Chapter 7: Diversity and Relational Practice in Community Health Nursing

Question 1

1. What practice demonstrates cultural competency for the care of clients with a cultural
   background different to one’s own?
   a. Maintaining an open attitude that welcomes differences
   b. Keeping all behaviours culturally neutral to avoid misinterpretation
   c. Relying on friendly gestures to communicate a caring attitude
   d. Avoiding showing prejudice by using the same behaviour with all clients

Answer 1

ANS: A
Leininger suggests the key principles of (1) maintaining a broad, objective, and open attitude toward individuals and cultures, and (2) avoiding seeing all people and cultures as alike.

Question 2

2. 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 sensitivity
   b. Cultural awareness
   c. Cultural knowledge
   d. Cultural skill

Answer 2

ANS: D
Cultural 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.

Question 3

3. 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.” What response does this statement exemplify?
   a. Cultural awareness
   b. Cultural blindness
   c. Cultural knowledge
   d. Cultural preservation

Answer 3

ANS: B
Cultural 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.

Question 4

4. A client at a community health outpost who describes a culturally safe encounter describes
   which CHN practices?
   a. Recognizing and respecting cultural identity
   b. Mirroring and matching of cultural behaviours
   c. Seeking similarities and commonalities
   d. Supporting the adoption of dominant cultural behaviours

Answer 4

ANS: A
Cultural safety refers to gaining an understanding of others’ health beliefs and practices so
that health care practices can avoid discrimination or domination. There is recognition and
respect for cultural identity so that a balance of power can exist between client and CHN.

Question 5

5. What would be an example of “overt racism”?
   a. Using traditional food and traditional dress
   b. Restricting the burning of sweet grass
   c. Participating in hate crimes
   d. Making job positions available only to persons who are Canadian-born

Answer 5

ANS: C
Overt 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.

Question 6

6. 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.” What
   behaviour does this statement exemplify?
   a. Ethnocentrism
   b. Prejudice
   c. Racism
   d. Stereotyping

Answer 6

ANS: A
Ethnocentrism, 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.

Question 7

7. A health care worker tells the CHN, “It does no good to try to teach those Indigenous clients
   about nutrition because they will just eat whatever they want to, no matter how much we teach
   them.” What behaviour does this statement exemplify?
   a. Cultural imposition
   b. Ethnocentrism
   c. Racism
   d. Stereotyping

Answer 7

ANS: D
Stereotyping 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 Indigenous people are not educable. The health care worker is also guilty
of making assumptions about noncompliance among other Indigenous people she has known;
this noncompliance may have had to do with their inability to buy nutritious foods, which tend
to be more expensive.

Question 8

8. A family from Mexico presents to the community health centre. None of the family members
   speak English, and no one at the health centre speaks Spanish. What will be the most
   appropriate action on the part of the CHN?
   a. Attempting communication using an English–Spanish phrase book
   b. Calling the local hospital and arranging a referral
   c. Emphatically stating, “No hablo Español” (I don’t speak Spanish) and repeating as
   necessary
   d. Finding an interpreter to translate

Answer 8

ANS: D
Communication 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.

Question 9

9. 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, who would be the most appropriate choice of interpreter?
   a. A female who does not know the client
   b. A female from the client’s community
   c. A male who is certified as a medical interpreter
   d. The client’s 20-year-old daughter

Answer 9

ANS: A
Although 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.

Question 10

10. 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. What 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.

Answer 10

ANS: A
Culturally competent nursing care is individualized for each client, reflecting the client’s
beliefs and values, and is provided with sensitivity.

Question 11

11. The CHN who wishes to develop cultural competence can improve cultural awareness by
    conducting which activity?
    a. Completing a survey of all the ethnic groups in the CHN’s community
    b. Considering how the CHN’s personal beliefs and decisions are reflective of his or
    her culture
    c. Inviting a family from another cultural background to participate in an event with
    the CHN
    d. Studying the beliefs and traditions of persons coming from other cultures

Answer 11

ANS: B
Cultural awareness is self-examination and in-depth exploration of one’s own beliefs and
values as they influence behaviour.

Question 12

12. The incidence of type 2 diabetes among Indigenous 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 mostly Indigenous students, the CHN incorporates into the presentation such foods
    as bannock and other healthy dishes familiar to Indigenous students. What level of prevention
    does this culturally sensitive action represent?
    a. Primary prevention
    b. Secondary prevention
    c. Tertiary prevention
    d. Both primary and secondary prevention

Answer 12

ANS: A
Primary prevention involves such activities as health teaching to prevent a problem from
occurring.

Question 13

13. A nurse practitioner (NP) has just found out that her new immigrant client is not taking the
    penicillin prescribed because he believes his illness is “hot” and 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 awareness
    b. Cultural brokering
    c. Cultural knowledge
    d. Cultural skill

Answer 13

ANS: D
Cultural 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.