270 Week 9 (PrepU and Slides)

Educate the staff to help them assist the client in selecting food choices from the client's menu that supports this belief

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?

Cultural Responsiveness

The ability to learn from and relate respectfully with people of your own culture as well as those from another culture

Minority

-This refers to a group that has less power or prestige within the society, but actually means a group with smaller population numbers. -The term has a negative connotation in many contexts, indicating a group that does not hold the "majority" values or does not behave in "appropriate" ways; or groups whose members are considered to have less access to benefits and resources of the dominant culture. (any category of people distinguished by physical or cultural difference that a society sets apart and subordinates)

B) This is culturally appropriate behavior

A 40-year-old nurse is taking a health history from a Hispanic man aged 20 years. The nurse notes that he looks down at the floor when he answers questions. What should the nurse understand about this behavior? A) The client is embarrassed by the questions. B) This is culturally appropriate behavior. C) The client dislikes the nurse. D) The client does not understand what is being asked.

Observe how the client and the client's family and friends interact with one another and with other staff members.

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?

Korean (Cultures, such as Chinese and Korean, are collectivistic, valuing the group/family as a whole and observing obligations that enhance the security of the group.)

A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse?

Cultural imposition characteristic

A client is admitted with end-stage pancreatic cancer and is experiencing extreme pain. The client asks the nurse whether an acupuncturist can come to the hospital to help manage the pain. The nurse states, "You won't need acupuncture. We have pain medications." Which characteristic has the nurse displayed?

Maintain eye contact while talking. (This indicates openness and sincerity. These patients freely express positive and negative feelings; therefore, the nurse may probe into emotional issues. Anglo culture is an open culture and members of this culture don't mind providing personal information. Also, clients of Anglo descent are not threatened by closeness so the nurse does not have to sit in another corner of the room.)

A client of Anglo-Saxon descent (e.g., Anglo-American or English Canadian) reports to the primary healthcare facility with symptoms of fever, cough, and running nose. While interviewing the client, which points should the nurse keep in mind?

"We'll need more genetic counseling in the future."

A client with the beta-thalassemia trait plans to marry a person of Italian ancestry who also has the trait. Which client statement indicates understanding of the teaching provided by the nurse?

When members of the community share a heritage that is unfamiliar to the nurse

A community health nurse understands the importance and impact of cultural competence when caring for clients in the community. In what situation will the nurse find that cultural competence is particularly important?

Body Language and Hand Gestures

A factor of communication and culture: Be mindful of your presentation around these actions, and be sure to clarify if there seems to be a strange or unexpected reaction on the other person's part.

Space

A factor of communication and culture: Cultural differences in personal area. Some cultures prefer to be set in corners, others prefer 3-6 feet for intimacy, and others prefer inches away when speaking to another.

Touch

A factor of communication and culture: How much of this, is comfortable and allowable, and by whom, are all based on culture.

Eye Contact

A factor of communication and culture: This, is a normal cultural variation in communication pattern. Some cultures insist on it and others find it disrespectful. If unsure of the patient's culture around this communication technique, it is best to ask.

Time

A factor of communication and culture: This, is perceived to be measurable (Western cultures) or fluid and flowing (Eastern cultures). Different cultural groups tend to place different values on the past versus present versus future.

Silence

A factor of communication and culture: This, shows respect and to allow for consideration of what has been said. Other cultures may tend to interrupt this, leaving no pause between speakers

Transcultural Nursing care practice

A nurse encourages both partners in a lesbian family to come into the examining room with the newborn during a well-baby check. What type of nursing is the nurse practicing?

Cultural Habituation for effective functioning

A nurse has migrated to a different country and started working there. Which factor is important for effective functioning?

"What are your dietary needs and preferences?" (By asking this, the nurse can gain insight into religious and cultural dietary practices.)

A nurse is admitting a client to the unit. Which cultural question is most appropriate?

A. Placing heated glass jars on the skin that are allowed to cool

A nurse is assessing an Asian client and observes several reddened and bruised areas on the skin. Further assessment reveals that the client was using cupping to treat back pain. The nurse understands this as which of the following? A. Placing heated glass jars on the skin that are allowed to cool B. Rubbing ointment into the skin with a spoon C. Rubbing ointment into the skin with a spoon D. Placing warm burning herbs directly on the skin

Ask the manager to find an interpreter who is able to provide the discharge instructions.

A nurse is caring for a client who speaks only French. The client's grandchild is bilingual and assists with translating, but the nurse needs to provide the client with discharge instructions. Which option would be best for the nurse and the client?

3 to 6 feet (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 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?

Emancipated and entitled to make her own decisions

A pregnant adolescent is considered to be this, It's the adolescent's right to decide whether she wants to have an epidural.

Cultural Diversity

Also known as cultural pluralism, defined as the co-existence of a difference in behavior, traditions, and customs. A diversity of cultures, often resulting from cross-border population flows (the existence of a variety of cultural or ethnic groups within a society.)

Ask the client in a nonthreatening way if she wishes to have an epidural, and then speak with the physician.

An adolescent client in labor is dilated 4 cm and asks for an epidural. For cultural reasons, the client's mother states that her daughter "has to bite the bullet, just like I did." What should the nurse do to make sure her client's request is honored?

Culture is central to health, health related definitions, health outcomes, and health practices ▸Disease - deviation from biomedical norm ▸Illness - the lived experience of culturally constructed categories ▸Sickness - patients' roles Impact of culture ▸Communication ▸Rituals/behaviors ▸Biologic variations

Assessing Culture in the healthcare setting

These cultures, are individualistic; they value self-reliance and independence and focus on individual goals and achievements and so would be less likely to include others in the discussion.

Australia and many European cultures are this:

-Space -Eye contact -Body language/hand gestures -Touch -Silence -Time

Communication Factors around Culture

People are often born into an ethnic group, or ethnicity develops by immersion in a community. People of the same ethnicity often speak similar dialects and share similar values. Ethnicity and race are terms used interchangeably; however, they are not the same thing.

Cultural Diversity and Group education

-Use of blood products and blood transfusions is accepted by most religions except for Jehovah's Witnesses. -Organ donation and autopsy are not accepted by certain cultural groups, including Christian Scientists, Orthodox Jews, Greeks, and some Spanish-speaking groups (because of the belief that the person will suffer in the afterlife if organs are removed or autopsy is done).

Cultural Understanding: Blood Products, Transfusions, and Organ Donations

-Drug metabolism differences, lactose intolerance, and malaria-related conditions, biochemical variations such as: -sickle cell disease -thalassemia -glucose-6-phosphate dehydrogenase (G6PD) deficiency -Duffy blood group -These brief examples of ethnic variation of diseases or susceptibility to disorders show that health status and health assessment are greatly influenced by biologic variations.

Cultural understandings: Biochemical Variation and Differential Disease Susceptibility

-Essential to interact with the client showing respect for the person, the family, and beliefs. -Challenge to learn about many of the cultural groups in your geographical area and interact with them enough to gain some understanding and appreciation for their worldviews -Use knowledge when meeting and assessing your clients, but be alert for behaviors, descriptions, or physical variations that need to be clarified as normal for their culture or abnormal and needing further assessment.

Culturally Competent Assessment Factors

Enculturation

Defined as a natural conscious and unconscious conditioning process of learning accepted cultural norms, values, and roles in society and achieving competence in one's culture through socialization (the process of learning culture)

Prejudice

Defined as a negative attitude and preconceived opinion toward an entire category of people, often an ethnic or racial minority, that is not based on reason or actual experience

Racist

Defined as a person with a prejudiced belief that one race is superior to others

Ethnicity

Defined as identity with a socially, culturally, and politically constructed group of individuals that holds a common set of characteristics not shared by others with whom its members come in contact -Subgroups that have a common history, ancestry, or other cultural identity that may relate to geographic origin, such as Southerners, Navajos, or Mexican Americans (Identity with a group of people that share distinct physical and mental traits as a product of common heredity and cultural traditions.)

Developmental Variation

Defined as socioeconomic status that has been found to have a direct relationship with fine motor skills (variation exhibited among members of a population at different ages or stages of development)

Acculturation

Defined as the circumstance when a person gives up the traits of his or her culture of origin as a result of context with another culture, to variable degrees.

Cultural Appropriation

Defined as the process by which cultures adopt customs and knowledge from other cultures and use them for their own benefit

A) cultural blindness.

Despite the presence of a large number of older adult residents of Asian heritage, a long term care facility has not integrated the Asian concepts of hot and cold into meal planning. The nurses at the facility should recognize this as an example of: A) cultural blindness. B) stereotyping. C) cultural assimilation. D) cultural imposition.

Providing culturally competent nursing care

Do to this, means that care is planned and implemented in a way that is sensitive to the needs of individuals, families, and groups from diverse cultural populations within society. The nurse must be aware that the healthcare system itself is a culture and that cultural imposition and ethnocentrism must be avoided.

The client may have a very different understanding of health promotion. (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.)

In addressing health promotion for a client who is a member of another culture, the nurse should be guided by which principle?

-Religion -Participation in religious traditions -Celebration of holidays -Use of alternative therapies

Factors included in a cultural heritage health assessment

First Nations

How do people of Canadian Indian descent prefer to be identified?

Norms

Learned behaviors about what is perceived to be appropriate or inappropriate (Expectations by which a society guides the behavior of its members)

Values

Learned beliefs about what is good and bad (the ideas, beliefs, and attitudes about what is important and help guide the way you live)

-Individuals who work within the health care systems are expected to follow these standards -The 14 standards (known as CLAS mandates) are organized by themes -Culturally Competent Care (Standards 1 through 3) -Language Access Services (Standards 4 through 7) -Organizational Supports for Cultural Competence (Standards 8 through 14).

National Standards for Culturally and Linguistically Appropriate Service (CLAS)

-To learn about the client's beliefs and usual behaviors associated with health and illness, including beliefs about disease causes, caregiving, expected treatments (both Western medicine and folk practices), daily hygiene, food preferences and rituals, religious beliefs relative to health care -Compare and contrast the client's beliefs and practices to standard Western health care -Compare the client's beliefs and practices with those of other persons from a similar cultural background (to avoid stereotyping) -To assess the client's health relative to diseases prevalent in the specific cultural group

Purpose and Scope of Cultural Assessment Factors

A nurse should always do this, by asking whether the patient whether has any religious needs that may affect health care Assessing how the client's religion may affect the client's health care needs ("What can we do to help you meet any religious needs you may have?")

Respect of a patient's religious beliefs

Plan and implement care in a way that is sensitive to the needs of the client.

The nurse cares for a client of a different cultural background. What is the best way for the nurse to provide culturally competent care to the client?

"What did you learn about anger when growing up?"

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?

Communicating with sensitivity using understandable terms (Being understood is essential to the provision of all nursing care. An interpreter may be needed. Speaking slowly and using simple terms is also useful.)

The nurse is caring for a 7-year-old boy and his family, who are immigrants. Which intervention will most significantly affect the success of the care provided?

-Consider cultural implications of the perception of pain. -Provide pain medication before activity that may increase pain. -Assess for pain control 30 minutes after administering an analgesic.

The nurse is caring for a client who has experienced significant pain following a surgical procedure. Which nursing interventions are appropriate?

"Can you tell me what foods you prefer to eat and what your family is bringing you?" (The nurse should attempt to provide culturally sensitive food; however, the nurse should assess what foods the client wants to eat. The nurse should educate the client on food preferences that are also appropriate to the disease-specific dietary restrictions. Even though the diet may be healthier, the nurse should first assess the client's preferences.)

The nurse is caring for a client who is admitted for hypertension (HTN). The nurse notes that the client has not been eating the food provided, and family members have brought in homemade food. What would be the best response by the nurse?

Ask the client if a spiritual leader is desired.

The nurse is caring for a terminally ill client who immigrated from Mexico. Which nursing intervention regarding spiritual care is appropriate?

"We can wait until your spiritual healer arrives and work together to answer these questions." (The culturally sensitive nurse understands that some cultures rely on a spiritual healer to restore harmony and health. If the client requests the spiritual healer to be present, the nurse should respect the client's beliefs and decision. Leaving the questionnaire with the client is not acceptable because the nurse needs to make sure the questionnaire is completed with the client. Telling the client that he or she is the only one who can fill out the questionnaire is not necessary and rude.)

The nurse is collecting the health history of a client and notes the client is apprehensive in answering questions. The client states, "My spiritual healer will be here soon." What is the best response by the nurse?

Ask the client why he or she is not eating. (This will help the nurse to understand the problem, rather than assume the client does not like the food. It is beneficial to discuss the client's culture and food choices and incorporate them within the diet that is prescribed.)

The nurse is concerned that a client is not eating the meals provided. Which interventions should the nurse implement to encourage eating?

Both are guided by a philosophy of living that does not include a religious faith.

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

"First remove the dressing." (Communication with patients with limited English-speaking abilities is facilitated when the nurse gives instructions in step-by-step sequence, avoids the use of contractions, has only one topic in a question, and uses nouns repeatedly instead of pronouns.)

The nurse is working with a client who speaks limited English. Which of the following statements/questions would facilitate communication with this client?

Seek a female health care provider to perform the examination.

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

Worldview

The way individuals or groups of people look at the universe to form basic assumptions and values about their lives and the world around them; includes cosmology, relationships with nature, moral and ethical reasoning, social relationships, magicoreligious beliefs, and aesthetics.

Race

This is a socially constructed concept that has meaning to a larger group. Originates from societal desire to separate people based on their looks and culture -Unscientific term referring to a group of genetically related individuals who share certain physical characteristics -It is not a physical characteristic and no genetic distinctiveness (A group of human beings distinguished by physical traits, blood types, genetic code patterns or genetically inherited characteristics.)

The Yin/Yang theory

This is an example of a naturalistic or holistic belief, held by many Asian groups in which health is believed to exist when all aspects of a person are in perfect balance or harmony.

Subculture

This is defined as a group of people with a culture that differentiates them from the larger culture of which they are a part. (the values and related behaviors of a group that distinguish its members from the larger culture; a world within a world)

Agnostics

This is defined as a person who asserts that he or she does not know whether there is a God or not (one who holds that nothing can be known about the existence of a higher power)

Atheists

This is defined as a person who denies the existence of God (denies the existence of a higher power)

Cultural Competence

This is defined as a set of congruent behaviors, attitudes, and policies that come together that enables cross-cultural situations -Integration and transformation about individuals and groups of people into specific standards, policies, practices and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes (the ability to interact and understand effectively with people of different cultures)

Culture

This is defined as a view of the world and a set of traditions that are used by a specific social group and are transmitted to the next generation. This, is a complex phenomenon involving many components such as beliefs, values, language, time, personal space, and view of the world, all of which shape a person's actions and behavior.

Ethnocentrism

This is defined as a way of looking at the world through a personal lens that has been influenced by personality, genetics, family/relationships, and media. (belief in the superiority of one's nation or ethnic group.)

Thalassemia

This is defined as an inherited defect in ability to produce hemoglobin Leading to hypochromia (reduced cell color)

Stereotyping

This is defined as an oversimplified conception, opinion, or belief about some aspect of an individual or group. (Judging someone on the basis of one's perception of the group to which that person belongs)

Cultural Imposition

This is defined as assuming that traditional measures are superior and the patient should conform to the superior belief regarding treatment ect. (imposes their beliefs, values, and practices on another because they believe their ideals are superior)

Culture Shock

This is defined as the acute experience of not comprehending the culture of the current environment (disorientation that people experience when they come in contact with a fundamentally different culture and can no longer depend on their taken-for-granted assumptions about life)

Cultural Relativism

This is defined as the belief that the behaviors and practices of people should be judged only from the context of their cultural system (the practice of judging a culture by its own standards)

Cultural blindness

This is defined as the person's inability to recognize his or her own values, beliefs, and practices and those of others because of strong ethnocentric tendencies.

Cultural Assimilation

This is defined as when one begins to assume some characteristics of a culture outside of one's own. (Absorption of a culturally distinct group into a dominant or prevailing culture)

The Office of Minority Health of the U.S. Department of Health and Human Services (USDHHS)

This office, has created standards that recommend voluntary acceptance by health care organizations of adopting standards to create systems that provide culturally and linguistically appropriate care for all persons seeking their service. -Federal funds depend on adherence to the standards; thus, the level of voluntary acceptance is more a mandate.

Transcultural nursing

This type of nursing is defined as care guided by cultural aspects and respects individual differences. (planned and implemented in a way that is sensitive to the needs of individuals, families, and groups representing the diverse cultural populations within our society)

Religion

This, is a collection of spiritual beliefs and practices. Spirituality may or may not include religion, which is a codified system of spiritual beliefs.

Ageism

This, is a form of stereotyping: prejudice or discrimination on the basis of a person's age 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?

Cultural habituation

This, reduces the extent to which people must take environmental cues into account; a predictable environment and being able to perceive the world as coherent are essential for human functioning. (the living culture)

Ask Chelsie if she minds if her mother is in the room with her. (Cultural and spiritual dynamics are important in taking a health history. A child this age likes choices and is concerned about modesty and privacy. For pre-adolescents, letting children choose whether or not a parent is with them in the exam room and during the history is appropriate. In either event, it is important to speak with the adolescent alone at some point.)

When 12-year-old Chelsie comes in for her annual check-up, the nurse must take a health history and do a physical exam. What is the most appropriate manner for the nurse to obtain a health history?

B) Cultural Shock

When a labor and delivery nurse tells a coworker that a client of Asian descent probably did not want any pain medication because "Asian women typically are stoic," the nurse is expressing a belief known as what? A) cultural assimilation. B) cultural shock. C) cultural imposition. D) cultural blindness.

Understand that his culture may influence his hygiene and ask him his preference (Preferences for hygiene vary widely among individuals and across cultures.)

When an adult client from Indonesia refuses a complete bath on the day after abdominal surgery, the nurse should:

Actively solicit information about the client's pain level Examples: -Direct Observation. Direct observation allows you to get to know the patient's behavior. -Interviews, Surveys and Rating Scales. -Likert-Type Testing of Attitudes and Opinions. -Tips or further questions

When the male client on his first postoperative day after chest surgery appears stoic and does not ask for any pain medication, the nurse should:

-Requesting native cuisine -Listening to folk music and dance -Asking to wear unique clothing (Pride in one's ethnicity is demonstrated by valuing certain physical characteristics, giving children ethnic names, wearing unique items of clothing, appreciating folk music and dance, and eating native dishes.)

Which behaviors demonstrated by the client would the nurse consider reflections of the client's pride in ethnicity?

B) Skin color

Which characteristic is used to describe racial categories? A) Language B) Skin color C) Music preferences D) Food likes and dislikes

Orthodox Jewish Americans

Which culture believes that leaving the body alone after death is disrespectful?

A) Mutual cultural assimilation occurs when characteristics from two groups are traded.

Which statement is true of cultural assimilation? A) Mutual cultural assimilation occurs when characteristics from two groups are traded. B) Cultural assimilation is the integration of a majority group with a minority group. C) Moving to a different culture may result in psychological discomfort. D) Cultural assimilation is identifying with a collective cultural group, primarily based on common heritage.

His Faith

While interviewing a client, a nurse is told that the client practices Catholicism. This client is identifying: