Yoost Chapter 21: Ethnicity and Culture Review Questions

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.

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 counseling to help them communicate more clearly c. Providing hospital signage in several languages to help patients and families navigate 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. 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. However, that is a small part of being culturally competent. It is impossible and unnecessary to delegate all care to persons of like ethnicity.

A patient prefers to seek acupuncture for pain relief before taking prescribed medication. What response by the nurse is most appropriate? 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.

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.

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 e. Cultural health practices

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 in the time domain. Cultural health practices are in the environmental control domain.

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 so the patient doesn't get charged for an interpreter. e. determine the patient's role and functions within the family.

ANS: A, B, C, E 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. Roles in the family are important to patients from all cultures. Avoid translation of medical information by a patient's family members or friends to ensure privacy and accuracy of essential, personal information. Patients are not charged for translation services.

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.

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.

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.

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.

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.

What aspect of culture is a full-time employed granddaughter of an elderly 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 reflects societal changes that affect traditional culture expectations of one generation's providing care in the home. Shared attributes, cultural norms, and gender role are all challenged by the granddaughter's actions.

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.

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, whiteboards, and gestures to communicate all important information. b. Verify patient understanding of questions asked when the patient responds with continuous affirmative answers. c. Arrange for a professional language translator to be present 24 hours each day. 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 a professional interpreter need not be present 24 hours a day. Ignoring or avoiding patients or families with culturally diverse backgrounds serves to isolate them and is never appropriate.

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.

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. Asking the dietary intern to verify with Middle Eastern patients whether or not they eat pork c. Telling the radiology technician that every non-Hispanic family is late for appointments d. Assuming that extended families share financial responsibility for medical bills

Answer: b Middle Eastern people typically do not consume pork products. This generalization would be helpful to use as a baseline when caring for Muslim or Jewish patients. It is always important to ask patients to verify whether they adhere to cultural norms. Same-gender nurses need not be assigned to all patients. Making broad statements regarding people of one culture is stereotyping and hurtful. Assuming anything without asking about patient traditions or preferences is inappropriate.

Which ICNP nursing diagnosis is most appropriate for a young 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. Impaired Family Process d. Difficulty Coping

Answer: c A key factor in Impaired Family Process 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.

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.

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.

Which of the following questions 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 should be assessed to raise the nurse's awareness of patient needs. Asking patients 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.

Which statements reflect 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 worldview 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.