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Fundamentals · chapter 5 · Cultural Competence

Cultural Practice in Nursing

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. Cultural competence importance

    Cultural competence enables a nurse to deliver the highest quality, safest, and most patient-centered care possible.

  2. Cultural assessment purpose

    An accurate and thorough cultural assessment allows for the gathering of patient-specific cultural information.

  3. Preferred language documentation

    Make note of the language the patient prefers to use and record this in the patient’s chart.

  4. Medical interpreter need

    If English is not the patient’s primary language, determine if a medical interpreter is required before proceeding with interview questions.

  5. Inclusive language use

    Use inclusive language that is culturally sensitive and appropriate. For example, do not refer to someone as “wheelchair bound”; instead say “a person who uses a wheelchair.”

  6. Respecting cultural expressions

    It is possible that you may not agree with a patient’s cultural expressions, but it is imperative that the patient’s rights are upheld. As long as the expressions are not unsafe for the patient or others, the nurse should attempt to integrate them into their care.

  7. Four Cs assessment tool

    The Four Cs of Culture model is an example of a quick cultural assessment tool that asks questions about what the patient C onsiders to be a problem, the C ause of the problem, how they are C oping with the problem, and how C oncerned they are about the problem.

  8. Best source of cultural knowledge

    Cultural knowledge is best obtained through cultural encounters with patients from diverse backgrounds to learn about individual variations that occur within cultural groups and to prevent stereotyping.

  9. Medication reconciliation importance

    It is important for the nurse to perform a thorough medication reconciliation so that complementary or alternative therapies are not missed. Patients may not consider these supplements as “medicines” or “drugs.”

  10. Supplement interaction risk

    As these products can interact with drugs, it is important to get a comprehensive list from the patient of all supplements they are taking.

  11. Cultural competence development

    It takes motivation, time, and practice to develop cultural competence, and it will evolve throughout your nursing career.

  12. Upholding cultural values builds trust

    Nurses who accept and uphold the cultural values and beliefs of their patients are more likely to develop supportive and trusting relationships with their patients.

  13. Bias impact in nursing

    Explicit bias in the form of discrimination due to gender identity, race, ethnicity, sexual orientation, or socioeconomic status negatively impacts the health status of various populations.

  14. Personal space permission

    The nurse should always ask for permission before entering a patient’s personal space and explain why and what is about to happen.

Terms to know

cultural knowledge
The term cultural knowledge refers to seeking information about cultural health beliefs, history, customs, and values to understand patients’ worldviews.
complementary therapies
Nonmainstream approaches to health that are used alongside conventional Western medical care are called complementary therapies.
alternative therapies
When nonmainstream approaches are used in place of conventional Western medical care, they are called alternative therapies (U.S. Department of Health and Human Services [HHS], n.d.a).
naturopathy
Derived from eighteenth- and nineteenth-century European natural healing systems, naturopathy involves a combination of therapies including herbal medicine, diet, acupuncture, and psychotherapy (HHS, 2017).
cultural competence
Cultural competence is a lifelong process of applying evidence-based nursing in agreement with the cultural values, beliefs, worldview, and practices of patients to produce improved patient outcomes.
transcultural nursing
In transcultural nursing, care incorporates the cultural beliefs and practices of individuals to help them maintain and regain health or face death in a meaningful way.
cultural self-awareness
A person’s understanding of their own culture and its impact on self is referred to as cultural self-awareness.
ethnocentrism
The belief that one’s culture (or race, ethnicity, or country) is better than and preferable to another’s culture is termed ethnocentrism.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A nurse meets a newly admitted older adult client for the first time. How should the nurse address the client?

    1. By a friendly nickname such as "dear".
    2. Formally, by title and last name, until the client says otherwise.
    3. By the name the family uses for the client.
    4. By first name, to build rapport quickly.

    Answer: Formally, by title and last name, until the client says otherwise.

    Until the nurse knows differently, the client is addressed formally by title and last name, and the nurse asks how the client wishes to be addressed and records it. First names, nicknames, or the family's name for the client assume a preference the client has not stated.

  2. During admission, a client says they take only "a sleep aid, melatonin, not a real medicine." What is the nurse's best action?

    1. Tell the client that conventional sleep medicine works better.
    2. Include it in a thorough medication reconciliation.
    3. Tell the client supplements are not allowed in the hospital.
    4. Leave it off the medication list, since it is a supplement.

    Answer: Include it in a thorough medication reconciliation.

    Clients may not consider supplements to be medicines, so a thorough medication reconciliation keeps complementary or alternative therapies from being missed. Leaving it off misses possible interactions, and telling the client that Western treatment is better is ethnocentrism.

  3. A nurse needs to enter a client's personal space to perform an assessment. The client pulls away and closes their eyes. What should the nurse do?

    1. Proceed quickly so the assessment is over sooner.
    2. Ask a family member to hold the client still.
    3. Ask permission, explain what will happen, and let the client assume a comfortable position.
    4. Document that the client is uncooperative.

    Answer: Ask permission, explain what will happen, and let the client assume a comfortable position.

    The nurse should always ask permission before entering personal space and explain why, and should recognize pulling away as an expression of cultural preference. Proceeding quickly, labeling the client uncooperative, or restraining the client ignores these cues.

  4. A nurse tells a client who uses herbal remedies, "Our Western treatments are better than those old remedies." Which concept does this statement reflect?

    1. Cultural knowledge
    2. Transcultural nursing
    3. Ethnocentrism
    4. Cultural self-awareness

    Answer: Ethnocentrism

    Ethnocentrism is the belief that one's culture is better than another's, and the textbook example is a nurse saying Western treatments are better than traditional remedies. Cultural self-awareness and cultural knowledge help the nurse avoid this, and transcultural nursing incorporates the client's beliefs into care.

  5. A nurse uses the Four Cs of Culture model to assess a client. Which questions belong to this model? Select all that apply.

    1. What are you doing to cope with this problem?
    2. What do you think is wrong?
    3. What do you think caused this problem?
    4. How concerned are you about this problem?
    5. How much does your insurance cover?

    Answer: What are you doing to cope with this problem?, What do you think is wrong?, What do you think caused this problem?, How concerned are you about this problem?

    The Four Cs ask what the client considers the problem, its cause, how they are coping, and how concerned they are. Insurance coverage is not one of the Four Cs.

  6. A nurse is conveying cultural sensitivity when meeting a client and family for the first time. Which actions are appropriate? Select all that apply.

    1. Stand or sit at least arm's length from the client at first.
    2. Use a family member to interpret without checking whether a medical interpreter is needed.
    3. Introduce yourself by name and role.
    4. Observe eye contact, touch, and other nonverbal behaviors and follow the client's lead.
    5. Politely ask questions about the client's beliefs to avoid misunderstandings.

    Answer: Stand or sit at least arm's length from the client at first., Introduce yourself by name and role., Observe eye contact, touch, and other nonverbal behaviors and follow the client's lead., Politely ask questions about the client's beliefs to avoid misunderstandings.

    The guidelines include introducing yourself by name and role, starting at arm's length, following the client's nonverbal lead, and politely asking about beliefs. If English is not the client's primary language, the nurse determines whether a medical interpreter is required before proceeding.

Where every quote comes from

Section 5.3 Cultural Practice in Nursing of Fundamentals of Nursing by Christy Bowen, Lindsay Draper, Heather Moore, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.