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What is culture?

Culture is the shared beliefs, values, customs, practices, and characteristics of a group of people.

What factors can be part of culture?

Ethnicity, religion, beliefs, values, customs, and health practices.

What is a subculture?

A variation within a larger cultural group.

How can culture influence health care?

It can affect perceptions of health and illness, health behaviors, treatment decisions, communication, family roles, and diet.

What is the most important nursing principle when caring for clients from different cultures?

Do not assume; assess the individual client.

Why should a nurse avoid assuming a client follows common practices of their cultural group?

Individuals within the same cultural group can have different beliefs, values, and practices.

What is time orientation?

A cultural view that may focus primarily on the past, present, or future.

How can present-time orientation affect health behavior?

A client may be less interested in treatment or prevention whose benefits will occur far in the future.

How can culture affect personal space?

Different clients and cultures have different expectations about comfortable physical distance.

How should a nurse respond to cultural differences in personal space?

Assess the client's preference rather than assuming what is comfortable.

How can culture affect touch?

Some clients may welcome touch while others may consider it uncomfortable or inappropriate.

What should a nurse remember about eye contact across cultures?

Direct eye contact can have different meanings and should not automatically be interpreted as honesty, interest, or respect.

What should a nurse avoid assuming when a client does not make eye contact?

Do not assume the client is dishonest, disinterested, or avoiding communication.

How can culture affect modesty?

A client may have preferences about exposure of the body or the gender of caregivers.

What should the nurse assess about social structure?

Who makes decisions, the family's role, and who the client wants involved in care.

How can culture influence life transitions and rituals?

Culture can shape practices related to birth, illness, and death.

What types of health practices might be influenced by culture?

Folk remedies, traditional healing practices, and religious practices.

What is the biomedical health belief system?

The belief that disease has a physical or biological cause.

What is the naturalistic health belief system?

The belief that illness results from an imbalance with nature.

What are examples of naturalistic health beliefs?

Eastern or Chinese medicine and hot-cold balance theories.

What is the magico-religious health belief system?

The belief that illness may be related to supernatural forces, good or evil, faith, or spiritual causes.

If a client's explanation of illness differs from the nurse's beliefs, what should the nurse do?

Understand the client's beliefs and determine how they affect the plan of care.

How can religion influence treatment decisions?

Religious beliefs may affect acceptance or refusal of specific treatments.

What is an example of religion affecting treatment?

Some Jehovah's Witness clients may decline blood transfusions.

What should the nurse do before assuming a religious practice applies to a client?

Ask the individual client about their preferences and beliefs.

What is cultural humility?

A lifelong process of self-evaluation, learning from clients, recognizing power differences, and building respectful partnerships.

What is the main idea behind cultural humility?

The nurse recognizes that the client is the expert on their own cultural experience.

What does cultural humility require from the nurse?

Lifelong self-reflection, self-critique, recognition of power imbalances, and willingness to learn from clients.

What statement best demonstrates cultural humility?

"Tell me about any cultural practices that are important for us to consider in your care."

What is cultural competence?

The ability to respectfully and effectively interact with people from different cultures while acknowledging individual preferences and differences.

What is the relationship between cultural competence and patient-centered care?

Culturally competent care respects the client's values, preferences, beliefs, and individual needs.

What are major components of cultural competence?

Cultural awareness, knowledge, acceptance, humility, sensitive communication, cultural safety, self-reflection, and recognition of power imbalances.

What is cultural preservation?

Helping a client maintain beneficial traditional practices.

What is cultural accommodation?

Supporting or facilitating beneficial cultural practices.

What is cultural repatterning?

Helping a client modify a cultural practice that is harmful to health.

What is cultural brokering?

Advocating, mediating, and bridging differences between the client's culture and the healthcare system.

A client wants to continue a harmless traditional health practice. What approach should the nurse use?

Cultural preservation or accommodation.

A cultural practice is harmful to the client's health. What approach should the nurse use?

Cultural repatterning.

A nurse helps resolve a conflict between a client's cultural beliefs and the healthcare team's plan. What is this?

Cultural brokering.

What is implicit bias?

Unconscious attitudes that can contribute to unintentional discrimination.

What is stereotyping?

Applying generalized beliefs about a group to an individual without assessing the person's actual beliefs.

What is the priority nursing action related to personal bias?

Perform self-assessment and recognize personal assumptions and biases.

What is ethnocentrism?

The belief that one's own cultural practices are better than those of other cultures.

How should a nurse prevent ethnocentric care?

Recognize cultural needs, reflect on personal beliefs, and individualize interventions.

What information should be included in a cultural assessment?

Ethnicity, religion, family structure, language, literacy, communication, education, values, food patterns, health practices, remedies, and health-promotion practices.

What is an appropriate cultural-assessment question?

"What health practices are important to you?"

What is an appropriate question about family involvement?

"Who would you like involved in decisions about your care?"

What type of question should be avoided during a cultural assessment?

A leading question based on a stereotype, such as assuming a client follows a practice because of ethnicity or religion.

How should the nurse initially address a client when trying to convey cultural sensitivity?

Use the client's last name unless the client gives permission to use another name.

How can the nurse convey cultural sensitivity?

Introduce themselves and role, avoid assumptions, respect beliefs, encourage questions, and incorporate client preferences.

What language should patient-education materials be provided in when possible?

The client's primary language.

Why is using family members as interpreters generally not advisable?

It can create problems with confidentiality, accuracy, family dynamics, and withholding or changing information.

What can differences in dialect cause during healthcare communication?

Translation and communication barriers.

What are social determinants of health?

External social and environmental conditions that affect health, functioning, quality of life, and health outcomes.

What are the five SDOH domains?

Healthcare access and quality, education access and quality, economic stability, social and community context, and neighborhood and built environment.

What does the healthcare access and quality domain include?

Insurance, cost, provider availability, transportation, language, health literacy, and access to services.

What are common barriers within healthcare access and quality?

No insurance, underinsurance, high costs, provider shortages, language barriers, and low health literacy.

How can poor healthcare access affect healthcare use?

Clients may rely on the emergency department for primary care.

Why should a nurse avoid immediately labeling a client "noncompliant"?

The client may face barriers such as cost, transportation, language, health literacy, or lack of providers.

What strategies can improve healthcare access?

Insurance programs, telehealth, community health centers, Medicare, Medicaid, and other access resources.

What population does Medicare generally serve?

Adults older than 65 and some younger people with qualifying disabilities.

What population does Medicaid generally serve?

People who qualify based on low income and other eligibility requirements.

What does the education access and quality SDOH domain address?

Access to quality education, literacy, school resources, and opportunities that affect future health and income.

How can quality education improve health?

It can improve employment opportunities, income, healthcare benefits, health decisions, and health outcomes.

What are examples of barriers in the education access and quality domain?

Poor-quality schools, bullying, violence, high student-to-teacher ratios, lack of school nurses, and funding disparities.

What is one nursing strategy related to education access and quality?

Connect students to resources and support school nursing or school-based mental-health services.

What does economic stability include?

Income, employment, housing, food, and access to a living wage.

How can poverty affect health?

It can increase poor nutrition, stress, unsafe living conditions, chronic disease, and reduced use of preventive care.

What is a food desert?

An area with limited access to healthy food.

What is a food swamp?

An area where unhealthy food is more available than healthy food.

What is the difference between a food desert and a food swamp?

A food desert lacks healthy-food access, while a food swamp has an abundance of unhealthy food compared with healthy options.

What strategies can improve economic stability?

Job training, career counseling, affordable childcare, food assistance, and affordable transportation.

What nursing actions can address economic instability?

Connect clients with healthcare, housing, food, employment, transportation, and community resources.

What does the social and community context domain include?

Family and community relationships, discrimination, bullying, violence, social support, and community resources.

What problems can occur within social and community context?

Bullying, violence, dysfunctional family relationships, STIs, adolescent pregnancy, and lack of social support.

What are examples of interventions for social and community context?

Mentoring, support groups, counseling, STI-prevention programs, and programs that strengthen family relationships.

What does the neighborhood and built environment domain include?

Housing, roads, transportation, safety, pollution, infrastructure, water, and access to community resources.

What is the difference between the natural environment and built environment?

The natural environment includes soil, water, oceans, and atmosphere; the built environment includes roads, buildings, and transportation.

What neighborhood factors should nurses assess?

Housing safety, crime, water, sewage, transportation, traffic, grocery access, parks, and pollution.

What environmental exposures can affect health?

Lead, pesticides, asbestos, radon, carbon monoxide, tobacco smoke, polluted water, and other contaminants.

What is the nurse's role regarding neighborhood and environmental risks?

Assess risks, educate the community, advocate, investigate health patterns, and participate in policy efforts.

What factors can contribute to vulnerability?

Poverty, lack of insurance, age, chronic stress, environmental exposure, communicable disease, discrimination, ACEs, nutrition, and employment.

How are vulnerability and SDOH related?

Vulnerability often results from multiple individual risk factors combined with social determinants of health.

What is a major nursing role when caring for vulnerable populations?

Advocacy.

How should nurses provide care to vulnerable populations?

Use culturally sensitive care, assess individual needs, coordinate services, improve access, promote prevention, and maximize client control.

Why is it important to assess individual preferences in vulnerable populations?

To avoid stereotypes and provide patient-centered care.

What are common health concerns among unhoused populations?

Respiratory disease, TB, skin problems, substance use, HIV/AIDS, trauma, mental illness, malnutrition, dental problems, and exposure-related illness.

What are priority nursing interventions for unhoused clients?

Connect them with shelter, food, healthcare, mental-health, employment, and education resources.

What barriers commonly affect rural populations?

Distance, transportation, weather, cost, and provider or hospital shortages.

What health concerns are common in rural populations?

Chronic disease, diabetes, obesity, suicide, injury, occupational exposure, respiratory disease, and reduced preventive care.

What are useful nursing interventions for rural populations?

Promote assistance programs, build community partnerships, improve access, and teach environmental and occupational safety.

What technology can help improve healthcare access in rural communities?

Telehealth.

What are common risks for migrant workers?

Poverty, unsafe work, pesticide exposure, infectious disease, heat illness, injuries, language barriers, transportation barriers, and poor continuity of care.

Why can migrant workers experience poor continuity of care?

Frequent relocation can interrupt healthcare and follow-up.

What social barriers can affect migrant workers?

Language barriers, transportation problems, poverty, and fear related to immigration status.

What occupational risk is especially important for migrant workers?

Pesticide exposure.

What are possible symptoms of pesticide exposure?

Headache, dizziness, dyspnea, nausea, abdominal cramps, confusion, muscle twitching or weakness, vomiting, rash, and respiratory symptoms.

What long-term problems can pesticide exposure cause?

Cancer, reproductive problems, Parkinson disease, liver damage, behavioral problems, and fetal-development effects.

What are common health concerns among veterans?

PTSD, depression, suicide, substance use, TBI, spinal cord injury, amputations, military sexual trauma, and sensory impairments.

What are important nursing interventions for veterans?

Coordinate resources, facilitate transitions, promote continuity, and strengthen VA-community partnerships.