Fundamental of Nursing: Ch 5 Cultural Diversity
A parent informs the nurse that immunizations are against her cultural and religious beliefs and she does not want her child to receive immunizations. The nurse proceeds to inform the parent that the child will be consistently ill and will not be allowed to start school unless immunized. The nurse also informs the parent that she had all of her children vaccinated. What is the nurse's behavior an example of?
Cultural imposition
Explanation: Asking the client to explain a ritual is part of developing cultural knowledge and is acceptable when motivated by sincerity and respect. Accommodating dietary preference is important, as long as it does not contradict the client's meal plan, and can increase nutritional intake.
Telling a client that wellness trumps values is a form of mandated change and is not culturally appropriate. Seeking cultural assistance can help the client accept health care services. Asking the grandmother to be involved is respectful of family roles, and disregarding this person could lead to conflict. Asking the ex-husband to be involved is inappropriate.
Which is a cultural norm of the health care system?
There is the use of a systematic approach and problem-solving methodology.
A nurse is planning meals for clients in a long-term care facility. Which cultural practice should the nurse take into consideration when choosing foods for these clients?
In the Asian and Hispanic culture, diseases and foods are classified as hot or cold, and a proper balance between them promotes wellness.
What is the priority assessment for the nurse when developing a plan of care for a client living in poverty?
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 are examples of a culturally appropriate nursing intervention? Select all that apply.
Asking the client's grandmother, who is the head of the family, to be involved in the plan of care Asking for cultural assistance from clergy at the client's request Allowing the client to eat food from home that is consistent with her dietary plan Asking sincerely for the client to explain religious rituals
In addressing health promotion for a client who is a member of another culture, the nurse should be guided by which principle?
The client may have a very different understanding of health promotion.
The use of one's culture as a cultural standard is known as:
ethnocentrism. Explanation: Cultural relativity suggests an underlying explanation for behavior, particularly for behavior that is repeated by different people of the same culture or ethnic group.
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.
When talking with a client, the nurse notes that the client keeps backing up. What would be the most appropriate response?
Ask the client about his personal space preferences. Explanation: It is most appropriate to ask the client what he prefers in regard to personal space. If the nurse needs to invade the client's personal space, it is important to discuss the matter. It is not appropriate to back away without assessing preference. It may make the client feel judged if the nurse asks him why he is backing away. Moving closer to the client just perpetuates the problem.
The nurse admits a Native American/First Nations client to the critical care unit to rule out a myocardial infarction (MI). The client has several family members in the waiting room. Which nursing action is most appropriate?
Ask the client their personal beliefs about family support during hospitalization. Explanation: Asking the client his or her beliefs exemplifies that the nurse recognizes the importance of respecting differences rather than imposing standards. If the client believes family support is significant to their health and recovery, the nurse should respect the client's believes and allow the visitors into the room.
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
A client from Malaysia is admitted to the health care facility with reports of cramping pain in the abdomen and loose stools. Where should the nurse be seated when interviewing the client?
At more than one arm's distance Explanation: While interviewing the Malaysian client, the nurse should sit at a distance of more than one arm's length from the client. The nurse should not sit alongside the client, as he may feel uncomfortable. If the nurse sits at the back of the client, the nurse may not be able to observe the client's body language. If the nurse sits in a corner of the room, communication may not be effective.
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 nurse caring for several clients on a hospital unit notices that the white client makes eye contact with the staff, while an older adult client of Japanese descent 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. Whites view eye contact as demonstrating engagement in a conversation, whereas elderly Japanese view avoidance of eye contact with a "superior" (the nurse in this scenario) as a sign of respect.
While studying about various cultures, the student nurse is aware that a subculture is based on which characteristics? Select all that apply
Gender Age Profession Hobbies Sexual preference Explanation: A subculture is based on any common interest or identity; therefore, all of these options are examples of subcultures.
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 that has no place in the professional realm.
Explanation: While interviewing a client of Arab descent, the nurse should avoid maintaining eye contact with the client. In Arab culture, maintaining eye contact is sexually suggestive; if the nurse does so during the interview, it may give the wrong message to the client.
However, the nurse may give a light handshake or ask about the client's personal life and medical history during the interview.
Explanation: Native Americans/First Nations tend to control their emotions and expressions of physical discomfort, especially among unfamiliar people. Stoicism should not be interpreted as a lack of feeling or caring.
In Western culture, whites and blacks tend to freely express positive and negative feelings. Therefore, the nurse would not expect the Native American/First Nations client to present with overwhelming grief, crying loudly, or requesting family members to be contacted immediately.
Which nursing actions are appropriate when collecting a health history for a client whose primary language is Spanish? Select all that apply.
Utilize the facility telephonic interpreting system. Have a bilingual nurse assist with the health history Request assistance from a certified-interpreter.
The staff nurse overhears the charge nurse talking to the unlicensed assistant personal (UAP). Which statement made by the charge nurse is an example of ethnocentrism?
"Italians are best at everything." Explanation: Ethnocentrism is the belief that one's cultural is better than other cultures. Therefore, the statement "Italians are the best at everything" demonstrates ethnocentrism. Stereotyping is a fixed attitude about people who share common characteristics. The other options are examples of stereotyping.
Explanation: The nurse's behavior is an example of cultural imposition, defined as the tendency to impose one's cultural beliefs, practices, and values on a person from a different culture. Stereotyping is when one assumes that all members of a culture, ethnic group, or race act alike.
Cultural blindness occurs when one ignores differences and proceeds as though they do not exist. Cultural conflict occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure in their own values.
Explanation: As a component of cultural assessment, the nurse should seek to understand the cultural lens through which the client may understand health promotion. Health promotion is not a concept exclusive to Western cultures, though it may be considered differently among non-Western cultures.
Even if health promotion is not a priority in a client's culture, the nurse should still address issues related to health promotion in a respectful and relevant manner. Health promotion is not directly linked to socioeconomic development levels.
Explanation: When caring for a client whose primary language is Spanish, the nurse should first utilize a certified interpreter.
If a certified-interpreter is unavailable, the nurse should then use the telephonic interpreting system or a bilingual staff member. The nurse should never use children to interpret. The nurse should speak in short sentences, using simple terminology.
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 have high respect for their clergy members. The other factors listed are not usually attributed to the black community.
Explanation: All nurses makes mistakes at some time when caring for culturally diverse clients. The best action is to learn from the mistake and not repeat the offense. While it may be appropriate to discuss with the client, asking him why he 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.
Nursing students are socialized into the:
health care 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.
The nurse is caring for a Haitian client. Which health belief system does the nurse anticipate?
using faith healing Explanation: Native American/First Nations clients believe that positive outcomes result from living in congruence with Mother Earth. People of Asian descent may uphold the yin/yang theory, which refers to the belief that balanced forces promote health. Latinos are more likely to adopt the hot/cold theory. Haitian clients may accept faith healing or practice forms of witchcraft or voodoo.
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?"
Which nursing intervention reflects culturally appropriate care when addressing a black 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 himself or herself. He or she should follow-up thoroughly with requests, respect the client's privacy, and ask open-ended rather than direct questions until trust has been established.
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 client with Asian heritage 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 his 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?"
A client of Arab descent has been admitted to the health care facility with varicose veins. What should the nurse avoid while conducting the interview of the client?
Maintaining eye contact
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.
When adhering to the standards of practice for culturally competent nursing care, the nurse understands that these standards are driven by which principles? Select all that apply.
Social justice Health equity Explanation: Standards of practice for culturally competent nursing care continue to be refined and are driven by the principles of social justice and health equity, with the aim of reducing health disparities. Cultural bias, stereotypes and patterned group behavior are general concepts related to culture.
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 him 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 and indicate low faith in the present treatment. It is inappropriate to call the doctor and complain about the client.
The new nurse is caring for a client of Asian descent. What should the nurse expect when caring for this client?
This client will require the nurse to keep an arm's length distance. Explanation: Clients of Asian descent feel more comfortable when the nurse keeps an arm's length distance. Direct eye contact with Asian clients is considered offensive. The nurse would not expect the client to touch during conversation, and the nurse would not sit close to the client.
A nurse who provides care in a large, inner-city hospital is aware of the large influence of culture on health. The nurse recognizes that culture is best understood as a shared system that encompasses:
beliefs, values, and practices Explanation: Culture is defined in many ways, but at the broadest level, it can be understood to be a shared system of beliefs, values, and behavioral expectations that provide social structure for daily living. These beliefs, values, and expectations frequently direct other aspects of an individual's life (e.g., thinking, behavior, dress, and diet) but these are not the central components of the concept of culture.
The nurse is caring for a Native American/First Nations client who has been given a diagnosis of terminal cancer. Which reaction does the nurse anticipate?
stoic listening without display of emotion
Which behavior by the nurse is stereotyping?
Avoiding clients who are elderly because their care is time consuming. Explanation: Avoiding elderly clients because their care is time consuming is stereotyping. This is a mistaken belief and an overgeneralization. Some elderly clients are very healthy. Ridiculing acupuncture is cultural conflict. Assuming that Western medicine is superior is cultural blindness. Grouping care assignments to allow ample time to provide care is an appropriate strategy in time management.
The nurse is caring for a black 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: 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.
When completing a transcultural assessment of communication, which assessment by the nurse is most appropriate?
Assessment of eye contact, personal space, and social taboos Explanation: Components of the transcultural assessment of communication are the cultural values associated with communication such as eye contact, personal space, and social taboos. Religious assessment, racial identification, and income levels are not part of the transcultural assessment of communication.
A client with Asian heritage is admitted to the unit. What cultural assessment might the nurse anticipate?
Nonverbal expressions of pain Explanation: While every client is unique, it is important to have a basic understanding of cultural tendencies. In the Asian culture, complaining is uncommon. As a result, client with Asian heritage may not report pain and the nurse must be careful to observe for nonverbal signs of discomfort. The other answer selections are not typical cultural considerations within the Asian culture.
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 nurse is interviewing a client who is Native American/First Nations. What question would be best to ask this client?
"Do you use herbal or medicinal plants?" Explanation: Many Native Americans/First Nations clients use herbal and medicinal plants as health care practice. Lactose intolerance and use of hot/cold theory is common among Hispanic and Asian clients. Clients of Jewish culture require a kosher meal.
The mother of a black newborn asks the nurse about the bluish-black areas she noticed around the infant's lower back and buttocks. What is the nurse's best response?
"These areas are normal and should disappear by early childhood." Explanation: These types of discolored areas are referred to as mongolian spots. The discolorations are clusters of melanocytes and appear as bluish-black areas typically found on an black infant's lower back and buttocks, as well as Indian and Asian infants. They are normal, occur in 80% to 90% of these populations, and typically disappear by early childhood.
Which nursing intervention reflects practice according to Madeline Leininger's transcultural nursing theory?
incorporating 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.
Explanation: Food preferences and preparation methods often are culturally influenced. Most Asians and Hispanics cultures or religions do not forbid pork. Muslim and Seventh Day Adventists do have dietary beliefs that include avoiding pork and pork products. Most Christian denominations do not fast during holy days.
Black culture does not consume a diet high in starch that needs to be addressed by a dietician. The Asian and Hispanic cultures do belief that a proper balance between foods classified as hot or cold, help to promote wellness. The hot and cold classification is not related specifically to the temperature to the food, rather an implied belief of the function of the food in the body.
The nurse is caring for a client of Asian descent and is post-operative 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. Clients who are of Asian descent tend to 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.
The nurse just attended a seminar on cultural diversity. Which statement by the nurse would require further education?
"Ethnicity and race are the same thing and are affected by cultural practice." Explanation: People are often born into an ethnic group, or ethnicity develops by immersion in a community. People of the same ethnicity often speak similar dialects and share similar values. Ethnicity and race are terms used interchangeably; however, they are not the same thing. Race refers specifically to physical characteristics.
Explanation: The nurse's response is an example of cultural imposition, which is defined as the belief that everyone should conform to the majority belief system. Cultural blindness is the result of ignoring differences and proceeding as though they do not exist. In this situation, the nurse did not ignore the request but inappropriately responded to it.
Cultural diversity is defined as a diverse group in society, with varying racial classifications and national origins, religious affiliations, languages, physical sizes, genders, sexual orientations, ages, disabilities, socioeconomic statuses, occupational statuses, and geographic locations. Cultural assimilation occurs when members of a minority group live within a dominant group and lose the cultural characteristics that make them different.
Health care facilities that sponsor health-promotion activities only in affluent areas are considered:
Culturally blind Explanation: Another way of thinking about ethnocentrism in nursing is that it can reflect an individual's, a group's, or an agency's cultural blindness. It can also reflect a lack of capacity to reach out effectively to minorities or culturally stigmatized groups.
A nurse is caring for a 79-year-old Appalachian woman who is placed in a long-term care facility by her son, who is no longer able to care for her. She appears disoriented and reports being bothered by the "bright lights and constant activity." The nurse appropriately documents what condition in the chart?
Culture shock Explanation: Culture shock is a feeling a person experiences when placed in a different culture perceived as strange. Culture shock may result in psychological discomfort, or disturbances, as the patterns of behavior a person found acceptable and effective in the client's culture may not be adequate or even acceptable in the new culture. Culture assimilation is a process where a minority group begins to replace their own cultural characteristics to the new culture in which they are living. Cultural blindness is when one ignores differences in another's culture and proceeds as though the difference do not exist.
A nurse is developing a care plan for a Hispanic client who has diabetes. What cultural intervention is most appropriate?
Dietary counseling, as Hispanic diets are often high in carbohydrates Explanation: Hispanic diets are often high in carbohydrates, which contributes to diabetes mellitus. Dietary counseling is most appropriate. All other options are not appropriate for the Hispanic culture.
When a home-bound client expresses her past-oriented ancestral heritage and family rituals, the nurse recognizes that the client is expressing:
Ethnic identity Explanation: Ethnicity or ethnic identity refers to self-conscious, past-oriented form of identity based on a notion of shared cultural (and perhaps ancestral) heritage, and current position in larger society. Race is based on biologic characteristics; assimilation refers to new customs and attitudes that are acquired through contact and communication among persons of a particular culture; subculture refers to a group of people within a culture who have ideas and beliefs which are different from the rest of that society.
When reviewing the chart of an older adult client, the nurse notes that the client identifies as Asian. The nurse realizes the client is referring to which ancestral and cultural factor?
Ethnicity Explanation: Ethnicity refers to a common bond of kinship with country of origin. Race refers to biologic differences. Ethnocentrism is the belief that one's personal heritage is superior to others, while values are beliefs and attitudes that are important to a person.
Which area is typically included in a cultural assessment?
Food preferences Explanation: Dietary tolerance is associated with both cultural food preferences and biologic variation.
Which teaching statement best exemplifies cultural competence in relation to time?
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.
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
A nurse is working in an inner city clinic with a heavy population of Hispanic migrant workers. Which nursing assessment is the priority?
Language assessment Explanation: While all of the assessments are appropriate, the priority assessment is communication. If the client speaks Spanish, it may be necessary to obtain a translator to provide culturally appropriate care.
While caring for a Hispanic client, the nurse inadvertently offends the client. What is the best action by the nurse?
Learn from the mistake and do not repeat it.
The nurse is caring for a client who speaks a differnt language than herself and is using an interpreter to communicate. What would be the best way to choose an interpreter for this client?
The interpreter should understand the health care system.
The nurse is caring for a client who is terminally ill and recently immigrated to the country. The nurse understands that in order to provide quality end-of-life care for the client, what would be the priority action by the nurse?
Understand the client's personal and cultural views regarding death and dying. Explanation: Differences in beliefs, values, and traditional healthcare practices are relevant when planning end-of-life care. It is the nurse's responsibility to become familiar with the client's personal and cultural views. The other options seek the views of others and do not address the client's personal and cultural views.
A client who immigrated from Pakistan informs the nurse of his dietary requests. The nurse responds to the special dietary needs by stating, "You are now living here, and you should try to start eating those foods common to our diet." This inappropriate response is an example of:
cultural imposition
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.
