Learning outcomes for Chapter 21, Yoost

The nurse is planning an educational program for an immigrant population. Which action taken by the nurse will enhance the effectiveness of the program? 1 Developing cross-cultural linguistic competencies 2 Asking colleagues to assist in teaching the class 3 Encouraging people to rely on Western therapies 4 Including only English-speaking people in the class

1 Experts have noted that in addition to cultural competence, linguistic competence is needed to offer appropriate care and responses to culturally diverse patients. The use of certain words may be specific to a culture, and the nurse needs linguistic competence to prevent any misunderstanding. Asking colleagues to assist in the teaching is ineffective if those colleagues lack linguistic competence. Including only English-speaking people in the program demonstrates the nurse's bias, which is not good nursing practice. Encouraging people to rely on Western therapies indicates an ethnocentric view.

The nurse is explaining the need for long-term calcium therapy to a patient. The patient tells the nurse, "I feel good now. I don't think I need to continue the therapy, but I may restart if there are any symptoms." How should the nurse interpret this statement? 1 The patient exhibits present-time orientation. 2 The patient thinks of time in a linear fashion. 3 The patient tends to structure time very rigidly. 4 The patient has a more lenient perception of time.

1 The patient is not inclined to continue the therapy because the patient feels good. The patient further says that the therapy can be continued later if there are any issues. This indicates that the patient has a present-time orientation with a "wait and see" approach. A patient who thinks of time in a linear fashion believes that a particular task should be completed in the here and now, as the opportunity may never come again. A patient who has a more lenient perception of time considers time to be flexible and does not worry about arriving late to a meeting. A patient who tends to structure time rigidly will adhere to a time-structured schedule and will be future-oriented.

A nurse is leading a small group of patients. According to Bruce Tuckman, in which order, from beginning to closure, should the nurse expect the small group to develop? Norming Adjourning Storming Performing Forming

1. Forming 2. Storming 3. Norming 4. Performing 5. Adjourning The development of a small group involves five stages, namely, forming, storming, norming, performing, and adjourning. In the forming phase, the group members completely rely on the leader to set the goals and objectives for the group. The storming phase involves conflicts among group members. In this phase, the leader has to play a vital role to work with the group members to resolve internal conflicts. In the norming phase, stronger trust builds among the participants. The performing phase involves problem solving by the members. The adjourning phase involves the dispersal of the group after completion of its goals.

7. The most important aspect of providing culturally competent care is exhibited through what action by the nurse? a. Seeking to understand individual patient customs, beliefs, and values b. Planning collaborative care with a variety of health care professionals c. Providing similar care for all patients regardless of their background d. Transferring patients to more culturally conducive areas more quickly

ANS: A Assessing and listening to each patient's customs and beliefs is the most important way to provide culturally congruent and patient-centered care. Collaboration with other professionals is secondary to needs assessment. Treating everyone identically or transferring patients with diverse cultural backgrounds off of the unit does not meet individualized, culturally sensitive standards of care.

3. Which action by a health care facility would demonstrate a commitment to providing culturally competent care? a. Providing continuing education events focused on delivery of linguistic services b. Referral of cultural diverse patients for psychiatric counseling to help them communicate more clearly c. Providing signage in English to help patients and families navigate from one department to the next more easily d. Delegation of all patient and family care to health care professionals that are of the same ethnicity

ANS: A CLAS Standards for Health Care recommend that health care organizations ensure that staff at all levels receive continuing education in linguistically appropriate services. Psychiatric counseling is unnecessary to overcome most communication challenges. Signage needs to be provided in multiple languages commonly spoken in the health care facility in order to better inform and direct patients who do not speak English. It is impossible and unnecessary to delegate all care to persons of like ethnicity.

5. What response is most appropriate for the nurse if a patient prefers to seek acupuncture for pain relief before taking prescribed medication? a. Recognize that alternative forms of treatment can be effective. b. Require that the patient take the ordered pain medication. c. Refer the patient for professional pain relief counseling. d. Have the patient's family get the patient to take the medication.

ANS: A Many health care professionals and patients recognize the effectiveness of alternative therapies, which are more typically associated with Eastern medicine. Patients should not be forced to take medication against their will. Counseling is unnecessary in this case, and seeking the family's help in convincing the patient to take the prescribed medication is not the best option.

9. What action by a nurse would indicate an understanding that foreign-speaking patients experience a clash of more than one culture when admitted to a health care facility? a. Explaining medical terms and verifying that the patient understands b. Sharing written patient information pamphlets for the patient to read c. Orienting the patient's family to the hospital lounge and visiting hours d. Contacting the pharmacy for generic and brand name medications

ANS: A Nurses need to be aware that three cultures intersect in culturally competent care; the nurses and patient's cultures as well as health care culture. Explaining medical terminology and verifying understanding demonstrates an understanding of this phenomena. Sharing pamphlets may not meet patient needs if they are unable to comprehend the written material. Orienting families and calling the pharmacy does not relate to exhibiting cultural competence.

1. Which factors are biological variations that should be assessed by the nurse when conducting a transcultural assessment? (Select all that apply.) a. Susceptibility to illness b. Body frame and structure c. Existence of genetic disease d. Social and work time orientation

ANS: A, B, C Susceptibility to illness, body structure, and the presence of a genetic disease are all biological variations that should be assessed during a transcultural assessment according to Giger and Davidhizar. Social orientation and work orientation are not biological phenomena.

2. The nurse is caring for a surgical patient who speaks only Mandarin Chinese. The nurse will (Select all that apply.) a. consider the body structure of the patient for rehabilitation needs. b. use the translation services of the institution for communication of the care plan. c. explore the cultural practices for foods, eye contact, and body space for care provision. d. ask a family member to translate.

ANS: A, B, C The nurse should take into account the patient's body structure and cultural practices when providing care. Use of a professional interpreter is necessary if the nurse and the patient do not speak the same language fluently. Avoid translation of medical information by a patient's family members or friends to ensure privacy and accuracy of essential, personal information.

6. Which strategy would most help an English-speaking nurse to communicate with a patient for whom English is a second language? a. Use acronyms when referring to community organizations. b. Abbreviate medical terminology as much as possible. c. Slow down when speaking to articulate more clearly. d. Speak more loudly when the patient misunderstands.

ANS: C Many people speak their native language very quickly, which can be confusing to others for whom it is a second language. Slowing down speech helps with articulation and clarity in speaking. Use of acronyms or abbreviations is extremely confusing to individuals who are not native to a language or are just learning it. Speaking more loudly will not help a person understand a foreign language.

4. Which action by the nurse is essential to providing culturally congruent care? a. Follow established patient interview guidelines without variation. b. Understand that environmental context need not be documented. c. Recognize one's own personal cultural heritage, patterns, and biases. d. Assume that cultural values are identical for all members of one family.

ANS: C Recognizing one's own personal biases and cultural norms is essential to providing culturally congruent care according to Leininger and McFarland. When assessing culturally diverse patients, it is essential for the nurse to adapt assessment questions in a manner that is more understandable to the non-English-speaking patient. Nurses should always note the environmental context in which patient interactions take place, consistently documenting the location of assessment. Beliefs and values of family members may vary significantly.

2. Immigrants who begin to use technology while continuing to adhere to their traditional mode of dress are exhibiting what aspect of cultural identity? a. Socialization b. Ethnocentrism c. Assimilation d. Acculturation

ANS: D Acculturation occurs when individuals accept some aspects of a new culture without losing their distinct cultural identity. Assimilation involves a total blending of cultures when individuals actually reject or lose much of their original cultural identity. Ethnocentrism is the belief that one's culture is superior to another. Socialization takes place throughout a person's life and involves nurture and a gradual acquisition of cultural characteristics.

8. What intervention should be initiated first by a nurse assigned to care for a culturally diverse patient admitted with significant body odor? a. Approach the patient with washcloths and towels ready to give a bath. b. Contact family members or friends to learn more about the situation. c. Ask the patient to bathe prior to conducting an admission assessment. d. Seek information to determine the underlying cause of the body odor.

ANS: D Assessment of the underlying cause of the body odor is the first step to patient-centered care. Assisting the patient to bathe or asking the patient to bathe may be appropriate interventions once the underlying cause of the body odor is established. Asking family or friends for insight into the source of body odor would be a last step if the patient was unable to provide adequate information and a physical assessment did not reveal the cause.

1. Which action by an individual best demonstrates enculturation? a. Using elaborate symbols to represent words b. Confronting parents with their traditional family values c. Providing for the necessities of life such as food and shelter d. Sharing cultural expectations with younger family members

ANS: D Enculturation is the process of passing culture from one generation to the next. Using symbols is one aspect of culture. Challenging traditional values reflects a developmental stage or change in worldview. Supplying basic needs is not dependent on culture.

6. What aspect of culture is a full-time employed granddaughter of an elderly Asian female exhibiting if she asks the social worker to place her grandmother in an extended-care facility against the wishes of her parents? a. System change b. Gender role c. Cultural norms d. Shared attributes

Answer: a As one aspect of a society changes, the systems within that society change. The granddaughter in this case is employed full time and unable to adequately care for her grandmother at home. Therefore, her request to have the grandmother placed in an extended-care facility is a reflection of societal changes that affect traditional culture expectations of one generation's providing care in the home. Shared attributes, cultural norms, and gender role all are challenged by the granddaughter's actions.

7. Culturally competent care would encourage which action by a patient's family? a. Asking the family's spiritual advisor to visit the patient b. Speaking English to everyone involved in patient care c. Adhering to highly publicized restrictive unit visiting hours d. Limiting food consumption to items provided by the cafeteria

Answer: a Culturally competent care allows for flexibility within safety guidelines and patient care limitations. Allowing a patient to meet with a spiritual advisor recognizes the importance of a patient's spiritual needs. Limiting language use, food consumption, and visiting hours in a strict manner without sensitivity to a patient's preference do not reflect culturally competent nursing care.

8. If a patient's primary language differs from that of the health care professionals providing care, which action is most appropriate for the nurse to take? a. Use colorful pictures, white boards, and gestures to communicate all important information. b. Recognize that continuous affirmative answers by the patient require verification of understanding. c. Arrange for a professional language translator to sit with the patient throughout the hospitalization. d. Decrease interaction with the patient and family to avoid making them uncomfortable for not understanding.

Answer: b Consistent affirmative answers from a patient in the form of verbal responses of nods may indicate that a patient does not really understand what is being asked and is just trying to be cooperative. It is important for the nurse to double check to make sure a patient understands instructions and questions to ensure safety and proper care. Not all information can be conveyed via pictures or gestures, and professional interpreters typically are not used as patient sitters. Ignoring or avoiding patients or families with culturally diverse backgrounds serves to isolate them and is never appropriate.

5. How best can a nurse evaluate goal attainment for a patient with a culturally diverse background? a. Assume that gender roles will be a challenge to overcome regardless of the patient's ethnicity. b. Base decisions on feedback from the patient and the nurse's professional judgment. c. Collaborate with future community care providers to determine patient strengths. d. Seek input from members of the patient's support system to avoid biased patient responses.

Answer: b Decisions about whether a patient has met treatment goals or outcomes should be based on patient feedback and a nurse's professional judgment. Gender role considerations are unlikely to play a role in evaluation. Future community care providers are unable to help in the evaluation of patient goals before participating in a patient's care. The patient is the primary person from whom information should be obtained in evaluating goals and outcomes.

2. Which action taken by a nurse would reflect application of an appropriate generalization in a patient care setting? a. Assigning same-gender nurses to all patients admitted to the unit b. Sharing with unlicensed assistive personnel that typically Muslim patients do not eat pork c. Telling the radiology technician that every Latino family is late for appointments d. Assuming that Asians share financial responsibility for medical bills

Answer: b Muslims typically do not consume pork products. This generalization would be helpful to use as a baseline for caring for Muslim patients. It is always important, however, for nurses to ask patients to verify whether they adhere to cultural norms. Same-gender nurses need not be assigned to all patients. Making broad statements that are unkind regarding people of one culture is stereotyping and hurtful. The Amish, not Asians, typically share responsibility for medical bills.

9. Which nursing diagnosis is most appropriate for a young Middle Eastern immigrant who expresses concern for the safety of his family members who were unable to relocate with him out of a war zone? a. Risk for Spiritual Distress b. Impaired Role Performance c. Interrupted Family Processes d. Ineffective Coping

Answer: c A key-related factor in interruption of family processes is a situational crisis that causes a change in communication and emotional and mutual support, which all are present in this case. None of the information provided indicates a spiritual crisis, ineffectiveness of coping, or impairment of role performance.

1. Which statement best serves as a guide for nurses seeking to learn more about ethnicity? a. Ethnicity, like culture, generally is based on genetics. b. A patient's ethnic background is determined by skin color. c. Ethnicity is based on cultural similarities and differences in a society. d. Culture and socialization are unrelated to the concept of ethnic origin.

Answer: c Ethnicity is based on cultural similarities and differences in a society or nation. The similarities are with members of the same ethnic group; the differences are between that group and others. Ethnicity is not based on or determined by genetics or skin color. Culture, ethnicity, and socialization are all related concepts.

10. What is the best method for the nurse to ensure that a Croatian patient's nutritional needs are met during hospitalization? a. Preorder a diet that is consistent with the typical Croatian patient's dietary preferences. b. Ask a Croatian co-worker for ideas on what would be best to order for the patient's meals. c. Request that a variety of dietary entrees be provided to the patient to provide options. d. Check with the patient on admission to determine dietary limitations and preferences.

Answer: d The best way to provide for a patient's dietary needs is to ask the patient for personal preferences, limitations, allergies, and typical dietary intake. Preordering, checking with a co-worker, or ordering a variety of options without input from the patient first does not reflect patient-centered care.

4. Which of the following questions is/are appropriate to ask during a transcultural assessment? (Select all that apply.) a. How do you act when you are angry? b. What is your role in your extended family? c. Why do you continue to speak German at home? d. When communicating with friends, how close do you stand? e. What is the purpose of not preparing beef with milk products?

Answers: a, b, d How a person acts when angry, the person's role in the family, and comfort with proximity all are relevant aspects of the patient's cultural norms, according to Giger and Davidhizar, and should be assessed to raise the nurse's awareness of patient needs. Asking a patient why they use their native language in the home is unnecessary. If primary language information is needed, the nurse should simply ask what language is spoken in the home. The nurse should not try to seek information about the reason a person maintains dietary traditions during the assessment process.

3. Which statement(s) reflect/s the practice of transcultural nursing? (Select all that apply.) a. May be considered a general and specialty practice area b. Focuses on the world view rather than patient needs c. Challenges traditional ethnocentric nursing practice d. Aims to identify individual patient care preferences e. Focuses patient care on the nurse's cultural norms

Answers: a, c, d Transcultural nursing is a general and specialty practice that focuses on both world view and individual patient and family needs for planning and providing care. It challenges nurses to investigate other cultures in order to reject ethnocentric care and respond to individual needs.

An Arab woman is admitted to the hospital. A male nurse is assigned to examine this patient. The patient is uncomfortable and expresses her displeasure at being assigned a male nurse. What should the head nurse do?

Assign a female nurse to carry out the examination. Arab women are generally reluctant to have males examine them. The head nurse should respect the patient's wish and culture and assign a female nurse to her. The head nurse should not ask the male nurse to proceed, as this would violate the patient's wish. The mere presence of a female nurse during an examination by a male nurse would not make the patient comfortable. Telling the patient the hospital is short staffed may not be true and should not be used as an excuse to disobey the patient's wishes.

LO 21.5 Describe how to develop culturally competent individualized plans of care using cultural assessment tools and the nursing process:

Cultural assessment requires the gathering of data in multiple areas of concern, such as language and traditional health practices. Each aspect of a patient's care plan should be determined after collaboration with patients and should reflect cultural sensitivity to their individual needs.

LO 21.1 Compare characteristics of culture and ethnicity:

Culture is symbolic, learned, shared, and integrated. Culture includes knowledge of values, beliefs, and ways of life of a particular group that are generally transmitted from one generation to another. Culture influences an individual's thinking and decision-making patterns. Ethnicity is expressed by identity with a particular racial, national, or cultural group, including observation of the group's customs, beliefs, and language.

LO 21.3 Identify factors that contribute to cultural identity acquisition:

How people choose to identify with or conform to a culture is determined by the extent to which they ascribe to the norms and traditions of the culture.

LO 21.2 Explain cultural concepts that affect a nurse's ability to provide culturally congruent care:

Some cultural concepts such as generalization may be helpful in guiding nursing practice within certain cultural settings. Others, such as stereotyping, discrimination, and racism, have a negative effect on a nurse's ability to provide culturally congruent care.

LO 21.4 Articulate an understanding of transcultural nursing and cultural competence:

Transcultural nursing focuses on a broad understanding of global health care and the incorporation of culturally sensitive interventions to demonstrate cultural competence.