Flashcards in LA# 8 - Stanhope chapters 7, 11, 18 Deck (54)
Which of the following practices applies to nursing care for clients with a foreign cultural background?a.Altering nonverbal behaviour to reflect the cultural norms the client is used tob.Keeping all behaviours culturally neutral to avoid misinterpretationc.Relying on friendly gestures to communicate a caring attituded.Avoiding showing prejudice by using the same behaviour with all clients
ACultural competence in community health nurses (CHNs) includes the adoption of culturally congruent behaviours. CHNs need to make sure their nonverbal communication techniques take into consideration the client’s use of eye contact, facial expressions, body language, touch, and space.
A CHN often used to sit with his legs crossed at the knees when collecting a client’s history. However, he stopped doing this around his Iranian clients after being told that they were offended because this posture exposed the sole of his foot. In changing his behaviour, which culture-related response did the CHN exhibit?a.Cultural sensitivityb.Cultural awarenessc.Cultural knowledged.Cultural skill
DCultural skill refers to the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients. The CHN’s use of cultural skill ensures that nonverbal communication techniques take into consideration the client’s use of eye contact, facial expressions, body language, touch, and space.
A CHN states, “The best way to treat clients from other countries is to care for them the same way we would want to be cared for ourselves. After all, we are all human beings with the same expectations and needs.” Which culture-related response does this statement exemplify?a.Cultural awarenessb.Cultural blindnessc.Cultural knowledged.Cultural preservation
BCultural blindness is a denial of diversity and the inability to recognize the uniqueness of individual clients. An example is CHNs who, attempting to be culturally unbiased, treat all clients in the same manner by conducting their nursing assessments using the same questions, do not actively listen to the responses, and fail to modify their questioning to gain an understanding of client culture and client uniqueness.
A CHN rearranges the room and moves the bed of a bedridden Muslim client so that the client is facing toward Mecca for his daily prayers. What does the CHN’s culture-related response exemplify?a.Cultural skillb.Cultural awarenessc.Cultural brokeringd.Cultural imposition
ACultural skill refers to the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of clients from diverse cultural backgrounds. For this client, daily prayers in the tradition of Islam are important, possibly more important from the client’s perspective than medical treatment.
Which one of the following is an example of “overt racism”?a.Using traditional food and traditional dressb.Restricting the burning of sweet grassc.Participating in hate crimesd.Making job positions available only to persons who are Canadian-born
COvert racism is an open demonstration by attitudes, actions, policies, and practices of a feeling of superiority over individuals or groups with the intent of harming or damaging. Hate crimes, for example, are considered to be one example of overt racism.
A health care provider states, “I’m not going to change the way I practise medicine regardless of where the client is from, because research shows that Western medicine is the best.” Which of the following behaviours does this statement exemplify?a.Ethnocentrismb.Prejudicec.Racismd.Stereotyping
AEthnocentrism, a type of cultural prejudice at the cultural population level, is the belief that one’s own cultural group determines the standards of behaviour by which all other groups are to be judged. CHNs who assume that their way of providing nursing care is the only right way are ethnocentric.
A health care worker tells the CHN, “It does no good to try to teach those Aboriginal clients about nutrition because they will just eat whatever they want to, no matter how much we teach them.” Which of the following behaviours does this statement exemplify?a.Cultural impositionb.Ethnocentrismc.Racismd.Stereotyping
DStereotyping occurs when generalizations are applied to an individual without exploring individual values, beliefs, and behaviours. In this instance, the health care worker makes the assumption that all Aboriginal people are not educable. The health care worker is also guilty of making assumptions about noncompliance among other Aboriginal people she has known; this noncompliance may have had to do with their inability to buy nutritious foods, which tend to be more expensive.
Migrant workers tend to have high occupational mobility, are often poor, and have limited formal education. They may seek health care only when they are ill and unable to work. What does the CHN need to do whenever she has a chance to interact with migrant workers?a.Advocate for emergency health care.b.Teach prevention and health maintenance.c.Ensure funding is available for adequate nutrition.d.Contact the Workplace Safety and Insurance Board (WSIB).
BCHNs work with clients from diverse cultural backgrounds, and one example is migrant workers. Because migrant workers are highly mobile and tend to seek health care only when they are ill and unable to work, whenever a CHN interacts with these clients, it is important to teach them about disease prevention, health maintenance, health protection, and health promotion activities before the clients move on.
A family from Mexico presents to the public health department. None of the family members speak English, and no one at the health department speaks Spanish. Which of the following will be the most appropriate action on the part of the CHN?a.Attempting communication using an English–Spanish phrase bookb.Calling the local hospital and arranging a referralc.Emphatically stating, “No hablo Español” (I don’t speak Spanish) and repeating as necessaryd.Finding an interpreter to translate
DCommunication with the client or family is required for a cultural assessment. When CHNs do not speak or understand the client’s language, they need to obtain an interpreter.
A 40-year-old Bosnian Muslim woman who does not speak English presents to a community health centre in obvious pain and requests a female health care provider. She indicates through gestures that the pain originates in either the pelvic or the genital region. Assuming several people are available to interpret, which of the following persons would be the most appropriate choice of interpreter?a.A female who does not know the clientb.A female from the client’s communityc.A male who is certified as a medical interpreterd.The client’s 20-year-old daughter
AAlthough it is important to use an experienced medical interpreter, in many cultures, it is considered inappropriate to have a male interpreter for a female client. This client has specifically requested a female health care provider; therefore, one might anticipate that the client will prefer a female interpreter as well. In spite of a male interpreter’s certification and ability, he cannot be effective if the client is withholding information that she feels is not right to discuss in front of a man. This client may also consider it inappropriate to have her daughter interpret private matters (especially of a sexual nature or if they involve infidelity). Additionally, the CHN should not use an interpreter from the same community as the client, in order to avoid breach of confidentiality.
At a local hospital, postpartum care policy requires that nurses observe the mother to assess her ability to care for the new baby and to promote bonding. A new immigrant mother says that, in her country, all infant care is provided by family members so that the mother can rest and recover. In her home country, it is believed that if the mother does not recover sufficiently, she will be unable to provide the best care. Which of the following actions will the culturally competent nurse take?a.Allow family members to provide care to the baby and assess the mother’s knowledge of child care through discussion.b.Explain the importance of bonding and how all good mothers gladly assume these responsibilities.c.Explain that the process of postpartum recovery does not require this much rest, but does require that she provide infant care.d.Explain that the mother must abide by hospital policy because documentation of this ability is required for discharge.
ACulturally competent nursing care is individualized for each client, reflecting the client’s beliefs and values, and is provided with sensitivity.
The CHN who wishes to develop cultural competence can improve cultural awareness by doing which one of the following?a.Completing a survey of all the ethnic groups in the CHN’s communityb.Considering how the CHN’s personal beliefs and decisions are reflective of his or her culturec.Inviting a family from another cultural background to participate in an event with the CHNd.Studying the beliefs and traditions of persons coming from other cultures
BCultural awareness is self-examination and in-depth exploration of one’s own beliefs and values as they influence behaviour.
The incidence of type 2 diabetes among Aboriginal peoples (First Nations, Inuit, and Métis) is three to five times higher than in the general population. When teaching a nutrition class to a group of students, of which a large percentage is Aboriginal, the CHN incorporates into the presentation such foods as bannock and other healthy dishes familiar to Aboriginal students. Which level of prevention does this culturally sensitive action represent?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Both primary and secondary prevention
APrimary prevention involves such activities as health teaching to prevent a problem from occurring.
A nurse practitioner (NP) has just found out that her immigrant client is not taking the penicillin prescribed because his illness is “hot” and he feels that penicillin, a “hot” medicine, will not provide balance. If the NP changes the penicillin to a different but equally effective antibiotic, which cultural attribute will the NP be demonstrating?a.Cultural awarenessb.Cultural brokeringc.Cultural knowledged.Cultural skill
DCultural skill refers to the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients. Cultural skill involves providing care that is beneficial, safe, and satisfying to the client.
Which one of the following is the designation given to groups at high risk of having poor health outcomes?a.Cumulative risk groupsb.Health disparity groupsc.Resilient populationsd.Vulnerable populations
DSpecific populations who are more vulnerable—that is, at-risk populations who are more susceptible to poor health because of socioenvironmental factors—are often referred to as vulnerable populations.
Which one of the following is the best intervention a community health nurse (CHN) can initiate to increase lasting resilience among new immigrants?a.Directing clients to English-as-a-second-language coursesb.Giving immigrant clients money to help them get settledc.Identifying areas in the city where housing is less expensived.Soliciting donations for food, clothing, and other needs
AResilience refers to the ability of the client to successfully cope when faced with a threat or hardship. Individuals with low resilience are more inclined to have feelings of hopelessness and may choose suicide as a method to resolve these feelings. Support needs to be provided to those with decreased resilience in order to enhance problem-solving skills and give a greater sense of personal autonomy. When the CHN places emphasis on client strengths and assets rather than client deficits and susceptibility, resilience is more likely to increase.
Which of the following interventions by the CHN would best serve a vulnerable population?a.Addressing multiple health concerns, including preventive education, when clients present for treatment of an illnessb.Establishing a system of networks so that clients may be referred to different services such as preventive care, acute illness care, and chronic treatmentc.Providing acute care services that focus on the client’s main health concern and setting up appointments at discharge for other concernsd.Referring clients to specialists to address specific health concerns
AWhen working with vulnerable populations, it is a good idea to arrange to have as many services as possible available in a single location and at convenient times. This “one-stop shopping” approach to care delivery is helpful for populations experiencing multiple social, economic, and health-related stresses. This becomes especially important if clients have problems accessing health care services.
Which definition accurately reflects the meaning of the term health inequities?a.Health inequities are the accumulation of multiple factors that lead to poor health.b.Health inequities occur when people are more inclined to become ill and usually do not seek appropriate care.c.Health inequities are unfair differences in health that could be avoided with reasonable action.d.Health inequities are wide variations in health status and services among certain population groups.
CHealth inequities refers to differences in health that could be avoided if reasonable action was taken, and therefore these differences are considered to be unfair and socially unjust.
Which of the following is a primary cause of vulnerability?a.Breakdown of family structuresb.Povertyc.Prejudiced.Social isolation
BPoverty is a primary cause of vulnerability. The lack of financial resources may cause some people to not seek preventive health services. This leaves them vulnerable and with increased risk of experiencing the effects of preventable illnesses.
Which level of prevention is a CHN practising when she offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Secondary and tertiary prevention
BScreening homeless persons for TB and providing medications to those who test positive are examples of secondary prevention. The TB screening identifies the disease in its early stages. Medications work to prevent further development of the disease.
A CHN is orienting a new recruit to a health clinic that primarily serves vulnerable populations. Which of the following statements by the CHN indicates a need for additional information?a.“If a client who does not speak English comes in, you must obtain an interpreter right away.”b.“We try to take care of as many problems as possible in one visit, so when you check the client in, ask about additional concerns.”c.“You will like working with Filipino immigrants because they have close-knit family structures.”d.“You will need to assist the client by scheduling any referral or follow-up appointments.”
CAssumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Both good and bad stereotyping can create problems. For example, even though Filipino families are generally close knit, by assuming that all Filipino families are this way, clinic care providers will likely miss recognizing such issues as family violence.
While screening for diabetes at a community clinic, a CHN found out that a new client had type 2 diabetes. The CHN then provided counselling, referred the client to an endocrinologist for initial assessment and treatment, helped with arrangements for financial assistance, arranged transportation, and booked a follow-up appointment. What role is this type of service most representative of?a.Case managementb.Client advocacyc.Holistic cared.Wrap-around services
ACase management involves linking clients with services and providing direct community health nursing services, including teaching, counselling, screening, and immunizing. Linking health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved.
CHNs at a clinic for homeless persons are concerned that clients rarely return for follow-up after their TB skin (Mantoux) tests. Which policy would be the most appropriate one for addressing this situation?a.Call all homeless clients 48 hours after testing to remind them to return to the clinic for follow-up.b.Have the homeless persons read the test result themselves and then mail in the results on a postage-paid card coded to protect privacy.c.Readminister the test if the client returns later than scheduled for follow-up.d.Routinely refer all homeless clients for chest X-rays.
BSecondary preventive activities are aimed at reducing the prevalence or pathological nature of a condition. They involve early diagnosis, prompt treatment, and the limitation of disability. CHNs can work with homeless and near-homeless aggregates to provide education about existing services and strategies for influencing public policy that will provide more comprehensive services for homeless and near-homeless persons. If necessary, CHNs should develop a method for homeless individuals to read the reaction to the TB skin test themselves and send the results to the facility where the skin test was administered.
Which of the following actions should a CHN take when using the case management approach with vulnerable populations?a.Be willing to enter into a long-term relationship with families.b.Direct and control the client’s care because the CHN knows what is most needed.c.Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals.d.Rotate assignments periodically, to prevent attachment and codependency.
ACase management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the CHN can offer the greatest benefit when she or he is willing to develop long-term relationships with the families served. Long-term relationships create trust and ensure continuity of care. Care involves a partnership between the CHN and the client. CHNs who direct and control the client’s care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control measures.
Which one of the following is an example of tertiary prevention by a CHN?a.Administering the Mantoux (skin) test to identify persons with TBb.Assessing for signs and symptoms of active TBc.Directly observing clients with active TB as they take their antituberculosis medicationsd.Interpreting TB skin test results
CTertiary prevention is implemented when CHNs provide directly observed therapy (DOT) to those with active TB.
Which one of the following is the cause of the greatest overall costs to the community for providing health care to the homeless?a.The need for increased preventive services to address the health conditions of the homeless populationb.The need for more frequent clinic visits by homeless clients for multiple health problemsc.The spread of contagious diseases by homeless people to those they pass on the streetd.The fact that most of the care for homeless people takes place in hospital emergency departments
DHomeless persons encounter the same problems accessing health care (e.g., lack of money, lack of housing, lack of transportation) that others do in impoverished conditions. Therefore, health care of homeless persons tends to be crisis oriented and sought in emergency departments. Low-income Canadians have the highest mortality rates and the highest rates of hospitalizations and emergency visits.
A CHN presents a proposal for a program for preventing teen pregnancy to a group of parents. In the discussion that follows the presentation, which of the following responses by a parent indicates the need for additional teaching by the CHN?a.“I do not know if my son is sexually active; however, I have decided that I am going to talk to him about birth control, just in case.”b.“I have found that being very strict and checking on my daughter whenever she is out are the best ways to prevent trouble.”c.“I plan to sit down with my daughter and have an honest talk about sexuality and potential risks.”d.“I will start spending more time with my teens when I get home from work.”
BParents who are extremely demanding and controlling or neglectful, and who have low expectations, are the least successful in instilling good values in their children. Children of parents who are neglectful are the most sexually active, followed by children of parents who are very strict. Furthermore, parents who discuss birth control, sexuality, and pregnancy with their children can positively influence delaying initiation of sexual activity and use of effective birth control. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and unwanted pregnancies.
By which of the following actions can the CHN best ensure long-term positive health outcomes in pregnant teens from low-income groups and their children?a.Help teen mothers learn about body changes during pregnancy.b.Develop programs that enable teen mothers to complete their education.c.Offer courses in proper care of babies.d.Monitor pregnant teens for early detection of problems in pregnancy.
BPrograms that enable the teen mother to complete her education increase her chances for a better future and improved health care over the long term, across the lifespan. Issues to discuss include education and career plans, family finances and qualifications for outside assistance, and personal values about pregnancy and parenting at this time in her life.
A CHN who works at a clinic for homeless persons wants to institute a more efficient treatment for chronic wounds. Which of the following actions offers the best way to improve outcomes for these clients?a.Administer antibiotics to all homeless persons with chronic, nonhealing wounds.b.Facilitate daily access to a room with soap, water, and bandages.c.Provide free bandaging supplies to clients at each clinic visit.d.Regularly monitor the wound condition of clients.
BHealth problems faced by homeless people often are related directly to poor access to preventive health care services. The CHN can implement tertiary prevention by designating a wound room in which clients can carry out wound care activities taught during clinic visits. Only infected wounds would need treatment with antibiotics, not all wounds. Free bandaging only addresses one part of the problem and monitoring does not improve outcomes; only treatment does.