Fundamentals Study Guide - Cultural Competence

Chapter 09: Cultural Competence Potter et al.: Fundamentals of Nursing, 10th Edition MULTIPLE CHOICE 1. A nurse is working at a health fair screening people for colorectal cancer. Which population group should the nurse monitor most closely for this form of cancer? a. Hispanic b. Asian Americans c. Non-Hispanic Caucasians d. Non-Hispanic Blacks ANS: B Colorectal cancer incidence and mortality increased with advancing age. Incidence and death rates were highest among people ag 75 years and older. Non-Hispanic blacks had higher colorectal cancer incidence and death rates than non-Hispanic whites, Asians/Pacific Islanders, and American Indians/Alaska Natives. 2. 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 th past few decades, the health of members of marginalized groups has actually declined. 3. 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. 4. 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. 5. 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, an 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 i universal) and the differences among them (culture that is specific to particular groups). 6. A nurse is beginning to use patient-centered care and cultural competence to improve nursing care. Which step should the nurse take first? 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, leadin 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. 7. 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.” 8. 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. 9. Which action indicates the nurse is meeting a primary goal of cultural competent care for 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 concentratin 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. 10. The nurse is caring for a Chinese 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. 11. A nurse is using core measures to reduce health disparities. Which group should the nurse focus on to cause the most improvemen 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 received worse care than high-income people for about 60% of core measures. American Indians and Alaska Natives received worse care than Caucasians for about 30% of core measures. 12. 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. 13. 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 medic 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. 14. 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? 15. 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 68 years old 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 a the elderly (age 65+), immigrants, persons with low incomes, persons who do not have a high-school diploma or GED, and person 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. 16. A nurse works at a hospital that uses equity-focused quality improvement. Which strategy is the hospital using? a. Document staff satisfaction. b. Focus on the family. c. Implement change on a grand scale. d. Reduce disparities. ANS: D Organizations can implement equity-focused quality improvement by recognizing disparities and committing to reducing them. Staff diversity is a priority for equity-focused quality improvement, not staff satisfaction. While the family is important, the focus on the patients. Organizations should start by implementing a change on a small scale (pilot testing), learning from each test, and refining the intervention through performance improvement cycles (e.g., plan, do, study, and act). 17. 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 rol 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. 18. 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. MULTIPLE RESPONSE 1. 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.) Cultural skills Cultural desire Cultural transition Cultural knowledge Cultural encounters a. b. c. d. e. 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. 2. A nurse is attempting to establish a respectful relationship with a newly admitted patient from Africa. 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 culture 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 professiona 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 cultural competent plan of nursing care. 3. A nurse is using the explanatory 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?” MATCHING A nurse is using Campinha-Bacote’s model of cultural competency to improve cultural care. Which actions describe the components the nurse is using? 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. 2. 3. 4. 5. Cultural skills Cultural desires Cultural awareness Cultural knowledge Cultural encounters 1. ANS: B 2. ANS: D 3. ANS: A 4. ANS: C 5. ANS: E