NU270 PrepU: Diversity (week 10)
A nurse is working in a clinic that serves a community with a high population of immigrants. Which nursing assessment is the priority?
Language assessment - Although all of the assessments are appropriate, the priority assessment is communication. If clients do not speak the dominant language, it may be necessary to obtain an interpreter to provide culturally appropriate care.
The nurse is teaching about sources of calcium for a client newly diagnosed with lactose intolerance. The client would require further teaching if which food is chosen?
yogurt - Clients who are lactose intolerant have a lack of the digestive enzyme lactase, which is needed to convert lactose into simple sugar. Lactose is found in dairy products. The client should be instructed on non-lactose foods that contain calcium. Green leafy vegetables are low glycemic carbohydrates. Prunes are fruits, and egg yolks are proteins. All three foods are acceptable for the client's diet.
A nurse who usually works on the surgical unit is asked to float to the oncology unit because of staffing needs. Which statement by the nurse indicates the possibility of the nurse experiencing culture shock?
"I am very stressed now because I do not understand how things work on this unit." - The nurse is experiencing culture shock because of the new environment. When the culture one has learned differs from the culture in one's environment, a person can become disoriented and stressed. The acute experience of not comprehending the culture of the current environment is called culture shock. Asking for an orientation to a new unit is proper procedure for a float nurse. The third statement indicates ethnocentrism, not culture shock. The fourth statement indicates stereotyping.
The nurse just attended a seminar on cultural diversity. Which statement by the nurse would require further education?
"Ethnicity and race are the same thing and are affected by cultural practice." - People are often born into an ethnic group, or ethnicity develops by immersion in a community. People of the same ethnicity often speak similar dialects and share similar values. Ethnicity and race are terms used interchangeably; however, they are not the same thing. Race refers specifically to physical characteristics.
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?
"Italians are best at everything." - Ethnocentrism is the belief that one's cultural is better than other cultures. Therefore, the statement "Italians are the best at everything" demonstrates ethnocentrism. The other options are examples of stereotyping. Stereotyping is a fixed attitude about people who share common characteristics.
Which questions should the nurse include in a cultural assessment? Select all that apply.
"What do you think is causing your illness?", "What religion do you belong to?", "What do you do to promote good health?", "Do have a particular name for this illness?" - Transcultural assessment encompasses a number of considerations surrounding illness, such as causation, naming, prevention, and health promotion. In addition, it is significant and appropriate to ask what religion or religious group a client identifies with. However, it is likely unnecessary and possibly inappropriate to elicit the client's views of those who belong to other religious groups.
A client has been admitted to the unit for chest pain. A nurse told the family that they could not be with the client. The family became very upset, and now the client wants to leave. What is the most culturally appropriate response by the charge nurse?
"Would you feel more comfortable with your family with you?" - Some cultures are very family oriented; others may have members who are skeptical of modern health care. The request for the client's family to leave most likely frightened the client. Asking the client how to make the client more comfortable is the best option. Asking the client why the client wants to leave is judgmental, implying there is no real reason to leave. Citing the hospital's policy regarding clients who leave against medical advice is not culturally sensitive and does not address the client's concerns. Clearly in this client's case, having the family present reduces, not causes, stress, so the comment about maintaining a stress-free environment is not valid.
What is the priority assessment for the nurse when developing a plan of care for a client from a poverty culture?
Access to care - Poverty has long been a barrier to adequate health care. If clients cannot access health care, it does not matter if they have affordable housing, health insurance, or the need for financial assistance. It is not possible to create a plan of care with client involvement without adequate support and access to care.
What is the priority assessment for the nurse when developing a plan of care for a client from a poverty culture?
Access to care - Poverty has long been a barrier to adequate health care. If clients cannot access health care, it does not matter if they have affordable housing, health insurance, or the need for financial assistance. It is not possible to create a plan of care with client involvement without adequate support and access to care.
Which behavior by the nurse demonstrates cultural blindness?
Administering antibiotics to a child whose parents do not believe in Western medicine - Cultural blindness occurs when one ignores differences and proceeds as though they do no exist. Administering antibiotics to a child when the parents do not believe in Western medicine is an example of cultural blindness. Convincing a client that Western medicine is most effective is cultural imposition. Dismissing acupuncture as ridiculous is inappropriate and an example of cultural conflict. Administering pain medication when a client shows nonverbal pain indicators is not an example of cultural blindness.
When talking with a client, the nurse notes that the client keeps backing up. What would be the most appropriate response?
Ask the client about personal space preferences. - It is most appropriate to ask the client what is preferred in regard to personal space. If the nurse needs to invade the client's personal space to do an examination or take vital signs, it is important to discuss the matter. It is not appropriate to back away without assessing preference. It may make the client feel judged if the nurse asks why he or she is backing away. Moving closer to the client just perpetuates the problem.
A nurse is providing care to a client from a culture different from the nurse's own. The nurse is having difficulty relating to the client. What intervention by the nurse is most appropriate?
Ask the client how the client wants to be treated based on the client's values and beliefs. - The best way to provide culturally appropriate care is to ask the client what the client values and believes and how the client would like to be treated. Asking another nurse to take over care will not help identify the cultural care needs. Researching the client's culture online and consulting the Minority Health Resource Center may be helpful as a learning experience later, but they do not help immediately in the provision of care. Also, remember that information about any culture is general and must be individualized.
Which scenario is an example of cultural competence in nursing?
Attending a conference for cultural diversity - Cultural competence can be shown by actively learning about culture through attending a conference. Assessing the rate at which an illness leads to death does not develop cultural competence. One's own church is a familiar culture, and attending it does not breed cultural expansion or competence. The provider should never assume that beliefs or values are shared.
A client believes that the illness is caused by an imbalance of yin and yang. The nurse states, "You can call it whatever you believe, but you have a metabolic disorder." What is this nurse demonstrating?
Cultural blindness - The nurse is demonstrating cultural blindness, which occurs when one ignores differences and proceeds as though they do not exist.
The nurse is caring for the teenage child of immigrants. The teenager voices distress because after living in the country for several years, he no longer wants to participate in some of the tradition religious rituals that are important to his parents. What is the teenager experiencing?
Cultural change - The teenager is experiencing cultural change. This often occurs when a person changes upon coming into contact with new beliefs and ideas. Culture shock is a stress response that involves being unable to comprehend the culture that one is immersed in. Viewing one's own culture as the only correct standard by which to view people of other cultures is ethnocentrism. Cultural relativity refers to an understanding that cultures relate differently to the same given situations.
The client is admitted to the hospital with a ruptured ovarian cyst. The client has expressed that it is very important that the spouse be present to receive all medical information. Using the concepts of culturally competent care, which is the best response?
Document the client's request in the nursing care plan. - A culturally sensitive nurse is one who respects a client's requests while ensuring that the requests reflect safe medical practice. This client's request does not interfere with client safety. Thus, the request should be respected and communicated through documentation to other healthcare personnel. Telling the client that the client must make all health care decisions does not address the client's request. There is no need to move to the hallway to discuss the client's care with the client's spouse, and this would likely be offensive.
A client tells the nurse that the only thing that helps the client sleep is a glass of warm milk. The nurse caring for the client insists that this cultural practice is a myth and tries to convince the client that reading a book would be better. What is the nurse demonstrating?
Ethnocentrism - Sometimes healthcare providers assume that their cultural belief (whether of the healthcare culture of or their own personal culture) is better than their clients' cultural beliefs. This is a form of ethnocentrism. Cultural pervasiveness refers to learning a set of behaviors within a particular culture. Culture shock is the feelings a person experiences when placed in a different culture. Stereotyping refers to preconceived and untested beliefs about people.
Which nursing intervention reflects practice according to Madeline Leininger's transcultural nursing theory?
Incorporating the client's request for complementary treatment therapy - Leininger's theory of transcultural nursing includes assessing a cultural nature, accepting each client as an individual, having knowledge of health problems that affect particular cultural groups, and planning of care within the client's health belief system to achieve the best health outcomes. Therefore, incorporating the client's request for complementary treatment therapy is an example of this theory. The others do not support this theory.
The nurse is caring for a client who perceives time differently. What action should the nurse take for this client?
Maintain flexibility when the client requests interventions at specific times. - People view time differently. Social time can reflect attitudes regarding punctuality that vary among cultures. The nurse should maintain a flexible attitude and adapt the time of interventions to the client's needs and requests. It is not realistic to have the client set all the times for the interventions or to have the interventions at a specific time or interventions at random times during the shift.
Which stereotypical ideas about older adult clients does the nurse associate with the concept of ageism? Select all that apply.
Physically impaired, Burdensome to family, Uninterested in intimacy - Ageism, a form of negative stereotypical thinking about older adults, promotes false beliefs about older adults being physically and cognitively impaired, lacking interest in sex, and being burdensome to families and society. Ageism is not associated with concepts of cognitive enhancement or financial independence.
The nurse is caring for a client admitted with an upper respiratory infection. The client tells the nurse about following the holistic belief of hot/cold. Which food items should the nurse provide to the client based on this information?
Soup, hot tea, and toast - The client believes in the hot/cold theory of disease, so the client needs to treat cold diseases with hot food and hot diseases with cold food. The most appropriate choice would be the soup, hot tea, and toast. The other options are all cold foods, which the client would not use to treat a cold disease such as an upper respiratory infection.
A newly hired young nurse overheard the charge nurse talking with an older nurse on the unit. The charge nurse said, "All these young nurses think they can come in late and leave early." What cultural factor can the new nurse assess from this conversation?
Stereotyping - The charge nurse is clearly exhibiting ageism, which is a form of stereotyping. Cultural assimilation is when one begins to assume some characteristics of a culture outside of one's own. Cultural blindness occurs when cultural differences are ignored. Cultural imposition occurs when one pushes one's cultural beliefs onto another person.
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." - Culture shock occurs when a person is immersed in an environment different from the one the person is accustomed to, resulting in rapid disorientation and distress. The client stating the machines scare him is experiencing culture shock. Difficulty reading a different language, missing absent family, and not understanding the purpose of medications are not indicative of culture shock.
The home health nurse is conducting a health history interview with a client that immigrated 3 months ago. What action observed by the nurse would indicate that the client is adapting to the majority culture?
The client reads books in the language of the new country. - The client who is adapting to the majority culture will take on characteristics or behaviors of the new culture. The client who immigrated and who is reading books in the language of the new country is trying to adapt to the majority culture. Preference to watch television in the native language, living in a neighborhood with immigrants from the native country, and preparing traditional meals from the native country are continuance of preferred cultural background and not adaptation.
What are characteristics of nurses that make them a subculture? Select all that apply.
Uniforms worn based on place of employment, Language or medical terminology used to communicate, Legal authorization to provide health care to others - The dominant culture of nurses is that of the middle-class group. Work ethic and importance of time are values of this group. Dress, terminology, and legal authority belong to the nursing subculture.
An older adult client who only speaks the nondominant language 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 qualified interpreter who is familiar with health care terminology is the best choice for providing translation for clients. Such a person is more likely to be objective and well versed in the requisite vocabulary than is a friend, family member, or hospital employee.
The nurse is taking a client history. With which client is direct eye contact appropriate?
32-year-old white woman - White Westerners generally make and maintain eye contact throughout communication. Although it may be natural for whites to look directly at a person while speaking, that is not always true of people from other cultures. It may offend clients of Asian descent or Native Americans/First Nations clients, who are likely to believe that lingering eye contact is an invasion of privacy or a sign of disrespect. Clients with Arab heritage may misinterpret direct eye contact as sexually suggestive.
A nurse is providing care to a client who has limited understanding of the dominant language. Which strategy is best for the nurse to use to ensure that the client obtains the needed health information?
Enlist the services of a qualified language interpreter - Hospitals are required to provide qualified language interpreters for the client who does not speak or understand the predominant language of the community. Obtaining qualified interpreters rather than bilingual members of the client's family or friends, however well-intentioned or convenient the latter might be, is important because interpretation of behavior goes beyond translation of words. Much medical vocabulary and terminology is difficult to translate into other languages, and another nurse who speaks the language or a laboratory aide from the same country as the client would not be trained to interpret.
In addressing health promotion for a client who is a member of another culture, the nurse should be guided by which principle?
The client may have a very different understanding of health promotion. - As a component of cultural assessment, the nurse should seek to understand the cultural lens through which the client may understand health promotion. Health promotion is not a concept exclusive to Western cultures, though it may be considered differently among non-Western cultures. Even if health promotion is not a priority in a client's culture, the nurse should still address issues related to health promotion in a respectful and relevant manner. Health promotion is not directly linked to socioeconomic development levels.
A nurse convinces a client who is a Jehovah's Witness that receiving blood products is more important than the legalistic components of religion. What client reaction may be expected following this mandated change?
The client states, "I feel like I abandoned my religion." - When clients are forced to participate in care that conflicts with their values, feelings of guilt and abandonment are likely. These feelings may deepen and threaten the client's well-being. The other answer choices are not related to mandated change.
A nurse is assigned to care for a client who does not speak the dominant language. An interpreter has been contacted and will be at the bedside shortly. Which action by the nurse would be most effective in reassuring the client until the interpreter arrives?
Using reassuring body language and making eye contact to assess needs - The nurse assigned to care for a client who does not speak the dominant language can reassure the client by using appropriate body language and anticipating needs until an interpreter arrives. Doing so is important because there may be a delay in the interpreter arriving. Gestures and symbols can be confusing, as can enlisting multiple people to communicate. Avoiding the client's room is not appropriate or in the best interest of the client.
A nurse is caring for a client with bacterial pneumonia and a temperature of 104°F (40.0°C). Yesterday, the client's temperature was 102°F (38.9°C). The health care provider on call prescribes cool compresses for the client to help lower the fever. The client insists that the nurse bring warm blankets because they will help the client to recover more quickly. The nurse recognizes that the client's request is an example of:
cultural ritual. - Clients and families often express rituals, or practices habitually repeated in certain contexts, during times of stress, such as during an acute hospitalization. Keeping the body covered and warm is a home remedy used by many cultures to help heal the body. As in this example, cultural rituals may conflict with Western medical beliefs. Cultural competence is an approach to health care in which one is aware of one's one cultural beliefs and biases and understands the effects that a client's culture has on the client's health care. Stereotyping involves applying a preconceived and untested generalization to a whole group of people. Ethnocentrism is the belief that one's culture is superior to another.
