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