N314 Exam 2

The clinic nurse is obtaining demographic data from a client. The client states, "Why do you need to know what my ethnicity is?" How should the nurse respond? "Collecting this information allows us to develop a personalized plan of care to meet your needs." "We require the information for identification purposes." "Understanding your background will prevent us from doing anything to offend you." "Insurance companies requires us to ask all clients."

"Collecting this information allows us to develop a personalized plan of care to meet your needs."

Which nursing intervention reflects culturally appropriate care when addressing a client? "Good morning, Mr. Smith. I am your nurse, John." "You can sit in this chair, Sally." "Thank you for coming to the clinic today." "I see you are here because you have a sinus infection."

"Good morning, Mr. Smith. I am your nurse, John."

The staff nurse overhears the charge nurse, who is of Italian heritage, talking to the unlicensed assistive personnel. Which statement made by the charge nurse is an example of ethnocentrism? "People who are Irish are usually alcoholics." "Asian people are bad drivers." "Italians are best at everything." "Hispanics are usually lazy."

"Italians are best at everything."

health models: Holistic Health Model

-Interrelated needs of body, mind, emotions, and spirit -People cannot be fully understood if examined in pieces apart from their environment

health models: Health Promotion Model

-Pender, Murdaugh, and Parson -assesses factors that determine how people interact with their environment

Community Based Nursing Theorists: Betty NEUMAN

-Systems Model -uses Primary, Secondary, and Tertiary in her model -individiuals, families, & communities are interrelated -stress and reaction to stress

Theorists for Health Promotion/Disease: Dorothea OREM

-Theory of Self-Care (ADLs) -Theory of Self-Care Deficit (when nursing care is needed) -Theory of Nursing Systems --Wholly compensation: unable to perform self-care --Partially compensation: nurse and pt. perform self-care --Supportive educative: nurse provides pt. education

What are some results of incivility?

-decreased pt safety -poor pt outcomes -med errors -delayed care -pt falls -preventable complications, harm, and even death -bullying

Importance of civility:

-est meaningful relationships -effective communication -create optimum learning environments -ensure quality patient care with best outcomes

Continuity of Care

-follow-ups of what's supposed to be happening -provisions of health services without disruption

Discharge Planning: Complex Referral

-high risk pts -time consuming -refer to discharge planner

Sunrise Model

-most abstract to least abstract -top of map provides worldview and social system level, which directs the study of perceptions of the world outside of culture

Discharge Planning: Basic

-most common, least complicated -teach pt about self-care, wound prevention -for non-complex pts.

Fragmentation

-mult. assessments & follow ups from other providers that cause loss in coordination ex) multiple providers prescribe different meds that confuse/upset the pt.

Discharge Planning: Simple Referral

-outside nurse's scope of practice -Refer to community (referral out)

Role of Hospice

-provide care for terminally ill -Treat symptoms & Px mgmt -nurse as part of team

Which client admitted to the emergency department might require the nurse to include interventions aimed at addressing culture shock in the plan of care? A client who immigrated 25 years ago reporting chest pain A client who recently immigrated and fell from a ladder A client whose parents were immigrants and is admitted with flu-like symptoms A client who is bilingual and has a history of asthma

A client who recently immigrated and fell from a ladder

A community health nurse is providing care to a group of Hispanic people living in an area that is predominantly populated by white people. What are the Hispanic people in this community an example of? A subculture A subgroup A minority A majority

A minority

The nurse discovers that a recently admitted client does not speak the same language as the nurse. Which action would the nurse take? Arrange for a trained language interpreter. Ask the client's adult child to interpret. Use written communication until a solution can be provided Ask a nonclinical staff member who speaks the client's language to interpret.

Arrange for a trained language interpreter.

The nurse is assessing an older adult who immigrated at the age of 3 years. The client speaks the same language as the nurse and lives in a neighborhood with many households from the country of origin. Which action by the nurse is most appropriate? Contact a traditional healer as part of culturally competent care of the client. Avoid direct eye contact with the client when speaking. Ask the client about special cultural beliefs or practices. Contact the client's oldest son to assist with health care decision making.

Ask the client about special cultural beliefs or practices.

Cultural Assessment Tools: Key Information Technique

Interview experts on the culture -Patient: best option is to get their POV, but in cases of barriers, use other sources -Trained interpreters -Family or friend

Personal space and distance is a cultural perspective that can impact nurse-client interactions. What is the best way for the nurse to interact physically with a client who has a different cultural perspective on space and distance? Know the client's cultural personal space preferences. Realize that sitting close to the client is an indication of warmth and caring. Sit 3 to 6 ft (0.90 to 1.80 m) away from the client in an attempt to not offend. Remember not to intrude into the personal space of the older adult.

Know the client's cultural personal space preferences.

The nurse is preparing to administer prescribed medication to a client who is Native American/First Nations. The nurse enters the room and observes a shaman performing a healing ritual for the client. What action would be the most appropriate by the nurse? Ask the shaman to leave the room. Wait in the room until the shaman is done. Leave the room and return when the shaman is finished. Administer the medication while the shaman continues the ritual.

Leave the room and return when the shaman is finished.

A nurse is assessing a client and determines that the client belongs to a minority group. Based on the nurse's understanding about marginalized identity groups, the nurse would anticipate that the client would likely experience which effects? Select all that apply. Less power Health disparities Greater advantages Improved access to care Increased economic privileges

Less power Health disparities

Importance of incivility

May result in psychological or physiological distress for the people involved. If unaddressed may progress to unsafe or threatening behaviors

Community Based Nursing Theorists: Moyra ALLEN (McGill Model)

McGill Model: 4 concepts: health, family, collabs, learning

health models: High-Level Wellness Model

Model that sees health as an on-going process towards person's highest level of functioning

A nurse is providing care to a client who is from a different culture. Which aspect about culture would be most important for the nurse to integrate into the client's care? Not all members of the same culture act and think alike. Culture is relatively static and unchanging. Individuals learn culture in a purposeful manner. Individuals can easily describe their culture.

Not all members of the same culture act and think alike.

Significance in Healthcare

Nursing focuses on human response to actual/threatened health problems considering culture increases quality & safety of pt care it's the pt's right to get care that is individualized/culturally acceptable to them

Madeleine Leininger's Theory

Transcultural Nursing Theory Sunrise Model Phenomenon: every individual & group belongs to a culture or subculture (beliefs and values influence nursing care)

The spouse of a client asks the nurse whether the spouse may bring in a cream from home to apply to the client's skin. The spouse says, "Whenever anyone gets sick, we always use this cream." The nurse interprets this as: ritual. ethnocentrism. stereotyping. subculture.

ritual.

dynamic state

rooted in adaptation to internal and external environment changes

Incivility

rude or disruptive behavior

Levels of Prevention: Secondary Prevention

screening those at risk for disease ex) annual skin checks, cholesterol testing, family Hx of heart disease

Ethnicity

self-consciousness (awareness) of one's identity often referred to as one's "roots" ex) language, style of dress

Ethnohistory

significant historical experiences of a particular group

A preconceived and untested belief about an individual or group of individuals is: racism. stereotyping. culturally competent care. cultural relativity.

stereotyping

Race

takes biologic characteristics as the marks of separate social status; based on physical characteristics

Cultural Skill

the ability to conduct a cultural assessment & physical assessment

Culture Care

the subjectively and objectively learned and transmitted values, beliefs, and patterned life ways that assist, support, facilitate, or enable another individual or group to maintain their well-being, health, improve their human condition life way, or deal with illness, handicaps or death.

Worldview

the way people look at the world/universe and form a "picture or value" about the world & their lives

Complementary (CAM)

therapies & meds used in addition to Western meds

Alternative (CAM)

therapies used instead of conventional meds

Diversity

variables/differences in ways that cultures perceive, know, and practice health and nursing care

define and give examples of risk perception

we make choices regarding our health/well-being based on our beliefs of what is most likely to happen ex) a person does not get a flu shot and they do not flu therefor they won't get the flu ever ex) if I don't quit smoking, I'll get cancer OR oh it won't happen to me

Nursing focuses on _____________

wellness

Holism: from Greek "holos" meaning ___________

whole

Levels of Prevention: Tertiary Prevention

Dx of chronic disease Ex) rehab facilities, long term care facilities GOAL: minimize complications & maximize function

Role of Nurse

-Education -Advocacy -Holistic -Case mgmt

CAM definition

Complementary and Alternative Medicine

The nurse is caring for a client 4 days after total hip arthroplasty and notes the client has lost weight. The unlicensed assistive personnel reports the client's food intake has decreased. Which question will the nurse ask the client to determine if cultural causes are responsible for the weight loss? "Is there something wrong with the food?" "Would you like to speak with a nutritionist?" "What type of food do you like to eat at home?" "Can you ask your family to bring you something you like?"

"What type of food do you like to eat at home?"

Community Based Nursing Theorists: Sister Callista ROY

-Adaptation Model -Looks at whole person -Pts are treated as complex beings -Framework for nursing practice/research

Role of Home Health (CHRIF)

-Community resources: identify resources that people needing assistance at home can use -Home environment: safety, cleanliness, mobility, personal space -Risk: impaired ability to manage a home -Individual: can they do ADL independently? -Family: ability of family members to provide care

Discharge Planning: Elements for Nurse

-Coordination/collaboration -Facilitation: eliminate problems/barriers -Negotiation: pt, nurse, and family create goals

Levels of Healthcare: Primary

Before there is an actual illness High population needs ex) health promotion, immunization, early detection

A nurse is conducting a cultural assessment of a client. Which person would the nurse identify as the expert? Older family member Client Nurse Health care provider

Client

Key Concepts of Leininger's Theory

Culture Care Diversity Universality Worldview Ethnohistory Sunrise Model

Upon moving to another country, a college student is very confused by many local customs. He is especially bothered by the custom of men and women eating in separate areas and it makes him angry and resentful of the new culture. What are the feelings experienced by this student? Culture shock Stereotyping Ethnocentrism Cultural assimilation

Culture shock

A client's spouse has asked that the client be cared for exclusively by female nurses. How should the nurse incorporate this request into the care plan? Document the request and make all reasonable efforts to honor it Assess the couple's rationale for making the request Determine whether the request is based on a valid reason or cultural preference Document the request as a knowledge deficit and address the couple's educational needs

Document the request and make all reasonable efforts to honor it

Cultural Competence Model

Dr. Josefina Campinha-BACOTE -all encounters are cultural encounters 5 interrelated constructs: cultural (1) desire (2) awareness (3) knowledge (4) skill (5) encounters

A nurse is caring for an older adult. How does the nurse demonstrate awareness of culturally competent care? Maintaining eye contact at all times Trying to speak louder than usual Using touch when communicating Establishing effective communication

Establishing effective communication

Theorists for Health Promotion/Disease: Prince Edward Island Model

GOAL: encourage patients to act on their own behalf nurse-patient partnership--pt participates in healthcare--sociocultural environment and determinants of health influence health

Health v. Wellness

Health - focuses on LIFESTYLE CHOICES to prevent illness Wellness - evolving process of achieving full potential; active state of being healthy

In which way can nurses develop cultural self-awareness? Ask peers and colleagues about practicing cultural competence. Objectively examine one's own beliefs, values, and practices. Realize nothing can be done to change one's values and beliefs. Assert to others that personal biases cannot be changed.

Objectively examine one's own beliefs, values, and practices.

Levels of Healthcare: Tertiary

Ongoing/long-term care High population needs ex) rehab, long-term care, hospice

Integrative Healthcare

Partnership with pt with focus on health promotion and disease prevention Principles: -Holistic -Therapeutic relationship -Focus on healing/curing

Discharge Planning: Elements for Patient

Patient: -Goal setting -Transition: moving around & increase self-concept -Continuity of Care: home health nurse visit within 24 hours or provider's office contacting pharmacy

Which statement best conveys the relationship between race and ethnicity? Race denotes physical characteristics, while ethnicity is rooted in a common heritage. Race and ethnicity can be considered to be synonymous in the context of health care. Race and ethnicity are both culturally determined concepts. Race is based on an individual's cultural history and is independent of ethnicity.

Race denotes physical characteristics, while ethnicity is rooted in a common heritage.

Which behaviors demonstrated by the client would the nurse consider reflections of the client's pride in ethnicity? Select all that apply. Requesting native cuisine Listening to folk music and dance Asking to wear unique clothing Crying when given a diagnosis of cancer Requesting assistance when transferring from bed to chair

Requesting native cuisine Listening to folk music and dance Asking to wear unique clothing

The nurse overhears a colleague state, "All people from that client's country are rude." What is the appropriate nursing response? Say nothing and ignore the comment. Agree and state, "Yes, I've noticed the same thing." Report the colleague to the nurse manager. Respond by saying, "Stereotypes keep us from accepting others as unique individuals."

Respond by saying, "Stereotypes keep us from accepting others as unique individuals."

Theorists for Health Promotion/Disease: Martha Rodgers

Science of Unitary Human Beings -humans & environments evolve, change, and move ahead together

A nurse overhears another nurse make a statement that indicates racism. The nurse makes this determination based on which characteristic indicative of social value? Skin color Size Language Dress

Skin color

A group of nursing students is reviewing information about culture and its links to a wide variety of unique behaviors and events. The group demonstrates understanding of this concept when it identifies which behavior as culturally linked to autopsy for Western nurses? The cause of death can be discovered. Rebirth is made impossible. The body ultimately decomposes into dust. The continuation of society is prevented.

The cause of death can be discovered.

The nurse is caring for several clients of different cultures. Which client situation would the nurse recognize as the client with highest risk of culture shock? The client from Ethiopia states, "All these machines attached to me scare me and I need to get them off." The client from Mexico states, " I am having difficulty reading these pamphlets you gave me." The client from France states, "I miss my family back home." The client from England states, "I do not understand what all these new medications are for."

The client from Ethiopia states, "All these machines attached to me scare me and I need to get them off."

An older adult client from a minority culture refuses to eat at the nursing home, stating, "I just do not like the food here." What factor should the staff assess for this problem? The client does not like to eat with other residents of the home. The client is using this as a means of going home. The food served may not be culturally appropriate. The food served may violate religious beliefs.

The food served may not be culturally appropriate.

The nurse is using an interpreter to communicate with a client who speaks a different language. What would be the best way to choose an interpreter for this client? The interpreter should speak in a loud voice. The interpreter should conduct the conversation quickly to avoid misinterpretation. The interpreter should understand the health care system. The interpreter should always make direct eye contact.

The interpreter should understand the health care system.

Describe the Wellness-Illness Continuum

Worsening of health (negative) >NEUTRAL< (no s/s) High levels of wellness (positive)

An older adult client who only speaks a different language than hospital staff has been admitted to the emergency department after suffering a fall and suspected hip fracture in the home. Who is the best person to perform translation services for the client? a hospital translator a family member a trusted friend a bilingual hospital employee

a hospital translator

bullying

a more serious form of incivility. (verbal abuse is the most common)

health models: Clinical Model

absence of signs and symptoms of disease or injury illness "happens" to a person

Subculture

an ethnic, regional, economic, or social group exhibiting characteristic patterns of behavior sufficient to distinguish it from others

Universality

commonalities in the ways that cultures share the perceptions, knowledge, and practices related to health and nursing care

Health

complete physical, mental, and social well-being, and not merely the absence of disease or infirmity

Culture

controls behavior in deep and persistent ways, many of which may be outside the awareness of the individual determines what a person believes to be right or true about the world (according to nurse anthropologists

Cultural Desire

desire to wanting to become culturally competent

the opposite of health is ____________

disease

health models: Health Belief Model

relationship between a person's beliefs and actions influencing factors: -personal expectations -earlier experiences with health/illness -sociocultural context -age and developmental state largely based on risk perception

The community health nurse is assessing a home-bound client. The client expresses their own past-oriented ancestral heritage and family rituals. The nurse recognizes that the client is expressing: ethnocentrism. assimilation. a subculture. ethnic identity.

ethnic identity.

Persistent gaps between the health status of minorities and non-minorities are defined as: racism. ethnocentrism. health disparities. cultural relativity.

health disparities.

Health Promotion Model

identifying risks & health strengths help determine how pt. can increase quality of life

Cultural Assessment Tools: Purpose

make an accurate assessment while minimizing nurse bias and ethnocentric tendencies and maximizing sensitivity

Cultural Assessment Tools: Ethnographic Interview

nurse asks open ended questions; from pt response, nurse asks for clarification. nurse documents.

Cultural Assessment Tools: Explanatory Model

nurse asks questions to understand a pt's beliefs or explanation of condition

Levels of Healthcare: Secondary

once a health issue has arisen Nursing is concentrated here ex) emergency care, critical care, diagnosis/treatment

Civility

polite, reasonable, and respectful behavior

Stereotype

preconceived and untested beliefs about people; usually stems from mass media depictions, folklore, etc. ex) male pts don't show pain, elderly patients get confused easily

Levels of Prevention: Primary Prevention

preventing disease ex) immunization and nutritional education

Cultural Knowledge

process by which the nurse seeks and obtains a sound educational base about culturally diverse groups

Cultural Awareness

process of conducting a self-examination of one's own biases towards other cultures

Cultural Encounters

process which encourages healthcare professionals to engage in face-to-face cultural interactions and other types of encounters w/ pts to form culturally diverse backgrounds in order to modify existing beliefs about a cultural group to prevent possible stereotyping