Chapter 09: Cultural Competence // Potter: Fundamentals of Nursing, 11th Edition

A nurse is discussing the changing demographics of the US population. What is expected to be the fastest growing racial ethnic group by 2060?

a. Hispanic

b. Asian

c. Multiracial

d. Non-Hispanic Blacks

ANS: C

The changing demographics of the US population create challenges for the health care system and health care providers. By the year 2060, the percentage of racial and ethnic minority groups in the United States is expected to climb to 32% of the population. The fastest-growing racial ethnic group in the United States is people whose ancestry is from two or more races, and this group is projected to grow by 200%. The next fastest growing is the Asian population, which is projected to double, followed by the Hispanic population.

A nurse is caring for an immigrant with low income. Which information should the nurse consider when planning care for this patient?

a. There is a decreased frequency of morbidity.

b. There is an increased incidence of disease.

c. There is an increased level of health.

d. There is a decreased mortality rate.

ANS: B

Populations with health disparities (immigrant with low income) have a significantly increased incidence of disease or increased morbidity and mortality when compared with the general population. Although Americans' health overall has improved during the past few decades, the health of members of marginalized groups has actually declined.

A nurse is assessing the health care disparities among population groups. Which area is the nurse monitoring?

a. Accessibility of health care services

b. Outcomes of health conditions

c. Prevalence of complications

d. Incidence of diseases

ANS: A

While health disparities are the differences among populations in the incidence, prevalence, and outcomes of health conditions, diseases and related complications, health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g., screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications.

A nurse is providing care to a patient from a different culture. Which action by the nurse indicates cultural competence?

a. Communicates effectively in a multicultural context.

b. Effectively provides for multifaceted healthcare needs.

c. Visits a foreign country.

d. Speaks a different language.

ANS: B

Cultural competence refers to a developmental process that evolves over time that impacts ability to effectively function in the multifaceted context. Communicates effectively and speaking a different language indicates linguistic competence. Visiting a foreign country does not indicate cultural competence.

The nurse learns about cultural issues involved in the patient's health care belief system and enables patients and families to achieve meaningful and supportive care. Which concept is the nurse demonstrating?

a. Marginalized groups

b. Health care disparity

c. Transcultural nursing

d. Culturally congruent care

ANS: D

The nurse is demonstrating culturally congruent care. Culturally congruent care, or care that fits a person's life patterns, values, and system of meaning, provides meaningful and beneficial nursing care. Marginalized groups are populations left out or excluded. Health care disparities are differences among populations in the availability, accessibility, and quality of health care services (e.g., screening, diagnostic, treatment, management, and rehabilitation) aimed at prevention, treatment, and management of diseases and their complications. Transcultural nursing is a comparative study of cultures in order to understand their similarities (culture that is universal) and the differences among them (culture that is specific to particular groups).

A nurse is beginning to use patient-centered care and cultural competence to improve nursing care. Which step should the nurse take first in achieving cultural awareness?

a. Assessing own biases and attitude

b. Learning about the world view of others

c. Understanding organizational forces

d. Developing cultural skills

ANS: A

Becoming more aware of your biases and attitudes about human behavior is the first step in providing patient-centered care, leading to culturally competent care. It is helpful to think about cultural competence as a lifelong process of learning about others and also about yourself. Learning about the world view, developing cultural skills, and understanding organizational forces are not the first steps.

A nurse is performing a cultural assessment using the LEARN mnemonic for communication. Which area will the nurse assess for the ―L‖?

a. Look

b. Listen

c. Liken

d. Leave

ANS: B

The ―L‖ in Learn stands for Listen: Listen to the patient's perception of the problem. Be nonjudgmental and use encouraging comments such as, ―Tell me more‖ or ―I understand what you are saying.‖

The nurse caring for a patient of Hispanic descent who speaks no English, is working with an interpreter. Which action should the nurse take?

a. Use long sentences when talking.

b. Look at the patient when talking.

c. Use breaks in sentences when talking.

d. Look at only nonverbal behaviors when talking.

ANS: B

Direct your questions to the patient. Look at the patient, instead of looking at the interpreter. Pace your speech by using short sentences, but do not break your sentences. Observe the patient's nonverbal and verbal behaviors.

Which action indicates the nurse is meeting a primary goal of culturally competent care for

marginalized patients?

a. Provides care to transgender patients.

b. Provides care to restore relationships.

c. Provides care to patients that is individualized.

d. Provides care to surgical patients.

ANS: A

Although cultural competence and patient-centered care both aim to improve health care quality, their focus is slightly different. The primary aim of cultural competence care is to reduce health disparities and increase health equity and fairness by concentrating on people of color and other marginalized groups, like transgender patients. Patient-centered care, rather than cultural competence care, provides individualized care and restores an emphasis on personal relationships; it aims to elevate quality for all patients.

The nurse is caring for a Asian patient using the teach-back technique. Which action by the nurse indicates successful implementation of this technique?

a. Asks, ―Does this make sense?‖

b. Asks, ―Do you think you can do this at home?‖

c. Asks, ―What will you tell your spouse about changing the dressing?‖

d. Asks, ―Would you tell me if you don't understand something, so we can go over

it?‖

ANS: C

The teach-back technique asks open-ended questions, like what will you tell your spouse about changing the dressing, to verify a patient's understanding. When using the teach-back technique, do not ask a patient, ―Do you understand?‖ or ―Do you have any questions?‖ ―Does this make sense?‖, and ―Do you think you can do this at home?‖ are closed-ended questions. ―Would you tell me if you don't understand something, so we can go over it?‖ is not verifying a patient's understanding about the teaching.

A nurse is using core measures to reduce health disparities. Which group should the nurse focus on to cause the most improvement in core measures?

a. Caucasians

b. Poor people

c. Alaska Natives

d. American Indians

ANS: B

To improve results, the nurse should focus on the highest disparity. Poor people consistently received inferior care compared to high-income people. American Indians and Alaska Natives received worse care than Caucasians.

A nurse is assessing culturally diverse population groups for the risk of suicide. Which assessment question will provide the most culturally relevant information?

a. ―Is suicide common in your culture?‖

b. ―How is suicide viewed in your culture?‖

c. ―Has anyone here every considered suicide?‖

d. ―Do you know anyone who as committed suicide?‖

ANS: B

Culturally congruent care or transcultural care emphasizes the need to provide cares based on the individual's cultural beliefs, practices, and values; therefore, effective communication is a critical skill in culturally competent care and helps you engage a patient and family in respectful, patient-centered dialogue. Asking how the act of suicide is viewed provides information on the cultural values, beliefs, and practices of a culture. None of the other options provide that insight.

A nurse is caring for a patient with limited English-speaking skills. What intervention should be implemented to best assist in educating the patient about their disease process?

a. Request a trained medical interpreter.

b. Provide information in graphic form when possible.

c. Use handouts prepared in the patient's native language.

d. Ask that a family member be present during educational teaching.

ANS: A

The National Culturally and Linguistically Appropriate Services (CLAS) Standards include standards for communication and language assistance. The standards apply when you are caring for patients who have limited English proficiency and/or other communication needs. All United States health care organizations must provide language assistance resources (e.g., trained medical interpreters, qualified translators, telecommunication devices for the deaf) for individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services. None of the other options provides the best form of communication since they all are subject to misinterpretation and nursing evaluation.

A nurse is assessing a patient's ethnic history. Which question should the nurse ask?

a. What language do you speak at home?

b. How different is your life here from back home?

c. Which caregivers do you seek when you are sick?

d. How different is what we do from what your family does when you are sick?

ANS: B

An ethnohistory question is the following: How different is your life here from back home? Caring beliefs and practice questions include the following: Which caregivers do you seek when you are sick and How different is what we do from what your family does when you are sick? The language and communication is the following: What language do you speak at home?

A nurse is teaching patients about health care information. Which patient will the nurse assess closely for health literacy?

a. A patient 35 years old

b. A patient with a chronic illness

c. A patient with a college degree

d. A patient with a high-school diploma

ANS: B

Many people in the United States experience challenges in using health care information. Patients who are especially vulnerable are the elderly (age 65+), immigrants, persons with low incomes, persons who do not have a high-school diploma or GED, and persons with chronic mental and/or physical health conditions. A 35-year-old patient and patients with high-school and college education are not identified in the vulnerable populations.

A nurse implementing the principles of Intersectionality will focus on what patient characteristic?

a. Values

b. Illness

c. Health

d. Experiences

ANS: D

Intersectionality is a research and policy model used to study the complexities of people's lives and experiences. Illness and health are outcomes viewed in respect to the patient's experiences. The patient's values and beliefs are formulated by their life experiences.

A nurse is providing care to a culturally diverse population. Which action indicates the nurse is successful in the role of providing culturally congruent care?

a. Provides care that fits the patient's valued life patterns and set of meanings.

b. Provides care that is based on meanings generated by predetermined criteria.

c. Provides care that makes the nurse the leader in determining what is needed.

d. Provides care that is the same as the values of the professional health care system.

ANS: A

The goal of transcultural nursing is to provide culturally congruent care, or care that fits the person's life patterns, values, and system of meaning. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Discovering patients' cultural values, beliefs, and practices as they relate to nursing and health care requires you to assume the role of learner (not become the leader) and to partner with your patients and their families to determine what is needed to provide meaningful and beneficial nursing care. Culturally congruent care is sometimes different from the values and meanings of the professional health care system.

A nurse is assessing the patient's meaning of illness. Which area of focus by the nurse is priority?

a. On the way a patient reacts to disease

b. On the malfunctioning of biological processes

c. On the malfunctioning of psychological processes

d. On the way a patient reacts to family/social interactions

ANS: A

To provide culturally congruent care, you need to understand the difference between disease and illness. Illness is the way that individuals and families react to disease, whereas disease is a malfunctioning of biological or psychological processes. The way a patient interacts to family/social interactions is communication processes and family dynamics.

A nurse is using Campinha-Bacote's model of cultural competency. Which areas will the nurse focus on to become competent? (Select all that apply.)

a. Cultural skills

b. Cultural desire

c. Cultural transition

d. Cultural knowledge

e. Cultural encounters

ANS: A, B, D, E

Campinha-Bacote's model of cultural competency has five interrelated components: cultural awareness, cultural knowledge, cultural skills, cultural encounters, and cultural desire. Cultural transition is not a component of this model.

A nurse is attempting to establish a respectful relationship with a newly admitted patient from another county. Which actions should the nurse take? (Select all that apply.)

a. Engage in face-to-face interactions.

b. Help the patient overcome barriers.

c. Consciously attempt to suspend judgment.

d. Stress that they will be working together to address problems.

e. Know limitations in addressing medical issues across cultures.

ANS: A, C

Ongoing development of cultural competence will present as your ability to interact effectively with people from different cultures, identifying the need to be respectful and responsive to the health belief practices or linguistic needs of our diverse population. Cultural awareness is the process of conducting a self-examination of one's own biases toward other cultures and the in-depth exploration of one's cultural and professional background. Cultural encounter is a process that encourages health care professionals to directly engage in face-to-face cultural interactions and other types of encounters with patients from culturally diverse backgrounds. The remaining options are not specific to a culturally competent plan of nursing care.

A nurse is using the Campinha-Bacote model to determine the cause of an illness. Which questions should the nurse ask? (Select all that apply.)

a. How should your sickness be treated?

b. What do you call your problem?

c. How does this illness work inside your body?

d. What do you fear most about your sickness?

e. What name does it have?

ANS: B, C, E

The questions for etiology include ―What do you call your problem?‖ and ―What name does it have?‖ Recommended treatment is asked by the question ―How should your sickness be treated?‖ Pathophysiology is asked by the question ―How does this illness work inside your body?‖ The course of illness is asked by the question ―What do you fear most about your sickness?‖

A nurse is using Campinha-Bacote's model of cultural competency to improve cultural care. Which actions describe the components the nurse is using?

1. Cultural skills

2. Cultural desires

3. Cultural awareness

4. Cultural knowledge

5. Cultural encounters

a. In-depth self-examination of one's own background

b. Ability to assess factors that influence treatment and care

c. Sufficient comparative understanding of diverse groups

d. Motivation and commitment to continue learning about cultures

e. Cross-cultural interaction that develops communication skills

1. ANS: B

2. ANS: D

3. ANS: A

4. ANS: C

5. ANS: E

A nurse is seeing all of these patients in the community health clinic. The nurse identifies which patient(s) as having a health disparity? (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

ANS: 1, 2, 3

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 transportation. 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. Medicaid insurance

2. Annual screening

3. Mother's history of breast cancer

4. Lack of transportation

5. Woman's age

ANS: 1, 4, 5

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

ANS: 1

A nurse desires to communicate with a young woman who is Serbian has and who has limited experience with being in a hospital. The nurse 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 treatment options for her condition.

ANS:

1. D

2. B

3. A

4. E

5. C

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 .

ANS: 1, 2, 4, 5

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. The head supervisors of the company

3. Workers who have a high school education

4. Workers employed for less than a year at the company

ANS: 3

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. Fresh fruits

4. Eggs

ANS: 4

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

ANS: 1

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 communication strategies that my patients will most commonly understand."

4. "Using pictures, drawings, and models can enhance the effectiveness 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."

ANS: 1, 2, 3, 4, 5

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 perspective in an intercultural encounter

e. The motivation of a health care professional to "want to" engage in cultural competence

ANS:

1. D

2. A

3. E

4. C

5. B