#14 - Chapter 5: Culturally Respectful Care
A new client comes to the primary care clinic and asks for help treating head lice. The interview reveals that the client lives with nine other people in a one-bedroom apartment. Which statement by the client is nurse's PRIORITY concern? A) "We do not have running water B) "I often worry about my future C) "I am receiving government assistance D) "We do not have air-conditioning
A) "We do not have running water The priority in this situation is the lack of running water. The already challenging task of eradicating head lice in a crowded living space is worsened by the lack of running water. The concern for one's future needs to be addressed, but the need for water is the first priority. That the client receives government assistance might serve as an indicator of the client's economic challenges but is not a priority nursing concern. The lack of air conditioning would be a concern in a heat wave, but not as much a priority as the lack of running water.
The unlicensed assistive personnel reports to the nurse that the client is refusing to eat the food on the meal tray. The nurse observes the client eating the food brought in by family members. How should the nurse respond? A) "What type of food did your family prepare for you, and does it have special meaning? B) "You can only eat the food that we serve you C) "Do you understand that you are on a strict diet and any variation can cause you harm? D) "I will need to get permission from your health care provider for your to eat the food your family brought in.
A) "What type of food did you family prepare for you, and does it have special meaning? The culturally competent nurse should assess the type of food the client is eating and if the food has special meaning. Some cultures use food for healing and balance during times of illness. The client may have a restricted diet, but educating the client and family can allow the client to meet the cultural needs while still getting nutrition and meeting the dietary restrictions. The nurse does not need to ask permission from the health care provider regarding the food brought in from the family. Telling the client that they must only eat the food offered in the health care setting is not true or empathetic.
Upon moving to another country, a college student is very confused by many local customs. The student is very confused by many local customs. The student is especially bothered by the meal time customs, which make the student angry and resentful of the new culture. What are the feelings experienced by this student? A) culture shock B) stereotyping C) ethnocentrism D) cultural assimilation
A) culture shock The student is experiencing culture shock, which is defined as the feelings a person experiences when placed in a different culture. Stereotyping is the assumption that all members of a culture, subculture, or ethnic group act alike. Ethnocentrism is the belief that one's ideas, beliefs, and practices are the best, are superior, or are most preferred to those of others. Cultural assimilation occurs when members of a marginalized identity group live within a dominant group and lose the cultural characteristics that make them different.
The nurse is caring for a client who does not speak the same language. To facilitate unencumbered communication with the client, the nurse will take which action(s)? Select all that apply A) determine in which language the client communicates effectively B) review facility policy on communication with clients who do not speak the same language C) schedule a certified interpreter when collecting client health history D) request that the client's spouse carries out language interpretation at discharge E) ask the client's child, who speak the same language as the nurse, to explain treatment options to the client
A) determine in which language the client communicates effectively B) review facility policy on communication with clients who do not speak the same language C) schedule a certified interpreter when collecting client health history All clients have the right to unencumbered communication with a health care provider. Using children as interpreters or requiring clients to provide their own interpreters is a civil rights violation. In addition, the use of untrained interpreters, volunteers, or family is considered inappropriate because it undermines confidentiality and privacy. It also violates family roles and boundaries. The best form of communication with a client who does not speak or has limited ability in the language used by the health care staff is through a certified interpreter. A certified interpreter is a translator who is certified by a professional organization through rigorous testing based on appropriate and consistent criteria.
A nurse is assessing a client and determines that the client belongs to a minority group. Based on the nurse's understanding about marginalized identity groups, the nurse would anticipate that the client would likely experience which effects? Select all that apply A) less power B) health disparities C) greater advantages D) improved access to care E) increased economic privileges
A) less power B) health disparities The term marginalized identity group refers to a group of people within a society whose members have different ethnic, racial, national, religious, sexual, political, linguistic, or other characteristics from most of society. Being of a marginalized group often results in having less power and being disadvantaged, including health disparities in a society. Greater advantages, improved access to care, and economic privileges are not associated with marginalized identity groups.
A nurse is attempting to gain insight into a client's cultural beliefs and attitudes. Which methods would the nurse likely use? Select all that apply A) open-ended interviewing B) ethnographic interviewing C) key informants D) short-term observation E) use of the client's language
A) open-ended interviewing B) ethnographic interviewing C) key informants E) use of the client's language Methods to gain the client's perspective include open-ended interviewing (a variant of which is the ethnographic interview); the use of key informants; observation over time (not short-term); and use of the client's language.
Which behavior(s) demonstrated by the client would the nurse consider reflections of the client's pride in ethnicity? Select all that apply A) requesting native cuisine B) listening to fold music and dance C) asking to wear unique clothing D) crying when given a diagnosis of cancer E) requesting assistance when transferring from bed to chain
A) requesting native cuisine B) listening to fold music and dance C) asking to wear unique clothing Pride in one's ethnicity is demonstrated by valuing certain physical characteristics, giving children ethnic names, wearing unique items of clothing, appreciating folk music and dance, and eating native dishes. Feeling emotional when given a concerning diagnosis and asking for assistance do not reflect pride in ethnicity.
The spouse of a client asks the nurse whether the spouse may bring in a cream from home to apply to the client's skin. The spouse says, "Whenever anyone gets sick, we always use this cream." The nurse interprets this as: A) ritual B) ethnocentrism C) stereotyping D) subculture
A) ritual Rituals are common and observable expressions of culture in hospitals, clinics, homes, schools, and work settings. Clients and their families practice rituals that are intimately important to them, particularly during illness and hospitalization. Observance of rituals in times of stress and uncertainty helps restore a sense of control, competence, and familiarity, and to that extent it is a desirable adjunct to nursing care. Ethnocentrism is a way of looking at the world through a personal lens that has been influenced by personality, genetics, family/relationships, and media. In its mildest form, ethnocentrism presents as subconscious disregard for cultural differences; in its most severe form, it presents as authoritarian dominance over groups different from one's own. Stereotypes are preconceived and untested beliefs about people. They are exaggerated descriptors of character or behavior that are commonly reiterated in mass media, idiomatic expressions, and folklore. A subculture is "an ethnic, regional, economic, or social group exhibiting characteristic patterns of behavior sufficient to distinguish it from others."
The nurse is caring for a client admitted with an upper respiratory infection. The client tells the nurse about following the holistic belief of hot/cold. Which food items should the nurse provide to the client based on this information? A) soup, hot tea, and toast B) turkey sandwich, milk, and gelatin C) chicken salad, water, and a frozen fruit juice bar D) fruit salad, apple juice, and pudding
A) soup, hot tea, and toast The client believes in the hot/cold theory of disease, so the client needs to treat cold diseases with hot food and hot diseases with cold food. The most appropriate choice would be the soup, hot tea, and toast. The other options are all cold foods, which the client would not use to treat a cold disease such as an upper respiratory infection.
The younger nurses on a unit, woh seem to adapt easily to the new technology presented, are perceived as threatening by two nurses who have worked on the unit for years. The older nurses being to ridicule the younger nurses, saying, "You might be able to work a computer, but we know how to provide real care." How should the charge nurse respond? A) the charge nurse should discuss the concept of cultural conflict and help both parties see their respective value to the unit B) the charge nurse should demonstrate cultural blindness and pretend that the issue does not exist C) the charge nurse should understand that this is steerotyping in the form of racism and intervene immediately D) the charge nurse should recognize that this is cultural imposition and younger nurses are forcing new technology on the older nurses
A) the charge nurse should discuss the concept of cultural conflict and help both parties see their respective value to the unit The scenario presents a classic example of cultural conflict. The older nurses feel threatened by those who are technologically savvy and try to prove their value so that they feel more secure. Both parties have value, and the charge nurse can use knowledge of diversity to help bring cohesion to the unit.
A nurse is admitting a client to the unit. Which cultural question is MOST appropriate? A) "Will you be able to eat the normal food provided? B) "What are your dietary needs and preferences? C) "Do you have food restrictions? D) "Will you be making requests for special food based on your religion?
B) "What are your dietary needs and preferences? By asking about dietary needs and preferences, the nurse can gain insight into religious and cultural dietary practices. Asking about "normal" foods assumes that a cultural dietary request is abnormal. The other options will produce limited insight and imply that a cultural dietary need is a restriction or hindrance.
Which scenario is an example of cultural competence in nursing? A) assessing the rate at which an illness causes death in a culture B) attending a conference for cultural diversity C) attending one's own church D) assuming the provider and the client share beliefs and values
B) attending a conference for cultural diversity Cultural competence can be shown by actively learning about culture through attending a conference. Assessing the rate at which an illness leads to death does not develop cultural competence. One's own church is a familiar culture, and attending it does not breed cultural expansion or competence. The provider should never assume that beliefs or values are shared.
Healthcare facilities that sponsor health promotion activities only in affluent areas are considered: A) culturally sensitive B) culturally blind C) culturally affluent D) culturally different
B) culturally blind Cultural blindness is a process of ignoring cultural differences and proceeding as if they do not exist. It can also reflect a lack of capacity to reach out effectively to minorities or culturally stigmatized groups. Cultural sensitivity is an awareness of and respect for the differences between one's own culture and another. Healthcare facilities are not described as culturally different or affluent.
A client is seeking care at a local clinic. The nurse is completing a cultural assessment. Which scenario would demonstrate cultural assimilation? A) the client speaks a different language from the nurse and requires an interpreter B) the client's child learned the area's most common language as a second language C) the client and child cook traditional foods for the family D) the client enjoys watching television programs from the home country
B) the client's child learned the area's most common language as a second language The child is demonstrating an example of cultural assimilation by taking on the language of the dominant culture. When a marginalized identity group lives within a dominant group, its members may adapt some of their cultural practices that once made them different. This process is referred to as cultural assimilation. Watching television from the home country, cooking traditional foods, and speaking only the original language demonstrate the original culture and an attempt to bring the minority culture into the dominant culture.
Which term describes the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture? A) acculturation B) cultural blindness C) cultural imposition D) cultural taboos
C) cultural imposition Cultural imposition is the tendency to impose one's cultural beliefs, values, and patterns of behavior on a person from a different culture. Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. Acculturation is the process by which members of a cultural group adapt to, or learn how to, take on the behaviors of another group. Cultural taboos are activities or behaviors that are avoided, forbidden, or prohibited by a particular cultural group.
Persistent gaps between the health status of minorities and non-minorities are defined as A) racism B) ethnocentrism C) health disparities D) cultural relativity
C) health disparities Despite continued advances in health care and technology, racial and ethnic minorities continue to have higher rates of disease, disability, and premature death than non-minorities. These differences are known as health disparities. Racism is the belief that one's race is superior to another. Ethnocentrism is the belief that one's culture is superior to another. Cultural relativity is the belief that an understanding of a person's behavior depends, at least in part, on an understanding of that person's cultural context.
The nurse is using an interpreter to communicate with a client who speaks a different language. What characteristic should this interpreter possess? A) the interpreter should speak in a loud voice B) the interpreter should conduct the conversation quickly to avoid misinterpretation C) the interpreter should understand the health care system D) the interpreter should always make direct eye contact
C) the interpreter should understand the health care system Certain strategies for fostering effective crosscultural communication are necessary when a nurse is providing care for a client who is not fluent in the same language as the nurse. Cultural needs should be considered when choosing an interpreter; however, it is also important to use an interpreter who understands the health care system. In choosing an interpreter, the nurse should not select one who speaks in a loud voice, conducts the conversation quickly, or always makes direct eye contact. Direct eye contact is regarded differently among cultures.
A nurse is working with a culturally diverse group of clients. The nurse understands that cultural norms: A) allows nurses to predict a client's response B) can be generalized to anyone of that culture C) are fairly consistent across cultural groups D) require an individualized approach by the nurse
D) require an individualized approach by the nurse Knowing a cultural norm does not enable one to predict a person's response. Generalizing about cultural norms in contemporary societies is inappropriate because people belong to more than one subcultural group and are influenced uniquely by multiple and diverse groups. Exceptions to cultural norms always exist. Therefore the nurse needs to approach each person as an individual.
The nurse overhears a colleague state, "All people from that client's country are rude." How should the nurse respond? A) say nothing and ignore the comment B) agree and state, "Yes, I noticed the same thing." C) report the colleague to the nurse manager D) respond by saying, "Stereotypes keep us from accepting others as unique individuals."
D) respond by saying, "Stereotypes keep us from accepting others as unique individuals." Stereotypes are preconceived ideas usually unsupported by facts. They tend to be neither real nor accurate. They can be dangerous because they interfere with accepting others as unique individuals. The nurse can professionally educate the colleague about the harm involved in stereotyping individuals. Ignoring the comment or reporting the colleague to the nurse manager would result in a missed opportunity to educate the colleague on stereotyping. Agreeing would only strengthen this harmful practice.
The nursing researcher is studying so-called "unnatural illnesses." What cause of such illness would be included in the study? A) cold aid B) food C) impurities in water D) witchcraft
D) witchcraft "Unnatural illnesses" are thought to be punishments for failing to follow a god's rules, resulting in evil forces or witchcraft causing physical or mental health problems. "Natural illnesses" are thought to be caused by dangerous agents such as cold air or impurities in the air, water, or food.
