The nurse is caring for a Hispanic client who reports that s...

The nurse is caring for a Hispanic client who reports that she is a practicing Roman Catholic. Which actions by the nurse most demonstrate spiritual and cultural sensitivity? Select all that apply.

A. Turn the client's bed toward the east, toward Mecca.
B. Ensure that meals while hospitalized include Halal foods.
C. Allow the client to observe communion daily if requested.
D. Facilitate anointing of the client by the priest if requested.
E. Advocate for the client in her choice to refuse blood products.

Correct Answer: C,D

Rationale: During response to illness, practicing Roman Catholics may request to be anointed while sick. They may also practice daily Holy Communion. Meals permissible by Muslims include Halal foods. Muslims also prefer to turn their bed toward the east, toward Mecca. Jehovah's Witness belief system includes refusal of blood products.

The nurse is caring for an older Orthodox Jewish client of the opposite sex whose condition is terminal. The nurse is implementing a plan of care and wishes to communicate this plan with the client and family. The nurse should be aware of what end-of-life spiritual and religious practices when planning and communicating with the client and family? Select all that apply.

A. The client may demonstrate a high level of anxiety.
B. Religious laws are suspended during times of severe illness.
C. During the process of dying, visitors and conversation should be kept to a minimum.
D. Family members may not shake hands or make direct eye contact with members of the opposite sex.
E. Clients that are of the Orthodox Jewish faith are usually very quiet and do not express what they are thinking or feeling.

Correct Answer: A,B,D

Rationale: Outward expressions of anxiety are commonly seen among Orthodox Jewish members, especially older individuals. The Orthodox Jew strictly follows the laws of Judaism; however, during times of severe illness, Jewish laws are not observed if doing so will endanger the client's health. In the Orthodox Jewish faith, members generally will not shake hands or make direct eye contact with members of the opposite sex. During times of illness or death, the Orthodox Jewish community, including family and friends, will frequently visit and are considered the nucleus of the Jewish culture. Clients of the Orthodox Jewish faith are generally very verbal about what they are feeling, especially in the older population.

The nurse is caring for a client who is of Asian descent and is assessing for client perceptions regarding nutrition. Which, in addition to the impact of food on disease and illness, should the nurse consider in order to provide culturally competent care?

A. Educational background and employment history
B. Familial support systems and financial well-being
C. Client perception of body weight and size relative to culture
D. Ability to purchase foods necessary for disease management

Correct Answer: C

Rationale: When addressing nutrition for clients with diverse cultural backgrounds, dietary preferences, the impact of food on disease and illness, and client perception of body weight and size relative to culture must be considered. For example, clients who are not part of the Western culture may not consider obesity to be a major health indicator; therefore, teaching regarding weight reduction may be difficult. The other options address social and financial status and are not directly related to cultural considerations with regard to nutrition.

The nurse is caring for a client who primarily speaks Spanish. An interpreter is currently unavailable. The nurse must perform a dressing change. What should the nurse do in order to enhance communication with this client prior to changing the dressing?

A. Use relatives to interpret because an interpreter is unavailable.
B. Speak slowly and allow the client time to interpret what is being said.
C. Use many nonverbal cues and repetition to reinforce what is being said.
D. Use common words in the nurse's language, because the client is likely to be familiar with them.

Correct Answer: B

Rationale: When caring for a client who speaks a language that is different from the nurse's, it is ideal for the nurse to call on a dialect-specific interpreter designated by the health care agency that is the same age and same gender as the client. If an interpreter is unavailable, the nurse should speak slowly and allow the client time to interpret what is being said. The nurse should avoid the use of relatives as interpreters to minimize bias and misinterpretation. The nurse should avoid using nonverbal facial expressions and body language, because they could be misinterpreted by the client. The nurse should use common words in the client's language if known; the nurse should become familiar with Spanish terms that are frequently used in health care.

The nurse is caring for an older adult client of an unfamiliar ethnic culture. The nurse shows an understanding of the general principles of culturally sensitive interaction when implementing which interventions? Select all that apply.

A. Addressing the client by his full surname in order to display respect
B. Maintaining eye contact with the client so as to show respect for the client's age
C. Utilizing the position of authority nurses hold to provide explanation of facility rules
D. Touching the client only when necessary and only after explaining the need to do so
E. Avoiding any frequent engagement with the client in conversation of a personal nature

Correct Answer: A,E

Rationale: Although cultural sensitivities vary, it is generally prudent to show respect for an older client of any ethnic background by using his or her formal name. Personal conversations not required as part of the assessment process should be avoided, as should a show of authority. Maintaining eye contact is not universally taken to be a positive behavior and so may be limited until it is determined to be acceptable by the client. Physical touching by strangers is not readily accepted in many cultures and should be engaged in cautiously and only when necessary and with permission from the client.

The nurse is caring for a postoperative client with spiritual and culturally based eating and food requirements. Which interventions demonstrate the nurse's spiritual and cultural consideration of the client? Select all that apply.

A. Encouraging the client to try new foods only until healing is complete
B. Suggesting the substitution of similar foods for the culturally appropriate ones
C. Asking the client to explain the factors that are important to his eating practices
D. Including the family in discussions regarding the preparation of accepted foods
E. Discussing the nutritional requirements the client currently has postoperatively

Correct Answer: C,D,E

Rationale: Spiritual and cultural consideration reflects attempts to maintain familiar customs to achieve the same healthy responses expected of our Western culture customs. Gaining knowledge of the customs and their importance to the client will be the basis for an understanding that allows for flexibility and compromise when necessary. Including the family in the discussion will assist with the process as will discussing the needs the client has at this particular time in order to formulate a plan to meet the needs while maintaining cultural customs. Encouraging new foods in place of the usual foods may be viewed as being insensitive and showing a lack of concern. Substitution is not always necessary.