NR 302 Ch. 2 cultural competence

What defines and influences and individuals belied about health and illness, coping mechanisms, and wellness behaviors?
Multiple and often changing cultural and subcultural identifications
The National Standards for Culturally and Linguistically Appropriate Services in Health Care state that
Health care org. should ensure patients receive
effective
understandable
respectful care
in a manner compatible with their cultural health beliefs and practices and language preference
Heritage consistency
degree to which a persons lifestyle reflects his or her traditional heritage.
Heritage consistency includes determination of a persons
cultural, ethnic, and religious background and socialization experiences
Culture has 4 characteristics
Learned from birth through language acquisition and socialization

Shared by all members of cultural group

Adapted to specific conditions related to environmental and technical factors and to the availability of natural resources.

Dynamic and ever changing

Ethnicity
Social group that claims to possess a common geographic origin, migratory status, religion, race, language, traditions, food
Religion
belief in divine or superhuman power or powers to be obeyed and worshipped as creator and ruler
Spirituality
persons personal effort to find purpose and meaning in life
Socialization
process of being raised within a culture and acquiring the characteristics of the group

ex: education

You assess factors related to heritage to determine
depth to which you and the patient identify with a traditional heritage
Culturally based perceived cause of illness and symptoms are viewed as
biomedical (scientific)
naturalistic (holistic)
magicoreligious
1. The nurse is reviewing the development of culture. Which statement is correct regarding the development of one’s culture? Culture is:

a.

Genetically determined on the basis of racial background.

b.

Learned through language acquisition and socialization.

c.

A nonspecific phenomenon and is adaptive but unnecessary.

d.

Biologically determined on the basis of physical characteristics.

B

Culture is learned from birth through language acquisition and socialization. It is not biologically or genetically determined and is learned by the individual.

During a class on the aspects of culture, the nurse shares that culture has four basic characteristics. Which statement correctly reflects one of these characteristics?

a.

Cultures are static and unchanging, despite changes around them.

b.

Cultures are never specific, which makes them hard to identify.

c.

Culture is most clearly reflected in a person’s language and behavior.

d.

Culture adapts to specific environmental factors and available natural resources.

D

Culture has four basic characteristics. Culture adapts to specific conditions related to environmental and technical factors and to the availability of natural resources, and it is dynamic and ever changing. Culture is learned from birth through the process of language acquisition and socialization, but it is not most clearly reflected in one’s language and behavior.

During a seminar on cultural aspects of nursing, the nurse recognizes that the definition stating “the specific and distinct knowledge, beliefs, skills, and customs acquired by members of a society” reflects which term?

a.

Mores

b.

Norms

c.

Culture

d.

Social learning

C

The culture that develops in any given society is always specific and distinctive, encompassing all of the knowledge, beliefs, customs, and skills acquired by members of the society. The other terms do not fit the given definition.

When discussing the use of the term subculture, the nurse recognizes that it is best described as:

a.

Fitting as many people into the majority culture as possible.

b.

Defining small groups of people who do not want to be identified with the larger culture.

c.

Singling out groups of people who suffer differential and unequal treatment as a result of cultural variations.

d.

Identifying fairly large groups of people with shared characteristics that are not common to all members of a culture.

D

Within cultures, groups of people share different beliefs, values, and attitudes. Differences occur because of ethnicity, religion, education, occupation, age, and gender. When such groups function within a large culture, they are referred to as subcultural groups.

When reviewing the demographics of ethnic groups in the United States, the nurse recalls that the largest and fastest growing population is:

a.

Hispanic.

b.

Black.

c.

Asian.

d.

American Indian.

A

Hispanics are the largest and fastest growing population in the United States, followed by Asians, Blacks, American Indians and Alaska natives, and other groups.

During an assessment, the nurse notices that a patient is handling a small charm that is tied to a leather strip around his neck. Which action by the nurse is appropriate?

a.

Ask the patient about the item and its significance.

b.

Ask the patient to lock the item with other valuables in the hospital’s safe.

c.

Tell the patient that a family member should take valuables home.

d.

No action is necessary.

: A

The nurse should inquire about the amulet’s meaning. Amulets, such as charms, are often considered an important means of protection from “evil spirits” by some cultures.

The nurse manager is explaining culturally competent care during a staff meeting. Which statement accurately describes the concept of culturally competent care? “The caregiver:

a.

Is able to speak the patient’s native language.”

b.

Possesses some basic knowledge of the patient’s cultural background.”

c.

Applies the proper background knowledge of a patient’s cultural background to provide the best possible health care.”

d.

Understands and attends to the total context of the patient’s situation.”

D

Culturally competent implies that the caregiver understands and attends to the total context of the individual’s situation. This competency includes awareness of immigration status, stress factors, other social factors, and cultural similarities and differences. It does not require the caregiver to speak the patient’s native language.

The nurse recognizes that an example of a person who is heritage consistent would be a:

a.

Woman who has adapted her clothing to the clothing style of her new country.

b.

Woman who follows the traditions that her mother followed regarding meals.

c.

Man who is not sure of his ancestor’s country of origin.

d.

Child who is not able to speak his parents’ native language.

B

Someone who is heritage consistent lives a lifestyle that reflects his or her traditional heritage, not the norms and customs of the new country.

After a class on culture and ethnicity, the new graduate nurse reflects a correct understanding of the concept of ethnicity with which statement?

a.

“Ethnicity is dynamic and ever changing.”

b.

“Ethnicity is the belief in a higher power.”

c.

“Ethnicity pertains to a social group within the social system that claims shared values and traditions.”

d.

“Ethnicity is learned from birth through the processes of language acquisition and socialization.”

C

Ethnicity pertains to a social group within the social system that claims to have variable traits, such as a common geographic origin, migratory status, religion, race, language, values, traditions, symbols, or food preferences.Culture is dynamic, ever changing, and learned from birth through the processes of language acquisition and socialization. Religion is the belief in a higher power.

he nurse is comparing the concepts of religion and spirituality. Which of the following is an appropriate component of one’s spirituality?

a.

Belief in and the worship of God or gods

b.

Attendance at a specific church or place of worship

c.

Personal effort made to find purpose and meaning in life

d.

Being closely tied to one’s ethnic background

C

Spirituality refers to each person’s unique life experiences and his or her personal effort to find purpose and meaning in life. The other responses apply to religion.

A woman who has lived in the United States for a year after moving from Europe has learned to speak English and is almost finished with her college studies. She now dresses like her peers and says that her family in Europe would hardly recognize her. This nurse recognizes that this situation illustrates which concept?

a.

Assimilation

b.

Heritage consistency

c.

Biculturalism

d.

Acculturation

A

Assimilation is the process by which a person develops a new cultural identity and becomes like members of the dominant culture. This concept does not reflect heritage consistency. Biculturalism is a dual pattern of identification; acculturation is the process of adapting to and acquiring another culture.

The nurse is conducting a heritage assessment. Which question is most appropriate for this assessment?

a.

“What is your religion?”

b.

“Do you mostly participate in the religious traditions of your family?”

c.

“Do you smoke?”

d.

“Do you have a history of heart disease?”

B

Asking questions about participation in the religious traditions of family enables the nurse to assess a person’s heritage. Simply asking about one’s religion, smoking history, or health history does not reflect heritage.

In the majority culture of America, coughing, sweating, and diarrhea are symptoms of an illness. For some individuals of Mexican-American origin, however, these symptoms are a normal part of living. The nurse recognizes that this difference is true, probably because Mexican-Americans:

a.

Have less efficient immune systems and are often ill.

b.

Consider these symptoms part of normal living, not symptoms of ill health.

c.

Come from Mexico, and coughing is normal and healthy there.

d.

Are usually in a lower socioeconomic group and are more likely to be sick.

B

The nurse needs to identify the meaning of health to the patient, remembering that concepts are derived, in part, from the way in which members of the cultural group define heal

The nurse is reviewing theories of illness. The germ theory, which states that microscopic organisms such as bacteria and viruses are responsible for specific disease conditions, is a basic belief of which theory of illness?

a.

Holistic

b.

Biomedical

c.

Naturalistic

d.

Magicoreligious

B

Among the biomedical explanations for disease is the germ theory, which states that microscopic organisms such as bacteria and viruses are responsible for specific disease conditions. The naturalistic, or holistic, perspective holds that the forces of nature must be kept in natural balance. The magicoreligious perspective holds that supernatural forces dominate and cause illness or health.

An Asian-American woman is experiencing diarrhea, which is believed to be “cold” or “yin.” The nurse expects that the woman is likely to try to treat it with:

a.

Foods that are “hot” or “yang.”

b.

Readings and Eastern medicine meditations.

c.

High doses of medicines believed to be “cold.”

d.

No treatment is tried because diarrhea is an expected part of life.

A

Yin foods are cold and yang foods are hot. Cold foods are eaten with a hot illness, and hot foods are eaten with a cold illness. The other explanations do not reflect the yin/yang theory.

Many Asians believe in the yin/yang theory, which is rooted in the ancient Chinese philosophy of Tao. Which statement most accurately reflects “health” in an Asian with this belief?

a.

A person is able to work and produce.

b.

A person is happy, stable, and feels good.

c.

All aspects of the person are in perfect balance.

d.

A person is able to care for others and function socially.

C

Many Asians believe in the yin/yang theory, in which health is believed to exist when all aspects of the person are in perfect balance. The other statements do not describe this theory.

Illness is considered part of life’s rhythmic course and is an outward sign of disharmony within. This statement most accurately reflects the views about illness from which theory?

a.

Naturalistic

b.

Biomedical

c.

Reductionist

d.

Magicoreligious

A

The naturalistic perspective states that the laws of nature create imbalances, chaos, and disease. From the perspective of the Chinese, for example, illness is not considered an introducing agent; rather, illness is considered a part of life’s rhythmic course and an outward sign of disharmony within. The other options are not correct.

An individual who takes the magicoreligious perspective of illness and disease is likely to believe that his or her illness was caused by:

a.

Germs and viruses.

b.

Supernatural forces.

c.

Eating imbalanced foods.

d.

An imbalance within his or her spiritual nature.

B

The basic premise of the magicoreligious perspective is that the world is seen as an arena in which supernatural forces dominate. The fate of the world and those in it depends on the actions of supernatural forces for good or evil. The other answers do not reflect the magicoreligious perspective.

If an American Indian woman has come to the clinic to seek help with regulating her diabetes, then the nurse can expect that she:

a.

Will comply with the treatment prescribed.

b.

Has obviously given up her belief in naturalistic causes of disease.

c.

May also be seeking the assistance of a shaman or medicine man.

d.

Will need extra help in dealing with her illness and may be experiencing a crisis of faith.

C

When self-treatment is unsuccessful, the individual may turn to the lay or folk healing systems, to spiritual or religious healing, or to scientific biomedicine. In addition to seeking help from a biomedical or scientific health care provider, patients may also seek help from folk or religious healers.

An older Mexican-American woman with traditional beliefs has been admitted to an inpatient care unit. A culturally sensitive nurse would:

a.

Contact the hospital administrator about the best course of action.

b.

Automatically get a curandero for her, because requesting one herself is not culturally appropriate.

c.

Further assess the patient’s cultural beliefs and offer the patient assistance in contacting a curandero or priest if she desires.

d.

Ask the family what they would like to do because Mexican-Americans traditionally give control of decision making to their families.

C

In addition to seeking help from the biomedical or scientific health care provider, patients may also seek help from folk or religious healers. Some people, such as those of Mexican-American or American-Indian origins, may believe that the cure is incomplete unless the body, mind, and spirit are also healed (although the division of the person into parts is a Western concept).

A 63-year-old Chinese-American man enters the hospital with complaints of chest pain, shortness of breath, and palpitations. Which statement most accurately reflects the nurse’s best course of action?

a.

The nurse should focus on performing a full cardiac assessment.

b.

The nurse should focus on psychosomatic complaints because the patient has just learned that his wife has cancer.

c.

This patient is not in any danger at present; therefore, the nurse should send him home with instructions to contact his physician.

d.

It is unclear what is happening with this patient; consequently, the nurse should perform an assessment in both the physical and the psychosocial realms.

D

Wide cultural variations exist in the manner in which certain symptoms and disease conditions are perceived, diagnosed, labeled, and treated. Chinese-Americans sometimes convert mental experiences or states into bodily symptoms (e.g., complaining of cardiac symptoms because the center of emotion in the Chinese culture is the heart).

Symptoms, such as pain, are often influenced by a person’s cultural heritage. Which of the following is a true statement regarding pain?

a.

Nurses’ attitudes toward their patients’ pain are unrelated to their own experiences with pain.

b.

Nurses need to recognize that many cultures practice silent suffering as a response to pain.

c.

A nurse’s area of clinical practice will most likely determine his or her assessment of a patient’s pain.

d.

A nurse’s years of clinical experience and current position are strong indicators of his or her response to patient pain.

B

Silent suffering is a potential response to pain in many cultures. The nurse’s assessment of pain needs to be embedded in a cultural context. The other responses are not correct.

The nurse is reviewing concepts of cultural aspects of pain. Which statement is true regarding pain?

a.

All patients will behave the same way when in pain.

b.

Just as patients vary in their perceptions of pain, so will they vary in their expressions of pain.

c.

Cultural norms have very little to do with pain tolerance, because pain tolerance is always biologically determined.

d.

A patient’s expression of pain is largely dependent on the amount of tissue injury associated with the pain.

B

In addition to expecting variations in pain perception and tolerance, the nurse should expect variations in the expression of pain. It is well known that individuals turn to their social environment for validation and comparison. The other statements are incorrect.

During a class on religion and spirituality, the nurse is asked to define spirituality. Which answer is correct? “Spirituality:

a.

Is a personal search to discover a supreme being.”

b.

Is an organized system of beliefs concerning the cause, nature, and purpose of the universe.”

c.

Is a belief that each person exists forever in some form, such as a belief in reincarnation or the afterlife.”

d.

Arises out of each person’s unique life experience and his or her personal effort to find purpose in life.”

D

Spirituality arises out of each person’s unique life experience and his or her personal effort to find purpose and meaning in life. The other definitions reflect the concept of religion.

The nurse recognizes that working with children with a different cultural perspective may be especially difficult because:

a.

Children have spiritual needs that are influenced by their stages of development.

b.

Children have spiritual needs that are direct reflections of what is occurring in their homes.

c.

Religious beliefs rarely affect the parents’ perceptions of the illness.

d.

Parents are often the decision makers, and they have no knowledge of their children’s spiritual needs.

A

Illness during childhood may be an especially difficult clinical situation. Children, as well as adults, have spiritual needs that vary according to the child’s developmental level and the religious climate that exists in the family. The other statements are not correct.

A 30-year-old woman has recently moved to the United States with her husband. They are living with the woman’s sister until they can get a home of their own. When company arrives to visit with the woman’s sister, the woman feels suddenly shy and retreats to the back bedroom to hide until the company leaves. She explains that her reaction to guests is simply because she does not know how to speak “perfect English.” This woman could be experiencing:

a.

Culture shock.

b.

Cultural taboos.

c.

Cultural unfamiliarity.

d.

Culture disorientation.

A

Culture shock is a term used to describe the state of disorientation or inability to respond to the behavior of a different cultural group because of its sudden strangeness, unfamiliarity, and incompatibility with the individual’s perceptions and expectations. The other terms are not correct.

After a symptom is recognized, the first effort at treatment is often self-care. Which of the following statements about self-care is true? “Self-care is:

a.

Not recognized as valuable by most health care providers.”

b.

Usually ineffective and may delay more effective treatment.”

c.

Always less expensive than biomedical alternatives.”

d.

Influenced by the accessibility of over-the-counter medicines.”

D

After a symptom is identified, the first effort at treatment is often self-care. The availability of over-the-counter medications, the relatively high literacy level of Americans, and the influence of the mass media in communicating health-related information to the general population have contributed to the high percentage of cases of self-treatment.

The nurse is reviewing the hot/cold theory of health and illness. Which statement best describes the basic tenets of this theory?

a.

The causation of illness is based on supernatural forces that influence the humors of the body.

b.

Herbs and medicines are classified on their physical characteristics of hot and cold and the humors of the body.

c.

The four humors of the body consist of blood, yellow bile, spiritual connectedness, and social aspects of the individual.

d.

The treatment of disease consists of adding or subtracting cold, heat, dryness, or wetness to restore the balance of the humors of the body.

D

The hot/cold theory of health and illness is based on the four humors of the body: blood, phlegm, black bile, and yellow bile. These humors regulate the basic bodily functions, described in terms of temperature, dryness, and moisture. The treatment of disease consists of adding or subtracting cold, heat, dryness, or wetness to restore the balance of the humors. The other statements are not correct.

In the hot/cold theory, illnesses are believed to be caused by hot or cold entering the body. Which of these patient conditions is most consistent with a cold condition?

a.

Patient with diabetes and renal failure

b.

Teenager with an abscessed tooth

c.

Child with symptoms of itching and a rash

d.

Older man with gastrointestinal discomfort

D

Illnesses believed to be caused by cold entering the body include earache, chest cramps, gastrointestinal discomfort, rheumatism, and tuberculosis. Those illnesses believed to be caused by heat, or overheating, include sore throats, abscessed teeth, rashes, and kidney disorders.

When providing culturally competent care, nurses must incorporate cultural assessments into their health assessments. Which statement is most appropriate to use when initiating an assessment of cultural beliefs with an older American-Indian patient?

a.

“Are you of the Christian faith?”

b.

“Do you want to see a medicine man?”

c.

“How often do you seek help from medical providers?”

d.

“What cultural or spiritual beliefs are important to you?”

D

The nurse needs to assess the cultural beliefs and practices of the patient. American Indians may seek assistance from a medicine man or shaman, but the nurse should not assume this. An open-ended question regarding cultural and spiritual beliefs is best used initially when performing a cultural assessment.

During a class on cultural practices, the nurse hears the term cultural taboo. Which statement illustrates the concept of a cultural taboo?

a.

Believing that illness is a punishment of sin

b.

Trying prayer before seeking medical help

c.

Refusing to accept blood products as part of treatment

d.

Stating that a child’s birth defect is the result of the parents’ sins

C

Cultural taboos are practices that are to be avoided, such as receiving blood products, eating pork, and consuming caffeine. The other answers do not reflect cultural taboos.

the nurse recognizes that categories such as ethnicity, gender, and religion illustrate the concept of:

a.

Family.

b.

Cultures.

c.

Spirituality.

d.

Subcultures.

D

Within cultures, groups of people share different beliefs, values, and attitudes. Differences occur because of ethnicity, religion, education, occupation, age, and gender. When such groups function within a large culture, they are referred to as subcultural groups.

The nurse is reviewing concepts related to one’s heritage and beliefs. The belief in divine or superhuman power(s) to be obeyed and worshipped as the creator(s) and ruler(s) of the universe is known as:

a.

Culture.

b.

Religion.

c.

Ethnicity.

d.

Spirituality.

B

Religion is defined as an organized system of beliefs concerning the cause, nature, and purpose of the universe, especially belief in or the worship of God or gods. Spirituality is born out of each person’s unique life experiences and his or her personal efforts to find purpose and meaning in life. Ethnicity pertains to a social group within the social system that claims to possess variable traits, such as a common geographic origin, religion, race, and others.

When planning a cultural assessment, the nurse should include which component?

a.

Family history

b.

Chief complaint

c.

Medical history

d.

Health-related beliefs

D

Health-related beliefs and practices are one component of a cultural assessment. The other items reflect other aspects of the patient’s history.

Which of the following reflects the traditional health and illness beliefs and practices of those of African heritage? Health is:

a.

Being rewarded for good behavior.

b.

The balance of the body and spirit.

c.

Maintained by wearing jade amulets.

d.

Being in harmony with nature.

D

The belief that health is being in harmony with nature reflects the health beliefs of those of African heritages. The other examples represent Iberian and Central and South American heritages, American-Indian heritages, and Asian heritages (See Table 2-3).

MULTIPLE RESPONSE

1. The nurse is reviewing aspects of cultural care. Which statements illustrate proper cultural care? Select all that apply.

a.

Examine the patient within the context of one’s own cultural health and illness practices.

b.

Select questions that are not complex.

c.

Ask questions rapidly.

d.

Touch patients within the cultural boundaries of their heritage.

e.

Pace questions throughout the physical examination.

B, D, E

Patients should be examined within the context of their own cultural health and illness practices. Questions should be simply stated and not rapidly asked.

The nurse is asking questions about a patient’s health beliefs. Which questions are appropriate? Select all that apply.

a.

“What is your definition of health?”

b.

“Does your family have a history of cancer?”

c.

“How do you describe illness?”

d.

“What did your mother do to keep you from getting sick?”

e.

“Have you ever had any surgeries?”

f.

“How do you keep yourself healthy?”

A, C, D, F

The questions listed are appropriate questions for an assessment of a patient’s health beliefs and practices. The questions regarding family history and surgeries are part of the patient’s physical history, not the patient’s health beliefs.