mod 1 Flashcards
characteristics of cultural competence
cultural awareness, cultural knowledge, cultural sensitivity, cultural skill, cultural humility, and cultural proficiency
Culturally congruent care
strategy to address health care disparities and improve patient outcomes regardless of ethnicity.
ways to reduce disparities
- humanize pt
- remain aware of onw biased
- do teach back w pt for clarity
- educate pt about disease
- welcome friends and family
- use qualified med interpreter
- learn words/common phrases
- consider health literacy
- have empathy
hold others accountable for cultural awareness - pt complete satisfaction surveys
cultural interactions
- culture of healthcare system
- culture pt
- culture nurse
cultural competent nursing practice
ETHNIC
explanation treatment healers negotiate intervention collaboration
Match the characteristic of cultural competence to the action of the nurse
- Called for a same-gender doctor to show respect to the culture
- Cultural sensitivity - Asked a Kurdish colleague for more information about the patient’s culture
- Cultural knowledge
- Noted the differences between his culture and the patient’s culture
- Cultural awareness
- Provided the patient’s culture-related data to colleagues
- Cultural proficiency
Cultural Proficiency
Maintaining and acquiring new cultural knowledge along with sharing that information with others to encourage a culturally competent organization
cultural knowledge
cultural understanding and acquiring info
cultural humility
recognize own limitations in knowledge and understanding others culture
cultural skill
effective comms w pt other cultures include beliefs and values
cultural sensitivity
respect for other cultures
cultural knowledge
cultural understanding and acquiring info
cultural awareness
know own culture and mindful about others cultures
cultural proficiency
get new cultural knowledge and sharing with others
Which nursing action exemplifies cultural awareness?
Questioning one’s own religious beliefs
Which statements about culturally competent nursing care are true?
- Cultural competence begins with cultural awareness.
- Cultural competence incorporates the patient’s culture into his or her health care plan.
Transcultural Assessment Model
communication, space, social orientation, environmental control, time, and biologic variation
communication
how to speak and body bx
biological variations
hair/skin color, physical size,
environmental control
cultural health practices
time
time in culture
social orientation
race, ethnicity, hobbies
space
comfort w space and physical touch
4 C’s of Cuture
call, caused, cope, concerns
What do you call your health problem/issue?
- “What do you think is wrong?”
- see issue from pt point view
What do you think caused your health problem/issue?
- what pt believes source problem
- caused by sin or supernatural??
How do you cope with your health problem/issue?
- “What have you done to try and make it better?
- id nontraditional treatments
What are your biggest concerns regarding the condition or recommended treatment?
- clarify pt perception severity illness
- concerns w treatment
When assessing a patient, the nurse asks, “What health remedies have you used to address your health issues?” Which cultural phenomenon is the nurse assessing?
environmental control
According the Giger and Davidhizar Transcultural Assessment Model, which questions might be asked when addressing the social orientation cultural phenomenon?
- What is your role in the family?
- Do you attend church regularly?
- What do you consider your ethnicity?
- What do you enjoy doing if you have free time?
Which rationales for asking specific questions during a cultural assessment are accurate?
- Allows the nurse to see the health concerns from the patient’s perspective
- Helps eliminate miscommunication between the nurse and the patient
- Strengthens the nurse-patient relationship
leiningers modes for guiding nursing actions and decision making
- cultural maintenance
- cultural accommodation or negotiation
- cultural care repatterning or restructuring
cultural maintenance
preserves values and beliefs while pt recovering
cultural accommodation or negotiation
pt becomes accepting of health intervention
cultural care repatterning or restructuring
making change while still adhering to traditions
assessing language and literacy
- use prof interpreter
- avoid abbreviations and acronyms
- use slower speech
- avoid speaking loudly
- limit jargon
- prov written or audiovisual
factors influencing comm
- overall health and emotions
- intent or reason
- nurse and pt’s skill
- both philosophical /cultural beliefs
- attitudes
- tendencies and judgements
- past experiences with current
cross cultural comms
- interpreter
- open-ended questions
- avoiding med term
- use pictures
Which cultural issue is the patient most likely to hide from the nurse?
illiteracy
Which interventions are most appropriate when a patient speaks the predominant language but it is not his or her native language?
- use professional interpreter
- prov written materials
- limit use of slang
The nurse is caring for a Puerto Rican patient who must make a decision about whether to have surgery for an advanced-stage brain tumor. Which action or characteristic would the nurse expect to see based on the patient’s ethnicity?
The patient will likely consult with the family before making a decision.
Which questions would best encourage cultural competency when first encountering a patient with complaints of low back pain in the emergency department?
- what concerns you most about your lower back pain?
- have you tried herbal remedies to help with the pain?
- have you sought treatment from an alternative HCP?
Which details would the nurse include during a culturally appropriate nursing assessment with respect to the cultural phenomenon of communication?
- preferred language
- tonal preference
- use of nonverbal comms
The nurse is performing a cultural health assessment on a patient who is of African descent. Which question would be most important to include in the cultural assessment based on the patient’s ethnicity?
- have you ever been told of a genetic susceptibility to a specific disease?
The nurse is caring for a Native American patient, newly diagnosed with lung cancer, who smokes his own tobacco. Which strategy would the nurse implement when providing culturally competent nursing care for this patient?
- cultural care restructuring
work to make mutual decisions together can continue some traditions
Which actions by the nurse specifically incorporate culture into a nursing intervention?
- ordering kosher diet
- requesting same-gender HCP
- requesting interpreter
Match the characteristic associated with cultural competence with the correct definition.
Acquiring, maintaining, and sharing new cultural information with others
- Cultural proficiency
Effectively communicating and including cultural beliefs in patient care
- Cultural skill
Recognizing limitations in knowledge and understanding of other cultures
- Cultural humility
Learning and gaining new information about other cultures
- Cultural knowledge
To provide culturally competent nursing care, the nurse must be aware of interactions among which cultures?
- pt personal culture
- nurse’s culture
- health care system culture
Which questions would the nurse ask during a culturally appropriate health assessment of a patient with complaints of cough based on the 4 Cs of Culture?
- what do you think caused cough?
- how do you cope with cough?
- what is biggest concern about cough?
- what you call type of cough you been experiencing?
The nurse is caring for a patient of Hispanic descent who understands English but is not fluent in the language. Which action or statement by the nurse would be most appropriate when attempting to alleviate the patient’s concern about an upcoming medical procedure?
- would you like me to have interpreter come to room so i can more thoroughly answer any question or concerns you have?
chinese americans
- Soft tone
- Slow speech
- Silence is valued
- Avoid eye contact
- Avoid excessive touch
hispanic americans
- Faster speech
- Loud tone
- Maintain eye contact
- Touch is acceptable
native americans
- Soft tone
- Slow speech with silence
- Respect is shown by avoiding eye contact
- Light touch is acceptable
african americans
- loud tone
- faster speech
- maintain eye contact but avoid prolonged
- touch acceptable
orthodox jews
- no tone or speech cadence preferred
- touch acceptable
- eye contact can be interpreted as sexual
paul and elder framerwork
intellectual standards
elements of reasoning/thought process
intellectual traits
intellectual standards
clarity - able to elaborate? descrive differently? accuracy - proven correct? relevance - relate to issue? logic - make sense? ander consistent precision - more specific, more details, more clarification fairness- biases? all viewpoints? depth - more complexities? breadth - another point of view? significance - main issue?
elements of reasoning
- have purpose
- attempt to figure something out, answer unknown
- always formed from a previous perspective or point of view
- based on known data or information
- based on specific concept or formed idea
- all lead to consequence or follow-up thought
- most often based on previous assumptions
intellectual traits
- integrity - hold self accountable
- autonomy - responsible for own thinking
- empathy - be in other’s shoes
- courage - challenge what though correct if necessary
- fair-mindedness - treat all viewpoints without bias
- perseverance - focus desired results, refuse give up
- confidence in reason - allow all the reach own conclusion and use good reasoning to accept or reject
- humility - discern what already know and what need to know
Which characteristics are reflective of critical thinkers?
- aware of their personal biases
- open minded
- listen well
According to Paul and Elder, clinical thinking requires which components?
- thought process
- reasoning
- intellectual standards
- intellectual traits
Match the intellectual standard associated with the Paul and Elder Framework with the descriptive question.
Do I have a bias that needs to be addressed?
- Fairness
Does the answer make sense?
- Logic
Can the thought be proven correct?
- Accuracy
Are more details necessary?
- Precisionclinical reasoning
specific thought process used in nursing when analyzing, evaluating, assessing, and managing patient at specific setting
specific process when health care providers collect, generate and test a hypothesis
clinical judgment
process HCP when they arrive at final brief, decision, or conclusion
affect ability to think critically
age and maturity positive moral development self-confidence personal biases past experience effective writing and speaking skills
stages of thinking of nurses
- novice - new or experienced moving floors/deps
- advanced beginners - <2 yrs
- competent - 2-3 yrs in same setting
- proficient - at least 3 yrs, maybe charge nurse
- expert - decisions based on intuition and instantaneously, charge nurse, preceptor, mentor, manager
nursing process and clinical judgment measurement model
assess analyze plan implement evaluate
nursing process and clinical judgment measurement model characteristics
analytic dynamic organized outcome oriented collaborative adaptable
Which description best corresponds to the term clinical judgment?
Requires recalling facts and recognizing patterns seen previously when caring for patients
According to Alfaro-LeFevre, which factors can affect a nurse’s ability to think critically?
life experience
self-confidence
moral development
Which characteristic of both the nursing process and the Clinical Judgment Measurement Model refers to changes over time in response to patients’ individual needs?
dynamic
5 rights of critical thinking
right cue - detail of pt info most important
right patient - most critical pt
right time - appr time carry out
right action - task most important and who? delegate?
right reason - action ethical, legal, professional?
Which activities would best promote critical thinking in nursing?
- Asking a peer to clarify their thoughts when discussing a specific nursing situation
- The newly graduated registered nurse identifying an experienced coworker to have as a mentor
- Writing about a specific patient experience and lessons learned from the experience
The nurse is caring for a patient who has been prescribed a blood transfusion after a traumatic injury. The nurse confirms it is the correct patient by reading his hospital wristband and verbally asking the patient his name and date of birth. The blood type is confirmed with a second nurse before initiation of the transfusion. This scenario is an example of which activity that enhances effective communication?
time-out
Match the factor that hinders critical thinking with the correct description.
Not gathering all the facts before reaching a conclusion
- Lack of information
Having an expectation of a result without selecting specific evidence
- Tunnel vision
Jumping to conclusions; not clearly thinking through presented information
- Illogical thinking
Believing the presented information is factual without validating first
- Erroneous assumption
Critical thinking is a conscious decision not to accept something at face value and instead attempt to analyze it from all perspectives. Which actions are considered part of the critical-thinking process?
- identifying concern
- determining which info is most relevant
- gathering input from others
- vetting info presented
According to Alfaro-LeFevre, which individual should be most adept at thinking critically?
a 22 yr olf woman whose father was in the military, requiring her to live in Germany, England, California, Florida, missouri
Which actions demonstrate a nurse using the Clinical Judgment Measurement Model (CJMM) and critical thinking when a patient reports increased pain at the surgical site?
- verifying no pain meds were prescribed after surgery and calling hcp to inform them of pt change in status to see if main meds can be given
- using nonpharmaceutical tx focused deep breathing and imagery to help relieve pt pain after verifying no pain med prescribed
- assess pt VS and verifying which pain meds prescribed and when pain meds last given
- assess surg site determine weather infection could be cause increased pain
Match the clinical reasoning process with its descriptor.
need to fix
Recognizing the detail that is most important in the scenario Right cue
Identifying which tasks are most important and should be performed first Right action
Identifying which tasks can be delegated Right expertise
Recognizing that the action is necessary and professional Right reason
Match the clinical reasoning process with its descriptor.
Recognizing the detail that is most important in the scenario
- Right cue
Identifying which tasks are most important and should be performed first
- Right time
Identifying which tasks can be delegated
- Right action
Recognizing that the action is necessary and professional
- Right reason
Match the description of the nurse with the appropriate career stage.
A nurse with 3 years of experience, who just started working in the ICU
- Novice
A nurse with 18 months of experience in the cardiac step-down unit
- Advanced beginner
The charge nurse in the neonatal ICU
- Proficient
The neurosurgery unit staff educator nurse
- Expert
Match the intellectual standard with the scenario that represents it.
The nurse completely understands the complexities of the issue.
- Depth
The nurse’s perspective has been confirmed as factual.
- Accuracy
Others understand the nurse’s point of view.
- Clarity
The nurse focuses on the most important aspects of the situation.
- Significance
An experienced nurse, who is precepting a new nurse, is caring for a critically ill patient and just placed a feeding tube as prescribed. After auscultation of air into the stomach to confirm tube placement, the preceptor initiates the tube feeding. The new nurse questions the starting of feeds without verifying nasogastric (NG) tube placement by x-ray, which is the new standard of care. The preceptor responds, “I have been a nurse for 20 years, and I have always verified placement by auscultation of air into the stomach.” This response is an example of which activity that can hinder critical thinking?
close-mindedness
The emergency department (ED) nurse is handing off care of a patient to the intensive care unit (ICU) nurse. The ED nurse is giving report using the Situation, Background, Assessment, Recommendation (SBAR) method. The ED nurse tells the ICU nurse that the patient is admitted for respiratory distress and is currently homeless. Which SBAR communication element does this scenario represent?
background
