Ch 9

Question 1

Culturally congruent care

transcultural care

Answer 1

emphasizes the need to provide care based on an individual’s cultural beliefs, practices, and values;

A patient-centered approach to providing transcultural care requires you to address your own implicit bias; be respectful of and responsive to individual patient preferences, needs, and values; and ensure that patient values guide all clinical care decisions

Question 2

Cultural competence

Answer 2

-professional health care must be culturally sensitive, culturally appropriate, and culturally competent to meet the multifaceted health care needs of each person, family, and community

Question 3

Worldview

Answer 3

In any intercultural encounter there is an insider perspective (emic worldview) and an outsider perspective (etic worldview).

Question 4

health disparity

Answer 4

a particular type of health difference that is closely linked with social, economic, and/or environmental disadvan- tage”

Question 5

Intersectionality

Answer 5

a research and policy model for studying the complexities of people’s lives and experiences

Each of us is at the intersec- tion of two categories: privilege and oppression.

Question 6

Oppression

Answer 6

a formal and informal system of advantages and disadvantages tied to membership in social groups, reinforced by societal norms, biases, interactions, and beliefs

Question 7

acculturation

Answer 7

acculturation occurs when an individual or group transitions from one culture and develops traits of another culture

Question 8

core measures

Answer 8

The core measures are a set of evidence-based, scientifically researched standards of care

The core measures are key quality indicators that help health care institutions improve performance, increase accountability, and reduce costs. The measures apply to all patients. The core mea- sures need to be meaningful to patients, consumers, and physicians while reducing variability in outcome measure selection, financial col- lection burden, and cost

There are now two core measure sets: one for adults and one for children

Question 9

cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desire. The five constructs provide a framework for you to practice in a culturally competent manner.

Answer 9

• Cultural awareness is the process of conducting a self-examination of one’s own biases toward other cultures and the in-depth explora- tion of one’s cultural and professional background. It also involves being aware of the existence of documented racism and other “isms” in health care delivery.
• Cultural knowledge is the process in which a health care profes- sional seeks and obtains a sound educational base about culturally diverse groups. In acquiring this knowledge, health care professionals must focus on the integration of three specific issues: health-related beliefs and cultural values, care practices, and disease incidence and prevalence.
• Cultural skill is the ability to conduct a cultural assessment of a patient to collect relevant cultural data about a patient’s presenting problem, as well as accurately conducting a culturally based physical assessment.
• Cultural encounter is a process that encourages health care profes- sionals to directly engage in face-to-face cultural interactions and other types of encounters with patients from culturally diverse backgrounds. A cultural encounter aims to modify a health care provider’s existing belief about a cultural group and to prevent possible stereotyping.
• Cultural desire is the motivation of a health care professional to “want to” (and not “have to”) engage in the process of becoming culturally aware, culturally knowledgeable, and culturally skillful in seeking cultural encounters.

Question 10

Linguistic competence

Answer 10

ability to communicate effectively and convey information in a manner that is easily understood by diverse audiences. You use transcultural communication skills to interpret a patient’s behavior and to behave in a culturally congruent way.

Question 11

The mnemonic LEARN represents the pro- cess of listening, explaining, acknowledging, recommending, and negotiating:

Answer 11

• Listen to the patient’s perception of the problem. Be nonjudgmen-
tal and use encouraging comments, such as “Tell me more” or “I
understand what you are saying.”
• Explain your perception of the problem.
• Acknowledge not only the differences between the two perceptions
of the problem but also the similarities. Recognize the differences
but build on the similarities.
• Recommendations must involve the patient.
• Negotiate a treatment plan, considering that it is beneficial to
incorporate selected aspects of the patient’s culture into the plan.
Applying the LEARN mnemonic will help you to reflect at each

Question 12

Summary pt 1

Answer 12

• Cultural awareness self-examines the dynamics of personal biases, stereotypes, values, and beliefs related to others different from one’s own heritage, while cultural encounter involves directly interacting with patients of a diverse population other than one’s own.
• Cultural desire is the pivotal and key construct of cultural compe- tence. It is your desire to engage with patients who have cultural differences that evokes the entire process of cultural competence.
• Cultural skill is the ability to conduct a cultural assessment of a pa- tient to collect relevant cultural data about a patient’s presenting problem, as well as accurately conducting a culturally based physical assessment.
• A person’s culture and life experiences shape the person’s world- view about health, illness, and health care.
• Culture is constantly changing in response to social influences such as lifestyle practices, social relationships, and biases.
• Poor health, disease risk factors, poor health outcomes, and limited access to health care are types of preventable health care disparities often interrelated and influenced by the conditions and social context in which people live.
• Disparities in access to quality health care, preventive health care, and health education contribute to poor population health.
• Social determinants of health are defined by conditions in which people are born, grow, live, work, and age. Social determinants in- clude economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.

Question 13

Summary pt 2

Answer 13

• Health care systems and providers contribute to the problem of health disparities as a result of inadequate resources, poor patient- provider communication, a lack of culturally competent care, system fragmentation, and inadequate access to language services.
• Gaining cultural knowledge and conducting a self-examination allow health care providers to understand the cultural factors that shape patients’ life experiences, their health care problems and behavior, and how they might perceive those problems while building a positive nurse-patient relationship.
• Cultural respect is critical to reducing health disparities and improving access to high-quality health care that is respectful and responsive to the needs of a diverse patient.
• Avoid forming inappropriate biases or stereotypes when assessing a patient’s needs. Approach each person individually, and ask questions to gain a better understanding of a patient’s perspective and needs.
• Ongoing cultural competence and cultural skill are necessary for a nurse to complete a cultural assessment and provide culturally ap- propriate nursing care for each patient, regardless of the patient’s cultural background.

• Knowledge about your patient directs your physical assessment, and the health care provider must learn to anticipate physical find- ings based on the patient’s cultural health practices and the physical characteristics of an ethnic or racial group.
• Teach-back is an ongoing process of asking patients open-ended questions to gather feedback through explanation or demonstra- tion until the health care provider feels confident in the patient’s ability to understand and safely apply the new educational content.
• Linguistic competence is the ability to communicate effectively and convey information in a manner that is easily understood by diverse audiences.
• Effective communication is a critical skill in culturally competent care and helps you engage a patient and family in a respectful, patient- centered dialogue. Qualified translators (written words), interpreters (verbal words), and/or the use of a cultural broker (mediator) are op- tions to be utilized to assist with linguistic needs related to effective communication.

Question 14

REFLECTIVE LEARNING
• Consider a patient that you cared for recently on the clinical unit. How did knowledge of your patient’s culture impact your nursing care?
• Discuss some of the social determinants of health that you identi-
fied while conducting your assessment of the patient. How have
these impacted the health of the patient?
• Review your personal approach to patient education when working
with a patient who has a different cultural background from your own. Remember, the teach-back method is a valuable tool for all health care providers to use with each patient. As the health care provider, did you do the following?
• Use a caring tone of voice and attitude?
• Display comfortable body language, make eye contact, and sit
down at the patient’s level?
• Ask open-ended questions?
• Take responsibility for making sure the instructions were clear
and understood?
• Use print materials that were reader friendly to support learning? • Observe the patient’s response to teach-back?

Question 15

A nurse is seeing all of these patients in the community health clinic. The nurse identifies which patient(s) as having a health dis- parity? (Select all that apply.)
1. A patient who has a homosexual sexual preference
2. A patient unable to access primary care services 3. A patient living with chronic schizophrenia
4. A family who relies on public transportation
5. A patient who has a history of hypertension

Answer 15

1.,2.,3

Question 16

A 35-year-old woman has Medicaid coverage for herself and two young children. She missed an appointment at the local health clinic to get an annual mammogram because she has no transpor- tation. She gets the annual screening because her mother had breast cancer. Which of the following are social determinants of this woman’s health? (Select all that apply.)
1. Medicaidinsurance
2. Annualscreening
3. Mother’shistoryofbreastcancer 4. Lack of transportation
5. Woman’sage

Answer 16

1.,4.,5.,

Question 17

During a nursing assessment a patient displayed several behaviors. Which behavior suggests the patient may have a health literacy problem?
1. Patient has difficulty completing a registration form at a medical
office
2. Patient asks for written information about a health topic
3. Patient speaks Spanish as primary language
4. Patient states unfamiliarity with a newly ordered medicine

Answer 17

1

Question 18

A nurse desires to communicate with a young woman who is Serbian and who has limited experience with being in a hospital. The nurse has 10 years of experience caring for Serbian women. The patient was admitted for a serious pregnancy complication. Apply the LEARN model and match the nurse’s behaviors with each step of the model.

____ 1. L
____ 2. E
____ 3. A
____ 4. R
____ 5. N
a. The nurse notes that she has learned that fathers can visit mothers at any time in both Serbia and the United States.
b. The nurse shares her perception of the woman’s experiences as a patient.
c. The nurse asks the patient how she can maintain bed rest when she returns home.
d. The nurse attends to the patient and listens to her story about hospitals in Serbia.
e. The nurse involves the patient in a discussion of the treatmen

Answer 18

1.,d.,
2.,b.,
3.,a.,
4.,e.,
5.,c.,

Question 19

Health care agencies must provide which of the following based on federal civil rights laws? (Select all that apply.)
1. Provide language assistance services at all points of contact free
of charge.
2. Provide auxiliary aids and services, such as interpreters, note
takers, and computer-aided transcription services.
3. Use patients’ family members to interpret difficult topics.
4. Ensure that interpreters are competent in medical terminology.
5. Provide language assistance to all patients who speak limited
English or are deaf.

Answer 19

1.,2.,4.,5.,

Question 20

A nurse working in a large occupational health clinic knows that
many of the workers at her company are marginalized and at risk for poor health outcomes. Which of the following individuals are most likely to be marginalized?
1. Wives of the employees
2. Theheadsupervisorsofthecompany
3. Workerswhohaveahighschooleducation
4. Workersemployedforlessthanayearatthecompany

Question 21

A mother is concerned about her child’s flulike symptoms. You learn from the health assessment that the mother practices the use of “hot” and “cold” foods to treat ailments. Which of the following foods do you expect the mother to use to treat her child?

1. Chicken
2. Yogurt
3. Freshfruits
4. Eggs

Answer 21

4

Question 22

Which explanation provided by the nurse is the most accurate
meaning for “providing culturally congruent care”?
1. It fits the patient’s valued life patterns and set of meanings.
2. It is the same set of values as those of the health care team
member providing daily care.
3. It holds one’s own way of life as superior to those of others. 4. It redirects the patient to a more socially expected set of
values.

Answer 22

1

Question 23

Which statements made by a nursing student about the teach-
back technique show understanding of the technique? (Select all that apply.)
1. “After teaching a patient how to use an inhaler, I need to use the teach-back technique to test my patient’s ability to use the inhaler correctly.”
2. “The teach-back technique is an ongoing process of asking patients for feedback.”
3. “Using teach-back will help me identify explanations and com- munication strategies that my patients will most commonly understand.”
4. “Using pictures, drawings, and models can enhance the effec- tiveness of the teach-back technique.”
5. “When doing my patient teaching, I will use plain language to make the material easier to understand for the patient.”

Answer 23

1.,2.,3.,4.,5.,

Question 24

Match the cultural concepts on the left with the correct definitions on the right.

____ 1. Etic worldview
____ 2. Worldview
____ 3. Cultural desire
____ 4. Intersectionality
____ 5. Emic worldview

a. Factor that shapes how people perceive others and how they relate to reality
b. Insider’s perspective in an intercultural encounter
c. A policy model that describes factors and power structures that shape and influence life
d. An outsider’s perspec- tive in an intercultural encounter
e. The motivation of a health care profes- sional to “want to” engage in cultural competence

Answer 24

1.,d
2.,a
3.,e
4.,c
5.,b