FON CHAPTER 5 CULTURAL DIVERSITY

A nurse is assigned to care for a client who does not speak the dominant language. An interpreter has been contacted and will be at the bedside shortly. Which action by the nurse would be most effective in reassuring the client until the interpreter arrives?

Using reassuring body language and making eye contact to assess needs Explanation: The nurse assigned to care for a client who does not speak the dominant language can reassure the client by using appropriate body language and anticipating needs until an interpreter arrives. Doing so is important because there may be a delay in the interpreter arriving. Gestures and symbols can be confusing, as can enlisting multiple people to communicate. Avoiding the client's room is not appropriate or in the best interest of the client.

When providing culturally competent care to clients, a nurse understands that cultural competence involves which characteristics? Select all that apply.

A process that requires life-long learning A commitment to promoting health equity Knowledge of influences on the clients' beliefs Awareness of one's own influences on responses Explanation: Cultural competency is an integral component of the knowledge and practice base of nursing and is continually improved through a life-long learning process and commitment to health equity. It requires a knowledge of the influences on clients' beliefs and self-awareness of one's own influences on clients' responses.Standards of practice for culturally competent nursing care continue to be refined and are driven by the principles of social justice and health equity, not fidelity, with the aim of reducing health disparities.

What is the priority assessment for the nurse when developing a plan of care for a client from a poverty culture?

Access to care Explanation: 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.

Which population group should the nurse routinely screen for heart disease?

White Explanation: Whites (Caucasians) have a high incidence of heart disease and should be screened based on race and age parameters.

Which questions may help the nurse assess his or her ability to relate to various groups in society? Select all that apply.

Can I welcome this person sincerely?" "Can I genuinely try to help this person and be comfortable enough to listen?" "Do I have the experience to help this person?" Explanation: When assessing how you relate to various groups in society, it is important to assess from a professional standpoint. Sincerity, listening, and experience are all components of a professional nature. Having dinner or considering a person as a mate brings about a personal element that may create bias; this has no place in the professional realm.

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 Explanation: 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.

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

First Nations Explanation: Although at one time Native Americans in the United States and the Native Indians in Canada all freely moved back and forth across what have become national boundaries, people of Canadian Indian descent prefer to be identified as First Nations people. Indians, Americans, and Canadians are general terms for persons who live in, or are from India, the United States, or Canada respectively.

Which nursing intervention reflects practice according to Madeline Leininger's transcultural nursing theory?

Incorporating the client's request for complementary treatment therapy Explanation: Leininger's theory of transcultural nursing includes assessing a cultural nature, accepting each client as an individual, having knowledge of health problems that affect particular cultural groups, and planning of care within the client's health belief system to achieve the best health outcomes. Therefore, incorporating the client's request for complementary treatment therapy is an example of this theory. The others do not support this theory.

Which teaching statement best exemplifies cultural competence in relation to time for the American culture?

It is important to be on time for your health care appointment. Explanation: In the United States, being on time and completing a job promptly are the expectation. This expectation is not the same in all cultures. It should be included when explaining cultural practice that timeliness is important. Being late for an appointment is considered disrespectful in the American culture.

Which disorders might a nurse screen for in a black client, based on race? Select all that apply.

Keloid formations Lactase deficiency Sickle cell anemia Explanation: Black people are more likely to have keloid formations, lactase deficiency, and sickle cell anemia compared with the general population. Black people are not more likely to have Tay-Sachs disease, gout, or cystic fibrosis.

When providing care to a client, the nurse refers to the client's ethnic group. Which aspects would the nurse include as pertaining to this concept? Select all that apply.

Language Religious beliefs Shared beliefs of origin Explanation: Although the terms race and ethnic group sometimes refer to the same people, race takes biologic characteristics as the markers of separate social status, and ethnic group takes social characteristics (such as language, religious tenets, shared beliefs of origin) as markers of cultural identity.

While caring for a client from a culture different from the nurse's, the nurse inadvertently offends the client. What is the best action by the nurse?

Learn from the mistake and do not repeat it. Explanation: All nurses make mistakes at some time when caring for culturally diverse clients. The best action is to learn from the mistake and not repeat the offense. Although it may be appropriate to discuss with the client, asking why the client is so mad is aggressive and may make the situation worse. The mistake was inadvertent and may not be the result of cultural bias. Focusing on your own majority culture will not help bring about learning associated with the mistake.

A nurse is caring for clients in a predominantly black community. What values or beliefs are commonly shared by members of this culture? Select all that apply.

Oriented to the present Frequently highly religious Clergy members highly respected Explanation: It is common to find individuals in the black community more oriented to the present, often highly religious, and displaying high respect for their clergy members. The other factors listed are not usually attributed to the black community.

A nurse is conducting a seminar for a group of nurses about the cultural competency in nursing. When describing culture, which terms would be appropriate for the nurse to use? Select all that apply.

Pervasive Holistic Recognizable Ritualistic Explanation: Culture is stabilizing, not unsettling, in that it makes human responses generally predictable, relative to socioecologic context, pervasive and holistic, recognizable in patterns at many levels, and ritualistic.

Which stereotypical ideas about older adult clients does the nurse associate with the concept of ageism? Select all that apply.

Physically impaired Burdensome to family Uninterested in intimacy Explanation: Ageism, a form of negative stereotypical thinking about older adults, promotes false beliefs about older adults being physically and cognitively impaired, lacking interest in sex, and being burdensome to families and society. Ageism is not associated with concepts of cognitive enhancement or financial independence.

A nurse receives a report for a client who is going to surgery in the morning. The nurse is informed that the client is Jehovah's Witness. What education is needed for this particular client?

The client needs to have a discussion with the health care team about blood product preferences. Explanation: Although the client is Jehovah's Witness, the nurse needs to initiate a discussion with the client about administration of blood and blood products. The nurse should not stereotype and assume the client will refuse all blood products. The client should be informed about choices and given options prior to surgery. These options should be provided without judgement or personal opinion. If the client chooses to refer to a spiritual counselor, this should be provided, but this is not education needed.

A nurse caring for culturally diverse patients in a health care provider's office is aware that patients of certain cultures are more prone to specific disease states than the general population. Which patients would the nurse screen for diabetes mellitus based on the patient's race? Select all that apply. a. A Native American patient b. An African-American patient c. An Alaska Native d. An Asian patient e. A White patient f. A Hispanic patient

a, c, e, f. Native Americans, Alaska Natives, Hispanics, and Whites are more prone to developing diabetes mellitus. African Americans are prone to hypertension, stroke, sickle cell anemia, lactose intolerance, and keloids. Asians are prone to hypertension, liver cancer, thalassemia, and lactose intolerance.

A nurse is telling a new mother from Africa that she shouldn't carry her baby in a sling created from a large rectangular cloth. The African woman tells the nurse that everyone in Mozambique carries babies this way. The nurse believes that bassinets are safer for infants. This nurse is displaying what cultural bias? a. Cultural imposition b. Clustering c. Cultural competency d. Stereotyping

a. The nurse is trying to impose her belief that bassinets are preferable to baby slings on the African mother—in spite of the fact that African women have safely carried babies in these slings for years.

A nurse is interviewing a newly admitted patient. Which question is considered culturally sensitive? a. "Do you think you will be able to eat the food we have here?" b. "Do you understand that we can't prepare special meals?" c. "What types of food do you eat for meals?" d. "Why can't you just eat our food while you are here?"

c. Asking patients what types of foods they eat for meals is culturally sensitive. The other questions are culturally insensitive.

Nurses are responsible for delivering culturally competent care for all clients. Culturally competent care does not account for:

client's height. Explanation: In partnership with the person, family, and others; the nurse develops an individualized plan considering the person's characteristics or situation including but not limited to: values, beliefs, spiritual and health practices, preferences, choices, developmental level, coping style, culture, environment, and available technology. A physical characteristic such as one's height does not contribute to cultural competence.

A nurse states, "That patient is 78 years old—too old to learn how to change a dressing." What is the nurse demonstrating? a. Cultural imposition b. Clustering c. Cultural competency d. Stereotyping

d. Stereotyping is assuming that all members of a group are alike. This is not an example of cultural competence nor is the nurse imposing her culture on the patient. Clustering is not an applicable concept.

A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish and the nurse speaks only English. What is the appropriate nursing intervention? a. Use short words and talk more loudly. b. Ask an interpreter for help. c. Explain why care can't be provided. d. Provide instructions in writing.

b. The nurse should ask an interpreter for help. Many facilities have a qualified interpreter who understands the health care system and can reliably provide assistance. Using short words, talking loudly, and providing instructions in writing will not help the nurse communicate with this patient. Explaining why care can't be provided is not an acceptable choice because the nurse is required to provide care; also, since the patient doesn't speak English, she won't understand what the nurse is saying.

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?

"Can you tell me what foods you prefer to eat and what your family is bringing you?" Explanation: 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 should verify the client's understanding of the diet but should avoid closed-ended questions such as asking if the client understands the specific diet for HTN.

A nurse who usually works on the surgical unit is asked to float to the oncology unit because of staffing needs. Which statement by the nurse indicates the possibility of the nurse experiencing culture shock?

"I am very stressed now because I do not understand how things work on this unit." Explanation: The nurse is experiencing culture shock because of the new environment. When the culture one has learned differs from the culture in one's environment, a person can become disoriented and stressed. The acute experience of not comprehending the culture of the current environment is called culture shock. Asking for an orientation to a new unit is proper procedure for a float nurse. The third statement indicates ethnocentrism, not culture shock. The fourth statement indicates stereotyping.

The nurse is teaching a black client about common health conditions. Which statement by the client most directly addresses a health problem with an increased incidence in this population group?

"It is important to monitor my blood pressure." Explanation: Monitoring the blood pressure is important for identifying the risk for hypertension and stroke, which are common health conditions among the black population. The other statements are correct for preventing diabetes, breast cancer, and osteoporosis, but these diseases are not disproportionately common health conditions for the population.

A client is admitted to the health care facility with hypoglycemia. After the client is stable, the nurse discovers that the client has not had the prescribed medicines. The client believes that eating saffron will keep blood sugar under control. What is the most appropriate response by the nurse?

"Why don't you take the medicines, too, and benefit from both?" Explanation: Although the nurse may disagree with the client's beliefs concerning the cause of health or illness, respect for these beliefs helps the nurse to achieve health care goals. Asking the client to consider the benefits of medicine is appropriate because the nurse, without disrespecting the client's beliefs, persuades the client to have medicines also. Stating that saffron does not have any effect on blood sugar level is inappropriate, as it disregards the client's beliefs. Agreeing with the client may encourage him or her and indicate low faith in the present treatment. It is inappropriate to call the health care provider and report on the client.

A geriatric client is observed smoking a cigarette and lowering the oxygen nasal prongs away from the nostrils. Which is the priority action of the nurse?

Remind the client to avoid smoking during oxygen therapy Explanation: There is a highly flammable risk when cigarettes are lit and smoked near oxygen therapy. Both the clients and guests should be advised and reminded not to smoke when oxygen therapy is present. Although tobacco chewing would lessen the flammable risk, this product is infrequently available. The nurse should discuss smoking habits and the interest to quit smoking cigarettes with the client. If the client expresses interest in a smoking cessation program or, even, the nicotine treatments, then it would be appropriate for the nurse to request a smoking cessation prescription from the physician. However, the nurse should always consider and discuss the client's preferences and coping mechanisms rather than institutionally pressuring or assimilating the client to stop smoking. Finally, while every client will die one day from medical diseases or accidents, the nurse must recognize the flammable risk the client is generating to him- or herself, those around them, and the surrounding environment. The nurse has a moral responsibility to remind the client of the flammable risks of mixing oxygen with cigarette smoking.

A client has recently immigrated and is exhibiting symptoms of culture shock. The client reports feeling unaccepted in the new culture. The client states, "I can't do anything right here." What is the priority nursing diagnosis?

Situational low self-esteem related to culture shock and feelings of fear and incompetence Explanation: The client is experiencing low self-esteem, which is often associated with culture shock. It is situational in nature and will likely improve with cultural assimilation. The client does not indicate powerlessness, spiritual distress, or social isolation.

A nurse convinces a client who is a Jehovah's Witness that receiving blood products is more important than the legalistic components of religion. What client reaction may be expected following this mandated change?

The client states, "I feel like I abandoned my religion." Explanation: When clients are forced to participate in care that conflicts with their values, feelings of guilt and abandonment are likely. These feelings may deepen and threaten the client's well-being. The other answer choices are not related to mandated change.

A client who does not speak the dominant language has been admitted to the health care facility reporting chest pain. Because the assigned nurse does not know the client's language, what would be the most appropriate solution for communication until a professional interpreter can be obtained?

The nurse should request the help of a family member if available, if not care should be administered that is in the best interest of the client. Explanation: The nurse should request the help of a professional interpreter to communicate effectively with the client who does not speak the same language as the nurse. If this is not readily available in an emergency situation, the nurse can ask a family member to help in basic communication if available. The nurse is responsible for providing care to stabilize the client regardless of language barriers. Trying to use a language dictionary to help communicate may be troublesome and time-consuming. The nurse cannot shun nursing responsibilities by asking for a different assignment or asking for a different nurse to take the case. Asking the client to communicate nonverbally may lead to a break in communication or misinterpretations.

In order to provide culturally competent care, nurses must be alert to factors inhibiting sensitivity to diversity in the health care system. Which nursing actions are examples of cultural imposition? Select all that apply. a. A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. b. A nurse treats all patients the same whether or not they come from a different culture. c. A nurse tells another nurse that Jewish diet restrictions are just a way for them to get a special tray of their favorite foods. d. A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. e. A nurse directs interview questions to an older adult's daughter even though the patient is capable of answering them. f. A nurse refuses to care for a married gay man who is HIV positive because she is against same-sex marriage.

a, d. Cultural imposition occurs when a hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily, and when a Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. Cultural blindness occurs when a nurse treats all patients the same whether or not they come from a different culture. Culture conflict occurs when a nurse ridicules a patient by telling another nurse that Jewish diet restrictions are just a way for Jewish patients to get a special tray of their favorite foods. When a nurse refuses to respect an older adult's ability to speak for himself or herself, or if the nurse refuses to treat a patient based on that patient's sexual orientation, the nurse is engaging in stereotyping.

The nurse practitioner sees patients in a community clinic that is located in a predominately White neighborhood. After performing assessments on the majority of the patients visiting the clinic, the nurse notes that many of the minority groups living within the neighborhood have lost the cultural characteristics that made them different. What is the term for this process? a. Cultural assimilation b. Cultural imposition c. Culture shock d. Ethnocentrism

a. When minority groups live within a dominant group, many members lose the cultural characteristics that once made them different in a process called assimilation. Cultural imposition occurs when one person believes that everyone should conform to his or her own belief system. Culture shock occurs when a person is placed in a different culture perceived as strange, and ethnocentrism is the belief that the ideas, beliefs, and practices of one's own cultural group are best, superior, or most preferred to those of other groups.

A nurse is using the ESFT model to understand a patient's conception of a diagnosis of chronic obstructive pulmonary disease (COPD). Which interview question would be MOST appropriate to assess the E aspect of this model—Explanatory model of health and illness? a. How do you get your medications? b. How does having COPD affect your lifestyle? c. Are you concerned about the side effects of your medications? d. Can you describe how you will take your medications?

b. The ESFT model guides providers in understanding a patient's explanatory model (a patient's conception of her or his illness), social and environmental factors, and fears and concerns, and also guides providers in contracting for therapeutic approaches. Asking the questions: "How does having COPD affect your lifestyle?" explores the explanatory model, "How do you get your medications?" refers to the social and environmental factor, "Are you concerned about the side effects of your medications?" addresses fears and concerns, and "Can you describe how you will take your medications?" involves therapeutic contracting.

A nurse is teaching a novice nurse how to provide care for patients in a culturally diverse community health clinic. Although all these actions are recommended, which one is MOST basic to providing culturally competent care? a. Learning the predominant language of the community b. Obtaining significant information about the community c. Treating each patient at the clinic as an individual d. Recognizing the importance of the patient's family

c. In all aspects of nursing, it is important to treat each patient as an individual. This is also true in providing culturally competent care. This basic objective can be accomplished by learning the predominant language in the community, researching the patient's culture, and recognizing the influence of family on the patient's life.

A nurse is caring for patients of diverse cultures in a community health care facility. Which characteristics of cultural diversity that exist in the United States should the nurse consider when planning culturally competent care? Select all that apply. a. The United States has become less inclusive of same-sex couples. b. Cultural diversity is limited to people of varying cultures and races. c. Cultural diversity is separate and distinct from health and illness. d. People may be members of multiple cultural groups at one time. e. Culture guides what is acceptable behavior for people in a specific group. f. Cultural practices may evolve over time but mainly remain constant.

d, e, f. A person may be a member of multiple cultural, ethnic, and racial groups at one time. Culture guides what is acceptable behavior for people in a specific group. Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group's needs. The United States has become more (not less) inclusive of same-sex couples. The definition of cultural diversity includes, but is not limited to, people of varying cultures, racial and ethnic origin, religion, language, physical size, biological sex, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location. Cultural diversity, including culture, ethnicity, and race, is an integral component of both health and illness.