Culture and Ethnicity

1. Despite significant improvements in the overall health status of the U.S. population over the past few decades, disparities among ethnic and racial minorities have

a.
Decreased as education levels equal those of non-Hispanic whites.
b.
Disappeared in relation to non-Hispanic white populations.
c.
Remained a serious challenge locally and nationally.
d.
Decreased faster than anticipated.

ANS: C

Despite significant improvements in the overall health status of the U.S. population over the past few decades, the persistence of disparities in health status among ethnic and racial minorities continues to be a serious local and national challenge. Hispanics, African Americans, and some Asian subgroups are less likely than non-Hispanic whites to have a high school education and often experience poorer access to care and lower quality of preventive, primary, and specialty care.

DIF: Remember REF: 101

OBJ: Describe social and cultural influences in health, illness, and caring patterns.

TOP: Assessment MSC: Nursing Process

2. Eliminating disparities in the health status of people from diverse racial, ethnic, and cultural backgrounds has become one of the two most important priorities of Healthy People 2020 because populations with health disparities have

a.
Increased incidence of disease.
b.
Lower levels of morbidity.
c.
Lower mortality rates.
d.
Decreased incidence of disease.

ANS: A

Populations with health disparities have a significantly increased incidence of disease or increased morbidity and mortality when compared with the general population.

DIF: Understand REF: 101-102

OBJ: Describe social and cultural influences in health, illness, and caring patterns.

TOP: Assessment MSC: Nursing Process

3. According to the Office of Minority Health (OMH), the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups are known as

a.
Culture.
b.
Subculture.
c.
Ethnicity.
d.
Cultural backlash.

ANS: A

The OMH describes culture as the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. Subcultures represent various ethnic, religious, and other groups with distinct characteristics from the dominant culture. Ethnicity refers to a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics. Cultural backlash occurs when an individual rejects a new culture because experience with a new or different culture is extremely negative.

DIF: Remember REF: 102

OBJ: Differentiate culturally congruent from culturally competent care.

TOP: Assessment MSC: Nursing Process

4. When asked to describe the differences between ethnicity and race, what should the student nurse explain?

a.
Ethnicity refers to a shared identity, whereas race is limited to biological attributes.
b.
Ethnicity and race are actually the same and are based in cultural norms.
c.
Ethnicity can be understood only through an ethic worldview.
d.
Race refers to a shared identity, whereas ethnicity is limited to biological attributes.

ANS: A

Ethnicity refers to a shared identity related to social and cultural heritage such as values, language, geographical space, and racial characteristics. Ethnicity is different from race, which is limited to the common biological attributes shared by a group such as skin color or blood type. In any intercultural encounter, there is an insider or native perspective (ethic worldview) and an outsider’s perspective (ethic worldview). Ethnicity is best understood by those who are a part of that ethnicity and have an “emic” worldview.

DIF: Understand REF: 102

OBJ: Differentiate culturally congruent from culturally competent care.

TOP: Assessment MSC: Nursing Process

5. Care that includes the nurse learning about cultural issues involved in the patient’s health care belief system and enable patients and families to achieve meaningful and supportive care is known as

a.
Ethnocentrism.
b.
Culturally competent care.
c.
Cultural imposition.
d.
Culturally congruent care.

ANS: B

The goal of transcultural nursing is culturally congruent care, or care that fits the person’s valued life patterns and set of meanings. Culturally competent care reflects the ability of a nurse to bridge cultural gaps in caring and enables patients and families to achieve meaningful and supportive caring. It is a step toward reaching culturally congruent care. Ethnocentrism is a tendency to hold one’s own way of life as superior to those of others. It is the cause of biases and prejudices. Cultural imposition is the use of one’s own values and lifestyles as the absolute guide in dealing with patients and interpreting behaviors.

DIF: Remember REF: 103

OBJ: Describe steps toward developing cultural competence. TOP: Assessment

MSC: Nursing Process

6. The nurse is caring for a Native American who has had recent surgery. In the patient’s culture, it is a sign of weakness to complain of pain. In the nurse’s culture, people who are having pain ask for pain medicine. The nurse has assumed that the patient has not been having pain and does not need medication because he has not complained of pain. What is the nurse doing?

a.
Utilizing cultural imposition by not asking the patient about his pain
b.
Striving to provide culturally congruent care by allowing the patient to suffer
c.
Operating from an emic worldview of the patient’s cultural beliefs
d.
Practicing discrimination by not giving the patient pain medicine

ANS: A

Health care practitioners who have cultural ignorance or cultural blindness about differences generally resort to cultural imposition and use their own values and lifestyles as the absolute guide in dealing with patients and interpreting their behaviors. Culturally competent care is the care provided by the nurse who attempts to bridge cultural gaps in caring, work with cultural differences, and enable patients and families to achieve meaningful and supportive caring. The nurse in this case has not been able to do this. Any intercultural encounter consists of an inside or native perspective (emic worldview) and an outsider’s perspective (ethic worldview). The nurse is obviously utilizing an ethic worldview. The nurse may be acultural, but she/he did not purposefully ignore the patient’s need.

DIF: Apply REF: 103-104

OBJ: Describe steps toward developing cultural competence. TOP: Implementation

MSC: Nursing Process

7. In performing a cultural assessment, knowledge of a patient’s country of origin and its history and ecological contexts is known as

a.
Ethnohistory.
b.
Biocultural history.
c.
Social organization.
d.
Religious and spiritual beliefs.

ANS: A

Knowledge of a patient’s country of origin and its history and ecological contexts is significant to health care and is known as ethnic heritage and ethnohistory. Biocultural history identifies a patient’s health risks related to the ecological context of the culture. Social organization refers to units of organization in a cultural group defined by kinship status and appropriate roles for their members. Religious and spiritual beliefs are major influences in the patient’s worldview about health and illness, pain and suffering, and life and death. Nurses need to understand the emic perspective of their patients.

DIF: Remember REF: 107| 110 OBJ: Identify major components of cultural assessment.

TOP: Assessment MSC: Nursing Process

8. The nurse is caring for a patient of Asian descent who speaks very little English. The nurse is especially concerned and attempts to develop a trusting relationship with the patient. She does this knowing that

a.
Cultural assessment needs to be done quickly to provide the best care early.
b.
Miscommunication cannot be tolerated in cultural assessment.
c.
The goal is to get the patient to conform to American health care norms.
d.
Cultural assessment is intrusive in contrast to other types of interviews.

ANS: D

In contrast to other types of interviews, cultural assessment is intrusive and time-consuming and requires a trusting relationship between participants. Miscommunication commonly occurs in intercultural interactions as the result of language and communication differences between and among participants, as well as differences in interpreting each other’s behaviors. The goal is to generate knowledge about the patient’s values, beliefs, and practices about nursing and health care.

DIF: Apply REF: 107 OBJ: Identify major components of cultural assessment.

TOP: Implementation MSC: Nursing Process

9. The nurse is caring for a patient who has emigrated from another country. The patient is in need of abdominal surgery but seems reluctant to sign the surgical permits. What is one tactic that the nurse should use?

a.
Determine the family social hierarchy.
b.
Encourage the patient to sign the permits.
c.
Call the physician so that surgery can be canceled.
d.
Impress on the patient that her life is in jeopardy.

ANS: A

Nurses should determine the family social hierarchy as soon as possible to prevent offending patients and their families. Working with established family hierarchy prevents delays and achieves better patient outcomes. Encouraging the patient to sign against her social beliefs can cause familial strife. Explaining the level of jeopardy may create undue stress. Nurses should be able to determine the correct hierarchy and should not involve the physician at this time.

DIF: Apply REF: 107| 111 OBJ: Identify major components of cultural assessment.

TOP: Implementation MSC: Nursing Process

10. The nurse is caring for a Chinese patient who is reluctant to answer questions about her health background. The nurse asks the patient if she would like her husband present when health questions are asked. The nurse does this knowing that the Chinese culture is a collectivistic and patrilineal culture. What does this mean?

a.
Kinship extends to both the father’s side and the mother’s side of the family.
b.
Kinship is limited to the side of the father.
c.
Kinship is limited to the side of the mother.
d.
The husband becomes part of the wife’s clan after marriage.

ANS: B

In collectivistic cultures, families are made up of distant blood relatives across three generations and fictive or nonblood kin. Kinship extends to both the father’s and the mother’s side of the family (bilineal) or is limited to the side of either father (patrilineal) or mother (matrilineal). Patrilineally extended families exist among Chinese and Hindus, where a woman moves into her husband’s clan after marriage and minimizes ties with her own parents and siblings.

DIF: Understand REF: 111

OBJ: Use cultural assessment to identify significant values, beliefs, and practices critical to nursing care of individuals experiencing life transitions. TOP: Assessment

MSC: Nursing Process

11. The nurse is caring for a patient who does not speak English. She decides to use an interpreter to explain procedures and to answer questions that the patient may have. In performing the interview, what should the nurse do?

a.
Direct questions to the interpreter to ask the patient.
b.
Disregard the age and gender of the interpreter.
c.
Direct questions to the patient.
d.
Ask the interpreter to ask the patient for clarification at the end.

ANS: C

If the patient needs an interpreter, the nurse should ensure gender, age, and ethnic compatibility of the interpreter with the patient’s preference and the topic of discussion. The nurse should direct questions to the patient and not to the interpreter and should have the interpreter ask the patient for feedback and clarification at regular intervals, not only at the end.

DIF: Apply REF: 105-106

OBJ: Use cultural assessment to identify significant values, beliefs, and practices critical to nursing care of individuals experiencing life transitions. TOP: Implementation

MSC: Nursing Process

12. Which statement is true relative to caring for a Hindu patient who is dying?

a.
The family will turn his head eastward or to the right.
b.
A close kin will stay with the patient to hear his last wishes.
c.
Anointing of the sick is a common right of the dying.
d.
The family will place a drop of water on the patient’s lips.

ANS: D

The family of a dying Hindu remains at the bedside to place a drop of the holy water from the River Ganges on the patient’s lips immediately after death to help his or her soul to the next life. The family of a critically ill Jewish patient will turn his or her head eastward or to the right side. A dying Hispanic patient will not be left alone, so that a close kin is able to hear the patient’s wishes, allowing the soul to leave in peace. Anointing of the sick is a Roman Catholic sacrament.

DIF: Apply REF: 111

OBJ: Use cultural assessment to identify significant values, beliefs, and practices critical to nursing care of individuals experiencing life transitions. TOP: Implementation

MSC: Nursing Process

13. In comparing American culture with Asian cultures, which of the following statements is true?

a.
American culture supports collectivism.
b.
Asian communication can be ambiguous.
c.
American communication patterns downplay autonomy.
d.
Asian communication is direct to avoid conflict.

ANS: B

Among Asian cultures, face-saving communication promotes harmony through indirect, ambiguous communication and conflict avoidance. American culture supports individualism, where people value assertive communication because it manifests the ideals of individual autonomy and self-determination.

DIF: Analyze REF: 112

OBJ: Use cultural assessment to identify significant values, beliefs, and practices critical to nursing care of individuals experiencing life transitions. TOP: Evaluation

MSC: Nursing Process

14. When caring for a patient of a different culture, it is important for the nurse to understand that

a.
The nurse should protect the patient from family intrusion in her health care decisions.
b.
Working within the established family hierarchy produces better outcomes.
c.
Women as primary caregivers make independent health decisions.
d.
Gender is not a factor when it comes to role expectations.

ANS: B

Working with established family hierarchy prevents delays and achieves better patient outcomes. Nurses need to determine who has authority for making decisions within the family and how to communicate with the proper individuals. Do not assume that just because the woman is the primary caregiver, she will make decisions independently. Determine the family social hierarchy as soon as possible. Gender also differentiates role expectations.

DIF: Understand REF: 112

OBJ: Demonstrate nursing interventions that achieve culturally congruent care.

TOP: Evaluation MSC: Nursing Process

15. The nurse is caring for a member of the Jewish faith who needs to undergo a critical procedure on Saturday. The patient is refusing the procedure because it is scheduled to be done on the Sabbath. The nurse impresses on the patient the urgency of the procedure, stating that delaying the procedure would put his life at risk. The patient continues to refuse. What should the nurse do?

a.
Cancel the procedure.
b.
Seek permission from the patient to contact the patient’s rabbi.
c.
Have a family member sign the permit.
d.
Have the procedure done against patient wishes.

ANS: B

Nurses need to identify and contact patients’ religious and spiritual leaders before problems occur. Nurses work with these leaders to mediate in times of crises. Canceling the procedure may occur, but not at this time. Doing so prematurely could lead to the patient’s death. A family member cannot make decisions for a competent patient. Having the procedure done against the patient’s wishes cannot be done.

DIF: Apply REF: 111

OBJ: Demonstrate nursing interventions that achieve culturally congruent care.

TOP: Implementation MSC: Nursing Process

16. The nurse is providing diabetic diet teaching to a Hispanic man and his wife. When the nurse is discussing foods that are acceptable, the wife continues to interrupt with statements like, “Oh, he doesn’t eat that,” or, “All he eats is rice and beans.” What should the nurse do?

a.
Ask the wife to leave so he/she can focus on teaching the patient.
b.
Explain how “rice and beans” are not acceptable foods on a diabetic diet.
c.
Provide a diet plan with only food alternatives selected by the patient.
d.
Refer the patient and his wife to a dietitian familiar with Spanish food choices.

ANS: D

The nurse should refer the patient to speak with a dietitian who is familiar with cultural food choices. If possible, he/she should develop a diet plan that includes the patient’s cultural diet preferences and can provide culturally sensitive teaching brochures that describe healthy food choices. Rice and beans may be acceptable alternatives in a balanced diet. The nurse should include people in the family who help shop for and prepare food in the home, along with the wife.

DIF: Apply REF: 111

OBJ: Demonstrate nursing interventions that achieve culturally congruent care.

TOP: Implementation MSC: Nursing Process

17. Providing culturally congruent care means providing care that

a.
Fits the patient’s valued life patterns and set of meanings.
b.
Is based on meanings generated by predetermined criteria.
c.
Is the same as the values of the professional health care system.
d.
Holds one’s own way of life as superior to those of others.

ANS: A

The goal of transcultural nursing is culturally congruent care, or care that fits the person’s valued life patterns and set of meanings. Patterns and meanings are generated from people themselves, rather than from predetermined criteria. Culturally congruent care is sometimes different from the values and meanings of the professional health care system. Ethnocentrism is a tendency to hold one’s own way of life as superior to those of others. It is not part of culturally congruent care.

DIF: Understand REF: 113 OBJ: Analyze outcomes of culturally congruent care.

TOP: Assessment MSC: Nursing Process

18. Leininger (1991) identified three nursing decision and action modes to achieve culturally congruent care. These modes are “cultural care preservation or maintenance,” “cultural care accommodation,” and “cultural care repatterning.” When assessing patients during the admission process, the nurse utilizes

a.
These action modes in a distinct order.
b.
These action modes individually, one at a time.
c.
Only one action mode per patient.
d.
All these action modes simultaneously.

ANS: D

Nurses are able to use any or all of these action modes simultaneously. These actions require that nurses have knowledge of the patient’s culture and have the willingness, commitment, and skills to work with patients and families in decision making. The outcome sought through these actions and decisions is meaningful, supportive, and facilitative care as judged by the patient.

DIF: Apply REF: 113

OBJ: Apply research findings in culturally congruent care. TOP: Implementation

MSC: Nursing Process

MULTIPLE RESPONSE

1. Compare the following statements. Which are considered predominant in non-Western cultures? (Select all that apply.)

a.
Causes of illness are biomedical in nature.
b.
Illness is an imbalance between humans and nature.
c.
Caring patterns are based in self-care and self-determination.
d.
Diagnoses are described as holistic.
e.
Treatment of disease can be magico-religious based.

ANS: B, D, E

Many non-Western cultures see the cause of illness as being an imbalance between humans and nature. Method of diagnosis is described as holistic, and treatment of illness is mixed to include magico-religious, supernatural herbal, biomedical, etc. Western cultures view the cause of illness as biomedical using scientific, high-tech methods of diagnosis.

DIF: Analyze REF: 104 OBJ: Analyze outcomes of culturally congruent care.

TOP: Evaluate MSC: Nursing Process

2. Foster (1976) identified two distinct categories of healers cross-culturally. Of the following characteristics, which are congruent with the healing practices of naturalistic practitioners? (Select all that apply.)

a.
Illness is impersonal and is due to biological forces.
b.
Illness is caused by alterations in the body equilibrium.
c.
Sorcerers can cause health and illness.
d.
Human relationships should be emphasized.
e.
Healing modalities include herbs, massage, and surgery.

ANS: A, B, E

Naturalistic practitioners attribute illness to natural, impersonal, and biological forces that cause alteration in the equilibrium of the human body. Healing emphasizes use of naturalistic modalities, including herbs, chemicals, heat, cold, massage, and surgery. In contrast, personalistic practitioners believe that an external agent, which can be human (i.e., sorcerer) or nonhuman (e.g., ghosts, evil, deity), causes health and illness. Personalistic beliefs emphasize the importance of humans’ relationships with others, both living and deceased, and with their deities.

DIF: Evaluate REF: 104

OBJ: Apply research findings in culturally congruent care. TOP: Evaluate

MSC: Nursing Process