Chapter 04: Cross-Cultural Caring and Aging

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. A paper on culture and illness would be likely to include the statement that: a. culture is the same as ethnicity. b. ethnic groups always share common geographic origin and religion. c. ethnicity involves recognized traditions, symbols, and literature. d. most members of an ethnic group exhibit identical cultural traits.

ANS: C

Ethnicity is a complex phenomenon including traditions, symbols, literature, folklore, food preferences, and dress. It is a shared identity. Ethnicity is more than just culture. It is social differentiation based on culture. Even within ethnic groups, there is considerable diversity.

DIF: Cognitive Level: Remembering REF: p. 44

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

2. Ethnocentrism is defined as: a. an understanding of another’s cultural beliefs and practices. b. a conflict that occurs when an individual interacts with another whose beliefs differ from his own. c. application of limited knowledge about one person with characteristics specific to another person. d. a belief that one’s ethnic group is superior to that of another.

ANS: D

A belief that one’s ethnic group is superior to that of another is the definition of ethnocentrism. Ethnocentrism does not involve an understanding of the beliefs of others. A conflict that occurs when an individual interacts with another whose beliefs differ from his own is the definition of cultural conflict. Application of limited knowledge about one person with characteristics specific to another person is the definition of stereotyping.

DIF: Cognitive Level: Remembering REF: p. 42

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

3. Regarding health care disparities, it is true that older adults of color have: a. equal risk factors for vulnerability as do all older adults. b. equal risk factors for vulnerability as do the young adults of color. c. increased risk factors for vulnerability if they are female. d. an increase in risk factors for vulnerability if care is provided by public facilities.

ANS: C

Older females of color have an added risk factor for vulnerability (gender) than do males of the same age and ethnic group. Ethnicity is an added factor for vulnerability. Age is an additional risk factor for vulnerability. Health care disparities are found across a wide range of clinical settings.

DIF: Cognitive Level: Remembering REF: p. 41

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

4. An older female patient tells a nurse the following: “In my culture, women are the silent partner in the family. Men make all of the decisions. However, when we came to the United States, all that changed. I became an American. I am in charge of my family just like my husband.” This is an example of: a. enculturation. b. acculturation. c. ethnicity. d. culture competence.

ANS: B

Enculturation is defined as cultural beliefs passed down from one generation to the next. Acculturation is the process by which persons from one culture adapt to another. Ethnicity is defined as the cultural group that one identifies with. Cultural competence involves stepping outside our own biases and understanding that others bring a different set of values.

DIF: Cognitive Level: Applying REF: p. 40

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

5. A home care nurse is caring for an older patient from a different culture who is bed-bound and high risk for development of a pressure ulcer. The nurse discusses the plan of care with the patient’s daughter, emphasizing the importance of turning every 2 hours and posts a turning clock on the wall. When the nurse returns later in the week, the turning clock has been removed, and the patient’s daughter reports that she turns her mother occasionally. She states, “I am taking very good care of my mother. You just don’t understand; our ways do not involve doing things on schedules.” The best response by the nurse is: a. “You must follow my guidelines and turn her every 2 hours, or I will not be able to take care of her.” b. “I understand that you value your culture, but culture cannot stop you from providing good care to your mother.” c. “I understand that you care very much for your mother. Perhaps caring for her is too much for you.” d. “How can we best work together to provide the best care for your mother?”

ANS: D

In providing cross-cultural care it is important that the nurse work with the patient and family and listen carefully and find a way to include the values and beliefs of the patient in the plan of care.

DIF: Cognitive Level: Analyzing REF: p. 43

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Psychosocial Integrity a. Biomedical b. Magico-religious c. Naturalistic d. Ayurvedic

6. An older patient learns that he has metastatic cancer. The patient states: “I must have angered God.” This is an example of which type of belief?

ANS: B

Magico-religious: views illness as caused by actions of a higher authority. Biomedical: views disease as a result of abnormalities in structure and function and disease caused by intrusion of pathogens into the body.

Naturalistic: based on the concepts of balance. Health is seen as a sign of balance.

Ayurvedic: the oldest known paradigm in the naturalistic system. Illness is seen as an imbalance.

DIF: Cognitive Level: Remembering REF: p. 46

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Psychosocial Integrity

7. A female nurse is caring for an older woman from the Hasidic Jewish community. The woman’s son is at the patient’s bedside. The nurse notes that when she communicates with the patient and her son, the son does not maintain eye contact with her and also notes that he withdraws when she attempts to shake his hand. The best response by the nurse is to: a. carry on conversation with the patient only, ignoring the son. b. continue conversing with both the patient and the son. c. ask the son to leave since he is not comfortable with her. d. ask the patient why the son will not engage with her.

ANS: B

In some cultures, direct eye contact or contact between men and women is seen as a sexual advance. This is true in the Hasidic culture. Options A and C are disrespectful to the patient and her son. Option D may put the son in an uncomfortable position.

DIF: Cognitive Level: Analyzing REF: p. 48

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. The nurse in a clinic setting that provides care for an ethnically diverse population of older clients shows an understanding of the LEARN Model to direct the assessment process when: (Select all that apply.)

a. recognizing that the client’s hands are clenched as she answers the assessment questions.

b. asking the client to describe what he thinks will help him feel better.

c. explaining to the client that herbal remedies may not be sufficient treatment for his chest congestion.

d. acknowledging that the client has a different view of the appropriate treatment.

e. suggesting to the client that it would be beneficial if she would trust her health care provider to prescribe the correct treatment.

ANS: A, B, C, D

The LEARN Model implements active listening to both the client’s verbal and nonverbal communication as a means of obtaining insight into the client’s perspective of his or her medical problem. This model also encourages the nurse to recognize that the perceptions may differ and to explain the differences in perceptions to the client. The model advocates arriving at a mutually agreed upon treatment plan rather than encouraging the client to surrender personal autonomy in the decision-making.

DIF: Cognitive Level: Remembering REF: p. 50

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. culture guides decision-making about health, illness, and preventive care. b. culture provides direction for individuals on how to interact during health care encounters. c. culture impacts attitudes toward aging. d. all members of a culture react in the same way in similar situations. e. knowledge of culture eliminates health care disparities.

2. A nurse completes a cultural assessment of an older adult who is being admitted to an assisted living facility. Reasons for completing a cultural assessment include: (Select all that apply.)

ANS: A, B, C

Although knowledge of culture has the potential to optimize care, not all individuals will respond in the same way to a specific situation. Knowledge of an individual’s culture will not eliminate health care disparities.

DIF: Cognitive Level: Understanding REF: pp. 49–50

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Look and speak to the interpreter b. Use technical terminology to ensure accuracy c. Allow more time for the interview d. Watch the client’s nonverbal communication e. Have the interpreter check whether the client understands the communication

3. A nurse in the ambulatory care setting is preparing to do an interview with a non-English-speaking client. The nurse secures an interpreter. In order to have the most effective interview, the nurse should do which of the following? (Select all that apply.)

ANS: C, D

For the most effective interview the nurse should look and speak directly to the client, avoid the use of jargon and technical terminology, observe the client’s nonverbal communications, and clarify understanding by asking the client to state in his/her own words what he or she understood, facilitated by the interpreter. The interview will take longer.

DIF: Cognitive Level: Remembering REF: p. 48

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Psychosocial Integrity