Chapter 4: Understanding Each Other: Communication and Culture

A non-Hispanic white nurse provides care to mostly Hispanic patients. It would be most important for the nurse to take which action? A. Discover cultural influences on healthcare perceptions and behaviors. B. Assist the patients to adapt to American culture and health beliefs. C. Avoid confrontation of underlying issues of discrimination. D. Improve communication by learning how to speak Spanish.

ANS: A As our society becomes more global and diverse, cultural competence is a dynamic concept that must be evaluated continuously as it relates to patient outcomes (Waite et al., 2014). Nurses need to know about culture because it influences both nurses' and clients' healthcare perceptions and behaviors. Nurses should learn about the culture of diverse clients and communities. Nurses need to recognize and overcome certain attitudes basic to the American culture. To provide culturally competent care, the nurse must address issues of discrimination. Learning how to speak another language is important, but it is more important to seek understanding of cultural influences on health.

Which patient would most likely be uncomfortable with close personal space during an interaction with the nurse? A. A 19-year-old white female patient who is standing 2 feet in front of the nurse. B. A 40-year-old African-American male patient who is sitting next to the nurse. C. A 60-year-old Latin-American female patient who is seated across from the nurse. D. An 82-year-old patient from France who is lying in bed with the nurse sitting next to the bed.

ANS: A Different cultures prefer different degrees of closeness in personal space. Optimal distance for a therapeutic conversation is usually 3 to 4 feet. Generally, middle-class Americans feel uncomfortable when standing close to people they do not know well. Latin Americans, African Americans, and the French welcome physical closeness. In most cultures, men need more space than women do. Usually people will tolerate a person standing close to them at their side more readily than directly in front of them. Direct eye contact usually requires more space. Placing oneself at the same level (e.g., sitting while the client is sitting or standing at eye level when the client is standing) is usually perceived as less threatening. Nurses should sit at eye level with bedridden clients.

Which characteristic would the nurse use to define culture? (Select all that apply) A. Learned and shared lifeways of a particular group. B. Social identity influenced by language and religion. C. Belief in superiority of one's own ethnic group. D. Values influence both thinking and actions. E. Several generations share the same beliefs.

ANS: A, D, E Culture is the learned and shared beliefs, values, and lifeways of a particular group that are generally transmitted intergenerationally and influence one's thinking and actions. Ethnicity refers to the social identity and origins of a social group due largely to language, religion, and national origin. Ethnocentrism is the universal tendency of people to believe that one's own race or ethnic group is the most important and/or that some or all aspects of its culture are superior to those of other groups.

The nurse is interviewing a Native American client. It is most important for the nurse to take which action? A. Maintain eye contact to show respect and interest. B. Assess whether the client is comfortable with eye contact. C. Avoid prolonged eye contact with this client. D. Sit next to the patient to avoid any eye contact.

ANS: B Eye contact is often cultural; some Native Americans believe that prolonged eye contact is rude and intrusive. However, it is important to assess each individual patient for preferences and comfort with eye contact.

The nurse provides care for a male patient. When the nurse addresses the patient, which would be most appropriate? A. Use both first and last name with each encounter. B. Ask the patient how he prefers to be addressed. C. Call the patient by his first name. D. Address the patient by his last name.

ANS: B It is important to call the patient by the name he or she prefers. The nurse should ask a person how he or she prefers to be addressed because considerable cultural variation exists. Most Americans are comfortable with calling people by their first names. This is perceived by some, however, as a failure to show respect.

A female nurse discusses a concern related to client care with a male physician. Which communication strategy, if used by the nurse, is most effective? A. Assume a subservient role to the physician. B. Use a direct approach with succinct sentences. C. Ask questions instead of making recommendations. D. Be polite and expect politeness from the physician.

ANS: B Simplicity of speech is recommended; use direct communication with few words. The nurse should not assume a subservient role to the physician; there needs to be a connection between communication, collaboration, and teamwork in the nurse-physician relationship to provide quality care. The nurse should be assertive, expect professional respect, and exude expertise.

The nurse provides care to a client from Nigeria who is visiting the United States. Which should the nurse use to communicate with this client? A. Review the predominant health beliefs of the Nigerian population. B. Appraise the client's health beliefs and behaviors with a cultural assessment. C. Consult with other nurses who have taken care of clients from other countries. D. Use standard communication techniques to establish a helping relationship.

ANS: B Tripp-Reimer and Afifi (1989) suggest two processes that nurses may use to communicate with clients from diverse cultures: cultural assessment and cultural negotiation. Cultural assessment refers to the appraisal of a client's health beliefs and behaviors. The information is then used to determine appropriate nursing interventions. Cultural negotiation refers to the process of negotiating with the client regarding differences in the lay and professional belief systems concerning appropriate care. Information obtained from other sources (e.g., written documents, other nurses, experts, and standards) is not specific to this client's health beliefs and behaviors.

The nurse needs to obtain a health history from a Spanish-speaking patient. Which action by the nurse is best? A. Ask a bilingual friend of the patient to interpret. B. Use nonverbal communication and draw pictures. C. Request a Spanish-speaking medical interpreter. D. Interview the patient's English-speaking daughter.

ANS: C Professional interpreters are able to communicate medical terms and can be of assistance in reducing the risks of breaches in patient privacy and confidentiality. Also, information can be directly obtained from the patient. When family members or volunteers serve as the interpreter, patients are often uncomfortable sharing sensitive information. Family members in a stressful situation may have difficulty being the interpreter. Although nonverbal communication is important, this method should only be used if an interpreter is not available.

The nurse cares for diverse clients in a community health setting. Which action should the nurse take first to learn about delivering care to diverse clients? A. Adopt a transcultural framework to develop culturally appropriate care. B. Ask clients about their personal healthcare beliefs. C. Develop a self-awareness of personal healthcare beliefs. D. Recognize ethnocentric beliefs of minorities in the community.

ANS: C The initial action that the nurse should take to learn about delivering care to diverse clients is to become familiar with personal healthcare beliefs and behaviors. Self- awareness helps nurses recognize that their beliefs and behaviors are not necessarily common to all. Nurses' lack of knowledge about their own culture can distort their perceptions of the beliefs and behaviors of clients from diverse cultures. Transcultural frameworks have been developed to help nurses provide culturally appropriate nursing care. Ethnocentrism interferes with the appreciation of diverse cultures and their healthcare beliefs and behaviors.

The nurse observes a nursing assistant interacting with an elderly patient. Which statement by the nursing assistant requires an immediate intervention by the nurse? A. "I will help you remember where your room is located." B. "Would you like me to read from your Bible today?" C. "Tell me a story about when you were young." D. "Sweetie, I will bring your coffee in a few minutes."

ANS: D The elderly should not be addressed using disrespectful terms such as "honey," "sweetheart," "gramps," and "granny" and other patronizing forms of speech. Short-term memory may decline with age; healthcare providers may assist patients as needed. The elderly may express their spirituality through prayer and reading the Bible. Sharing stories helps an elderly patient to review life and establish meaning.