessment Use a cultural assessment model

Confirms clarity of your explanation -Ongoing process of asking clients for feedback through explaining or demonstrating and presenting info in a new way until you are sure client understands -Shame-free teaching environment

Skills and Interventions Teach Back The "Teach Back" technique is an ongoing process of asking patients for feedback by demonstration. In this instance, the registered nurse is asking the patient to self-administer insulin in front of the nurse.

Current Measures -Test of Functional Health Literacy in Adults (TOFHLA) -Reading and math skills -Rapid Estimate of Adult Literacy in Medicine (REALM) -Word recognition -Veteran's Administration (VA) "How confident are you in filling out medical forms for yourself?"

Skills and Interventions Health Literacy

Most vulnerable -Elderly (>65 years) -Immigrants -No HS diploma or GED -Chronic mental or physical conditions

Skills and Interventions Health Literacy

Directly affects health outcomes 90% of people in US experience challenges w/health care info

Skills and Interventions Health Literacy Health literacy is the ability to obtain and understand health information.

The nurse is caring for a critically ill patient. Which intervention supports the formation of a human-altruistic value system, according to Watson's transpersonal caring theory? 1 Assisting the patient in activities of daily living 2 Smiling at the patient and talking in polite language 3 Educating the patient to acquire proper self-care skills 4 Applying the nursing process in systematic decision making

Smiling at the patient and talking in polite language According to Watson's transpersonal theory, smiling and greeting the patient and showing loving kindness to the patient support the formation of a human-altruistic value system, one of the 10 carative factors identified by Watson. Assisting the patient in activities of daily living is an example of meeting human needs, another carative factor identified by Watson. Educating the patient to acquire proper skills related to self-care promotes transpersonal teaching-learning. Applying the nursing process in systematic decision making indicates that the nurse is using creative problem solving when providing patient care.

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

Social Determinants of Health

Marital status, # of children, religious affiliation

Social Organizations Sample: Giger & Davidhizar's Transcultural Assessment Model

Distance, degree of comfort

Space Sample: Giger & Davidhizar's Transcultural Assessment Model

The nurse applies Swanson's theory of caring while attending to patients. Which definition best describes the knowing component of Swanson's theory of caring? 1 Being emotionally present for the patient 2 Facilitating the patient's passage through changes in life 3 Striving to understand an event as it has meaning in the life of the patient 4 Caring for the patient as the nurse would have done for him- or herself

Striving to understand an event as it has meaning in the life of the patient Swanson's theory of caring comprises five caring processes. Knowing is striving to understand an event as it has meaning in the life of the other person. Being with refers to being emotionally present for the patient. Enabling is facilitating the patient's passage through changes in life. Doing for is caring for another person as that person would have done if it were possible. Maintaining belief is sustaining faith in the other person's ability to get through an event.

S "R-E-S-P-E-C-T"

Support

A patient is experiencing paraplegia after a motorcycle accident. How can the nurse involve the family members in patient care? 1 Keep the family members excluded from patient care. 2 Tell the family members jokes to keep them happy during the hospitalization. 3 Give the family members information about services such as respite care and community resources. 4 Teach the family members about caregiving techniques and have them participate in the care.

Teach the family members about caregiving techniques and have them participate in the care. The nurse should involve the family in the patient's care. This helps in the emotional well-being of the patient. The nurse should teach family members some techniques that can help them participate in caregiving. Excluding the family is not advised. The nurse should involve the family but should not make them perform all the caregiving interventions. The use of humor and giving information about respite care may be effective in relieving tension, building relationships and protecting the caregiver's health, but it does not help in the patient's care.

Orientation to time (sun vs clock), physiochemical reaction to time (circadian rhythms)

Time Sample: Giger & Davidhizar's Transcultural Assessment Model

What do you think has caused your problem? Why do you think it started when it did?

Time and mode of onset explanatory model

A comparative study of cultures to understand their: Similarities (universal culture) Differences (specific to particular group)

Transcultural nursing

E T H N I C T

Treatments already tried test Skills and Interventions Cultural Assessment

"R-E-S-P-E-C-T" T

Trust

Respect a client's health beliefs Leininger

Understand the effect of these beliefs on health care delivery

The nurse is following Swanson's theory in caring for a patient. Which actions are included in knowing the patient? 1 Instilling faith in this patient 2 Helping the patient perform daily activities 3 Understanding the patient and the patient's suffering as a whole 4 Knowing the interventions that should be performed with the patient

Understanding the patient and the patient's suffering as a whole Knowing the patient is a very important component of nursing. Knowing the patient happens over time. This involves knowing and understanding the patient as a whole, including knowing the patient's disease and the needed interventions. Instilling faith is a component of nursing but not part of knowing the patient. Similarly, helping the patient perform daily activities is a part of nursing but not part of knowing the patient. Knowing the interventions and performing them skillfully depends on the nurse's understanding and ability.

Recognizing a patient's discomfort and providing a solution (an assistant of the same gender) is an example of this.

Watson's Carative Factor "creative problem-solving, caring processes" allows for application of the nursing process in a systematic way to solve problems and provide patient-centered care.

Encouraging flexibility and autonomy increases nursing satisfaction.

When nurses' job satisfaction is high, they have a greater connectedness with their patients and believe that caring practices are part of the nursing culture. Increasing the working hours of staff usually decreases nursing satisfaction.

Cultural Knowledge Model of Cultural Competence Campinha-Bocote

World View Shaped by historical and social factors Determines Interaction Information Processing

Providing presence is a person-to-person encounter conveying

closeness and a sense of caring. It involves being there and being with. Being there is not only a physical presence but also includes communication and understanding. Presence is an interpersonal process that is characterized by sensitivity, holism, intimacy, vulnerability, and adaptation to unique circumstances.

Ability to explain to a client the health care provider's perspective on the illness and its perceived causes

explain Leininger

Ability to get the client's explanation of an illness and its causes

explanation Leininger

Ask questions to help you understand client's

explanatory model His/her views about health, illness, treatment Five topics in most models

Did you have this problem before?

focused Skills and Interventions Cultural Assessment

The differences in health due to social, economic, and/or environmental disadvantage is called

health disparity.

Caring touch

helps to comfort the patient and establish a personal connection between the nurse and the patient.

The division of the patients on the basis of gender, sexual orientation, occupation, class, and immigration status is called

intersectionality.

Task-oriented touch

is the touch that takes place while the nurse is performing a nursing task or procedure.

Noncontact touch

mainly involves eye contact, not physical touch.

Partnership is

needed to negotiate roles when necessary and be flexible with respect to the issues of control.

Ability to negotiate a mutually agreeable, safe and effective treatment plan

negotiate Leininger

What do you think caused your illness?

open-ended Skills and Interventions Cultural Assessment

Support involves

recognizing barriers in care and adherence and helping the patient to overcome them.

Empathy is

required to understand the patient's rationale for his or her illness.