Culture & Diversity

Cultural groups

categorized around racial, ethnic, religious, or socially common practice patterns

Oppression

systematic limitation of access to resources may be covert or subtle typically linked to laws, education, or even healthcare norms and regional access to services and transportation.

Sexism

the belief that one sex is innately superior to the other

Polychronic

the use of time that emphasizes flexible schedules in which multiple tasks are pursued at the same time

Using an interpreter

use a certified medical interpreter Validate there number If requested, provide an interpreter of the same gender as the patient. Address your questions to the patient, not the interpreter, but maintain eye contact with both the patient and the interpreter. Avoid using metaphors, medical jargon, similes, and idiomatic phrases. Observe the patient's nonverbal communication. Plan what to say and avoid rephrasing or hesitating. Use short questions and comments. Ask one question at a time. Speak slowly and distinctly, but not loudly. Provide written materials in the patient's language as available.

Heterosexism

view of heterosexuality as only correct sexual orientation

Social differences

- Communication - Environmental control - Religious variations - Space - Time - Biological variations - Susceptibility of disease - Skin color

People from vulnerable populations likely to be:

- older - living in poverty - homeless - in abusive relationships - mentally ill - chronically ill - children

Hallmarks of diversity

-cultural differences -gender -race -class -sexual orientation -age

U.S census bureau Identifies 5 races

1. White 2. Black or African American 3. American Indian or Native Alaskan 4. Asian 5. Native Hawaiian or other pacific islanders *Hispanic, Latino, or Spanish origin many identify as members of any race.

Poverty

A lack of income to meet basic needs that include food and nutrition, education and other basic services, productive resources for income, and healthcare *Children living in a female-headed household at most risk of poverty

4 Elements of Culture and society

A physical element. The geographic area in which a society is located An infrastructure element. The framework of the systems and processes that keep a society functioning A behavioral element. The way people in a society act and react to each other A cultural element. All the values, beliefs, assumptions, and norms that make up a code of conduct for acceptable behaviors within a society.

The nurse is assessing a client of a different culture who has different religious beliefs than that of the nurse. Which statement or question by the nurse demonstrates cultural competence when assessing the​ client? (Select all that​ apply.) A. "Are there certain times of the day that you need privacy for prayer or​ meditation?" B. "How do you feel about taking medications or blood products if they are​ prescribed?" C. "I cannot continue with this assessment if you are not willing to be compliant with my plan of​ care." D. "Would you prefer to be examined by a nurse who is of your​ sex?" E.​"May I ask what your partner might think about this plan of​ care?"

A. "Are there certain times of the day that you need privacy for prayer or​ meditation?" B. "How do you feel about taking medications or blood products if they are​ prescribed?" D. "Would you prefer to be examined by a nurse who is of your​ sex?" E.​"May I ask what your partner might think about this plan of​ care?" The nurse can show knowledge of a​ client's culture by asking appropriate questions that are not demeaning or rude. Asking about family support opens the conversation so the client feels comfortable speaking about family objections. Religious or cultural beliefs may require a female client to be examined by female​ nurse, or they may necessitate that the nurse plan care around the​ client's daily spiritual practices. 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. Refusing to work a plan of care around a​ client's cultural beliefs is unethical and not beneficial to the client.

The nurse is preparing a presentation on cultural differences and health disparities in the United States. Which information is appropriate for the nurse to​ include? (Select all that​ apply.) A. African American men are at greater risk for stroke than any other single population. B. Racial residential segregation makes it difficult for people of color to access equitable healthcare systems. C. Gay and lesbian individuals face greater discrimination in health care than transgender individuals. D. American Indians and African Americans have a lower incidence of skin cancer. E. Undocumented immigrants often do not seek healthcare until their condition becomes critical.

A. African American men are at greater risk for stroke than any other single population. D. American Indians and African Americans have a lower incidence of skin cancer. E. Undocumented immigrants often do not seek healthcare until their condition becomes critical. American Indians and African Americans have a lower incidence of skin cancer. Racial residential segregation makes it difficult for people of color to access equitable healthcare systems. African American men are at a greater risk for stroke than any other single population. Undocumented immigrants often do not seek healthcare until their condition becomes critical. Transgender individuals face greater discrimination in health care than do gay and lesbian individuals.

The nurse wants to provide culturally competent care to a client who lives on a​ long-term care unit. Which activity is appropriate for the nurse to​ implement? (Select all that​ apply.) A. Asking the client where he thinks illness originates B. Memorizing which foods members of each culture eat to restore health C. Seeking to understand​ one's own​ culture, its​ beliefs, and its assumptions D. Teaching the client about the U.S. healthcare system E. Asking the client and his family how the illness affects them

A. Asking the client where he thinks illness originates C. Seeking to understand​ one's own​ culture, its​ beliefs, and its assumptions E. Asking the client and his family how the illness affects them To provide culturally competent​ care, the nurse must first understand 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 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. Teaching the client about the U.S. healthcare system does not help the nurse in providing culturally competent care.

Which aspects of culture should the nurse consider when assessing a​ client? (Select all that​ apply.) A. Culture refers to patterns of behavior. B. A​ client's culture is determined by race. C. Customs are part of the culture of a client. D. Beliefs are a part of culture. E. Values are a part of culture.

A. Culture refers to patterns of behavior. C. Customs are part of the culture of a client. D. Beliefs are a part of culture. E. Values are a part of culture. The culture that encompasses a​ client's way of life is based on patterns of behavior. 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 as skin​ color, but it is not related to a​ client's culture.

Which competencies should an organization emphasize to support culturally congruent nursing​ care? (Select all that​ apply.) A. Demonstrate respect for all clients regardless of cultural background B. Anticipate family involvement in all aspects of a​ client's care C. Provide continuing education related to cultural awareness and competency D. Consider the effect of discrimination on vulnerable individuals and groups E. Ensure access to interpreters as needed

A. Demonstrate respect for all clients regardless of cultural background C. Provide continuing education related to cultural awareness and competency D. Consider the effect of discrimination on vulnerable individuals and groups E. Ensure access to interpreters as needed Maintaining cultural competence is an ongoing process. Competencies associated with culturally congruent nursing practice include: communicating with appropriate language and behaviors by ensuring access to interpreters as needed. The organization should support respect for all individuals regardless of cultural background. The organization should consider the effects of discrimination on vulnerable individuals and groups.​ Additionally, Continuing education should be provided that focuses on cultural awareness and competency. Anticipating family involvement in all aspects of a​ client's care can be viewed as a stereotypical expectation and would not support culturally congruent nursing care.

Which is a core belief about health in​ non-Western cultures? A. Health is a state of harmony that encompasses​ mind, body, and spirit. B. Health is the absence of disease. C. Health is the strength to do anything you want. D. Health is an attribute of youth.

A. Health is a state of harmony that encompasses​ mind, body, and spirit. Non-Western cultures view health as a harmonious state. Western society sees health as the absence of disease. Saying that health is an attribute of youth might indicate ageism. Saying that health is the strength to do anything that you want would be a personal interpretation of health and not a core belief of a​ non-Western culture.

The nurse is researching cultures and diversity in health care. Which cultural characteristic that affects health care should the nurse classify as an environmental​ control? A. Preventive medicine B. Skin color C. Personal boundaries D.Emphasis on the past

A. Preventive medicine Preventive medicine is environmental​ control because those who follow an internal locus of control will be motivated to eat​ healthy, exercise, and make use of other wellness measures. Skin color is a biological factor. Personal boundaries are space​ factors emphasis on the past is a time orientation.

The nurse is providing care to a non-​English-speaking client who is noncompliant with care. The client has expressed a desire to use traditional​ culturally-based therapies. Which should the nurse identify as a potential cultural barrier to the client following the recommended​ care? (Select all that​ apply.) A. The importance of the​ client's family involvement in managing illness and disease B. The lack of insurance to cover the necessary medication and related supplies C. The belief that illness is not related to pathophysiology D. Lack of​ certified, dialect-specific interpreters E. Lack of trust in the healthcare system and providers

A. The importance of the​ client's family involvement in managing illness and disease C. The belief that illness is not related to pathophysiology D. Lack of​ certified, dialect-specific interpreters E. Lack of trust in the healthcare system and providers Barriers to care that are influenced by cultural differences may include: -Lack of trust in the healthcare system or the​ provider -The belief that illness is not related to​ the pathophysiology -Lack of​ certified, dialect-specific​ interpreters, -Involvement of the family in managing illness and disease. 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. Which information should the nurse​ include? (Select all that​ apply.) A. The kinds of food and drink the client prefers B. The​ client's region or country of origination C. Whether the client has insurance D. The cultural or religious influences in decision making E. The language spoken at home Your answer is correct.

A. The kinds of food and drink the client prefers B. The​ client's region or country of origination D. The cultural or religious influences in decision making E. The language spoken at home 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 at 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 healthcare delivery.

Cultural competence

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

Acculturation

Accepting the majority group culture as ones own. May choose to discard some practices from culture of origin.

Assimilation

Adapting to and integrating characteristics of dominant culture.

Diversity

An array of differences among individuals, groups, and communities.

The nurse is preparing a presentation on social differences for colleagues. Which statement should the nurse include in the​ presentation? A. "Practices regarding proximity to​ others, body​ movements, and touch are similar across​ groups." B. "Subcultures can maintain heritage and identity through​ dress, foods​ eaten, and cultural​ festivities." C. "Clients from​ present-oriented cultures are generally receptive to preventive healthcare​ measures." D. "Individuals with an external locus of control are more likely to take preventive healthcare measures than those with an internal locus of​ control."

B. "Subcultures can maintain heritage and identity through​ dress, foods​ eaten, and cultural​ festivities." Subcultures can maintain heritage and identity through​ dress, foods eaten, and cultural festivities. Practices regarding proximity to​ others, body​ movements, and touch differ among​ groups, such as when an​ individual's perception of personal space causes comfort or anxiety.​ Present-oriented cultures focus on the here and​ now, and individuals from these cultures may not be receptive to preventive healthcare measures. Those who follow an external locus of control are less likely to be engaged in preventive measures than those who follow an internal locus of​ control because they do not see themselves as being in control of their health.

A​ non-English-speaking immigrant mother seeks care at a local outpatient clinic in an area where many immigrants have settled. The mother is accompanied by​ 15-year-old child who speaks English. 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 child to act as a translator. D. Conduct a physical assessment with no explanations.

B. Ask the local immigrant service organization to provide an interpreter. 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 the provision of an interpreter. Asking a family member to act as a translator may create confidentiality issues. Signs and gestures are inadequate for clear communication. An interpreter should be available to explain the physical assessment.​ However, the​ client's privacy should be​ protected, so the interpreter may not be present in the examining room at all times.

The nurse is reviewing the medical records of a small urgent care clinic to identify clients who may be considered vulnerable. Which client should the nurse include as those who may be​ vulnerable? (Select all that​ apply.) A. A​ 22-year-old woman who is crying and anxious due to fighting with her roommate B. A​ 32-year-old woman who lists the local shelter as her home address C. A​ 42-year-old man with a psychiatric history who lives in his car in a nearby park D. A​ 17-year-old teenager enrolled in an afterschool​ boys' and​ girls' program E. An​ 82-year-old man living alone with no family nearby

B. A​ 32-year-old woman who lists the local shelter as her home address C. A​ 42-year-old man with a psychiatric history who lives in his car in a nearby park E. An​ 82-year-old man living alone with no family nearby Vulnerable populations include older​ adults, children, people living in​ poverty, homeless​ people, and those who are in abusive​ relationships, are mentally​ ill, or are 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.

The nurse is to provide an assessment for a client from a​ non-English-speaking culture. Which factor would the nurse need to understand related to the​ client's worldview?​ (Select all that​ apply.) A. Education level B. Healthcare practices C. Healthcare beliefs D. Language E. Values

B. Healthcare practices C. Healthcare beliefs D. Language E. Values Healthcare​ 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 healthcare​ provider, an interpreter will be required. Healthcare 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.

Values and Beliefs

Basic principles that help to: -Define meaning -Identify acceptable behaviors -Choose emotional reactions -Determine appropriate actions Values and belief systems are part of a culture, as are family relationships and roles

Which should the nurse include when caring for a client of a different​ culture? A. Enforce the use of specialty practitioners. B. Instruct client to take ordered medications. C. Be nonjudgmental in healthcare beliefs. D. Enforce the use of Western healthcare practices.

C. Be nonjudgmental in healthcare beliefs. The nurse should be nonjudgmental in healthcare beliefs for all clients and include their beliefs into the plan of care. The nurse should never enforce Western health care or any healthcare practices on any client. The nurse should not enforce the use of specialty practitioners if the client does not believe in this practice. The nurse would instruct the client to take the medications​ prescribed, but this is unrelated to the​ client's culture.

The nurse belongs to a Christian denomination that considers homosexuality sinful.​ However, while working with a lesbian​ client, the nurse maintains an​ open, interpersonal rapport with the client while providing​ consistent, effective care. Which term best describes the​ nurse's behavior? A. Enculturation B. Assimilation C. Cultural humility D. Stereotyping

C. Cultural humility The nurse is practicing cultural​ humility, which is the realization that a client needs​ care, not judgment. Assimilation is the process of adapting to and integrating characteristics of the dominant culture as​ one's own. Stereotyping is an overgeneralization of group characteristics that reinforces societal biases and distorts individual characteristics.​ Enculturation, or cultural​ transmission, is exemplified by a process that children use to learn cultural characteristics from adults.

The nurse is treating a male client from India who is recovering from surgery. The nurse is concerned that several of the​ client's family members are gathered in the hospital room throughout the​ day, and that the​ client's mother insists on caring for the client even when the nurse is present. Which intervention would indicate that nurse needs more​ teaching? A. Teach the client and his family about safety issues such as crowding and​ self-medication. B. Explain to both the client and his family members the necessity of early mobility. C. Remind the family that the nurse is equipped to provide the client with​ safe, effective care. D. Provide the client with nutritional counseling and incorporate preferred foods into their meal plan.

C. Remind the family that the nurse is equipped to provide the client with​ safe, effective care. Clients whose origins are from India tend to have strong family​ ties, so it is not uncommon for several family members to gather in the​ client's room, causing crowding. Because the mother typically will provide care for the​ client, this may be cause for concern for the​ nurse, because many from India believe in​ self-medication and herbal​ medicines, which may interfere with treatment. The​ nurse, therefore, should collaborate with the client and family to provide​ safe, effective care. The nurse should also explain to the client and his family members the necessity of early mobility and independence with activities of daily​ living, as well as help the client meet nutritional needs through meal​ accommodation, nutritional​ counseling, and incorporation of preferred foods in the meal plan.

The nurse makes a​ statement, "Chinese people drink only hot​ tea, so​ don't put coffee on their​ trays." the charge nurse identifies this remark as an example of which concept associated with​ culture? A. Prejudice B. Diversity C. Stereotyping D. Ethnocentrism

C. Stereotyping Stereotyping is 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.

Belief systems related to illness and disease

Can affect both patient expectations, practices and healthcare professionals provision of services Can present barriers to necessary care Tensions may arise when different health belief systems conflict

The nurse manager is planning a presentation for a group of nurses about culture and diversity. Which barrier to respecting a​ client's culture should the nurse manager include in the​ presentation? (Select all that​ apply.) A. Refusal of Western healthcare providers to believe in mind-body connection B. Clients may not trust the current healthcare system and the providers C. Belief that illnesses are linked to scientific pathophysiology and not changes in energy D. Refusing to allow family members to be involved in managing illness and disease E. Incorporating the​ client's beliefs into the plan of care

Clients from other cultures may not trust the current healthcare system and providers because they believe in traditional healers. Current Western healthcare providers may not believe in the mind-body connection and turn to traditional​ science, whereas a client from another culture may not believe that illnesses are linked to scientific pathophysiology. Another barrier is refusing to allow the family to be involved in managing illness and disease. It is not a barrier when healthcare providers incorporate the​ client's beliefs into the plan of care.

Enculturation

Cultural transmission is exemplified by how children learn cultural characteristics from adults

Multiculturalism

Cultures & subcultures coexisting within a given society in which no one culture dominates

Undocumented Immigrants

Don't seek healthcare until condition is critical, fear of deportation Lack preventive care, inadequate immunization and medical records inaccurate health information Nurses are bound to provide high quality care to any patient

Which statement by the nurse indicates a need for cultural competence​ training? A. "Do not bother the client in room 2 during his​ prayers." B. "The client in room 5 prefers hot beverages when​ ill." C. "Provide the client in room 3 a female nurse because she is​ Muslim." D. "The client down the hall is on welfare. She will be​ back."

D. "The client down the hall is on welfare. She will be​ back." The nurse stating the client on welfare will be back due to lack of income indicates insensitivity to someone with financial issues. Many cultures prefer hot beverages when ill. This is acknowledging the​ client's beliefs. The nurse is recognizing the​ client's religion when providing the client time to pray. The nurse understands the importance of​ same-sex healthcare providers in the Muslim faith.

The preceptor is monitoring a graduate​ nurse's assessment of a male client who recently immigrated to the United States from China. Which assessment activity by the graduate nurse indicates the need for​ follow-up regarding culturally competent​ care? A. Determine if the client has any daily spiritual practices. B. Inquire if the client speaks any English. C. Ask the client about food preferences or food preparation needs. D. Discourage use of acupuncture or cupping for pain relief.

D. Discourage the use of acupuncture or cupping for pain relief. The provision of culturally competent care begins with incorporating culture into the initial nursing assessment. It is appropriate for the nurse to ask the client about his proficiency in English to ensure that they communicate effectively about treatment. The nurse should inquire about religious or cultural practices at specific times of the day or during the week and plan care accordingly. The nurse should also ask about​ (not discourage) the use of traditional healing practices such as herbal supplements or mind-body practices​ (e.g., cupping,​ acupuncture). Administering culturally competent care also involves inquiring about cultural practices related to food preparation and preferences.

Standards of Competence

Demonstrating respect for all individuals, regardless of cultural background or heritage Participating in lifelong continuing education related to cultural awareness and competency Considering the effect of discrimination on vulnerable individuals and groups Communicating with appropriate language and behaviors, using interpreters and translators as appropriate and with permission from the patient.

Homophobia

Fear, hatred or mistrust of gays and lesbians

Minority

Group of individual's outside the dominant group

Ethnic group

Group of individuals who have common characteristics: -Nationality -Language -Values -Customs -Share a cultural heritage

Worldview

How people in a culture perceive ideas & attitudes about the world, other people, life in general. A cultures world view support its overall belief system to explain the meaning of life. -god? -life after death -purpose?

Belief systems

Influence individual decisions and actions Passed on from generation to generation May be rooted in religious faith or practices Children learn from parents and family Culture evolves as things change Based on people's experiences and exposure to differences

Internal vs external locus of control

Internal = one controls own's life External = outside forces dictate one's life

Homelessness

Most vulnerable patients Nurses can identify resources to help these patients

Cultual humility

Ones personal cultural values are not superior to the cultural values of other. thus preventing an abuse in power.

Classism

Oppression of groups of people based on socioeconomic status.

Culture

Patterns of behavior and thinking that people living in social groups learn, develop, and share

Subculture

People within a culture whose practices or beliefs are separate from the dominant culture.

Cultural values

Preferred ways of behaving or thinking sustained over time and used to govern a cultural groups actions and decisions

Social justice

Recognizing that not all groups are treated equally

Discrimination

Restriction of justice, rights and privileges

Class

Socioeconomic variations base on: -money -access to resources

Racism

The oppression of a group of people based on perceived race

sexual orientation

The sexual attraction of an individual to the same, opposite or both sex

Monochronic

The use of time that emphasizes punctuality, schedules, and completing one task at a time.

Strategy to reduce maternal morbidity

Timely and thorough antepartum assessments Best practice care Responding to concerns & distress Racial equity training Develop quality standards for maternal care Awareness of maternal care issues Expanded Medicaid coverage

Bias

favoring a group or individual over another

vulnerable populations

groups of patients who are more likely to develop health problems as a result of excess health risks, who are limited in access to health care services, or who depend on others for care -Poverty *Major -Age -Health/disease state -Education status -Language spoken -Socioeconomic situation

health disparity

health inequity. The preventable difference in care by medically underserved and socioeconomically disadvantaged populations

Stereotyping

is an overgeneralization of group characteristics that reinforces societal biases and distorts individual characteristics.

Birth equity

optimal maternal and child outcomes for pregnant and postpartum women and their babies. *US has highest maternal mortality

Race

physical attributes linked to continent of origin

Ageism

prejudice and discrimination against older people