Concepts 8 & 9: CULTURE AND DIVERSITY
Compare and contrast the diverse needs of vulnerable population.
Vulnerability may come from many sources, including financial circumstances, place of residence, education, age, functional or developmental status, inability to communicate effectively, chronic or terminal illness or disability, personal characteristics, sexual preferences, immigration status, or oppression
ageism
a deep and profound prejudice in American society against older adults
healthcare disparity
a difference in measurement of access to or quality of healthcare services between and individual or group possessing a defined characteristic when other variables have been controlled, such as individual health choices, disease courses, and other variations from the normative measure
social justice
a framework in which to explore the complexities surrounding the variety of factors that impact diverse and vulnerable populations
prejudice
a negative belief or preference that o generalized about a group that lead to prejudgement
religion
a set of doctrines accepted by a group of people who gather together regularly to worship that offers a means to relate to God or a higher power; an organized system of beliefs and practices
alternative therapies
a term used to describe used of these diverse therapies instead of conventional therapies including acupuncture; cultural practices related to food preparation or practices at specific times of the day or during the week
How might a pediatrics' client development be impacted if his or her mother is homeless?
Homelessness and being raised in a culture of poverty can impact growth and development. Appropriate maturation depends in part on a sense of constancy, stability, and safety. When basic needs for food, shelter, and security are not met, the child cannot access the resources and energy necessary to gain mastery over developmental tasks
What does the "A" stand for in the LEARN model of cultural competence? a. Affirm b. Assert c. Acknowledge d. Accept
c. Acknowledge Acknowledge and discuss the differences and similarities between the perceptions of the client and that of the health care team. Assert, affirm, and accept are not steps in the LEARN model.
multiculturalism
characterized by many subcultures coexisting within a given society in which no one culture dominates
ethnic groups
group of individuals who have common racial characteristics and share a cultural heritage
minority
refers to an individual or group of individuals who are outside the dominant group
discrimination
the differential treatment of individuals or groups, based on categories such as race, weight, gender, or social class, that occurs when an individual acts on prejudice and denies other people one or more of their fundamental rights
bias
the favoring of a group or individual over another
subculture
used to label groups characterized by specific norms, beliefs and values that coexist or even oppose those of the dominant culture
Which group is diagnosed with AIDS at a rate that is more than ten times that of Caucasians? a. Hispanics b. African Americans c. Asian Americans d. Pacific Islanders
b. African Americans African Americans have a rate of AIDS infection that is ten times that of Caucasians. Hispanics have a rate three times the Caucasian rate of AIDS infection. Asian Americans and Pacific Islanders do not have higher rates of AIDS.
worldview
the way in which people in a culture perceive ideas and attitudes about the world, other people, and life in general
Chen Yong, a 23-year-old Chinese student, goes to the local Chinatown clinic when he hurts his leg playing soccer. He is told that the doctor is not available and he will have to return the following day for treatment. What health care disparity does this incident illustrate? a. Asians do not want to use Western medical services. b. Asians are unlikely to have health insurance. c. Asians prefer to use acupuncture and herbs for treatment. d. Asians have reported problems with receiving timely health care.
d. Asians have reported problems with receiving timely health care. Asians were 1.5 times as likely as Caucasians to report that they sometimes or never get care for illnesses or injury as soon as they wanted to. Although some Asians may select traditional Chinese medicine in certain situations, that is not a concern in this situation. Health care coverage is not the problem in Chen Yong's case.
stereotyping
the act of generalizing that all people in a group are the same
complementary therapies
any of the diverse array of practices, therapies, and supplements that are not considered part of conventional or traditional medicine that are used in addition to conventional treatments
assimilation
the process of adapting to and integrating characteristics of the dominant culture as one's own
acculturation
the process of adapting to the majority culture and accepting it as one's own
cultural humility
the recognition that a healthcare provider's personal cultural values are not superior over the cultural values of others, thus preventing an abuse of power
sexual orientation
the sexual attraction of an individual to the same sex, the opposite sex, or both sexes
transgender/transsexual
people who are born with typical male or female anatomies but feel as though they have been born into the "wrong body"
How might an adolescent's development be impacted by the realization that he or she is homosexual?
The adolescent could potentially experience impacted development in the form of facing cultural stigma against homosexuality
diversity
the unique variations among and between individuals, variations that are informed by genetics and cultural background, but that are refined by experience and personal choice
heterosexism
the view that heterosexuality is the only correct sexual orientation
cultural values
preferred ways of behaving or thinking that are sustained over time and used to govern a cultural group's actions and decisions
cultural groups
racial, ethnic, religious, or social groups with specific group behaviors and characteristics that are learned and shared, including language, customs, beliefs, and values
You are a nurse working in a children's rehabilitation center. A 6-year-old girls who is recovering from a car crash comes your center for an extended stay. She speaks a little English. Her family has recently moved here from China, and her parents speak very little English. Although they are grateful for the help they are receiving, they are very stressed about their daughter's situation 1. How might the nurse assess this family's values and beliefs in light of the family's inability to speak English? 2. How might involvement of an interpreter to facilitate communication impact the client and her family's values and beliefs? How can you overcome this problem? 3. how can you advocate for this client's values and beliefs while she is institutionalized? 4. The client's family wishes to pray at the child's bedside using candles, which are not allowed because of the risk for fire related to oxygen use. How can you advocate for this family while managing safety?
1. It would be essential for the nurse to access someone who is able to communicate with the client and their family in their native language. The nurse should either access a bilingual professional in the healthcare facility or through electronic or telephone language banks 2. There are several potential problems with using interpreters. Some, but not all interpreters have cross-cultural knowledge and can interpret both words and the meanings behind them. Meanings and context can be lost in interpretation. Interpreters must be careful to interpret only what each party is trying to convey and avoid introducing personal biases. The age or sex of the interpreter may be an issue. The addition of an interpreter can interfere with building rapport. Some of these issues can be addressed by ensuring that only professional interpreters are used, establishing clear role expectations, speaking directly to the client and family, and maintaining eye contact with both the client/family and the interpreter Linking the concept of culture and diversity with the concept of advocacy 3. Care within institutional settings should always be individualized to address each client's unique values and beliefs. Nurses can advocate for client-centered care in the context of treatment planning and assist to establish practices that are flexible enough to address these needs. As partners in care, nurses should encourage clients to participate in treatment decisions and assert their right to continue cultural and spiritual practices. One area of emphasis may be monitoring policies that may present barriers to culturally sensitive care, such as restrictive visitation policies. Activities should be tailored to meet the diverse needs of the populations served. Food services should be equipped to handle diverse preferences and needs. All patients should have access to pastoral services or other spiritual resources 4. The nurse could attempt to provide the family with battery-operated candles or lights that simulate candles
Discuss how cultural and religious preferences may impact an individual's lifestyle and healthcare choices.
A cultural belief system influences an individual's decisions and actions in society regarding everything from preparing food and caring for the sick to rituals of death and burial
vulnerable populations
social groups with inadequate access to health care because they lack resources and are exposed to more risk factors
cultural competence
the ability to apply the knowledge and skills needed to provide high-quality, evidence-based care to clients of diverse backgrounds and beliefs to overcome barriers and access resources promoting health and wellness
homophobia
the fear, hatred, or mistrust of gays and lesbians often expressed in overt displays of discrimination
classism
the oppressing of groups of people based on their socioeconomic status
racism
the oppression of a group of people based on their perceived race
culture
the patterns of behavior and thinking that people living in social groups learn, develop, and share
enculturation
the process by which children learn culture from adults. also called cultural transmission
sexism
when male values, beliefs, or activities are preferred over female ones
The nurse observes the client in prayer with family members. Which cultural phenomenon would the nurse recognize is occurring? a. Time orientation b. Personal space c. Environmental control d. Social organization
d. Social organization Religious beliefs are part of what may identify the social organization of the culture of a family unit. Although the family members might be close to each other, focus is not on personal space, which refers to the comfortable or appropriate distance for interaction with other people. Time orientation differs among cultures, with some putting more value on the past and present; Anglo-American culture places more emphasis on the future However, the focus during this client's prayer is not on time. The family is displaying social organization and not controlling the environment around them.
The nurse is using an interpreter to discuss the care plan with a client of another culture. What form of communication is the nurse using to communicate with the client? a. Eye contact b. Silence c. Touch d. Verbal
d. Verbal Rationale: Verbal communication is an important tool to use when exchanging information about the plan of care. Using an interpreter is an example of using appropriate verbal communication to ensure that the client understands the information. Silence, touch, and eye contact are forms of nonverbal communication.
Which are aspects of organizational governance that should reflect adherence to cultural competence standards? (Select all that apply.) a. Translation services b. Policies and procedures c. Mission statement d. Organizational practice implementation e. Staff training
b. Policies and procedures c. Mission statement d. Organizational practice implementation
Which is an accurate description of the term transsexual? a. Transsexuals demonstrate preferences toward one gender group over another. b. Transsexuals are individuals born with anatomical characteristics that do not seem to fit the typical definitions of female or male c. Transsexuals have negative feelings or behaviors toward gays or lesbians. d. Transsexuals are individuals who perceive themselves to be in the "wrong body"
d. Transsexuals are individuals who perceive themselves to be in the "wrong body" Transsexuals are individuals, of any anatomical gender who perceive themselves to be in the "wrong body" Intersex refers to individuals born with anatomical characteristics that do not seem to fit the typical definitions of female or male. Sexists demonstrate preferences toward one gender group over another. Homophobes have negative feelings or behaviors toward gays or lesbians.
race
a term used to describe socially defined populations that share genetically transmitted physical characteristics, such as skin color and bone structure
Describe how belief systems impact the provision of health care
Culturally based beliefs and traditions can affect the course and outcome of disease and illness. Healthcare providers and clients bring their respective cultural backgrounds and expectations to each interaction. These differences can impact both the expectations and practices of the client and the provision of services by nurses and other healthcare professionals. Cultural differences can present barriers to necessary care, such as: i. The importance, or lack of importance, for family members in managing illness and disease ii. Lack of trust in the healthcare system and providers iii. The belief that illnesses are not linked to scientific pathophysiology iv. Refusing to believe the mind-body connection v. Fear or denial of death or life after death vi. Cultural assumptions about disease and illness that may influence the presentation of symptoms or the response to treatments vii. Failure of clients to see a pattern of repeated illness as a chronic condition rather than their symptoms as unrelated occurrences viii. Cultural beliefs that discussing prognosis and risks with clients can influence outcomes or be dangerous
Which cultural phenomenon that affects health care is classified as an environmental control? a. Faith healing b. Personal boundaries c. Skin color d. Emphasis on the past
a. Faith healing Faith healing is an environmental control. Skin color is a biologic factor. Emphasis on the past is a time orientation. Personal boundaries are space factors.
What indicates to the nurse that the client who recently emigrated from India has experienced acculturation? a. The client attends a community center across town to make new friends. b. The client lives in a neighborhood that is predominantly Indian. c. The client shops at a grocery store owned by people from India. d. The client speaks very little English.
a. The client attends a community center across town to make new friends. Rationale: A person experiences acculturation when they begin to adapt or borrow habits of the new culture. The other behaviors are examples of a client who may feel comfortable only in the client's Indian culture.
A male nurse is caring for a female client from another culture. As the nurse enters the room, the client avoids eye contact and moves to the other side of room. The nurse's best response is to: a. Invite a male family member to be present during care. b. Ask a female nurse to perform care. c. Perform the care without acknowledging the client's behavior. d. Before touching the client, explain the procedures and ask permission to do them.
d. Before touching the client, explain the procedures and ask permission to do them. Rationale: The response showing the nurse is respecting the client's practices is one that shows a respect for the personal boundaries of the client. There is no need for a male family member to be present or for a female nurse to give care when performing noninvasive procedures. Ignoring a client's behavior and nonverbal communication is not therapeutic.
Which are examples of nonverbal communication? (Select all that apply.) a. Sitting forward in a chair b. Crossed arms c. Yelling d. Lack of eye contact e. Blushing
a. Sitting forward in a chair b. Crossed arms d. Lack of eye contact e. Blushing
Henry Lee is approximately 55 years old. Born in China, he has been living in the United States for the last 10 years, working as a professor at a local university. Following surgery for a broken arm, he refuses pain medication, explaining that his discomfort is bearable and he can survive without medication. When you check on him, you find him restless and uncomfortable. You have a standing order to administer medication as needed, and again offer to administer medication. Mr. Lee again refuses, saying that your other responsibilities are more important than his discomfort and he does not want to impose 1. What do you think is behind Mr. Lee's refusal to accept medication? 2. What can you do or say to change Mr. Lee's perception of the situation? 3. What additional information might influence your nursing care?
1. Mr. Lee's cultural beliefs may be influencing his choice to refuse pain medicine. Mind, body, spirit and emotions are never separated according to traditional Chinese medical beliefs 2. The nurse may discuss alternative therapies that may be acceptable to Mr. Lee's beliefs such as acupuncture, acupressure, massage, heat therapies, qugone and tai chi. Also reassure Mr. Lee that the Nurse is responsible for his care and pain management and is a priority for the nurse 3. Ask Mr. Lee if he is taking any Herbal Medications or treatment prior to admission or while hospitalized. How Mr. Lee normally treats pain? It would be important to get Mr. Lee to rate his pain on a scale 0-10 and set a pain goal with Mr. Lee.
Mrs Rivera, a 79-year-old woman of Mexican heritage, is admitted to a long-term care facility. Neither she nor her immediate family members peak, write, read, or understand English. She has been a lifelong member of an Orthodox Catholic Church and will not allow staff to help her undress. She tells a translator she is very modest and does not want the nursing staff to examine her under her clothing. When asked about advanced directives, living wills, or medical power of attorney, both the client and the family inform the staff "that is none of your business" 1. What client teaching will the nurse provide through the use of a medical interpreter? 2. How can the nurse advocate for Mrs. Rivera's diversity requirements while maintaining facility policy and meeting the client's healthcare needs? 3. What nursing diagnosis and interventions would be appropriate for Mrs. Rivera's plan of care?
1. The nurse can provide teaching through the medical interpreter about the nature and purpose of advance directives, living wills, and medical power of attorney, emphasizing that their purpose is to ensure that the client's wishes are carried out in accordance with her beliefs and values. Teaching may also focus on boundaries and privacy maintained in the healthcare setting and the purpose of collecting information. Teaching can also focus on way to maintain the client's privacy and modesty while assisting her to dress, such as keeping her covered, using drapes, or trying to assign female healthcare workers if available 2. The nurse can advocate for Mrs. Rivera's right to exercise full participation in her healthcare and to make choices that are consistent with her beliefs. The nurse can ensure that all persons caring for Mrs. Rivera are aware of her modesty needs, that female healthcare workers are assigned to her, and that extra care is taken to drape and cover her or carry out as many self-care activities privately as she desires. The nurse can also elicit other needs and preferences related to care and ensure that these are incorporated into a plank of care 3. Anxiety related to perceive threats to value/belief systems: • Reassure the client that values and beliefs will be integrated into her care • Have the client list needs and preferences and discuss ways that healthcare members can accommodate those needs Powerlessness related to transition to long-term care setting: • Acknowledge the client's concerns about losing control • Encourage the client's participation in treatment decisions • Allow the client to carry out activities independently • Facilitate access to rituals and routines that are consistent with the client's
The Harper model is an evidence-based model of ethical multiculturalism developed and presented at the 34th Annual Transcultural Nursing Society Conference. This model includes key attributes of cultural competence and the relationship to a continuum of ethical philosophies. Dr. Harper has said, "Cultural competence occurs on a continuum. Even when you believe you are competent, you can always learn more!" 1. How do beneficence and nonmaleficence relate to the concept of cultural competence? 2. Where on Harper's continuum do you think most nurses are? Most student nurses? What would help you become more culturally competent?
1. The nurse should be culturally competent in relation to the client's treatment, providing beneficial care that is ethically sound. Nonmaleficence may come into play when a nurse avoids certain actions in order to stay within the client's cultural beliefs 2. Most nurses should be culturally competent through their knowledge of ethics and experience with culture. Student nurses would not have as much experience. To become more culturally competent, I would need to familiarize myself with diverse cultures and expectations from health care providers as well as how to address situations where culture may interfere with patient treatment
Susan Moore is a 16-year-old who comes to a local family practice clinic for a first time appointment complaining of painful, irregular, and heavy menstrual periods. Her mother with her to the clinic visit. Susan's assessment is notable for her lack of participation in regular medical care. Her parents homeschool Susan and her sisters, and her mother tells you that they hardly see a physician. Following a thorough nursing assessment and physical examination, the family nurse practitioner diagnoses Susan with endometriosis and recommends hormonal contraceptives. Susan's mother is adamant that Susan not take any medication, saying they believe in using only "natural" therapies and do not use prescription drugs. Susan begins to cry, complaining of how much pain she is in constantly, and she pleads with her mother to let her try the medication 1. What are the priorities for care for Susan based on the information presented here? 2. How can you show cultural sensitivity to Susan and her mother and promote evidence-based care? 3. Using therapeutic communication, what could you say to do or affect Susan's mother's decision regarding her daughter's treatment?
1. The priority is to assist the client to effectively manage her condition. Other priorities may be to establish a trusting relationship with both Susan and her mother in order to establish participation in regular health care 2. The nurse can validate both the client's and the client's mother's concerns while presenting factual information necessary to consider all treatment options 3. The nurse could explore further with Susan's mother what specific concerns are related to using prescription medications. Values and beliefs may be based on people's experiences with the world. By better understanding the nature and origin of the mother's beliefs, the nurse can formulate a culturally appropriate plan of care. For example, if the mother's beliefs were influenced by a lack of knowledge about the safety and efficacy of prescription medications, the nurse may be able to provide the information necessary to address these concerns and influence the mother's decision related to treatment
An Arab couple has come to a local clinic because the An Arab couple has come to a local clinic because the wife, who is 6 months pregnant, is not feeling well. The husband speaks English fluently, but the wife's proficiency in English is more limited. Both are dressed in American-style clothes. During the assessment, the registered nurse, Clea Smith, determines that the couple has a 9-month-old and a 2-year-old at home. Mrs. Smith also learns that the husband is the head of the household, making most of the major decisions for the family, and that the wife has sole responsibility for the family's care and daily living needs. The wife presents with exhausting and elevated blood pressure. After obtaining a urine specimen, the physician diagnoses toxemia and order the wife to be on strict bed rest and to return in 2 weeks. While the husband conveys concern for his wife's health, he is reluctant to have her treatment disrupt the household routine 1. What are the priorities of care for the wife? 2. What additional information would you like to collect about this family? 3. Using either the ASKED or LEARN model, describe how the nurse working with this family could understand and address this situation and the physician's recommendations with both the husband and wife
1. The priority of care is safely managing the wife's hypertension and ensuring that resources are in place to facilitate adherence to treatment 2. Additional information would be availability of resources (family or friends who could assist with managing household responsibilities) and the couple's understanding of the implications of not following through with bed rest - both for the wife's immediate health and longer-term family function. Although the husband is concerned about the wife's health, he may be balancing the needs of the entire family, not understanding how serious his wife's condition is and what the consequences are of not following through with the recommended treatment 3. The nurse could apply the LEARN model, ensuring first that both the husband and the wife, through an interpreter, had an opportunity to express all of their feelings and concerns, by: (L) Listening attentively and empathizing with their needs. (E) The nurse would Elicit any other culturally relevant information, such as who shares the concern about disruption of family role function, what other cultural implications of the prescribed treatment may be, and then the nurse would Explain her perception of the problem. "I understand that in your culture it is important for your wife to maintain responsibility for managing the household. The health team's concern is that without bed rest your wife may be at risk for serious complications..." (A) The nurse would Acknowledge the family's strengths. "We can see that your family means a great deal to you..." (R) The nurse would then Recommend alternatives while respecting the decisions of the husband and the wife. "There may be someone in your family who is willing to help out" or "There may be home health services that would carry out household duties under your wife's direction." (N) Finally the nurse would Negotiate alternative. The nurse would talk about the benefits of adhering to bed rest for the wife, the baby, and the future integrity of the family. The nurse would also explain the possible consequences of not following through with bed rest. The nurse would help the husband and wife make decisions about treatment as appropriate. "Perhaps we could address your wife's and your family's needs by making a referral to a home health agency that is familiar with your (values, beliefs, culture) ..."
14. Which statement would be the most effective way to approach a family from another culture regarding the nutritional needs of their children? a. " I would like to teach you about the nutritional requirements of your children." b. "We are going to be changing your family's eating habits to improve the health of your children." c. "Here is the diet plan your children should be on." d. "Your children are overweight and need more exercise." Rationale: The best way to overcome racial and ethnic disparities in healthcare and well-being is through education. The other statements challenge the family's values, without offering education or allowing for family input. Such strategies have a low chance of success.
14. Which statement would be the most effective way to approach a family from another culture regarding the nutritional needs of their children? a. " I would like to teach you about the nutritional requirements of your children." b. "We are going to be changing your family's eating habits to improve the health of your children." c. "Here is the diet plan your children should be on." d. "Your children are overweight and need more exercise." Rationale: The best way to overcome racial and ethnic disparities in healthcare and well-being is through education. The other statements challenge the family's values, without offering education or allowing for family input. Such strategies have a low chance of success.
Describe how culture values and beliefs are learned or transmitted.
Culture is transmitted by people living together in society; it is transmitted from one generation to the next through language, material objects, rituals, customs, institutions and art. An individual learns culture from other people in society. Enculturation occurs in families until the children are ready to leave and establish their own values, beliefs, and practices through exposure to other cultural or societal practices through work, marriage, or higher education. However, enculturation may continue among family members who live close to each other, celebrate religious holidays together, or otherwise work to maintain the culture within their family and limit their exposure to cultural differences. Cultural behaviors are learned by: i. Observing other's actions ii. Hearing instructions on what behaviors are right or wrong iii. Imitating others doing a behavior iv. Getting reinforced (either positive or negative) for enacting a behavior v. Internalizing behaviors vi. Spontaneously doing the behaviors without thinking about it
Distinguish variations of social behaviors found in diverse groups.
Some common social behavior variations among people of different cultures involve communication, environment control, hygiene, space, time, and social organization i. Environmental control: is the ability to attempt to control nature or environmental factors. The use of folk healers, specific healing traditions, and practices are attempts to intervene in a complex environment. ii. Biologic variations: include any genetic and physical differences among multicultural groups. Examples include skin color, nutritional habits, body build, susceptibility to certain diseases, and variations in metabolizing psychoactive medications. iii. Social organization: includes the type of family unit, such as an extended or nuclear family. It also includes types of social organizations, such as religious or multicultural, which help to shape the identity of a culturally diverse group or client. iv. Personal space: Different cultures have different definitions of personal space. v. There are likely to be variations among appropriate distances in social or public settings as well as intimate settings. Many people have a personal boundary or space which produces anxiety when crossed. vi. Time orientation: Different cultural groups value different aspects of time. The past and present might be more valued by nondominant cultural groups, although the dominant Anglo-American culture of the United States places more emphasis on the future.
intersex
a general term used to describe a variety of conditions in which reproductive or sexual anatomy does not fit the typical definitions of male or female
The nurse notices that the young adult client from another culture consults with the parent before making any decisions. Which action by the nurse would be most important at this time? a. Accept the behavior of the client and the parent. b. Ask the parent to leave the room so that the client can make decisions. c. Ignore the parent and repeat the questions, looking directly at the client. d. Take the client out of the room and continue the session without the parent.
a. Accept the behavior of the client and the parent. Rationale: The nurse must consider the family roles of clients from another culture and adapt care to the client. The other actions would demonstrate a lack of understanding by the nurse of the differences of the client's culture.
Identify disparities in the provision of or access to health care among cultural groups and vulnerable populations
a. African Americans had a rate of new AIDS cases 10 times greater than Caucasians. b. Hispanics had a rate of AIDS 3 times higher than Caucasians. c. Asian adults age 65 and over were 50% more likely than Caucasians to lack immunizations against pneumonia. d. The largest disparity for Asians and poor populations were related to the timeliness of care. e. Asians were 1.5 times as likely as Caucasians to report that they sometimes or never get care for illnesses or injury as soon as they wanted to. f. Hispanics were 1.7 times as likely as Caucasians, and poor people were 3 times as likely as high-income people, to report poor health care provider-client communication. g. African Americans and Hispanics both had worsening disparities in colorectal cancer mortality from 2000 to 2006.
A nursing instructor is discussing the concept of cultural diversity with a group of nursing students. While discussing broad groups, the instructor realizes she needs to reinforce teaching this concept when her students give which example? a. An example of diversity is the customs of a community. b. A project discussing health care diversity in the inner city versus the suburbs of a major city. c. A subgroup of diversity could include education, or occupation. d. The sexual orientation of a group of college sophomores participating in a birth control study.
a. An example of diversity is the customs of a community. Rationale: The customs of a community are considered part of the culture. Diversity refers to the quality of being different. Characteristics that distinguish broad groups from one another. Examples include age, race, gender, sexual orientation, and religion. Subgroups of diversity include socioeconomic status, education, occupation, interests, marital status, or rural versus urban living situations.
1. The nurse wants to provide culturally competent care to a client who lives on a long-term care unit. Which activities are appropriate for the nurse to implement? (Select all that apply.) a. Asking the client and his or her family how the illness affects them b. Memorizing which foods members of each culture eat to restore health c. Asking the client where he or she thinks illness originates d. Seeking to understand one's own culture, its beliefs, and its assumptions e. Educating the client about the U.S. health care system
a. Asking the client and his or her family how the illness affects them c. Asking the client where he or she thinks illness originates d. Seeking to understand one's own culture, its beliefs, and its assumptions Rationale: To provide culturally competent care, the nurse must first understand his or her own culture, its beliefs, and its assumptions. To assist in evaluating a client's culture, the nurse should ask certain questions to understand the client's beliefs. Asking where the client thinks his or her illness comes from will help the nurse understand illness from the client's perspective. Not all members of a culture eat the same thing. Memorizing stereotypes will not help the nurse to provide culturally competent care. Educating the client about the U.S. health care system does not help the nurse in providing culturally competent care.
The nurse is assessing the health status of an adult client. Which aspects of culture will the nurse consider when assessing this client? (Select all that apply.) a. Culture is defined by nonphysical traits. b. Beliefs are a part of culture. c. Customs are part of the culture of a client. d. A client's culture is determined by race. e. Values are a part of culture.
a. Culture is defined by nonphysical traits. b. Beliefs are a part of culture. c. Customs are part of the culture of a client. e. Values are a part of culture. Rationale: The culture that encompasses a client's way of life is based on nonphysical traits. The values and beliefs a client holds are part of culture and can influence health care. Customs can influence a client's attitude toward health. Race refers to physical and genetic heritage and is directly related to such physical traits a client may have as skin color, but it is not related to a client's culture.
A nurse administrator is asked to write guidelines for the staff nurses for the use of the hospital's interpreter services for non-English-speaking clients. Which recommendations will the administrator include in the guidelines? (Select all that apply) a. Provide teaching sheets in the client's language b. Use verbal and nonverbal cues when addressing the client c. Use technical medical terminology related to the client's diagnosis and treatment d. Use family members as the first line of interpretation e. Address questions to the client
a. Provide teaching sheets in the client's language b. Use verbal and nonverbal cues when addressing the client e. Address questions to the client Learning Objective: Identify factors causing disparities in the provision of or access to health care services. Rationale: Effective communication with interpreter services includes using nonverbal and verbal communication, including eye contact; speaking in simple, not complex terms; and providing the client with teaching sheets in their language. Family members should not be used as interpreters for confidentiality reasons. Questions should be addressed to the client.
A mother from Latin America brings her febrile baby to the primary care provider because she thinks her baby's body is out of balance. The mother tells the nurse that she also plans to consult a curandero. The best course of action on the part of the nurse is to: a. Tell the mother that the baby may have seizures if the high fever continues. b. Provide teaching and ensure the mother understands the use of the medication. c. Explain to the mother that curanderos use ineffective folk medicine. d. Tell the mother that acetaminophen is stronger magic than the curandero's magic.
a. Tell the mother that the baby may have seizures if the high fever continues. Rationale: It is important for the nurse to teach the mother that the child could have severe consequences if the medication is not given. Providing teaching but not discussing the risk of seizures is not the best response because it does not teach the mother why the medication is so important. Statements that are disrespectful of the client's culture will likely alienate the mother and potentially result in harm to the child.
The nurse is providing care to a client who is newly diagnosed with type 2 diabetes mellitus. The health care provider orders diabetic education, and notes that the client is noncompliant with his medication and diabetic diet. The client recently emigrated from Vietnam to live with his daughter and does not speak English. The client has expressed a desire to use traditional culturally based therapies to treat the diabetes. Repeat testing shows no improvement in glycemic control. Based on the client's culture, what are the barriers to the recommended diabetic care? (Select all that apply.) a. The belief that illness is not related to pathophysiology b. The lack of insurance c. The importance of the beliefs and cultural practices of the client's family and community d. Lack of trust in the health care system and providers e. Cultural belief that discussing the disease can influence the disease process
a. The belief that illness is not related to pathophysiology c. The importance of the beliefs and cultural practices of the client's family and community d. Lack of trust in the health care system and providers e. Cultural belief that discussing the disease can influence the disease process Rationale: Barriers to care that are influenced by cultural differences may include lack of trust in the health care system or the provider; the belief that illness is not related to pathophysiology; the influence of family and community as well as a cultural belief that discussing an illness can influence the disease process. Although a lack of insurance may influence the client's entry into care, it does not have cultural significance.
The nurse is performing a cultural assessment on an adult client. What type of information would be used to complete the cultural assessment? (Select all that apply.) a. The language spoken in the home b. The client's region or country of residence c. The kinds of food and drink the client prefers d. Whether the client has insurance e. The cultural or religious influences in decision making
a. The language spoken in the home b. The client's region or country of residence c. The kinds of food and drink the client prefers e. The cultural or religious influences in decision making Rationale: Subjective data would be gathered by asking questions about cultural beliefs. Objective data would be gathered through observation of the client and the interactions between significant family members who might be present. Discovering the region or country the client originates from and lives in would give clues about the client's culture. It is important to know what language is spoken in the home and whether the client understands English so that communication can be effective. Insurance is not necessarily a question that would come up during a cultural assessment, although socioeconomic status may affect health care delivery.
The nurse is assigned for the day to a unit whose clients are diagnosed with AIDS and complains about being on this unit. The nurse realizes which of the following about the assignment? a. The nurse needs to deal with feelings related to this group of clients. b. The nurse will refuse to provide care for these clients. c. The nurse needs to ask to be reassigned to another unit. d. Another nurse will report the fellow caregiver's complaints.
a. The nurse needs to deal with feelings related to this group of clients. Rationale: It is important for nurses to explore personal attitudes and feelings about clients who are different from themselves. Nurses cannot abandon clients or refuse to care for them based on dislike. The nurse needs to be aware of personal prejudices so that appropriate care can be given to all. The nurse may or may not report the fellow caregiver's complaints; however, all nurses have the responsibility to provide client care with respect. The nurse who is refusing to care for this group of clients should discuss this problem with management and it is not the responsibility of fellow nurses.
The nurse is assessing a client of a different culture who has different religious beliefs. Which statements or questions by the nurse would demonstrate cultural competence when assessing the client? (Select all that apply.) a. "How do you feel about taking medications or blood products if they are prescribed?" b. "I cannot continue with this assessment if you are not willing to be compliant with my plan of care." c. "I apologize for keeping you so long. Would you like some privacy for prayer before continuing the exam?" d. "May I ask what your partner might think about this plan of care?" e. "I understand that you may not believe in receiving human blood products; is that correct?"
b. "I cannot continue with this assessment if you are not willing to be compliant with my plan of care." Rationale: The nurse can show knowledge of a client's culture by asking appropriate questions that are not demeaning or rude. Asking how the client feels about taking medications opens the conversation to what cultural or religious beliefs might interfere with the medical care of the client. Attitudes of acceptance and recognition would help to build rapport with the client. An accepting attitude does not mean the nurse agrees with the client but that the nurse is willing to accept what the client believes, and work it into the plan of care. Communication is an important skill for a nurse when assessing and caring for a client with a different culture to ensure proper care. Asking about family support opens the conversation so the client feels comfortable speaking about family objections. A nurse who does not demonstrate cultural competence would hinder the health care being provided to the client and may hinder the client's compliance. Refusing to work a plan of care around a client's cultural beliefs is unethical and not beneficial to the client.
A nurse is reviewing the medical records of a small urgent care clinic. The nurse has been asked to identify clients who may be considered vulnerable. Which clients will the nurse include as those who may be vulnerable? (Select all that apply.) a. A 17-year-old in an afterschool boys'and girls'program b. A 42-year-old man with a history of psychiatric illnesses who lives in his car in a nearby park c. A 32-year-old woman who lists the local shelter as her home address d. A 22-year-old woman who is crying and anxious because she is fighting with her roommate e. An 82-year-old man living alone with no family nearby
b. A 42-year-old man with a history of psychiatric illnesses who lives in his car in a nearby park c. A 32-year-old woman who lists the local shelter as her home address e. An 82-year-old man living alone with no family nearby Rationale: Vulnerable populations include the elderly, children, people living in poverty, homeless people, and those who are in abusive relationships, are mentally ill, or chronically ill. An episode of anxiety or an altercation without a history of abuse is not considered evidence of belonging to a vulnerable population. A teenager in an afterschool program is not considered a member of a vulnerable population.
A nursing student is doing an internship in an inner-city free clinic. As part of the curriculum the nursing student is expected to give a presentation on health care disparities in the United States. Which statistics are appropriate for the student to include in the presentation to classmates? (Select all that apply.) a. Caucasians were more likely to report poor health care communication than the Hispanic population. b. Asian individuals are more likely not to seek care for an illness or injury. c. African Americans have a higher rate of new AIDS cases than Caucasians. d. Caucasians populations have a worsening health disparity in colorectal cancer mortality than Hispanic or African American populations. e. Asian adults over the age of 65 are more likely than Caucasians not to be immunized against pneumonia.
b. Asian individuals are more likely not to seek care for an illness or injury. c. African Americans have a higher rate of new AIDS cases than Caucasians. e. Asian adults over the age of 65 are more likely than Caucasians not to be immunized against pneumonia. Rationale: Health disparities among non-Caucasian populations are a concern in the United States. According to the 2010 National Health Disparities report, African Americans have a rate of AIDS that is ten times greater than Caucasians. Asian adults were 50% more likely than Caucasians not to be vaccinated for pneumonia. Asians were 1.5 times more likely not to get care for an illness or injury. African American populations have worsening colorectal cancer mortality from 2000dash-2006 than Caucasians. Hispanics are 1.7 times more likely to report poor communication with their health care provider than Caucasians.
An immigrant Hmong family (parents and two children) comes to a local outpatient clinic in an area where many Hmong have settled. The mother, age 42, has a hacking cough. How should the nurse address the language barrier? a. Use signs and gestures to communicate b. Ask the local immigrant service organization to provide an interpreter c. Ask the oldest child to act as translator d. Conduct a physical assessment with no explanations
b. Ask the local immigrant service organization to provide an interpreter Asking a family member to act as translator may create confidentiality issues. Signs and gestures are inadequate for clear communication. A representative of a local organization will understand the culture and may even have specific helpful knowledge of the family's background. Federal law requires provision of an interpreter.
The nursing students are meeting for a post conference following their shift on a medical floor. One of the students is reviewing a client's cultural background. Which statement by the student illustrates the concept of cultural humility? a. The nurse's example of her authoritative stance when teaching her client which diet is best for his diagnosis. b. The nurse's expression of sensitivity to the differences between her client's culture and her own. c. The nurse's discussion of her cultural superiority over her client's culture. d. The nurse's explanation to her client that his religious beliefs lack scientific validity when discussing his diagnosis.
b. The nurse's expression of sensitivity to the differences between her client's culture and her own. Rationale: Cultural humility is displayed when a nurse recognizes that his or her personal cultural values are not superior to the cultural values of another person. The nurse is not demonstrating cultural humility when he or she is claiming cultural superiority over another person. Taking an authoritative stance to influence a client against dietary choices does not reflect cultural humility. Abusing the power of the nurse's position against the client's religion is not using cultural humility. Cultural humility is demonstrated when the nurse is sensitive to the differences in his or her client's culture, even though the nurse's personal values are not the same as the client's.
Angela Seitz, age 82, tells the nurse that the surgeon to whom she was referred told her that he does not do hip replacement surgery on someone as old as she. How would the nurse describe the surgeon's attitude? a. The surgeon is demonstrating homophobia. b. The surgeon is demonstrating ageism. c. The surgeon is demonstrating classism. d. The surgeon is demonstrating gender bias.
b. The surgeon is demonstrating ageism. Ageism is discrimination against older adults. Gender bias is demonstrating preferences towards one gender group over another. Classism involves oppressive practices based on socioeconomic status. Homophobia involves negative feelings or behaviors toward gays or lesbians.
The nurse is to provide an assessment for a client of Asian descent and his family. What would the nurse need to understand related to the client and his family's worldview? (Select all that apply.) a. Educational level b. Values c. Health care practices d. Health care beliefs e. Language
b. Values c. Health care practices d. Health care beliefs e. Language Rationale: Health care beliefs, language, and values are part of a culture's worldview and can influence a client's acceptance of and cooperation with the treatment plan. If the client does not speak the same language as the nurse and the health care provider, an interpreter will be required. Health care practices may differ from what the nurse plans and can include alternative practices that may interfere with the treatment plan. Although not part of the worldview or culture, the client's level of education will be considered when planning teaching for the client.
The nurse is working with a client from a different culture who thinks his illness is due to his past sins. The nurse's best response to the client is: a. "You seem like such a nice person." b. "I think you are being very hard on yourself". c. "Can you tell me more about what you are thinking?" d. "You have an infection that is caused by a virus."
c. "Can you tell me more about what you are thinking?" Rationale: By inviting the client to say more, the nurse may gain more insight and information before deciding on a course of action. The other statements negate the client's feelings and are not therapeutic.
The nurse is assessing the cultural needs of an adult male client who states that he believes in the hot-cold theory. Which response by the nurse indicates understanding of the basis of this cultural belief? a. "Is this the practice of voodoo?" b. "What does this belief have to do with your health care?" c. "I am not familiar with this theory. Would you be willing to share more information about it with me?" d. "That is ridiculous and we cannot agree with this theory."
c. "I am not familiar with this theory. Would you be willing to share more information about it with me?" Rationale: Asking the client about his belief ensures that the nurse understands it. The nurse would not be judgmental or enforce beliefs onto the client, and using words like "ridiculous" is unacceptable and shows no cultural knowledge. Asking the client if the practice of the hot-cold theory is voodoo would indicate that the nurse does not have a cultural knowledge or understanding and would not make the client feel comfortable. Asking this client what his belief has to do with his health care would indicate that the nurse does not have an interest in incorporating the cultural beliefs of the client into a health care plan and would be inappropriate.
10. The nurse observes the client from another country becomes restless and avoids eye contact when the nurse discusses birth control. What should the nurse do to demonstrate cultural competence? a. Tell the client that the instruction can occur later when she is feeling better. b. Ask the client if there is a family member that should be present. c. Ask the client if this is something that she would like to learn. d. Close the room door and provide the client with something to drink.
c. Ask the client if this is something that she would like to learn. Rationale: Cultural competence is the ability to apply the knowledge and skills needed to provide quality care to clients of different cultures. The nurse is instructing a client from a different culture regarding birth control. It is not clear whether the nurse assessed this client's desire to learn about birth control, and the client's nonverbal behavior could serve as a clue. The nurse should ask the client if this is something that she would like to learn. Closing the door and providing the client with something to drink will not address the client's nonverbal behavior. Asking the client if there is a family member who should be present does not address whether the client wants to participate in the instruction. Telling the client that the instruction can occur later when she is feeling better is assuming that the client is not feeling well and not addressing the client's nonverbal behavior.
The nurse learns that a male client is HIV positive. What should the nurse do when providing care to this client? a. Wear a gown and gloves at all times. b. Ask the client if he has a girlfriend. c. Follow standard precautions. d. Avoid direct contact with the client.
c. Follow standard precautions. Rationale: The nurse's reaction to the client's HIV positive status should be one of non-prejudice. The only choice that would demonstrate non-prejudice would be following standard precautions, which are implemented for all client care. Avoiding direct contact with the client, asking the client if he has a girlfriend, and wearing a gown and gloves at all times would indicate that the nurse has biased feelings against the client's HIV status and possible sexual orientation.
What should the nurse do prior to beginning the assessment of a foreign-born, non-English-speaking client? a. Find out if a family member is available to interpret for the nurse and client. b. Create a checklist of assessment questions, using the easiest medical jargon to limit words. c. Locate an interpreter for the assessment, preferably of the same sex as the client. d. Prepare the assessment questions in advance so the interpreter can read them to the client.
c. Locate an interpreter for the assessment, preferably of the same sex as the client. Rationale: When using an interpreter for client care, the nurse should use an interpreter of the same sex as the client. To protect client confidentiality, family members should not be asked to interpret for the nurse or client. The nurse should talk to the client, even in the presence of an interpreter. The nurse should not prepare questions in advance and expect the interpreter to read them to the client. The nurse should limit the use of medical jargon, so creating a checklist of assessment questions using medical jargon to limit words would be inappropriate.
The nurse educator is presenting an in-service to staff nurses regarding the spiritual health of clients admitted to the unit. Which role of the nurse will the educator include in the presentation? a. Asking the client's family for permission before disclosing the client's prognosis b. Declining to discuss spirituality directly out of respect for differing beliefs c. Introducing clients to the chaplain, who can assist them in finding religious belief d. Assisting the client in recalling past experiences in which he or she drew upon hope while in crisis
d. Assisting the client in recalling past experiences in which he or she drew upon hope while in crisis Rationale: Spiritual health is the state of wellness encompassing personal fulfillment as well as the fulfillment of life with others. The nurse can support the client's spirituality by assisting the client to recall times when he or she experienced hope. Spirituality is not the same as religious beliefs. The nurse can assist the client in developing spirituality without involving religious practices. The client should be the focus of care and information. It is important to include the family and any source of support, but the focus is the client. The role of the nurse is to support the client's experience of spirituality, not promote religious belief. The chaplain can provide support to the client in the development of his or her personal spiritual development.
A nurse makes the following statement, "Chinese people drink only hot tea, so don't put coffee on their trays. I know this because my last assignment was in San Francisco." The charge nurse identifies this remark as an example of which concept associated with culture? a. Diversity b. Prejudice c. Ethnocentrism d. Stereotyping
d. Stereotyping Rationale: Stereotyping is noted when a person assumes all members of a particular group have the same characteristics. This nurse is assuming all members of a group have the same eating habits. Ethnocentrism is the belief in the superiority of one's own culture and lifestyle. This nurse is making a generalization about a culture, not declaring the superiority of her own culture. Prejudice is a judgment about a person, place, or racial background that has no basis in knowledge. This nurse is making an assumption that all Chinese have the same traits. Diversity is a state of being different and occurs between and within cultural groups. It is not related to the statement this nurse made.
