Chapter 05: Cultural Diversity
The nurse has just attended a seminar on concepts of cultural diversity. Which statement made by the nurse would require further education?
"Culture cannot be influenced, and you are born with your culture." Explanation: Culture is learned through life experiences from one generation to the next. Culture helping to define identity, language being the primary way that people share their culture, and culture being seen in attitudes of certain populations are correct options; these are all components that define culture.
The nurse is caring for a client who is postoperative 24 hours from an appendectomy. The client is hesitant to get out of bed. How should the nurse respond?
"Can you describe what you are feeling when you try to move?" Explanation: The client who is hesitant to move and get out of bed may be expecting pain. Some clients, however, my control their emotions and expressions of physical discomfort in front of strangers. Telling the client to get up and walk to prevent complications is important, but the nurse needs to assess why the client is hesitating to get up. Leaving the client or waiting for the family does not address the reason why the client is hesitant to get up.
Which nursing intervention reflects culturally appropriate care when addressing a client?
"Good morning, Mr. Smith. I am your nurse, John." Explanation: The nurse can demonstrate professionalism and culturally appropriate care by addressing clients by their last names and introducing oneself. The nurse should follow up thoroughly with requests, respect the client's privacy, and ask open-ended rather than direct questions until trust has been established.
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 nurse is demonstrating ethnocentrism. Which statement would reflect this concept?
"My Russian heritage is superior to all others." Explanation: Ethnocentrism is viewing one's own culture as the only correct standard by which to view people of other cultures. 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. They may be demeaning ("People on welfare are lazy, just living off handouts"; "Irish people are all heavy drinkers") or idealizing ("Asians are always the smartest in the class"; "Nurses are patient people"). Either way, they mislead and deny the individuality of the person.
Which statement by the nurse demonstrates ethnocentrism?
"That client needs to learn that pain is best managed with traditional medications like morphine." Explanation: Ethnocentrism is the belief that the practice in one's own culture is superior to another. Traditional pain management with morphine may not be the best option for the client. Assuming the client is too old to learn is stereotyping. The other options are assumptions or generalizations in the provision of care and are not examples of ethnocentrism.
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?
"We do not have running water." Explanation: 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.
A nurse is admitting a client to the unit. Which cultural question is most appropriate?
"What are your dietary needs and preferences?" Explanation: 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.
The nurse is caring for a client 4 days after total hip arthroplasty and notes the client has lost weight. The unlicensed assistive personnel reports the client's food intake has decreased. Which question will the nurse ask the client to determine if cultural causes are responsible for the weight loss?
"What type of food do you like to eat at home?" Explanation: The culturally sensitive nurse will determine the type of food a client prefers to eat. The nurse should try to accommodate a client's food preferences. Asking if there is something wrong with the food is confrontational and does not address the problem. There is no need to consult a nutritionist unless a client has special food preferences or dietary concerns. The nurse will need to assess a client's preferences before determining if it would be helpful for the family to bring the client food.
A client has been admitted to the unit for chest pain. A nurse told the family that they could not be with the client. The family became very upset, and now the client wants to leave. What is the most culturally appropriate response by the charge nurse?
"Would you feel more comfortable with your family with you?" Explanation: Some cultures are very family oriented; others may have members who are skeptical of modern health care. The request for the client's family to leave most likely frightened the client. Asking the client how to make the client more comfortable is the best option. Asking the client why the client wants to leave is judgmental, implying there is no real reason to leave. Citing the hospital's policy regarding clients who leave against medical advice is not culturally sensitive and does not address the client's concerns. Clearly in this client's case, having the family present reduces, not causes, stress, so the comment about maintaining a stress-free environment is not valid.
The nurse is assessing an older adult who immigrated at the age of 3 years. The client speaks the dominant language and lives in a neighborhood with many households from the country of origin. Which action by the nurse is most appropriate?
Ask the client about special cultural beliefs or practices. Explanation: Asking the client his or her beliefs exemplifies that the nurse recognizes the importance of respecting differences rather than imposing standards. The nurse cannot assume the client's beliefs based on cultural appearance, so contacting a tribal healer, avoiding making eye contact, or asking the client's son is not appropriate. Once asked, if the client believes cultural support is significant to health and recovery, then the nurse should respect the client's beliefs or practices.
The nurse is caring for a terminally ill client who immigrated from Mexico. Which nursing intervention regarding spiritual care is appropriate?
Ask the client if a spiritual leader is desired. Explanation: The appropriate response is to ask the client if a spiritual leader is desired, which is observant of the client's preferences. The nurse should not generalize that a Latino client is Roman Catholic, nor should the nurse refrain from inquiring about spiritual needs.
Which scenario is an example of cultural competence in nursing?
Attending a conference for cultural diversity Explanation: 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.
Which behavior by the nurse is stereotyping?
Avoiding older adult clients because their care is time consuming Explanation: Avoiding older adult clients because their care is time consuming is stereotyping. This is a mistaken belief and an overgeneralization. Some older adult clients are very healthy. Ridiculing acupuncture is cultural conflict. Assuming that Western medicine is superior is ethnocentrism. Grouping care assignments to allow ample time to provide care is an appropriate strategy in time management.
A client who does not speak the dominant language is admitted to the hospital. Which cultural intervention would be most appropriate by the nurse?
Call for an interpreter who is familiar with health care. Explanation: Use of a family member to interpret is often discouraged because misinterpretation is more likely to occur. Speaking a different language is not a hearing problem. It is a communication issue, so speaking loudly and slowly is not beneficial. When communication is hampered, eye contact and presence are important. Although some cultures do minimize eye contact, this is not the most appropriate response. Contacting an interpreter who is familiar with healthcare environments is the most appropriate response.
A nurse is conducting a cultural assessment of a client. Which person would the nurse identify as the expert?
Client Explanation: When gathering cultural information, the interviewee is the expert. Other family members may provide information about the culture, but the client is the expert. The nurse and health care provider are responsible for obtaining information related to the culture.
The home health nurse is conducting the health history interview with a client who does not speak the dominant language. What would be the best action made by the nurse?
Conduct the health history utilizing a telephonic interpreter (over-the-phone translation). Explanation: When speaking with a client who does not speak the dominant language, the nurse should use a trained or certified interpreter. If an on-site interpreter is unavailable, the nurse should other methods including bilingual staff, volunteers, webcam, or telephonic interpreting. The nurse should maintain a moderate, low tone in voice and avoid shouting or talking loudly. The nurse should avoid using medical terms. Because the client may not be able to read the dominant language, it is not appropriate to write out all questions using appropriate medical terminology. When asking questions, the nurse should discuss one topic at a time and avoid conjunctions.
A family has recently immigrated. All members are quickly learning the language and the children are all in public school. Both parents are working and adapting to the new culture. What is this family demonstrating?
Cultural assimilation Explanation: When a minority group lives within a dominant group, many members may lose the cultural characteristics that once made them different and take on the values of the dominant culture. This process is called cultural assimilation.
Upon moving to another country, a college student is very confused by many local customs. He is especially bothered by the custom of men and women eating in separate areas and it makes him angry and resentful of the new culture. What are the feelings experienced by this student?
Culture shock Explanation: 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 minority group live within a dominant group and lose the cultural characteristics that make them different.
The nurse is caring for a client who is postoperative 3 days from coronary artery bypass graft. The client has a prescription to ambulate. What is the best action by the nurse?
Discuss with the client the need for assistance during ambulation. Explanation: For members of some cultures, providing care and performing nursing interventions can intrude into personal space. The nurse should discuss with the client the need for assistance during ambulation and prepare the client for potential closeness. The client may ambulate independently, but the nurse should still assist. Having the family or physical therapy ambulate the client does not address the issue related to culture and nursing interventions.
A client's spouse has asked that the client be cared for exclusively by female nurses. How should the nurse incorporate this request into the care plan?
Document the request and make all reasonable efforts to honor it Explanation: Although cultural assessment in a tactful and respectful manner is likely appropriate in this situation, the care team's guiding principle and obligation should be to accommodate and respect the couple's request. It would be inappropriate for the care team to attempt to convince the couple to change their minds or assume that it is a personal preference. The nurse would not teach the couple that male nurses on the unit are empathetic, as having female nurses is the client's preference.
Classification of illness can occur with cultural practice. What is an example of an unnatural illness?
Evil forces caused a client to develop schizophrenia. Explanation: In some groups, illnesses are classified as natural and unnatural. Natural illnesses are caused by dangerous agents, such as cold air or impurities in the air or water. Unnatural illnesses are punishments for failing to follow a god's rules, resulting in evil forces, or witchcraft causing physical or mental health problems.
What factor threatens to increase the number of people who are living at poverty level?
Feminization of poverty Explanation: The feminization of poverty threatens to increase those at poverty level. This is caused by the increase in female-headed households through divorce, abandonment, unmarried motherhood, and changes in abortion laws. The older population is increasing. The immigrant population does not directly increase or decrease poverty level. Lack of health insurance is an issue for those who are in a poverty culture but does not increase those at the federal poverty level.
A nurse is working in a clinic that serves a community with a high population of immigrants. Which nursing assessment is the priority?
Language assessment Explanation: Although all of the assessments are appropriate, the priority assessment is communication. If clients do not speak the dominant language, it may be necessary to obtain an interpreter to provide culturally appropriate care.
A nurse is assessing a client and determines that the client belongs to a minority group. Based on the nurse's understanding about minority groups, the nurse would anticipate that the client would likely experience which effects? Select all that apply.
Less power Health disparities Explanation: The term minority 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 minority 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 minorities.
The nurse is assessing an infant of Asian descent and notes dark blue spots on the infant's lower back. What action should the nurse take next?
Press lightly on the pigmented area and observe the infant's reaction. Explanation: Mongolian spots are a type of hyperpigmentation that results in dark blue areas on the lower back, abdomen, thighs, and arms. To differentiate Mongolian spots from a bruise or injury, the nurse should press on the Mongolian spot. Mongolian spots do not produce pain when pressure is applied. The nurse will not ask the parents to leave the room as they are the legal guardians of the infant and should be present for the assessment. This action is only taken if suspicion of abuse is readily apparent. The nurse should assess before calling the health care provider. The nurse needs to complete the assessment before documenting it. Because this is not an ominous finding warranting further investigation, the nurse would not contact the authorities.
Which statement best conveys the relationship between race and ethnicity?
Race denotes physical characteristics, while ethnicity is rooted in a common heritage. Explanation: The term "race" is usually used in reference to particular physical characteristics, while ethnicity is an identification with a cultural group that is often based on a common heritage. Because it is rooted in objective physical traits, race is usually considered to be somewhat independent of culture.
The nurse overhears a colleague state, "All people from that client's country are rude." What is the appropriate nursing response?
Respond by saying, "Stereotypes keep us from accepting others as unique individuals." Explanation: 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.
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 overhears another nurse make a statement that indicates racism. The nurse makes this determination based on which characteristic indicative of social value?
Skin color Explanation: Racism uses skin color, not size, language or dress, as the primary indicator of social value.
The nurse is caring for a client whose language skills are very limited in the dominant language, and an interpreter has been obtained. The interpreter appears to be telling the client more than the nurse is saying and possibly providing an opinion or medical advice. Which action is appropriate for the nurse to take?
Speak privately with the interpreter and instruct them to only provide language interpretation. Explanation: All clients have a right to proper communication with a healthcare provider. Obtaining a certified interpreter is the most appropriate way to ensure accurate communication between a client and the provider. However, the interpreter must have a clear understanding of their role as a language interpreter only and not provide medical information or advice. The nurse should speak privately with the interpreter if there is a suspicion that the interpreter is not respecting boundaries. Using a computerized application to identify key medical words does not allow full communication to take place, and thus, key health information can be missed.
A newly hired young nurse overheard the charge nurse talking with an older nurse on the unit. The charge nurse said, "All these young nurses think they can come in late and leave early." What cultural factor can the new nurse assess from this conversation?
Stereotyping Explanation: The charge nurse is clearly exhibiting ageism, which is a form of stereotyping. Cultural assimilation is when one begins to assume some characteristics of a culture outside of one's own. Cultural blindness occurs when cultural differences are ignored. Cultural imposition occurs when one pushes one's cultural beliefs onto another person.
A family has immigrated and settled in a neighborhood that primarily speaks their native language. The nurse caring for this family recognizes that which family member will likely require the greatest amount of time to learn the dominant language?
The 45-year-old mother in the family who does not work outside the home Explanation: The 45-year-old mother will have the greatest challenge in learning the dominant language due to not working outside the home and living in a community that speaks the native language. Children usually assimilate more rapidly and learn the language of the dominant culture quickly because they leave home each day to go to school, making new friends in the dominant culture. Wage earners also tend to learn a new language more quickly through the work setting. Language acquisition is tied to necessity and assimilation, rather than to the degree of difficulty.
The younger nurses on a unit, who 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 begin 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?
The charge nurse should discuss the concept of cultural conflict and help both parties see their respective value to the unit. Explanation: 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.
The nurse is caring for several clients of different cultures. Which client situation would the nurse recognize as the client with highest risk of culture shock?
The client from Ethiopia states, "All these machines attached to me scare me and I need to get them off." Explanation: Culture shock occurs when a person is immersed in an environment different from the one the person is accustomed to, resulting in rapid disorientation and distress. The client stating the machines scare him is experiencing culture shock. Difficulty reading a different language, missing absent family, and not understanding the purpose of medications are not indicative of culture shock.
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 is seeking care at the local clinic. The nurse is completing a cultural assessment. Which scenario would demonstrate cultural assimilation?
The client's child learned the dominant language as a second language. Explanation: The child is demonstrating an example of cultural assimilation by taking on the language of the dominant culture. When a minority 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.
The nurse is using an interpreter to communicate with a client who speaks a different language. What would be the best way to choose an interpreter for this client?
The interpreter should understand the health care system. Explanation: Obviously, nurses cannot become fluent in all languages, but certain strategies for fostering effective cross-cultural communication are necessary when providing care for clients who are not fluent in the dominant language. 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.
Which is a cultural norm of the health care system?
There is the use of a systematic approach and problem-solving methodology. Explanation: Cultural norms of the health care system include the use of a systematic approach and problem-solving methodology; the omnipotence of technology; the dislike of tardiness, disorderliness, and disorganization; and the use of certain procedures attending birth and death.
An older adult client who only speaks the nondominant language has been admitted to the emergency department after suffering a fall and suspected hip fracture in the home. Who is the best person to perform translation services for the client?
a hospital translator Explanation: A qualified interpreter who is familiar with health care terminology is the best choice for providing translation for clients. Such a person is more likely to be objective and well versed in the requisite vocabulary than is a friend, family member, or hospital employee.
The nurse is preparing the discharge plan for a new mother and her newborn son. Which new teaching should the nurse ensure is included after noting the family is Jewish?
care following the scheduled circumcision Explanation: Orthodox Judaism and some members of non-orthodox Jewish denominations consider circumcision as a sacred ritual which is performed on the 8th day of the infant's life. Clients of other faiths may request the circumcision be completed before the newborn is discharged home from the hospital and some will choose not to circumcise their newborn. The other choices should be part of every client's discharge teaching.
A nurse is caring for a client with bacterial pneumonia and a temperature of 104°F (40.0°C). Yesterday, the client's temperature was 102°F (38.9°C). The health care provider on call prescribes cool compresses for the client to help lower the fever. The client insists that the nurse bring warm blankets because they will help the client to recover more quickly. The nurse recognizes that the client's request is an example of:
cultural ritual. Explanation: Clients and families often express rituals, or practices habitually repeated in certain contexts, during times of stress, such as during an acute hospitalization. Keeping the body covered and warm is a home remedy used by many cultures to help heal the body. As in this example, cultural rituals may conflict with Western medical beliefs. Cultural competence is an approach to health care in which one is aware of one's one cultural beliefs and biases and understands the effects that a client's culture has on the client's health care. Stereotyping involves applying a preconceived and untested generalization to a whole group of people. Ethnocentrism is the belief that one's culture is superior to another.
Nurses are socialized into the:
healthcare culture. Explanation: Culture enables people of similar cultural heritage to understand the meanings of each other's words as part of the particular context, to read each other's nonverbal behavior fairly accurately, and to communicate through symbols. All of these characteristics apply to health care, so health care can be considered a culture into which one can be socialized. The other answers pertain to the career, practice, or intellectual aspects of nursing but not as much to the social aspect of nursing.
A client says to the nurse, "Why don't you wear a white cap like nurses do on the soap operas?" This is an ethnocentric statement based on the:
media. Explanation: Ethnocentrism is a way of looking at the world through a personal lens that has been influenced by personality, genetics, family/relationships, and media. None of the remaining options play a role in the client's comment to the nurse.
A woman has moved from the east coast to the west coast. She is a single parent of four children who is having difficulty finding employment due to a lack of a car and primarily speaking an uncommon language for the area. Which factor is a barrier to health care?
primary language other than the dominant one Explanation: The client speaking a language that is uncommon for the area as one's primary language is a barrier to health care. Being from a different culture, female, or the parent of multiple children does not create a barrier to care.
A nurse is working with a culturally diverse group of clients. The nurse understands that cultural norms:
require an individualized approach by the nurse. Explanation: 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 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:
ritual. Explanation: 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."
A preconceived and untested belief about an individual or group of individuals is:
stereotyping. Explanation: Stereotypes are exaggerated descriptors of character or behavior that are commonly reiterated in mass media, idiomatic expressions, and folklore. Racism is believing that one's race is superior to another. Culturally competent care is care that involves an awareness of one's own cultural beliefs and biases and an understanding of how a client's culture affects the client's health care. Culture 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.
