Ch. 5 Diversity Flashcards
A nurse is caring for patients of diverse cultures in a community health care facility. Which characteristics of cultural diversity that exist in the United States should the nurse consider when planning culturally competent care? Select all that apply.
A) The United States has become less inclusive of same-sex couples.
B) Cultural diversity is limited to people of varying cultures and races.
C) Cultural diversity is separate and distinct from health and illness.
D) People may be members of multiple cultural groups at one time.
E) Culture guides what is acceptable behavior for people in a specific group.
F) Cultural practices may evolve over time but mainly remain constant.
d, e, f.
A person may be a member of multiple cultural, ethnic, and racial groups at one time. Culture guides what is acceptable behavior for people in a specific group. Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group’s needs. The United States has become more (not less) inclusive of same-sex couples. The definition of cultural diversity includes, but is not limited to, people of varying cultures, racial and ethnic origin, religion, language, physical size, biological sex, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location. Cultural diversity, including culture, ethnicity, and race, is an integral component of both health and illness.
In order to provide culturally competent care, nurses must be alert to factors inhibiting sensitivity to diversity in the health care system. Which nursing actions are examples of cultural imposition? Select all that apply.
A) A hospital nurse tells a nurse’s aide that patients should not be given a choice whether or not to shower or bathe daily.
B) A nurse treats all patients the same whether or not they come from a different culture.
C) A nurse tells another nurse that Jewish diet restrictions are just a way for them to get a special tray of their favorite foods.
D) A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence.
E) A nurse directs interview questions to an older adult’s daughter even though the patient is capable of answering them.
F) A nurse refuses to care for a married gay man who is HIV positive because she is against same-sex marriage.
a, d.
Cultural imposition occurs when a hospital nurse tells a nurse’s aide that patients should not be given a choice whether or not to shower or bathe daily, and when a Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. Cultural blindness occurs when a nurse treats all patients the same whether or not they come from a different culture. Culture conflict occurs when a nurse ridicules a patient by telling another nurse that Jewish diet restrictions are just a way for Jewish patients to get a special tray of their favorite foods. When a nurse refuses to respect an older adult’s ability to speak for himself or herself, or if the nurse refuses to treat a patient based on that patient’s sexual orientation, the nurse is engaging in stereotyping.
A nurse caring for culturally diverse patients in a health care provider’s office is aware that patients of certain cultures are more prone to specific disease states than the general population. Which patients would the nurse screen for diabetes mellitus based on the patient’s race? Select all that apply.
A) A Native American patient
B) An African-American patient
C) An Alaska Native
D) An Asian patient
E) A White patient
F) A Hispanic patient
a, c, e, f.
Native Americans, Alaska Natives, Hispanics, and Whites are more prone to developing diabetes mellitus. African Americans are prone to hypertension, stroke, sickle cell anemia, lactose intolerance, and keloids. Asians are prone to hypertension, liver cancer, thalassemia, and lactose intolerance.
A nurse is using the ESFT model to understand a patient’s conception of a diagnosis of chronic obstructive pulmonary disease (COPD). Which interview question would be MOST appropriate to assess the E aspect of this model—Explanatory model of health and illness?
A) How do you get your medications?
B) How does having COPD affect your lifestyle?
C) Are you concerned about the side effects of your medications?
D) Can you describe how you will take your medications?
b.
The ESFT model guides providers in understanding a patient’s explanatory model (a patient’s conception of her or his illness), social and environmental factors, and fears and concerns, and also guides providers in contracting for therapeutic approaches. Asking the questions: “How does having COPD affect your lifestyle?” explores the explanatory model, “How do you get your medications?” refers to the social and environmental factor, “Are you concerned about the side effects of your medications?” addresses fears and concerns, and “Can you describe how you will take your medications?” involves therapeutic contracting.
The nurse practitioner sees patients in a community clinic that is located in a predominately White neighborhood. After performing assessments on the majority of the patients visiting the clinic, the nurse notes that many of the minority groups living within the neighborhood have lost the cultural characteristics that made them different. What is the term for this process?
A) Cultural assimilation
B) Cultural imposition
C) Culture shock
D) Ethnocentrism
a.
When minority groups live within a dominant group, many members lose the cultural characteristics that once made them different in a process called assimilation. Cultural imposition occurs when one person believes that everyone should conform to his or her own belief system. Culture shock occurs when a person is placed in a different culture perceived as strange, and ethnocentrism is the belief that the ideas, beliefs, and practices of one’s own cultural group are best, superior, or most preferred to those of other groups.
A nurse states, “That patient is 78 years old—too old to learn how to change a dressing.” What is the nurse demonstrating?
A) Cultural imposition
B) Clustering
C) Cultural competency
D) Stereotyping
d.
Stereotyping is assuming that all members of a group are alike. This is not an example of cultural competence nor is the nurse imposing her culture on the patient. Clustering is not an applicable concept.
A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish and the nurse speaks only English. What is the appropriate nursing intervention?
A) Use short words and talk more loudly.
B) Ask an interpreter for help.
C) Explain why care can’t be provided.
D) Provide instructions in writing.
b.
The nurse should ask an interpreter for help. Many facilities have a qualified interpreter who understands the health care system and can reliably provide assistance. Using short words, talking loudly, and providing instructions in writing will not help the nurse communicate with this patient. Explaining why care can’t be provided is not an acceptable choice because the nurse is required to provide care; also, since the patient doesn’t speak English, she won’t understand what the nurse is saying.
A nurse is interviewing a newly admitted patient. Which question is considered culturally sensitive?
A) “Do you think you will be able to eat the food we have here?”
B) “Do you understand that we can’t prepare special meals?”
C) “What types of food do you eat for meals?”
D) “Why can’t you just eat our food while you are here?”
c.
Asking patients what types of foods they eat for meals is culturally sensitive. The other questions are culturally insensitive.
A nurse is telling a new mother from Africa that she shouldn’t carry her baby in a sling created from a large rectangular cloth. The African woman tells the nurse that everyone in Mozambique carries babies this way. The nurse believes that bassinets are safer for infants. This nurse is displaying what cultural bias?
A) Cultural imposition
B) Clustering
C) Cultural competency
D) Stereotyping
a.
The nurse is trying to impose her belief that bassinets are preferable to baby slings on the African mother—in spite of the fact that African women have safely carried babies in these slings for years.
A nurse is teaching a novice nurse how to provide care for patients in a culturally diverse community health clinic. Although all these actions are recommended, which one is MOST basic to providing culturally competent care?
A) Learning the predominant language of the community
B) Obtaining significant information about the community
C) Treating each patient at the clinic as an individual
D) Recognizing the importance of the patient’s family
c.
In all aspects of nursing, it is important to treat each patient as an individual. This is also true in providing culturally competent care. This basic objective can be accomplished by learning the predominant language in the community, researching the patient’s culture, and recognizing the influence of family on the patient’s life.
A hospice nurse is caring for a patient who is dying of pancreatic cancer. The patient tells the nurse “I feel no connection to God” and “I’m worried that I find no real meaning in life.” What would be the nurse’s best response to this patient?
A) Give the patient a hug and tell him that his life still has meaning.
B) Arrange for a spiritual adviser to visit the patient.
C) Ask if the patient would like to talk about his feelings.
D) Call in a close friend or relative to talk to the patient.
c.
When caring for a patient who is in spiritual distress, the nurse should listen to the patient first and then ask whether the patient would like to visit with a spiritual adviser. To arrange for a spiritual adviser first may not respect the wishes of the patient. A hug and false reassurances do not address the diagnosis of spiritual distress. Talking to friends or relatives may be helpful, but only if the patient desires their visits.
A nurse who was raised as a strict Roman Catholic but who is no longer a practicing Catholic stated she couldn’t assist patients with their spiritual distress because she recognizes only a “field power” in each person. She said, “My parents and I hardly talk because I’ve deserted my faith. Sometimes I feel real isolated from them and also from God—if there is a God.” Analysis of these data reveals which unmet spiritual need?
A) Need for meaning and purpose
B) Need for forgiveness
C) Need for love and relatedness
D) Need for strength for everyday living
c.
The data point to an unmet spiritual need to experience love and belonging, given the nurse’s estrangement from her family and God after leaving the church. The other options may represent other needs this nurse has, but the data provided do not support them.
A nurse is performing spirituality assessments of patients living in a long-term care facility. What is the best question the nurse might use to assess for spiritual needs?
A) Can you describe your usual spiritual practices and how you maintain them daily?
B) Are your spiritual beliefs causing you any concern?
C) How can I and the other nurses help you maintain your spiritual practices?
D) How do your religious beliefs help you to feel at peace?
c.
Questioning how the staff can meet patients’ spiritual practices assesses spiritual needs. Asking the patient to describe spiritual practices assesses spiritual practices. Asking about concerns assesses spiritual distress, and asking about feeling at peace assesses the need for forgiveness.
A patient whose last name is Goldstein was served a kosher meal ordered from a restaurant on a paper plate because the hospital made no provision for kosher food or dishes. Mr. Goldstein became angry and accused the nurse of insulting him: “I want to eat what everyone else does—and give me decent dishes.” Analysis of these data reveals what finding?
A) The nurse should have ordered kosher dishes also.
B) The staff must have behaved condescendingly or critically.
C) Mr. Goldstein is a problem patient and difficult to satisfy.
D) Mr. Goldstein was stereotyped and not consulted about his dietary preferences.
d.
On the basis of his name alone, the nurse jumped to the premature and false conclusion that this patient would want a kosher diet.
A nurse working in an emergency department assesses how patients’ religious beliefs affect their treatment plan. With which patient would the nurse be most likely to encounter resistance to emergency lifesaving surgery?
A) A patient of the Adventist faith
B) A patient who practices Buddhism
C) A patient who is a Jehovah’s Witness
D) A patient who is an Orthodox Jew
c.
Patients who practice the Jehovah’s Witness faith believe blood transfusions violate God’s laws and do not allow them. The other religious groups do not restrict modern lifesaving treatment for their members.
