NU270 PrepU: Culture (week 9)

An important part of cultural competence includes the capacity to communicate effectively and convey information that is easily understood. When providing care the nurse should know that cultural competence includes which example?

linguistic competence - Linguistic competence, the capacity to communicate effectively and convey information that is easily understood by diverse audiences and address the health literacy needs of patients and their families, is an important part of cultural competence. Cultivation analysis, negociation skills, and dramatism is not included in examples of cultural competence.

Which nursing intervention reflects culturally appropriate care when addressing a client?

"Good morning, Mr. Smith. I am your nurse, John." - The nurse can demonstrate professionalism and culturally appropriate care by addressing clients by their last names and introducing oneself. The nurse should follow up thoroughly with requests, respect the client's privacy, and ask open-ended rather than direct questions until trust has been established.

Nurses are socialized into the:

healthcare culture. - Culture enables people of similar cultural heritage to understand the meanings of each other's words as part of the particular context, to read each other's nonverbal behavior fairly accurately, and to communicate through symbols. All of these characteristics apply to health care, so health care can be considered a culture into which one can be socialized. The other answers pertain to the career, practice, or intellectual aspects of nursing but not as much to the social aspect of nursing.

Nurses are aware that culture links a wide variety of behaviors and events uniquely. For Westerners, which is a culturally linked behavior to autopsy?

the cause of death can be discovered - Westerners believe that autopsy is used to discover the causes of death. Hmong who have not converted to Christianity believe that autopsy prevents continuation of society and rebirth. Judeo-Christians believe that the body ultimately decomposes into dust.

The nurse is caring for a client scheduled for an emergency cardiac catheterization. The transport team arrives to take the client to the catheterization laboratory at the same time a group of men arrive to see the client. The client explains to the nurse that these men are the elders from church who have come to perform a "laying on of hands" to help the client have a cardiac catheterization safely. The best response by the nurse is which of the following?

"I will wait outside of your room with the transport team; let us know when you are finished." - It is important to respect the client's wishes. This ritual may provide the peace of mind the client needs to mentally enter into this procedure.

In preparation for being discharged to home, the nurse is teaching a client with a chronic right ankle stasis ulcer about wound care. What statement by the client indicates a need further teaching?

"I'll apply a home herb mixture to the wound to promote healing." - The nurse should first determine how the client will apply an herb mixture to the ulcer. The nurse should then encourage the client to consult the health care provider (HCP) because home remedies may be beneficial or may interfere with the medical treatment plan. In many cultures, home remedies are commonly used and may be helpful. The nurse must be sensitive to these traditions and cultural beliefs. The other statements demonstrate that the client understands the plan of care for the ulcer.

A nurse needs to encourage a client who is Hispanic and has severe depression to express the client's feelings. What distance between the nurse and the client may help facilitate therapeutic communication?

3 to 6 feet - A distance of approximately 3 to 6 feet may help facilitate good therapeutic interaction between the client who is Hispanic and the nurse. People from some cultures, including Hispanics, are more comfortable with less than 4 to 12 feet of space between them when talking. A distance of 10 to 12 inches or 15 to 18 inches is considered the intimate communication zone, which may make the nurse and client feel uncomfortable. A distance of 15 to 18 feet between the nurse and the client is considered the public communication zone, which is unlikely to facilitate therapeutic communication.

Which of the following is an example of the sociocultural dimension influencing a person's health-illness status?

A single mother of two applies for food stamps in order to feed her family. - The sociocultural dimension refers to health practices and beliefs that are strongly influenced by a person's economic level, lifestyle, family, and culture. In general, low-income groups are less likely to seek medical care to prevent illness, and high-income groups are more prone to stress-related habits and illness. Answer A is an example of the environmental dimension, B is an example of the spiritual dimension, and C is an example of the emotional dimension.

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.

The nurse is differentiating beliefs of atheists from agnostics. Which statement is accurate?

Both are guided by a philosophy of living that does not include a religious faith. - An atheist is a person who denies the existence of a higher power; an agnostic is one who holds that nothing can be known about the existence of a higher power. Nurses do not offer religious counseling for any reason. Neither belief is life denying.

It is important for the nurse to acknowledge cultural differences that may influence the delivery of health care. In order to do this, the nurse must do which of the following?

Confront the nurse's own bias and influence of his or her culture. - To truly acknowledge the cultural differences that may influence health care delivery, the nurse must confront bias and recognize the influence of his or her own culture and cultural heritage.

A family is anxious for information about the status of their ill infant. The parents do not understand the dominant language, but their 14-year-old child is competent in the language, both spoken and written. The health care provider is present, but an interpreter is unavailable. What should the nurse do?

Coordinate health care provider and interpreter schedules and arrange an information-sharing session for later in the day. - An interpreter is essential. Explanations need to be given and questions relayed and answered. The interpreter needs understanding of the health care environment, not just the language. The parents are anxious for information and "not knowing" is difficult. However, children in the family should not be used as interpreters. This may upset family dynamics by giving a great deal of power to a child.

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.

Persistent gaps between the health status of minorities and non-minorities are defined as:

health disparities. - Despite continued advances in health care and technology, racial and ethnic minorities continue to have higher rates of disease, disability, and premature death than non-minorities. These differences are known as health disparities. Racism is the belief that one's race is superior to another. Ethnocentrism is the belief that one's culture is superior to another. Cultural relativity is the belief that an understanding of a person's behavior depends, at least in part, on an understanding of that person's cultural context.

The nurse is assessing a client of an Eastern culture who is admitted due to the need for anger management. What question should the nurse ask to determine the effect of culture on the client's expression of anger?

"What did you learn about anger when growing up?" - While all of these questions are pertinent to assessment of anger reactions in a client, questions related to culture need to center around how clients learned about anger when growing up and how it is displayed. While clients can learn to move past learned behaviors as a child, it is important to understand what these learned behaviors are.

The unlicensed assistive personnel reports to the nurse that the client is refusing to eat the food on the meal tray. The nurse observes the client eating the food brought in by family members. How should the nurse respond?

"What type of food did your family prepare for you, and does it have special meaning?" - The culturally competent nurse should assess the type of food the client is eating and if the food has special meaning. Some cultures use food for healing and balance during times of illness. The client may have a restricted diet, but educating the client and family can allow the client to meet the cultural needs while still getting nutrition and meeting the dietary restrictions. The nurse does not need to ask permission from the health care provider regarding the food brought in from the family. Telling the client that he or she must only eat the food offered in the health care setting is not true or empathetic.

A nurse in a rural community completed a workshop on traditional Chinese culture and how to incorporate traditional Chinese values into one's healthcare practice. One nurse notes caring for a client with Chinese heritage who did not act the way the nurse would anticipate based on the workshop. The nurse asks why the client's behavior differs from what is being taught. What is the most appropriate response by the presenter?

"You have to remember that not all members of a culture share identical beliefs." - The nurse is assuming that all members of a culture behave in a manner that reflects the same values and beliefs. This is not accurate and relies on stereotyping. Regardless of a client's diagnoses or health concerns, cultural practices will vary within groups. The upbringing of the client will influence cultural practices and preferences, but this is not the only factor that results in variation between people within a specific culture. Stating the client is trying to "fit in" is an assumption and should not be stated as a factor unless the nurse has assessed this to be true for this specific client. In a culturally safe environment, clients do not have to try to fit in.

A client who recently immigrated from Eastern Europe comes to the clinic for an evaluation. During the assessment, the nurse notes that the client has adopted the local area's mannerisms and dress. The nurse interprets this as what?

Acculturation - The client is exhibiting acculturation, the socialization process by which minority groups learn and adopt selective aspects of the dominant culture. Cultural identity refers to the set of cultural beliefs with which one looks for standards of behavior. Linguistic competence is the capacity to communicate effectively and convey information that is easily understood by diverse audiences. Cultural competence is a set of skills that respect and respond to the health beliefs, practices, and cultural and linguistic needs of diverse clients to bring about positive health care outcomes.

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.

A woman is in the second stage of labor, 8-cm dilated and 90% effaced. She keeps very quiet without expressing any outward signs of pain. Which intervention by the nurse would be most appropriate in this situation?

Allow the woman to labor according to her cultural beliefs. - The way people respond to pain is an example of a trait that is heavily influenced by culture. Some women and children scream with pain; others remain stoic and quiet. Both are "proper" responses, just culturally different. The best nursing intervention is to allow the woman to labor the way that is best for her. Administering pain medication without permission is unacceptable nursing practice. The nurse will have to assess the woman frequently, especially noting if any blood is coming from the vagina and performing frequent vaginal exams to know when it is time to push. "A close watch" could mean just looking into the room frequently. In some cultures, being stoic is expected behavior, so minimizing the pain may not be the goal of the woman.

The nurse is caring for an 8-year-old with a life-threatening illness. The parents do not speak the native language and want the child discharged so they can pursue alternative therapies that they believe will be less expensive. What is the most important action taken by the nurse to help the family and the child?

Arrange to have a translator present when talking with the parents. - A translator is an immediate priority. No effective health teaching or social intervention will be effective until there is an established means of communication with the family.

The nurse observes that a coworker is unable to understand that an intelligent person would engage the services of a medicine man. The nurse's coworker has strong ethnocentric tendencies and an inability to recognize others' values, beliefs, and practices. The nurse understands that the coworker's behavior is an example of which attitude?

Cultural blindness - Cultural blindness results in bias and stereotyping. Cultural taboos are those activities governed by rules of behavior that are avoided, forbidden, or prohibited by a particular cultural group. Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Acculturation is the process by which members of a culture adapt or learn how to take on the behaviors of another group.

The nurse caring for several clients on a hospital unit notices that one client makes eye contact with the staff, while another client from a different ethnic background does not make eye contact when speaking to the staff. What cultural concept explains this difference?

Cultural relativity - Cultural relativity refers to the concept that cultures relate differently to the same situations, such as the meaning of eye contact. Some cultures view eye contact as demonstrating engagement in a conversation, whereas other cultures view avoidance of eye contact with a "superior" (the nurse in this scenario) as a sign of respect. Cultural dissonance, cultural negativity, and cultural neutrality do not apply to this scenario involving eye contact.

The emergency department nurse is caring for a client injured in a motor vehicle collision. The client recently immigrated to the country. The nurse should implement interventions aimed at addressing which issue?

Culture shock - Culture shock is bewilderment over behavior that is culturally atypical for the client. The client who recently immigrated from another country would experience culture shock over being in a new culture, including a new culture of health care in the new country of residence. Ethnocentrism is the belief that one's culture is better than other cultures. Generalization is the belief that a person shares cultural characteristics with others from a similar background. Ageism is a negative belief that older adults are physically and cognitively impaired.

In order to help preserve and maintain a client's cultural belief regarding the need for "hot foods," which action should the culturally competent nurse take?

Educate the staff to help them assist the client in selecting food choices from the client's menu that supports this belief - In cultural care preservation/maintenance, the nurse assists the client in maintaining health practices that are derived from membership in a certain ethnic group. The nurse helps the client select and obtain foods congruent with these beliefs most effectively by educating staff. This is not necessarily possible or even advised if there are medically required food restrictions.

The nurse is caring for a client from another culture who is diagnosed with lung cancer. Which nursing action best demonstrates culturally sensitive care?

Incorporating the client's need for daily prayer into the nursing care plan. - Nurses should be culturally competent and sensitive to provide care that respects (not just not offends) and incorporates the client's culture. Incorporating the client's culture creates an individual plan of care and not a treatment plan for all clients with the same diagnosis. The nurse should not use unmodified standardized care plans that do not account for cultural differences. Explaining the biomedical culture to the client does not ensure culturally sensitive care. The nurse should attempt to understand the client's culture, not have the client understand the culture of the health care system.

A client who is admitted to the ER with severe right-sided abdominal pain is diagnosed with appendicitis. The surgeon is called and proceeds to explain the procedure to the client and asks her to sign the consent. The client refuses and informs the doctor that her husband needs to be called to do this. Which of the following religions does this client likely practice?

Islam - Some Muslim women are not allowed to make independent decisions; husbands may need to be present when consent is sought. The other religions, Hinduism, Catholicism, and Judaism, do not restrictions on women to make independent health care decisions.

A client doesn't make eye contact with the nurse during an interview. The nurse suspects that the client's behavior has a cultural basis. What should the nurse do first?

Observe how the client and the client's family and friends interact with one another and with other staff members. - Assessing the client's interactions with others helps the nurse determine whether the behavior is part of a usual pattern. It also may help the nurse understand the meaning of the behavior for this particular client. Reading about a different culture, consulting other staff members, and talking with the client are helpful after the nurse has observed the client's interaction with others. The nurse must be able to accept the client as an individual but need not accept unhealthy or inappropriate behaviors. The nurse should work with the client to better understand the cultural differences.

The nurse is planning strategies to increase sensory stimulation for clients in isolation. Which considerations should the nurse keep in mind? Select all that apply.

Sensory functioning tends to decline progressively throughout adulthood., An individual's culture may dictate the amount of sensory stimulation considered normal., Different personality types demand different levels of stimulation. - Because sensory functioning tends to decline throughout adulthood, it is especially important for the nurse to plan stimulating activities for these clients in isolation. Culture and personality guide the amount and level of sensory stimulation necessary for individuals. The amount of stimuli different individuals consider optimal is not constant; this could lead to overstimulation. Sensory functioning develops over time; it isn't established at birth. Medically fragile infants should have a decrease in environmental stimulation.

A pregnant client comes to the local health clinic for her scheduled prenatal visit. On her chart, the nurse notices that the client indicated that she resides in an extended family situation. Which arrangement would validate this information?

She lives with her grandmother, her uncle, her mother, and her younger sister. - Extended families consist of parents, children, aunts, uncles, and/or grandparents. Blended families consist of parents who have children from previous marriages and potentially children from the new marriage. Groups of individuals who are not necessarily related by blood ties but who are living together to raise their families are referred to as communal families. In the binuclear family, children are members of two families as a result of custody or "joint parenting" arrangements.

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.

A nurse is performing an admission assessment on a client newly admitted to the hospital and has documented the client as being a member of the Native American subculture. Which of these best describes a subculture?

a unique cultural group that exists within the larger culture - Subcultures are unique cultural groups that coexist within the dominant culture of the United States. Subcultures are not defined according to the size of their membership or the lack of specific geographic origins. Subcultures may have some values that differ from those of the dominant culture but this is not their defining characteristic.

The nurse educator is discussing spirituality for nurses in a mental health class. The nurse educator asks a student nurse, "Which of the following is most consistent with spirituality?" The student nurse identifies which description?

feeling a connection to a higher power - Spirituality develops over time and is a dynamic, conscious process characterized by two movements of transcendence; either deep within the self or beyond the self. Self-transcendence involves self-reflection and living according to one's values in establishing meaning to events and a purpose to life. Closely intertwined with beliefs about health and mental illness, living according to one's beliefs, and participation in common ways of worshipping are not things that are most consistent with spirituality.

A Malaysian client is admitted to the healthcare facility with reports of cramping pain in the abdomen and loose stools. Where would the nurse be seated when interviewing the client?

at more than one arm's distance - While interviewing the Malaysian client, the nurse would sit at a distance of more than one arm's length from the client. The nurse would not sit alongside the client because the client may feel uncomfortable. If the nurse sits at the back of the client the nurse may not be able to observe the client's body language. If the nurse sits in a corner of the room communication may not be effective.

A client admitted with tuberculosis reports concerns about paying for needed medications. The nurse should:

collaborate with the social worker to investigate possible availability of funds. - The nurse should collaborate with the social worker about the client's financial concerns. This collaboration can be done independently without a physician's order. The physician must notify the public health department of the client's diagnosis, but a public health worker does not get involved with the client's financial concerns. The physician and home health nurse are not typically involved with the client's financial concerns until after the client is discharged.

A new client is admitted to the unit, and the nurse's initial assessment will include a systematic appraisal of the client's cultural characteristics, health practices, and beliefs. What type of assessment will the nurse perform to gather this information?

cultural - A cultural nursing assessment is a systematic appraisal or examination of individuals, families, groups, and communities in terms of their cultural beliefs, values, and practices. The nurse should include cultural beliefs and health practices in any initial assessment. When assessing any client, the nurse must consider general appearance and obvious physical characteristics, components that make up biocultural assessment.

The nurse should instruct an Islamic female client who is reluctant to undergo pelvic examination from an assigned male health care provider to:

seek a female health care provider to perform the examination. - The woman is from a culture or ethnic group whose values influence her feelings about a pelvic examination, particularly one done by a male health care provider.