Chapter 2- Addressing Diversity of Older Adults

11. A nurse plans culturally competent care for a variety of clients. Which of the following cultures is most strongly tied to the low health status? A) Hispanic in race B) Low socioeconomic status C) Member of LGBT society D) Resident of urban community

Ans: B Lower socioeconomic position is an overriding determinant of health status. Hispanic subgroups vary in rates of disability. While urban older adults and those in the LGBT community have special needs, their health is not significantly worse than others as a whole.

9. A nurse performs a reflective cultural self-assessment. Which of the following outcomes should the nurse expect? A) An accurate ranking of different cultures according to their specific merits B) Identification of the flaws and weaknesses of the nurse's own culture C) Progression from judgmental views of other cultures to recognition of positive attributes D) The ability to assess clients according to their cultural affiliation rather than individual characteristics

Ans: C The process of cultural competence is often described as a progression from judgmental attitudes and practices to positive approaches. It does not focus primarily on the deficits of one's own culture and it does not replace individualized assessment and care with cultural generalizations. Culturally competent care does not involve "ranking" different cultures.

8. Following knee replacement surgery 10 days earlier, a 79-year-old woman has been diagnosed with an infection in the knee. A sample of synovial fluid has been cultured in order to determine the causative microorganism and to select an appropriate antibiotic. This course of events characterizes what major health belief system? A) Magico-religious paradigm B) Holistic paradigm C) Scientific paradigm D) Analytical paradigm

Ans: C The scientific (biomedical) health paradigm prioritizes cause-and-effect relationships (i.e., microorganisms and infection) along with manipulation of these through pharmacologic interventions and surgery. The holistic paradigm emphasizes the interconnectedness of mind, body, and spirit, and the magico-religious paradigm emphasizes supernatural factors. The "analytical paradigm" is not among the three major health belief systems.

12. A nurse verifies the health belief system of the Puerto Rican older adult client. Which of the following beliefs is this client most likely to hold? A) Health is a gift or reward given as a sign of God's blessing and goodwill. B) Health is obtainable by reaching a mature age. C) Health is the absence of disease. D) Health is the quality of wholeness associated with healthy functioning.

Ans: A The magico-religious perspective is common among Latino and Caribbean groups. Those with this perspective believe that health is a gift or reward given as a sign of God's blessing and goodwill. Scientific perspective holds that health is an absence of disease. Holism associates health with healthy functioning and well-being.

13. A clinic nurse assesses a client who has limited English-speaking ability. The child interprets for the client. Which action by the nurse is most appropriate? A) Obtain a professional interpreter. B) Talk directly to the interpreter. C) Teach the family member the appropriate medical terminology. D) Use the family member as a source for improving cultural competence.

Ans: A A professional medical interpreter is preferred. The use of a child can influence the client's answers to questions. When using an interpreter, speak directly to the client.

1. A nurse manager justifies the budget for education regarding cultural competency for the staff. Which of the following justifications will best support the need for this education? A) Life expectancies among minorities are expected to increase while those among non-Hispanic whites are expected to decrease. B) Government and health care organizations support the need for culturally competent care. C) The proportion of health care consumers who are minorities continues to increase. D) Nurses have a moral obligation to achieve cultural competency with all cultural groups.

Ans: C The proportion of health care consumers who are minorities is increasing and is predicted to continue increasing. Life expectancies of all groups, not only minorities, are predicted to increase. Government and health groups have called for culturally appropriate care, but this argument gives less support to administration than the power of money. Nurses have an obligation to achieve cultural competency with the groups they work with, but not with all cultural groups.

5. A nurse speaks at a staff development in-service. Which of the following statements by a nurse participant shows the need for education? A) "I know that the consequences of racism are still present and they're linked to health disparities." B) "I'm sure the percentage of client-care hours that we spend working with minority clients is bound to increase." C) "There's a huge amount of diversity within the group that's labeled 'Asians and Pacific Islanders.'" D) "It's inaccurate to link the prevalence of particular diseases with particular minority groups."

Ans: D The prevalence of some pathologies varies between different ethnic groups. The effects of racism are indeed linked to health disparities, and nurses are predicted to spend a higher percentage of client-care hours with members of minority groups in the future. As with most groups, there is vast diversity within the group "Asians and Pacific Islanders."

2. A nurse is beginning a new job in an area with a large African American population. Which of the following statements will assist the nurse to understand this ethnic/race culture to better plan nursing care? (Select all that apply.) A) African Americans as a group have a wide range of socioeconomic conditions. B) Female-headed households are common among African Americans. C) Lifestyle and risk factors account for the health disparities with older African Americans. D) Older African Americans are more likely than other older Americans to live alone. E) Older African Americans are more likely to be caring for their grandchildren.

Ans: A, B, E Female-headed homes are a common family structure among African Americans. The differences in health outcomes between African Americans and other groups are attributed mostly to disparities in health care provision. Older African Americans are more likely to live with family. Half of those older African Americans who live with their grandchildren are the primary care provider to those children.

3. A nurse has observed an increasing number of older Asian Americans in the hospital. Which of the following statements regarding Asian cultures will best assist the nurse to plan nursing care? A) Asian Americans as a group have lower mortality rates. B) Health is often viewed as a state of physical and spiritual harmony. C) Older Asian Americans are more likely than other Americans to live alone. D) Care of elders is commonly provided in institutional environments such as nursing homes.

Ans: B While it is true that Asian Americans as a group have lower mortality rates at all ages, the statement that best assists the nurse to plan care of the Asian client is that a common view of health from the Asian perspective is that of harmony in the spiritual and physical contexts. Asian Americans are less likely to live alone. It is more common for older Asian Americans to live with family than in nursing homes.

4. A nurse's colleague states, "Older people who live in the country are a lot healthier than city folk." Which statement by the nurse is most appropriate? A) "The differences aren't large, but rural adults do have better health outcomes than do city dwellers." B) "But chronic conditions are more common among rural adults." C) "Overall, yes. Higher levels of family support translate into longer average life spans for rural adults." D) "Unfortunately, no. And this is mostly attributable to the problem of homelessness."

Ans: B Chronic conditions are overrepresented among rural adults. Overall, rural adults have worse health outcomes than do urban dwellers. While family support levels are generally high, this does not mean that rural adults live longer lives on average. Lack of access and other factors, rather than homelessness, are cited as reasons for the differences in health outcomes between rural and urban adults.

6. A nurse has recently begun to provide care to older adults in a large, urban hospital. Having lived until recently in an ethnically homogeneous region, the nurse has begun to recognize the significant differences in priorities and perspectives of clients from other cultural groups and has taken action to learn about these groups. What stage of cultural self-assessment is this nurse demonstrating? A) Unconsciously incompetent B) Consciously incompetent C) Consciously competent D) Unconsciously competent

Ans: B Cultural competence begins with unconscious incompetence as a state of not being aware that one is lacking knowledge about another culture. When the person becomes aware of this knowledge gap, he or she progresses to a state of conscious incompetence and takes actions to learn about the cultural group; this stage is demonstrated by the nurse in this question. A person progresses to a stage of conscious competence by verifying generalizations and incorporating culture-specific interventions in care. The final stage is unconscious competence, when knowledge of the cultural group is fully integrated into one's thinking and approach

7. A nurse reads up on some of the more common cultural groups in the local area. How should the nurse interpret the information that is available about cultural groups? A) Characteristics of cultural groups are normally consistent between every member of that group. B) Cultural generalizations can be useful and accurate, but they do not replace individualized assessment and care. C) It is simplistic and problematic to make generalized claims about members of a particular cultural group. D) It is unjust to categorize individual clients as being members of a specific cultural group.

Ans: B Nurses need to be knowledgeable about different cultural groups, but they need to use this information as a backdrop for exploring the ways in which individuals identify with the characteristics of the various cultural groups to which they belong. Generalized knowledge may be accurate and clinically useful, but it is not replacement for individualized knowledge. Nurses need to recognize that the culture of each individual person is based on his or her membership in many groups and is internalized in a unique and personal way.

10. A nurse at a long-term care facility has completed the admission assessment of a 79-year-old male resident. The resident has identified himself as gay and has expressed sadness at having to leave his partner of several decades in order to move to the facility. The nurse should recognize that this resident is likely to have a history of: A) Homelessness B) Stigmatization C) Nominal employment or unemployment D) Infectious diseases

Ans: B Stigma is a common experience among LGBT (lesbian, gay, bisexual, and transgender) older adults, and the likelihood of this is greater than the likelihood of homelessness, unemployment, or infectious diseases.

14. Which of the following sources might nurses use to improve their cultural competence? (Select all that apply.) A) Discuss cultural norms with clients' families. B) Explore the resources in Online Learning Activities. C) Read journals and other references. D) Utilize organizations listed at the end of chapters. E) Write teaching materials in prominent local languages.

Ans: B, C, D Professional sources are suggested to improve nurses' cultural competence. Nurses are encouraged to read journals and other references and by exploring the resources in Online Learning Activities in this chapter. Health care professionals are encouraged to contact local organizations to obtain culturally specific information about groups that reside in their locale. Clients' families should not be the primary source of data regarding cultural norms; nurses should be knowledgeable about cultural groups. Nurses should remain open to families input to their loved ones.

15. A nurse works to protect vulnerable populations and reduce health disparities. Which of the following nursing actions work toward that goal? (Select all that apply.) A) The nurse acknowledges that the clients in subgroups will not change beliefs or actions. B) The nurse communicates a nonjudgmental attitude toward health system beliefs. C) The nurse incorporates clients' belief systems into the plan of care. D) The nurse asks the client how the care system can incorporate the clients' health beliefs. E) The nurse teaches each client about preventive care.

Ans: B, C, D, E Health promotion interventions, such as teaching about prevention and early detection of certain conditions, are particularly important when caring for older adults who are members of a minority group. Nurses communicate nonjudgmental attitudes and asking open-ended questions to elicit information about each person's life experiences and cultural influences. Nurses need to be aware of the health beliefs that influence their clients, so they can adapt their interventions accordingly.