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Suggested Answers to Critical Thinking Exercises

Chapter 7, Overview of Transcultural Nursing

1. You are assigned to care for a hospitalized patient who emigrated to the United States from
India 5 years ago. You know little about this patient’s culture.
a. What is the evidence base for use of a cultural assessment tool to ensure that cultural
considerations are included in the nursing plan of care?
The evidence base for use of cultural assessment tools to ensure cultural considerations in
the nursing plan of care includes both classic and current nursing research. Campinha-
Bacote (2002) indicates that a culturally competent care provider will have the awareness
to recognize a lack of knowledge. Motivated by a desire to know more about the patient’s
culture, this provider will to seek more information. This nurse will skillfully collect
relevant cultural data utilizing validated assessment tools. Additional evidence for the use
of cultural assessment tools includes the following resources:
 Campinha-Bacote, J. (2002). The Process of Cultural Competence in the Delivery of
Healthcare Services: A Model of Care. Journal of Transcultural Nursing, 13, 181–
184. doi: 0.1177/10459602013003003
 Giger, J.N. & Davidhizar, R.E. (2012). Transcultural nursing: Assessment and
intervention (6th ed.). St. Louis: Elsevier.
 Leininger, M.M. (Ed.). (2001). Culture care diversity and universality: A theory of
nursing. New York: National League for Nursing Press.

b. What best practices and policies located in key organizational books or internet
resources could guide your care for this patient?
Best practices and policies from key resources include:
 National Center for Cultural Competence, Georgetown University Center for Child
and Human Development: http://nccc.georgetown.edu/
 National Institutes of Health, National Center for Complementary and Alternative
Medicine: http://nccam.nih.gov/
 Transcultural Nursing Society: www.tcns.org
 National Standards for Culturally and Linguistically Appropriate Services. U.S.
Department of Health and Human Services, Office of Minority Health:
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15

c. Explain why it is important to examine your own feelings about the patient’s possible
cultural beliefs and practices.
Campinha-Bacote (2002) indicated why it is important for a nurse to examine his or her
own feelings about a patient’s cultural beliefs and practices. Cultural awareness begins
with a self-examination and exploration of one’s own cultural background. This reflection
includes biases, prejudices, and assumptions about one’s own culture. Lack of awareness
may lead to cultural imposition, which is a tendency to impose one’s own beliefs, values,
and behavior patterns on those from other cultures. Cultural desire motivates the nurse to
learn more about the patient’s culture and to develop essential assessment skills to ensure
a positive cultural encounter. Culturally competent care will be hindered if the nurse lacks
cultural awareness, knowledge, desire, or skills.

d. Is it guaranteed that the common cultural beliefs of persons from India will be the same
as this patient’s beliefs?
There is no guarantee that this patient’s beliefs will mirror common beliefs of persons
from India. The students should be able to discuss the differences between cultural
generalizations versus stereotypes. For example, Hinduism is the most common religion
in India; a generalization would be that many Indians practice Hinduism and thus, are
vegetarians. However, there is no guarantee that this Indian patient is a practicing Hindu
or adheres to a vegetarian diet; such an assumption would involve stereotyping. The
nurse would need to use a cultural assessment tool to clarify this patient’s cultural
preferences and practices.

2. A 34-year-old man who is originally from Haiti is hospitalized in the neurosurgical intensive
care unit with a traumatic brain injury subsequent to a 30-foot fall from a scaffold. His
immediate family members insist on staying with him around the clock, and many extended
family members visit each day, staying late into the night. His prognosis is poor, and when
his attending physician discusses discontinuing life support therapy with his family members
who are his legal next of kin, they acquiesce but request that all family members be allowed
to remain present to witness his death. Policies in the intensive care unit do not permit more
than three family members to be with a patient at any given time. The staff members
complain that they have difficulty completing their tasks with other critically ill patients
because of the distractions they face from the multiple family members visiting this man.
a. How can you help the nursing staff explore the meaning of the family’s behavior and
understand their own negative feelings about this behavior?
The nursing staff should explore the meaning of the family’s behavior and understand
their own reactions to the behavior. First, the nursing staff members might need more
information about the Haitian culture, especially regarding illness and death beliefs and
practices. A nurse educator could help the staff explore their reactions to the family’s
behaviors and presence (e.g., perceived nonadherence to unit policy, distracting from
other patients). Increasing their awareness of their personal biases, prejudices, and
assumptions, as well as providing information about the family’s culture, could improve
this cultural encounter, as well as future cultural encounters. A discussion regarding the
commonalities and differences with representatives of various ethnic groups could
improve the nurse’s cultural competence.

b. Devise a strategy that will help resolve this situation.


One or more of the following strategies might help resolve the situation and decrease
stress among the staff members:
 Move the patient to a private area on the unit, such at the end of a hallway in the
intensive care unit to make more room for the family members to be present.
 Move the patient to a room near the intensive care unit entrance so that the family
members will not have far to go from the waiting area. Request the family adhere to
the policy, with three to four individuals taking 10- to 15-minute turns to be with the
patient. Assure all members that they will be ushered back at the point of death.
 Move the most critical patients away from the Haitian patient’s area so that they will
not be disturbed and their nurses will feel less distracted.
 Once life support is removed, transfer the patient out of the intensive care unit to a
private room that will accommodate the visiting family.

3. You are a nurse working in a diabetes center. You are assessing a 44-year-old woman newly
diagnosed with type 2 diabetes who arrived in the United States from Mexico 2 years ago.
During your initial assessment of the patient, you note that she has an amulet tied around her
neck. When you question her on the meaning of the amulet, she appears reluctant to respond
and averts her eyes.
a. What aspects of the patient’s background would you want to further assess to determine
the best process for continuing assessment and care?
Regarding this patient’s background, the nurse would need to investigate and understand
the Mexican culture, especially health, alternative therapies, and spirituality beliefs. With
this information, the nurse would be able to complete a comprehensive assessment and
provide culturally competent care. Also, an understanding of communication patterns,
including verbal and nonverbal cues inherent to this culture, will help the nurse interpret
the patient’s reaction better. For example, the patient’s avoidance of the topic and eye
contact may be related to an assumption that the American nurse will not respect her
views regarding the amulet, or the patient could fear loss of the amulet’s power and
protection if discussed. The lack of eye contact could reflect her respect for the nurse.

b. Identify culturally sensitive methods you might use to ensure that the patient receives the
care required without violating any cultural practices.
Culturally sensitive methods might include seeking more information indirectly from a
family member regarding the patient’s beliefs and practices or from a medical translator
knowledgeable about the patient’s culture. The nurse can provide the diabetic education
and ask about health beliefs or practices that might impact her diabetes care.

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